Health New Zealand has rejected claims by the Public Service Association that recent IT outages across the country are linked to cuts to its Digital Services Team.

Hospitals across the Northern region were impacted by a 12-hour outage overnight on January 28 affecting clinical and operational systems.

Staff at Te Tai Tokerau, Waitematā, Auckland and Counties Manukau had to resort to paper-based workarounds and manual systems until the services were restored in the early hours of the following morning.

The Public Service Association Te Pūkenga Here Tikanga Mahi says the outage took down ED, laboratory and inpatient systems, preventing clinicians from accessing key patient information and communicating internally and across the region, slowing down patient care.

National secretary Fleur Fitzsimons says this latest incident follows outages at Southern Hospitals earlier this month and that “these failures are a direct result of (the government’s) short-sighted decision to underfund and cut roles at Health NZ's digital services team”.

Southern hospitals were impacted by an outage on 22 January 2026 which meant staff could not access the hospital administration system, SI PICS, or clinical portal Health Connect South, among other systems.

Another outage on 13 January 2026 lasted most of the day and forced Southern clinicians to again resort to paper-based workarounds.

Fitzsimons says, "the Government oversaw the loss of the very experts who maintain and upgrade these critical systems, and now we are seeing the predictable consequences - hospitals forced onto whiteboards and paper forms while trying to deliver modern healthcare."

Acting chief information technology officer Darren Douglass says there is no link between IT outages in recent weeks and staffing numbers in the Digital Services team as it was a technology failure in all recent outages.

"We have a complex environment, many of our technology components, systems or infrastructure, are old, and on occasion, they fail," he said.

In the Auckland case the failure was in part of the network infrastructure in a data centre that hosts a number of Health NZ systems. Local and national teams and global vendors all responded and he is confident the service the failure will not reoccur.

While the level of system availability has remained stable over the past 12 months, Douglass acknowledged it needs to be better.

"Our clinical staff and frontline staff should expect better than they are getting, and we are working really hard to make sure that we do that and we deliver those improvements," he said.

The restructure of Health NZ’s data and digital directorate last year saw the disestablishment of 1815 roles, including more than 750 vacancies. Staff were given the opportunity to apply for 651 newly established roles.

The PSA called on the government to immediately review funding for health digital services and IT infrastructure. 

"When clinical systems fail, patient safety is at risk. Doctors and nurses are doing their best with manual systems, but this is 2026 - our health system should not be grinding to a halt because of preventable IT failures," Fitzsimons said.

Andrew Brant, executive director Northern Region Health New Zealand, says emergency departments (EDs) remained open throughout the Auckland incident, with patient care continuing safely during the disruption.

Brant says Health New Zealand is completing an incident debrief to identify potential opportunities to improve the organisation’s systems.

“We appreciate the professionalism and adaptability of our staff across the region in managing the disruption,” he says.

Image: Public Service Association national secretary Fleur Fitzsimons

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New Zealand's largest independent primary healthcare group has halved recruitment times and enabled mobile workforce management across more than 50 clinics using Oracle Fusion Cloud HCM (Human Capital Management) in partnership with implementation partner Deloitte.

Tāmaki Health recently won Oracle's Asia-Pacific Breakthrough Award for implementing a comprehensive digital human resources system that transforms how the healthcare organisation manages its 1,500 staff serving 350,000 enrolled patients.

The global award was presented at Oracle's conference in Las Vegas and attended by 80,000 people.

Benefits of transformation

Lisa Ryan, chief people capability and culture officer at Tāmaki Health, says the organisation was looking to improve the employee experience all the way through from recruitment to onboarding and working for Tāmaki.

“We wanted to make that whole experience seamless and easy for people with less bureaucracy and paperwork, and a reduction in errors in their information, which also improves our data quality,” she says. 

“This improves our understanding of who our people are, allowing us to quickly diagnose what we are doing with respect to training, recruitment and turnover, to ensure we are running these processes in a highly efficient and accurate manner.”

Ryan says the new system addresses longstanding challenges faced by the organisation, which still relied heavily on Excel spreadsheets, Word documents, DocuSign and emails.

Oracle Fusion Cloud HCM enables the entire employee lifecycle to be managed through mobile devices. 

Managers can now approve job offers from their mobile phones, which has helped to significantly reduce recruitment time by around 50 percent.

"Once approved we can get an offer letter out within an hour or two," Ryan says. 

"The candidate can get that offer letter immediately through a link and assuming they accept it, we can move into that onboarding phase immediately."

She says mobile access is crucial for a workforce that includes over 600 health professionals who are often moving between clinics.

"They know when they are working, where they are working, how much they are going to get paid, and they can look at their pays - all through their phone,” says Ryan.

Implementation and impact

The project was implemented in phases in partnership with Deloitte. The first focused on core systems including recruiting, onboarding, training, compensation review and succession planning. The second phase will add rostering, absence management and time tracking capabilities.

Ryan says the expertise and collaborative approach of the Deloitte team significantly contributed to the project’s success and they continue to be a valuable partner as the organisation looks to realise further benefits.

The system has been "very well regarded and well received”. Managers have appreciated the speed and ease of processes and new employees like the easy access to assigned training and immediate feedback when it is completed.

Chief digital officer Samir Ranchhod says the organisation's digital strategy focused first on clinic-facing improvements before expanding to back-office functions. 

"We have led a culture of innovation and transformation. A lot of that has been forward facing with our clinics initially, which has made it a much easier process to get staff to adapt to the change,” he says.

Ryan says the system's impact extends beyond administrative efficiency to patient care, as shorter recruitment times mean some roles are being filled as soon as the previous employee finishes.

This is particularly important for nursing and GP positions and results in the clinics being able to see more patients in a day.

The system also streamlines mandatory training and compliance processes such as audits, with managers able to quickly summarise all staff at specific clinics and provide evidence of qualifications and training.

Compensation reviews, including back-pay calculations, now integrate directly with payroll systems.

"Before Oracle HCM it could take two to four weeks to work through all of the back pay issues,” she says.

A stand-out system

Ryan has previous experience implementing Oracle HCM at a 24,000-person organisation across 34 US states and was impressed by Oracle's focus on back-end engineering and its position as part of a broader technology ecosystem.

"Oracle have a reputation based on focusing their efforts and resources on their developers: the technicians that are actually developing the product," she says.

Ranchhod says the platform's ‘out of the box’ artificial intelligence capabilities were a key factor in the decision to go with Oracle. 

"It is a platform that is already AI ready,” he says, adding that the organisation plans to implement AI agents in the future.

For recruitment, this could reduce the need to advertise new roles as the AI will be able to mine existing candidate pools. 

Ryan explains; "we will be able to tell it: go to the nursing talent pool of previous applications and look for nurses that have these particular qualifications or this particular experience or they live in this particular area”.

Also, for workforce planning using rostering data combined with patient visit information. 

" AI agents could tell us where is the greatest patient need, and therefore, where we should be rostering certain doctors or nurses and prescribers at certain times in certain places,” she says.

Global recognition

Ranchhod says winning the award was particularly significant as Tāmaki was competing against much larger international companies in the Asia-Pacific region.

“I am hugely proud because this recognises not just a technology deployment, but the collective discipline, resilience, and ambition of our entire organisation,” he says. 

“This achievement reflects what becomes possible when our teams from people and capability (HR) , operational leaders, and our digital teams move in sync toward a common vision.” 

Image: Lisa Ryan, chief people capability and culture officer and Samir Ranchhod, chief digital officer - Tāmaki Health, at the Oracle Awards.

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The New Dunedin Hospital project is a proving ground for many digital hospital concepts.  

After a formal review of costs and options, the new Health Minister Simeon Brown confirmed in late January that the new Dunedin Hospital will be built on the former Cadbury Factory site as planned.

A dedicated digital health design lab has been established over the road from the outpatients building to test and validate technologies before they are deployed in the actual facility. 

Phil King, senior portfolio lead, data & digital facilities technology team says all the technology going into the outpatients building will go through the design lab. 

“It means we can get all the vendors on board, they can go through cyber assurance and technical validation testing,” King says.  

This approach allows clinicians and other staff to experience the new digital workflows in a realistic setting, providing feedback to refine designs before implementation.  

From the ground up 

Phil Baskerville, digital project director New Dunedin Hospital – Whakatuputupu, explains that integrating digital planning from early in the design process ensures that every aspect of the hospital, from its layout to its lighting, supports the seamless integration of technology.  

“It is about building a hospital that is inherently smart, rather than retrofitting technology into an existing space,” he says. 

This involves considering the various layers of operation: everything from the building's physical infrastructure to the digital systems that manage patient information and workflows. 

First is the passive layer of what is needed to make the building work, such as cabling, access control and eight ‘communication rooms’. 

On top of that are the active systems such as wifi, digital signage and firewalls, then comes the digital facility systems such as real time location monitoring and patient wayfinding.  

Finally, you have the digital systems for the end user such as clinical room scheduling and the South Island Patient Information Care System (SI PICS). 

“One of the key things we are delivering is the patient and whānau-centric operation inside the new building, so that all users are catered for,” Baskerville says. 

“Whether someone is digitally enabled or not, they both get that efficient process through the building.” 

A patient-centric approach  

For Southern patients, the digital journey will begin before they arrive at the hospital.  

Baskerville outlines how patients will receive appointment reminders via email or text message, along with options to provide pre-appointment information electronically. Upon arrival, patients can check in via smartphone app or kiosk, similar to modern airline check-in processes. 

"It will be an email a week or two weeks beforehand, then a 24-hour bump with a text message," he describes.  

"On the day, patients can check in and we will text them to say, 'Hey, could you come up to the lobby on the second floor for your appointment.'" 

Digital wayfinding solutions will help guide patients through the facility, which is especially valuable when people are not feeling their best.  

"When you are sick, you're not at full cognitive function, so digital wayfinding will help people,” Baskerville says.  

“It's like a private Google Map that can literally give step-by-step instructions on how to get to the appointment room or how to get out of the building." 

For staff, the digital hospital promises more efficient workflows and real-time location systems will allow better coordination of people and resources. 

"If we need an ultrasound machine for a guiding needle biopsy, let's find the one three meters away, as opposed to the one on a different floor," Baskerville explains. 

A new nurse call system will also route requests more intelligently.  

"If a patient just needs some water, it will send a message to the nearest orderly who can bring you that water, that is versus duress-type alarms which require a different response," Baskerville adds. 

Automating workflows 

Phil King describes digital hospitals as those that leverage technology to automate workflows and reduce the burden on clinicians.  

The digital infrastructure to support this automation is enormous. Modern hospitals may have thousands of interconnected devices and hundreds of critical applications that must function for the facility to operate.  

"If you went into a hospital back in 1990, you would be lucky to find one or two PCs in the corner," King says.  

"Nowadays, there are thousands of interconnected devices, whether they are scanners, laptops, workstations on wheels, biomedical equipment - the majority are all now on the network." 

They must also ensure new facilities are ready for both current and future technologies. 

King explains that new builds are designed to be at minimum "digital hospital infrastructure ready" with enough power, cooling, and data capacity to support advanced systems. 

"We are putting enough resilience and power and data in so that in five years, if Health NZ does decide to invest in an enterprise-grade Electronic Medical Record (EMR), we do not have to pull those walls apart," he says.  

King says this proactive planning is critical, as retrofitting existing hospitals for new technologies can be extremely costly and disruptive. By building digital capabilities in from the start, the aim is to create more flexible, future-proof facilities. 

A sustainable future  

While the focus is currently on infrastructure and foundational systems, future phases will tackle clinical applications and more advanced capabilities. 

The team is already working closely with clinical services to plan the digitisation of workflows and migration away from paper-based processes. 

The approach and lessons learned from the Dunedin project are also being shared and applied to the Nelson and Whangārei Hospital Redevelopments. 

New Dunedin Hospital 
Passive infrastructure, engineering systems 

• Nurse call 
• Engineering systems 
• Communication rooms and structured cabling 
• Access control 
• Security systems 
• Electronic bed cards 

Active Infrastructure Facility Systems 

• Active network and wifi 
• Compute and storage 
• User computing 
• Digital screens and signage 
• DAS 
• Handsets 
• Cyber security – firewalls 

Digital Facility systems 

• Fridge monitoring 
• Message integration engine 
• Real time location services 
• Digital way finding 
• Patient queue management systems 
• Patient journey boards 

Digital Health solutions – end-user 

• HCS – file scanning 
• Clinical room scheduling 
• HCS – clinical workflow forms 
• SI PICS – patient journey updates 
  

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Dedalus Group ("Dedalus"), the global leader in health software 1 , with a vast network of hospitals serving a population of over 540 million patients, has today announced a strategic collaboration with Amazon Web Services (AWS) to make AWS the preferred and recommended cloud service provider for Dedalus' solutions. This partnership aims to deliver enhanced scalability, advanced security features, and innovation, ensuring that healthcare providers can leverage cloud technology to streamline operations and provide better patient outcomes.

By selecting AWS as its preferred and recommended cloud service provider, Dedalus reinforces its commitment to driving the digital transformation of healthcare by enabling providers to adopt flexible, scalable cloud infrastructure. The partnership allows Dedalus to integrate advanced cloud capabilities from AWS that will support the development of enhanced applications for clinical workflows, population health management, and patient engagement.

Key benefits of this partnership include:

• Enhanced security and compliance: AWS provides robust security and compliance controls to align with stringent European and other regional healthcare data privacy and security standards, enabling Dedalus’ clients to manage sensitive patient information securely.
• Scalability and Performance: AWS global infrastructure allows Dedalus’ applications to scale efficiently, enabling healthcare providers to meet changing demands and improve overall system responsiveness.

Alberto Calcagno, CEO of Dedalus group, stated, “Our collaboration with AWS represents a significant milestone in our mission to transform healthcare systems worldwide. AWS provides a secure, resilient, and innovative cloud infrastructure that enables us to empower healthcare organizations with the technology needed to improve patient care, enhance resources, and achieve better health outcomes.”

Alejandro Rasumoff, Chief of Teleradiology Department of Hospital Italiano de Buenos Aires (HIBA), in Argentina, stated, “The strategic decision to implement PACSonWEB from Dedalus, a cloud-native solution hosted on AWS, as the Teleradiology platform for the Hospital Italiano of Buenos Aires has significantly improved our business operations. Leveraging the AWS Cloud enables us to enhance agility and reduce costs compared to onpremises framework. This solution has garnered strong acceptance from our radiologists and clients, both in remote regions of Argentina and internationally."

“Healthcare providers around the globe are increasingly looking to the cloud to modernize their systems and provide more patient-centric care,” said Dave Levy, VP Worldwide Public Sector at AWS. “AWS is proud to be Dedalus' preferred and recommended cloud service provider and looks forward to supporting their innovative solutions that improve healthcare delivery worldwide.”

Dedalus and AWS work closely with healthcare systems, hospitals, and diagnostic labs globally to offer a smooth transition to the cloud, offering tools and services that reduce the complexity of cloud adoption. By working with AWS, Dedalus is uniquely positioned to provide healthcare organizations with next-generation cloud solutions that align with their operational, clinical, and strategic goals.
 
Ready to innovate? Visit our website: www.dedalus.com

Source: Dedalus media release

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A car fitted with a satellite on the roof is enhancing the health care being delivered in the most remote area of Hawke’s Bay.

In Wairoa, Health New Zealand | Te Whatu Ora kaimahi like district nurses, midwives, and physios travel long distances across remote, back country roads to visit patients. Until recently this meant working long periods out of mobile coverage – making the job much harder.

The installation of a Starlink satellite on top of a Toyota RAV4 has removed all mobile black spots. It’s providing mobile and internet coverage to previously unconnected areas.

It’s been a game changer for Nerys Williams, Wairoa Rural Nurse Specialist and Prescriber. High-speed internet connectivity goes everywhere she does.

“I now have access to key patient data while I’m out and about. It means I can double check a child’s immunisation record, download a patient’s latest blood test results or x-ray and change appointments in the system,” she says.

Starlink sends a signal to a satellite in space and comes back, at up to 425Mbit/sec. In comparison, people with fibre at home typically get download speeds of 300Mbit/sec.

Sym Gardiner, Data and Digital Lead Service Improvement Analyst, says Starlink is a key tool for clinicians who work in remote places.

“It allows clinicians to access any system available in the hospital, no matter what the cell coverage is like in the area they’re working. They can even access clinical records if the power goes out.

“This is enabling our healthcare kaimahi to do their job no matter where they are.”

“The high-speed internet allows clinicians to download big patient studies such as cardiac ultrasounds, which is essentially a video recording looking at the structure of the heart and can contain up to 160 images.

“Clinicians can access these images and recordings just as quickly – sometimes even faster – than if they were working at the hospital. This is enabling our healthcare kaimahi to do their job no matter where they are.” 

Sym demonstrated this by logging on to a Teams video call in Tuai, a small township 45 minutes inland from Wairoa, and chatted to clinicians in Hastings. Normally cellphone coverage would be patchy at best.

Starlink is powered by a power box in the boot of the car which charges while driving. Once stopped, it has about eight hours of power. An internal aerial provides internet coverage to those inside the car while an external aerial creates a Wi-Fi bubble with 50-60 metre range.

It means clinicians like Nerys can use their laptop and phone inside a patient’s home, while the car is parked outside.

While visiting a patient in Tuai, Nerys was able to record his blood pressure and change his next specialist appointment to a time that was better suited.

Nerys says not only does it give her better oversight of clinical records, it saves her time at the end of the day.

“I’m far more productive. Now I can enter data and notes straight into the system rather that having to take written notes and re-enter the information at the end of the day.”

Mark-Shane Tuuta-Rurehe says he’s fortuntate Nerys is able to call in and do her checks as he relies on a carer to drive him into Wairoa and back – about a two-and-a-half hour round trip.

“Nerys’s visits really help, otherwise I’d be back and forth to Wairoa and it cuts into my time with my carer,” he says.

Sym says the Hawke’s Bay Data and Digital team had been working on a way of connecting remote workers for the past few years and then Cyclone Gabrielle highlighted the need for this technology.

“The Starlink helps our rural kaimahi in their day-to-day delivery of health care and it has enough “oomf” for an office of about 20 people to run off.

“If we have another cyclone, where both ends of the fibre are cut, Wairoa’s got nothing. We’re not going to let that happen again. Starlink means staff can still make calls and log on to our private network to access the systems they need,” Gardiner says.

“Satellite connectivity is a key enabler. In emergencies you can set up a mobile emergency centre clinic from anywhere with full communication and health information capability.

“It’s enhancing the care we deliver and making us more resilient, should another natural disaster occur.” 

Source: Health NZ - Te Whatu Ora media release

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Phase one data and digital funding for the New Dunedin Hospital has been released following an independent review that says funding uncertainty was creating a risk to the workstream.

Cabinet commissioned a review of the New Dunedin Hospital (NDH) project which was completed in May this year by Robert Rust, former chief executive of Health Infrastructure New South Wales.

The New Dunedin Hospital Review found that the delivery of the NDH project as currently scoped and planned is probably not achievable within the approved budget.

The current scope includes the facilities, data and digital, and transformation workstreams. The approved budget for the NDH Facilities is $1.88 billion plus $225 million for data and digital.

The review recommends approval and the release of tagged funds for the data and digital implementation business cases (both digital infrastructure and software) should be progressed, saying “funding uncertainty and/or the timing of funding release is a risk to both the Data and Digital and Transformation workstreams”.

A Health New Zealand Te Whatu Ora spokesperson says funding for the first phase of the data and digital workstream has been released and work is underway.

“When the outpatient building opens, modern digital infrastructure and solutions will be in place. This includes digital wayfinding services, patient check in kiosks, digital signage, and WiFi connectivity,” the spokesperson says.

“Building management functions will also be in place for the medical devices that will be used in the new facility, as well as updated electronic information portals for the community plus administrative and clinical users.”

“The digital solutions (both digital infrastructure and software) being implemented in Dunedin are foundational contributions to the national standard as part of the Digital Facilities Framework for Health NZ and are intended to be applied to other major projects such as Nelson and Whangārei hospitals.”

The review recommends that the scope of the NDH inpatient and outpatient buildings, including data and digital, should be “fixed as a matter of urgency and no further changes should be considered unless they are matters which would render the facilities no longer fit-for-purpose”.

Also, that responsibility for the wider workforce/system transformation and digital transformation should be clearly identified as being the responsibility of hospitals and specialist services (HSS) and digital and data senior management under a broader system-wide transformation initiative.

It says the project steering group should “only need to satisfy itself that those parts of the workforce/system and digital transformation that are necessary for the facility to operate effectively on opening have been provided, or a work-around is in place”.

The report says that data and digital was originally excluded from the NDH project, but a business case was developed and approved for the data and digital workstream in 2022 and funding of $225m was established in the Budget that year.

This included an operating contingency of $64m over the four years from 2022/23 to 2025/26 and a capital contingency of $161m in total. 

It says the scope of the preferred option was much broader than what was ultimately approved, which was the ‘minimum viable solution’. 

“The focus of the workstream to date has been on the Outpatient Building and it is understood that this is well developed and keeping pace with required progress,” the expert review says. 

“However, the scoping for Inpatients is less well developed, and will benefit from Outpatient Building reviews, issues resolution, and lessons learned.”

Health Minister Shane Reti said in July at a Digital Health Association event that the $225m data and digital fund for the NDH was being retained.

Picture: Artist’s impression of the New Dunedin Hospital

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The Government is seeking advice on two options for delivering the New Dunedin Hospital project within its existing funding appropriation to ensure the people of Dunedin get the modern, fit-for-purpose medical facilities they need.

 At the same time, Ministers have warned that much-needed upgrades to other regional hospitals could be at risk if budget blow-outs at New Dunedin Hospital aren’t addressed, Infrastructure Minister Chris Bishop and Health Minister Dr Shane Reti said today.
“The project had approved funding of $1.59 billion under the previous government. In March this year, Cabinet agreed to authorise a further $290 million in capital funding due to cost pressures. The current appropriation is therefore $1.88 billion,” Mr Bishop says.

“We now know that the New Dunedin Hospital, as currently designed, can’t be delivered within that appropriation. In fact, despite the project’s original 2017 cost estimates of $1.2 - $1.4 billion, it’s now possible it could approach $3 billion, which would make it one of the most expensive hospitals ever built in the southern hemisphere. 

“This cost simply cannot be justified when hospitals around New Zealand are crying out for maintenance, upgrades and new facilities. Dr Reti and I are concerned that badly needed infrastructure upgrades to Whangarei, Nelson, Hawke’s Bay, Palmerston North and Tauranga hospitals may be put at risk if New Dunedin continues to go so far over budget. 
 
“Because of our concerns regarding the project, earlier this year Cabinet commissioned a one-off independent review into the project which was undertaken by independent expert Robert Rust, former chief executive of Health Infrastructure New South Wales.

“Today we are releasing Mr Rust’s report and its findings to the public. The people of Dunedin deserve transparency about this problematic and poorly-managed project – and so do all the taxpayers who are funding it.”

The Rust Review found that ‘the delivery of the NDH project as currently scoped and planned is probably not achievable within the approved budget and that there remains significant uncertainty as to the cost of the Inpatients Building.’

Dr Reti says the uncertainty is due to several factors that not only impact its financial achievability but also go to the heart of whether the new hospital can deliver the health outcomes promised. 

“The Rust Review makes it clear that, even now, the specifics and scope of the project are still being debated,” Dr Reti says.

“To make matters worse, insufficient money had been set aside for other associated costs such as a pathology lab, refurbishment of the existing facilities and car parking which are collectively estimated at an additional $400 million. No business cases have been prepared for any of these additional elements of the project. 

“Compounding our concerns is the fact that recent project pricing came in several hundred million dollars over the hospital’s appropriation, even without including the pathology lab, refurb of existing facilities or car parking.

“Health NZ and Infrastructure Commission advice has made it clear that this project was troubled from the moment the site was selected in 2018 and has been trapped by this poor decision making ever since.

“The extraordinary cost premiums associated with the land purchase and demolition costs, contaminated ground, piling difficulty, flood level risk, and an extremely constrained construction site flanked on three sides by state highways made it an unattractive project for contractors and suppliers, further driving up construction costs. Since the 2017 Business Case, the cost per square metre to build the hospital has increased by 200% from $10,000 per sqm to $30,000 per sqm.”

Ministers have instructed Health NZ that the project is to be delivered within its current appropriated budget of $1.88 billion, and to provide urgent advice on two options for delivering it:

1. Revision of the project’s specification and scope within the existing structural envelope, such as reducing the number of floors, delaying the fit-out of some areas until they’re needed, and/or identifying further services that can be retained on the existing hospital site or in other Health NZ buildings within Dunedin among other possible solutions.
2. A staged development on the old hospital site including a new clinical services building and refurbishing the existing ward tower.

Officials will deliver this advice in the coming weeks.
 
“We’re incredibly frustrated by the challenges in delivering these much-needed, modern, fit-for-purpose hospital facilities, just as the people of Dunedin and its surrounding regions are. We remain committed to finding a solution, but we must now take urgent steps to apply the long overdue rigour which all taxpayers would rightly expect,” Mr Bishop says.

Robert Rust's Dunedin hospital independent review: https://tewaihanga.govt.nz/dunedin-hospital-independent-review-publish

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Two national public cloud platforms for the health sector have been launched and will host components of the National Data Platform.

The Amazon Web Services (AWS) and Microsoft Azure sector platforms have both been deployed this year as part of the Health New Zealand Te Whatu Ora hybrid multi-cloud programme.

Hybrid multi-cloud is a mixed computing, storage, and services environment made up of on-premise, private and public cloud services.

eHealthNews reported last October that the national hybrid multi-cloud programme had been allocated $4.55 million to build national cloud platforms. At that time, up to 80 percent of Health NZ applications were on-premise.

Senior responsible officer for the sector platform delivery phase of the hybrid multi-cloud programme, Steve Miller, says the launch of the new cloud platforms is a “crucial step towards a modern, resilient and adaptable health IT ecosystem that best serves our communities”.

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The AWS platform will host components of the National Data Platform (NDP) and is also expected to host the Aotearoa Immunisation register, National Bowel Screening data, and the Hira marketplace.

The first data sets on the NDP are the Medicines Data Repository (MDR) and the Cardiovascular Disease Risk Assessment (CVDRA).

The latest NDP update says these are the start of the NDP journey to “become the common place for access to highly curated and analytically ready Te Whatu Ora data”.

“Work is underway to define the roadmap beyond this first horizon. From June 2024 we will start to increase access to the platform and add more data - but we must balance the delivery of this value with ensuring that we do not compromise on privacy and security,” it says.

The refreshed NDP timeline says that in April, data engineers will have access to raw MDR and CDVR data and a limited set of business users will get access later in the month as part of the alpha release.

Chief data officer Kari Jones tells eHealthNews this will enable Health NZ to undertake planning and reporting relating to those data sets.

“The initial phases of the NDP have prioritised internal uses focused on health analytics, operational performance, and strategic planning,” she says.

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Healthcare organisations are looking to innovative digital technology to streamline clinical workflows, improve patient care and boost business performance. However, legacy IT systems and practices often stand in the way and make deploying new digital healthcare solutions across the enterprise daunting.

Fortunately, help has arrived. Forward-looking health IT leaders are turning to a new generation of cloud-based data integration platforms to simplify operations, overcome staffing challenges, accelerate innovation and reduce cybersecurity risk.

Legacy data integration issues
Healthcare IT environments are notoriously fragmented. Until recently, there were no widely adopted, universal standards for formatting and exchanging healthcare data. Each healthcare application vendor and system provider took a different approach. In response, most healthcare organisations implemented point-to-point connections or deployed on-premises data integration engines to transform and route dissimilar data from disparate sources.

Driven partly by government health data sharing initiatives, HL7^® FHIR^® is emerging as an industry-standard data exchange format. However, most major healthcare organisations still rely on aging on-premises integration platforms that impair application performance and are difficult and expensive to scale and maintain.

To make matters worse, many healthcare IT departments are plagued by staffing shortages. Hiring and retaining IT talent is a challenge. Millions of people around the world quit their jobs in 2022 as part of the “great resignation”, and healthcare organisations were hit particularly hard. Today, many healthcare IT teams struggle to do more with less and don’t have the time and resources to administer and extend their legacy data integration systems.

Not surprisingly, 90% of healthcare executives want to change their existing data exchange mechanisms, according to a recent study of 240 healthcare executives, The ANZ State of Healthcare Analytics & Interoperability Study 2023-24, conducted by tech advisory firm Ecosystm for InterSystems.

Cloud-based data integration platforms
One solution is a healthcare cloud integration platform. This state-of-the-art data integration solution is delivered as a remotely hosted, fully managed service for ultimate operational simplicity, agility and economics. It helps organisations to streamline integration efforts and address new business, technology and regulatory requirements – quickly, efficiently and cost-effectively.

Specifically conceived as a platform as a service (PaaS) offering, a cloud integration platform is built from the ground up with speed, resiliency and scalability in mind. It is also designed to protect data privacy, is equipped with easy-to-use tools for interface analysts and app developers, and it is backed up by service level assurances for peace of mind.

A typical healthcare cloud integration platform provides all the features and functions of a traditional on-site healthcare data integration solution, including built-in data transformation libraries and graphical user interfaces for app developers and integration specialists.

However, cloud integration platforms differ from traditional on-premise solutions in many ways. For example, they will include the cloud compute, storage and networking resources needed to support each customer instance at whatever scale and speed is required.

They will also typically provide sophisticated cybersecurity functions, including comprehensive identity and access management controls, threat detection and response capabilities, and data encryption functionality. And they will support high availability with automatic failover capabilities.

Why a cloud integration platform?
Cloud integration platforms offer a variety of economic and operational advantages compared to traditional on-premises data integration solutions. A cloud platform can help organisations accelerate time to value and avoid lopsided business models with long payback periods. With a cloud platform, you can eliminate capital outlays and tightly align ongoing operations expenses with evolving business requirements.

In other words, you can pay for only what you use – why should you pay more just because you want to interface to another system?

It can also help organisations to simplify IT operations and speed up innovation. With a cloud platform, the service provider takes care of the underlying infrastructure. The customer organisation’s internal resources stay focused on core business imperatives like writing interfaces or rolling out new clinical applications. Benefits include:

• No capital equipment expenses. With a cloud platform, the service provider owns the underlying compute, storage, networking, and security infrastructure.
• Lower ongoing operations expenses. The service provider is responsible for all infrastructure administration, support and maintenance, and all physical space, power and utilities.
• No idle resources or squandered capacity. A cloud platform provides pay-as-you-grow scalability. With an on-premises approach, you must overprovision compute and storage capacity to support future requirements.
• Greater IT productivity. A cloud platform can help alleviate IT staffing challenges. IT teams don’t need to keep up to date with the latest hardware, threat prevention and resource allocation trends and can reallocate personnel and budget for more strategic tasks.
• Inherent extensibility. Cloud platforms are adaptable and future proof. Service providers deliver new features and functions without disrupting service.
• Economical geo-redundancy. Cloud platforms support cost-effective failover across data centres (availability zones), ensuring continuous service in the event of a catastrophe.
  

Building a business case for cloud integration
A cloud integration platform is an obvious choice for an organisation deploying a data integration solution for the first time – that is, a greenfield deployment. But most major healthcare organisations probably already have at least one, or even many, data integration solutions in place.

Many people assume there are only two choices – continue to invest in an expensive legacy integration solution, or lift and shift the whole thing. But there is a third way. Cloud integration can provide incremental value to an organisation by meeting just the next integration challenge instead of doing a full migration.

To make the right choice, you’ll need to consider two questions. Does a new cloud integration platform make good financial sense? Or are you better off trying to extend your existing on-premises solution? You’ll need to do a total cost of ownership (TCO) analysis to find out.

When building a business case, be sure to consider intangible expenses. Planners often overlook indirect expenses like opportunity costs. For example, legacy system administration and maintenance burdens can divert valuable IT resources from other projects that might improve patient care in ways that are difficult to quantify. Similarly, legacy system performance constraints can hinder clinical workflows and impair patient satisfaction and retention in ways that are difficult to measure.

Assigning a dollar value to some of these nebulous costs might be difficult, but you can’t simply ignore them. They represent the hidden expenses of maintaining the status quo and are crucial for understanding the true total cost of ownership (TCO).

To help you get started, InterSystems has developed a healthcare cloud integration platform decision guide, including a detailed TCO comparison chart. This is available at: https://www.intersystems.com/business-case-healthcare-cloud-integration.pdf/.

Maybe it’s time to take a fresh look at your approach to data integration. A healthcare cloud integration platform can help you streamline integration efforts, boost application performance and availability, and free up resources to support core business initiatives.

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Te Whatu Ora national hybrid multi-cloud programme has been allocated $4.55 million to build national cloud platforms on Microsoft Azure and Amazon Web Services (AWS) by 2024.

James Allison, director of digital enterprise services, says AWS and Microsoft Azure cloud services have the scale and security required to host health applications and services that can improve workflow for clinicians and support consumers by making it easier to share information across Aotearoa New Zealand.

Currently, up to 80 percent of Te Whatu Ora applications and services are on-premise.

Allison says the hybrid multi-cloud programme “is creating the landing zones allowing us to shift the dial to include private cloud and public cloud capabilities, aligned to government strategy.”

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Hybrid multi-cloud is a mixed computing, storage, and services environment made up of on-premise, private and public cloud services. Te Whatu Ora is working with both Amazon and Microsoft to enable access to their enterprise grade public cloud offerings.

The organisation says there is also an important role for local providers in other areas of the cloud programme, such as testing, design, advice, and support.

“Our hybrid multi-cloud programme is about creating the foundational platform for us to harmonise our activities and manage our technical debt challenges,” Allison says.

“It is preparing enterprise-class spaces that will enable us to progressively transition our applications”.

Allison adds that everything is being designed to be able to move data and workloads back to New Zealand when public cloud data centres are built locally. Both Amazon and Microsoft have announced plans for data centres in New Zealand.

“By the end of this year we will have those enhancements completed to both platforms and we will merge other Amazon and Microsoft tenants onto these enterprise platforms,” he says.

“This is an opportunity to rationalise, consolidate and get to a level of scale that supports care delivery.”

Te Whatu Ora interim central region data and digital lead Steve Miller says there are already multiple workloads on both Amazon and Microsoft Azure, such as the Central region’s patient administration system, which recently moved to the cloud.

Te Whatu Ora now has a national view of all the former 29 entities’ environments and is using a visualisation tool to view a real time dashboard of the whole environment.

“This supports our planning around what we start to transition and modernise as part of the process,” Miller explains.

He says the health system already makes extensive use of public cloud capability, which has been developed to make it fit for purpose for the entire sector.

“We are building on our existing work and adding more features. This gives us a great chance to adopt new technology platforms and work methods.”

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It was with a mixture of delight and concern that we read “Digital Strategy for Aotearoa highlights digital health innovations”. Delight because the concept of digital twin (DT) technology was described in the article, but concern because the DT “would show the origin, composition and likely replacement date of each item used in both constructing and running the hospital, mapping thousands of items digitally”. While we agree this is a laudable and worthwhile goal, it also brought to mind a well-known whakatauki: “He aha te mea nui o te ao? He tangata, he tangata he tangata | What is the most important thing? It is people, it is people, it is people.”

A vision of healthcare using people-centric DT technology
A patient arrives to hospital for elective surgery, they have been prepared for the surgery for some time as their treatment plan/appointments are available via their healthcare pathway portal (Pathway Modelling - PM), but they are still nervous. They are not familiar with the hospital layout, but the same portal provides a wayfinding app (Wayfinding through Hospitals) and they easily find their way to the surgical centre. Along the way they share a link on the pathway portal with their whānau so that PM can keep them informed about progress.

While the patient makes their way to the surgical centre, the centre is notified of their arrival and the relevant patient history is shared with the centre - the patient receives a notification about their data that is shared (Electronic Health Records). In parallel to a nurse reviewing and getting consents with the patient, the anaesthetist and surgeon use different views of the patient record to check for complicating conditions and recent scans respectively.

Both the anaesthetist and surgeon have time to view the patient’s information as their schedule is running smoothly. A surgical scheduling (Surgical Scheduling) system has enabled planners to easily find the best schedule, balancing time overruns due to variation in surgery times with operating room utilisation. This schedule also leverages PM and integrates with occupancy monitoring for ICUs/wards (Ward Occupancy) to make sure no “downstream” issues ensue.

After the surgery the patient spends a short time in an intensive care unit (ICU) recovering. ICU beds are available because data-informed tactical decisions ensure nurse rosters match the surgical schedule (CVICU Planning) and strategic decisions on ICU capacity (Critical Care Planning). As the patient is transferred from the surgical centre to the ICU, the patient portal updates to let their whānau know their status (PM).

The patient is transferred to the ward to complete their in-hospital recovery after some imaging to check for infection in their surgery wound. A DT of the radiology department (Radiology DT) - part of the overall hospital DT - provides patient prioritisation and right-sizing of critical radiology resources.

The hospital DT ensures patients are transported between services in a timely manner via an automated, optimised dispatch of orderlies and transit nurses (see Optimised Patient Transit).

The whole hospital runs efficiently (the right equipment, at the right time at the right place). The right equipment through automated communication between the hospital and its suppliers (see Sharing Data to Improve the Supply Chain) and the Surgical Sterilisation Unit DT – part of the hospital DT – ensures key equipment is sterilised and ready in time.

Clinicians and administrators can get real-time visibility of patients throughout the hospital by location (see Ward Occupancy) or treatment pathway with either dashboard views or accurate geo-spatial visualisations, all provided by the hospital DT and the healthcare pathway portal.

Previous system bottlenecks can be replayed and alternative mitigation processes developed to ensure they don’t reoccur, for example using the Emergency Department DT. The hospital’s “air traffic controllers” continually fast forward the hospital’s DT to predict, understand and alleviate any impending issues.

Hospital management get certainty for CapEx investment as the hospital DT can also experiment with big changes and evaluate their effect on the overall hospital system using empirical data (Deploying AGVs within a Hospital).

DTs extend to the community, also utilising data sources to ensure patients receive the required resources for quality healthcare (Data-Informed Districting).

Putting people at the centre
People are, in general, harder to model and keep track of than items. However, there is over a decade of research into precursors of people-centric digital twin technology within the Aotearoa New Zealand healthcare system. The focus of digital twin technology for healthcare delivery in Aotearoa New Zealand should be the people within healthcare. It is only by placing people - i.e., tangata whenua and tangata Tiriti, not items, at the centre of healthcare digital twins that Aotearoa New Zealand will be able to provide the best quality of care for its people.

Digital Twin Technology and Precursor Research Projects
Pathway Modelling
Electronic Health Records (EHRs)
Ward Occupancy
Radiology DT
Sharing Data to Improve the Supply Chain
Emergency Department DT
Wayfinding through Hospitals
Surgical Scheduling
Optimised Patient Transit
Surgical Sterilisation Unit DT

Main Picture: Michael O’Sullivan, Associate Professor, Department of Engineering Science, Auckland University

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Te Whatu Ora Capital, Coast & Hutt Valley and Te Whatu Ora Wairarapa have resolved the ICT issue affecting systems across Greater Wellington’s hospitals.

Services across Wellington Regional Hospital, Kenepuru Community Hospital, Ratonga Rua o Porirua, Hutt Hospital, and Wairarapa Hospital are now operating as normal once again.

Over the course of the morning the fault slowed access to a range of clinical and support systems including patient records, clinical notes, laboratory results, payroll, some swipe access cards, and the Citrix application that enables staff to work remotely.

While teams and services worked hard to try to minimise the impact of the issue on patients, some people attending outpatient appointments or planned procedures will have experienced delays of up to 30 minutes or so. While no patients required rescheduling at Wairarapa or Hutt Valley, around 80 Capital Coast patients had to have appointments – in services such as medical outpatients and cancer – rescheduled for the next available opportunity, and we are running additional evening and weekend sessions to catch up for these cancer patients. No surgeries were deferred across the two districts.

Source: Te Whatu Ora media release

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Use of the NZ ePrescription Service (NZePS) grew rapidly in response to the Covid-19 pandemic. In order to improve stability, security and scalability, service provider Whānau Tahi migrated the NZePS to Microsoft Azure.

NZePS provides a core platform for the secure exchange of electronic prescription and dispensing information between authorised prescribing and dispensing organisations and systems and to-date has been primarily focussed on community prescribed and dispensed medications.

Pre Covid-19, while dispensing systems were using NZePS for all community based dispensing, uptake of the service was relatively low from prescribing systems at around 16 percent of general practices in March 2019.

When Covid-19 hit New Zealand’s shores, the opportunity to deliver benefit to the community via paperless prescribing was recognised. The service became critical as general practices rapidly switched to a digital first approach when caring for patients and the number of GPs sending prescriptions electronically has been steadily climbing since.

The total number of NZePS compliant eScripts being issued rose from around 620,000 in March 2020, to more than 1.5 million in March 2022.

Migrating to the cloud
Whānau Tahi provides managed application and hosting services for NZePS, the end-to-end system that supports the transmission of prescriptions from GP practices (typically), through to dispensing at a pharmacy, on behalf of Te Whatu Ora – Health New Zealand.

The service was previously hosted ‘on-premise’, on an older technology stack, which made it difficult to scale and maintain performance. It prevented the use of many modern tools available in the cloud, to improve security, stability, performance, compliance and integration.

With the increase in cloud-based solutions and cloud-first strategy adopted by Te Whatu Ora, there was an opportunity to modernise NZePS infrastructure.

Allan Blackwell, Whānau Tahi, chief technology officer, says the move to Azure is part of an organisation-wide drive to modernise Whānau Tahi services and leverage the cloud.

The significant uptake and transactional nature of NZePS, combined with its need for high performance, made it a great candidate to shift first, and the move was completed in December 2021.

“We saw a huge opportunity to move from our traditional hosting environment to the cloud,” says Blackwell.

“The Azure product is really robust, and we have improved our backup and disaster recovery abilities.”

He says moving to Azure unlocks the ability for Whānau Tahi to transform at scale.

“It was a challenge, but in conjunction with our partners Parallo and Defend, we moved one of the largest workloads out of an inflexible on-premise infrastructure stack to a modern flexible highly tooled cloud technology stack.”

Stable and secure
NZePS is a critical system in Aotearoa New Zealand’s data and digital health landscape and security and privacy is of utmost importance.

Clinton George, chief information and security officer Whānau Tahi, says the use of the Azure platform enables to deliver a highly secure and compliant product to the health system.

“We now have improved resilience, improved performance and improved ability for others to integrate with the service. We are leveraging the Azure technology stack tools including self-healing, cloud monitoring and platform management,” he says.

“With the move to Azure, we now have access to a wider range of cloud management tools, improved security and performance management tools, and improved tools for development operations, code and change management.

“We also have the ability to introduce extra security layers such as multifactor authentication and conditional access really easily,” George adds.

“The investment in Azure underpins a lot of what we do. We've got a great secure work environment that enables us to be able to work really effectively on the product, and with the product.”

George says the cloud platform enables the 24-hour monitoring of the platform, application and security and by “making use of the huge smarts that you get in Azure” they have achieved an exceptional overall uplift in security.

Integrating and expanding
A number of digital health suppliers, such as those providing practice management systems for GPs, need to integrate with NZePS to enable their customers to access the service.

Blackwell says migrating to the cloud has enabled Whānau Tahi to respond to requirements from Te Whatu Ora Medicines Digital strategy team to enhance NZePS Application Programming Interfaces (APIs) using modern security techniques and to align with modern FHIR API standards.

Processing times in NZePS have also been reduced, which reduces time taken to draw down scripts to be dispensed at the pharmacy.

“The Azure platform allows us to track and observe performance and scale as needed. You get immediate feedback and insight into service performance, which is of massive value to the whole health sector,” Blackwell says.

“We have increased our agility and ability to innovate faster and deliver benefits to our customers and the wider health system.”

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The government has allocated $97 million to fund stage one of the data and digital solutions and infrastructure for the New Dunedin Hospital.

The focus for stage 1 will be digital infrastructure, which includes digital wayfinding services, digital check-in kiosks, information displays and the network, building management and WIFI connectivity required for the new Outpatient Building to operate.

Minister of Health Ayesha Verrall says, “the Minister of Finance and I have agreed to an additional $97 million to go towards the data and digital infrastructure required to make the new hospital operational.

“Its design and use of the latest technologies will mean better patient flow and improved access to diagnostics and treatment spaces which will help reduce unnecessary delays.”

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Te Whatu Ora Southern chief digital officer Patrick Ng says it is exciting to have sign-off for stage one funding. This covers the full digital infrastructure for the new outpatient building, opening in 2025.

Also funding for adaptation of existing digital solutions so that they will work with the new building and business case funding to request funding for the future requirements of the inpatient building, when it opens.

Ng says the new outpatient building will not house paper medical records.

“All of the digital infrastructure that we need for the operation of a contemporary facility is going to be in place when the outpatient building opens,” he says.

“Patients will receive their appointment on their device, receive guidance on where to park and what entrance to use, and be able to navigate to their appointments more seamlessly.

“After they check in digitally using a kiosk, they will be able to receive updates about when their appointment is going to occur and wait for notifications in the café, rather than in the waiting room, if they want to.

“It will feel a lot more modern, contemporary and seamless and it should minimise how much time patients spend ‘lost’ in our buildings.”

A scanning initiative will use a solution called Side Capture to digitally scan all new medical record content and make this available via the clinical portal, Health Connect South. This solution is already used in Nelson Marlborough and Mid Central districts.

There is also a project to increase the use of digital forms, so more information is input electronically.

“These paper light initiatives mean that clinicians will be able to access the information they need from the electronic clinical portal that they currently use, rather than from the paper medical chart. That enables them to access the information immediately, and for multiple clinicians to access the content at the same time,” says Ng.

Only new documents will be scanned, not historical, but over time these will replace the need to request paper records.

Southern is also in the process of appointing a digital infrastructure delivery partner to “act as an integrator and to bring together all the third party products and services that are needed to create the overall digital infrastructure for the new buildings,” he explains.

“We have put a lot of effort into the design of the digital infrastructure and worked with our national colleagues. At least 50 percent of the design can be reused for other projects such as Nelson and Whangarei hospitals when the digital infrastructure requirements for those new buildings are put together.”

Te Whatu Ora Southern in also planning to go live with the South Island Patient Information Care System (SI PICS) in October of this year.

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NICE (Nasdaq: NICE) has announced that Whakarongorau Aotearoa – New Zealand Telehealth Services has implemented NICE’s CXone cloud-native platform to transform its contact centre operations and deliver frictionless customer experiences to support the health of the New Zealand public.

Whakarongorau Aotearoa is a social enterprise that manages the New Zealand government-funded national telehealth services across seven digital channels as part of the National Telehealth Services Contract, operating several contact centres.

After growing its operations significantly throughout the COVID-19 pandemic to respond to the needs of the public, Whakarongorau Aotearoa realised it needed a more agile and flexible solution to handle its operational needs. To move into its next phase of maturity and to better respond to strategic opportunities and community needs digitally, Whakarongorau Aotearoa selected NICE and its partner Converged Communication Network Applications (CCNA) to transition its contact centre environment to a mature, cloud-based contact centre solution that delivers greater scalability to rapidly respond to changing business requirements and adapt to evolving public health concerns.

NICE CXone enables Whakarongorau Aotearoa to meet its immediate needs. As Whakarongorau Aotearoa operates the centralised platform for New Zealand’s National Telehealth Services, it provides significant reporting requirements to the New Zealand government. CXone delivers comprehensive reporting capabilities that allow the organisation to achieve greater insight into its services at a granular level, providing Whakarongorau Aotearoa the ability to further streamline its operations. Additionally, CXone allows Whakarongorau Aotearoa to continue to evolve and deliver to more channels in which it can better support the New Zealand public.

Mike Mulvaney, Director of Technology Services, Whakarongorau Aotearoa – New Zealand Telehealth Services, said, “The health of the New Zealand public is of the utmost concern for Whakarongorau Aotearoa. NICE CXone enables us to rapidly respond to changing public health events, seamlessly scale the supporting workforce as needed without disruption to service users and will empower us to provide better service to reach even more New Zealanders.”

Darren Rushworth, President, NICE International, said, “CXone will provide Whakarongorau Aotearoa the ability to seamlessly move into its next phase of maturity and grow with the organisation as it continues to evolve. CXone will allow them to support New Zealanders effectively and create exceptional customer experiences.”

Source: NICE media release

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Information stolen from Pinnacle Midlands Health Network's IT platform, including individual screening and immunisation data, has been uploaded to the dark web by cyber criminals.

The information and data relates to past and present patients and customers of the Pinnacle group in the Waikato, Lakes, Taranaki and Tairāwhiti districts. It also includes Primary Health Care Ltd practices from across Taranaki, Rotorua, Taupō-Tūrangi, Thames-Coromandel and Waikato.

Pinnacle Health suffered a cyber-attack on Wednesday 28 September. A statement from the Network says malicious actors accessed a third-party IT server, and the affected IT was immediately taken offline and contained.

Justin Butcher, chief executive of Pinnacle Incorporated, says much of the information and data that was stolen has since been made public.

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“We acknowledge that this will be concerning to our patients and their whānau, and we are taking this seriously," he says.

“While Pinnacle does not hold GP notes and consultation records, we now have a much clearer understanding of the breadth of stolen data. This includes high level data related to the use of hospital services, claiming information related to services that Pinnacle provides, and information sent to practices around immunisation and screening status of individual patients.

“Cyber incidents like this are a constant threat, and while they are the doing of malicious actors, we feel for everyone who may have been affected," says Butcher.

Head of cyber at Theta, Pete Bailey, says only those people within Pinnacle Health and responding to the incident have knowledge of what is happening there, but the attack appears to follow a pattern seen for the past few years, where attackers are generally trying to extort a ransom from a victim.

"The approach is to gain access to the system, download information (normally sensitive information such as patient data or financial information), and then ask for payment so that the information won’t be published," he says.

"When the organisation doesn’t pay the ransom, then a sample of the information is often published on the dark web to prove that they have it, and try and get the victim to pay."

Bailey says the issue with these attacks is that even if the ransom is paid, and the attacker says that they have deleted the data, they often do not, as it is too valuable to them.

"They often extort a ransom from a victim, and then a few months later go ahead and sell the data on the dark web as well. This way they get a much better financial return for the time they have put into the attack," he says.

Pinnacle has notified the police and the Office of the Privacy Commissioner about the attack.

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Three thousand data outlets, 200,000 metres of cable and a technology refresh is enabling the latest models of ICT equipment to support the newly opened Wellington Children's Hospital.

Te Wao Nui, which opened on September 30, has 50 inpatient beds and another 101 outpatient beds, and will provide care for babies and children up to the age of 16.

Chief digital officer for Te Whatu Ora – Health New Zealand Capital and Coast, Hutt Valley and Wairarapa district, Martin Catterall, says most the ICT technology in the new building has been refreshed to provide the latest models of equipment to compliment the new build.

"This is about future proofing, making sure new technologies are scalable going forward," he says.

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A new digital communication tool, Vocera, has been implemented to enable staff to communicate more easily and to engage with other staff in what is a much larger building than they previously had. Staff wear the wireless devices around their necks and they are voice and touch activated.

Between 60-70 large screen TVs will be mounted on the walls to entertain the children. A further number of large screen TV’s are being used to display patient/clinical information and ”Capacity at a Glance” type information in the staff write-up rooms.

Catterall says there is extensive wifi across the building for staff and children as well as Sky TV in all of the bedrooms and treatment rooms. A large LED interactive wall in the waiting room has a camera and enables children to interact with various content.

A 'donor display' TV has an animation showing donors and provides the real-time ability to donate and see your name displayed.

Health Minister Andrew Little says the clinical teams looking after children at the hospital will find it easier to collaborate and provide better care.

Te Wao Nui has been built with a $53 million contribution from benefactors Mark Dunajtschik and Dorothy Spotswood, with the Government contributing another $53 million and $10 million being raised by the Wellington Hospitals Foundation.

The Wellington Children's Hospital is one of only five hospitals in the country that performs specialist paediatric surgery. It provides paediatric surgical services for our tamariki and rangatahi, as well as tamariki and rangatahi from Hutt Valley, Wairapapa, Manawatu, Whanganui, Hawkes Bay, Nelson and Marlborough.

Picture:Te Wao Nui
Image credit: photographer Andy Spain


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Te Whatu Ora Health NZ has gone to market for a digital infrastructure delivery partner for the New Dunedin Hospital, with a contract worth in excess of $60 million.

The New Dunedin Hospital includes 421 beds and will be “state of the art, using digital infrastructure to manage patient flows and improve efficiency,” the Registration of Interest (ROI) says.

The ROI estimates the value of the hardware and services components for the outpatients building, due to open in 2025, to be approximately $25 million. The second stage is estimated at $35 million for the inpatient building, due for completion in 2029.

The delivery partner will procure, commission, install, integrate, manage and support all in-scope products for the hospital, as well as “establish and manage a prototype and staging lab to deliver a fully integrated digital environment across all ICT at the New Dunedin Hospital”.

The scope includes a patient engagement solution, electronic patient journey boards, digital wayfinding and digital signage, to allow patients to check-in electronically and provide them with directions.

Also, a real time location system to enable patient movement and the tracking of clinical equipment, and electronic bed cards to replace charts.

Support facilities, such as logistics and kitchen areas, are also part of the scope.

An overview from chief digital officer for Te Whatu Ora Southern District Patrick Ng, says the district’s digital transformation programme comprises of digital solutions and digital infrastructure.

“In the first instance, our digital solutions will be about readying our existing solutions to work in the new buildings, including developing our processes to become a paper lite hospital that is no longer reliant on paper medical charts as the competent medical record,” he says.

The district also envisages new digital solutions, such as a contemporary electronic health record with workflow, but will need to make a robust, national case for investment in these future transforming digital solutions.

“There are high expectations about being able to use the digital infrastructure design that we have created for future hospital buildings such as Nelson and Whangarei,” says Ng.

Tony Lloyd, programme director of the new hospital, says in a case study for the new Digital Strategy for Aotearoa that staff will have role-based access to medical information, enabling the patient experience to have greater continuity and be more personalised.

“We want the new hospital to make it easier for hospital staff to be even more patient-centric than they are now,” he says.

“This will involve better booking management systems, records management (including patients contributing to their own health records), being able to navigate hospitals better, wearable devices that enable both improved tracking of patient health and earlier departures (because the hospital continues monitoring patients at home).”

“The vision is for the new Dunedin hospital to become a blueprint for 5 more New Zealand hospital builds now in the pipeline.”

Shortlisted respondents to the ROI will be invited to participate in a closed RFP process with the contract expected to start in June 2023.

Budget 2022 allocated $225 million over ten years  to fund the digital transformation of the Southern region’s health system, with $155m available in the next four years.



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What does infrastructure have to do with health and health equity?
Everything. The reforms currently taking place in the health and infrastructure sectors are inviting innovation and collaboration at unprecedented scale in New Zealand.

With reforms comes opportunity. An opportunity to better provision for the future. The door is open for us to bring our experience and expertise to the table and together challenge business as usual approaches.

Health outcomes and infrastructure are intrinsically linked.

Affordable, quality homes improve security and health for people. Well-designed schools improve how children learn and grow. Affordable high-speed internet connects people with their whānau and communities, their culture, knowledge and opportunities. Hospitals and medical buildings impact the healthcare environment for staff and patients.

Having the right underlying infrastructure plays an undeniable role in improving people’s wellbeing, providing opportunities, and reducing disparities.

The opportunity in front of us
The public health sector oversees approximately $24 billion dollars of assets. How can we use these reforms to bring together information about the condition and performance of healthcare infrastructure and better provision for the future?

Having the right information, with the right context, at the right time, leads to better decision making. Using digital engineering processes such as Building Information Modelling (BIM) and digital twins, information on critical assets can be captured to offer greater insights on performance.

If investment decisions are informed by information, every dollar can drive health outcomes. This approach delivers clear benefits.

Research by the Centre for Digital Built Britain in the UK found that every NZD$2 invested in information management can support NZD$10.20-$12 of direct productivity gains. Amounting to NZD$13.80 in total cost savings. This is while also helping government reach policy targets, including accelerating the path to Net Zero carbon, improving social outcomes and supporting more inclusive infrastructure.

Looking at the big picture with a National Digital Twin
Ko te manu kai i te miro, nōna te ngahere, ko te manu kai i te mātauranga, nōna te ao
The bird that eats the miro berry, has the forest, the bird that eats knowledge, has the whole world.

In last year’s budget the New Zealand government signaled they will be investing $57.3b in infrastructure development from 2021 to 2025. The extra funding will support investment in roads, public transport, schools, hospitals, housing, and climate change mitigation.

This presents a significant opportunity to be intentional about sharing a kete mātauranga. What if we had a basket of knowledge that weaves together wisdom from:

• wisdom from the engineering and architecture communities on how to create infrastructure that provides the best outcomes for people and nature
• regional health data that shows where discrepancies are
• and a te ao māori worldview and pūrākau – “oral histories [which] can be seen as simultaneously as data, and encoded knowledge, and a capsule of wisdom… a repository for context-specific information and data”.
  
  

Good data is critical to understand the role of our infrastructure in improving health outcomes for people.

Our infrastructure is currently designed, built and operated as a series of silos. What could happen if instead we shift our approach and view to operate as a system of systems? This could be captured in a national digital twin.

A national digital twin enables secure, resilient data sharing across sectoral and organisation boundaries so that everyone can consider the big picture when making decisions.

Better access to connected data through a national digital twin could also support our response and resilience to sudden seismic activity, flooding and other natural disasters. This can help our health systems get back on track faster and deliver better health outcomes. Other countries are currently developing national digital twins, what can we learn from them?

Reform is opportunity. Systemic challenges need systemic solutions. Technology is not the only solution but applied wisely it is a key enabler in shaping better decisions. We can all agree that challenges like this call for collaboration.

FranklyAI - understanding communities to make the right interventions
As the health sector shifts towards a model of distributed services in smaller and repurposed buildings, rather than big campus developments, we have an opportunity to co-create a shared understanding of the specific needs of communities with desired health outcomes.

FranklyAI is a powerful online platform and multilingual conversational engagement tool. Developed in response to the need for diversity, equity and representation in the data collection and decision-making processes. Frankly removes language and cultural barriers by enabling people to give feedback in their native language. Insights are then displayed through an unbiased lens – allowing deeper insights into the needs of a community.

Watch the webinar, Social determinants of health: a systems thinking approach, on 25 May at 12.30pm – register now.

If you would like to provide feedback on the above feature article please contact the editor Rebecca McBeth.

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There were three key factors driving Nelson Marlborough District Health Board’s (NMDHB) switch from running its Roster-to-Pay on-premise with AMS to deploying its new AMS Pulse cloud solution. While NMDHB had successfully managed a highly complex pay environment for a 3,000 strong workforce on-premise for decades, in mid-2021 it decided the advantages of cloud were more than compelling.

According to Trish Casey, GM People and Capability at NMDHB, moving away from maintaining a hardware stack wasn’t the only consideration. “Firstly, there was removing the need to have inhouse expertise to manage an increasingly complex technical environment – including managing test environments in delivering the Holidays Act and the many MECA (Multi-Employer Collective Agreement) changes.

“Security was also top of mind, particularly with the recent attacks on DHBs. We were looking for a much stronger, inbuilt, discipline around data security and system access. Finally, increasingly, our people were wanting to remotely access our roster and pay systems which AMS Pulse makes really easy.”

Praise for Joint AMS Pulse Project Delivery
Delivered in just eight months, alongside the many disruptions Covid imposed, Trish was full of praise for the joint project team and how they approached the whole process. “What really impressed me was the project management discipline and the very structured approach taken. Every activity was clearly defined, the actions identified and scheduled with clear ownership. The plan was meticulously followed with everything listed and tested to ensure a smooth delivery.”

While not everything went completely to schedule, risk was minimised by running a live test on an interim payroll run, in-between cycles, with a small subset of employees. This was then followed up by the first major payroll run where the transition was made from old to new and, as Trish puts it: “Everyone got paid.”

Head of Workforce Management for AMS, Ben Barlow, says this was one of the more complex AMS Pulse projects to date. “Nelson Marlborough DHB use the full extent of AMS product functionality, and this was a good test of how well it really has translated into AMS Pulse in the cloud. We also set up a cloud data replication service using MS Azure, that accurately updates all relevant data. It ensures customised internal reporting and integrations built by NMDHB for on-premise, can be sustained in the cloud,” he said.

Real Complexity in Health Payroll
“Timing was also critical. There were very small windows of opportunity for project delivery with year-end, Holidays ACT and MECA compliance looming. It was also an incredibly busy time for the Nelson Marlborough payroll team with Covid creating multiple shift changes, overtime and leave requirements above and beyond the norm,” he concludes. “The project delivery is a credit to everyone involved.”

It is complexity that can’t be underestimated. NMDHB’s Trish Casey has worked in many different industries but none of them presents the issues of managing payroll in a health workforce. “You are managing different cohorts of workers, all on different shifts, across different sites, under different employment agreements. If you consider all the pressures of Covid, the recent high profile MECA settlements and the remediation and rectification related to Holidays Act changes – there really isn’t anything else like it.”

Source: AMS media release

Sector updates are provided by organisations to eHealthNews.nz and have not necessarily been edited or checked for accuracy. Any queries should be directed to the organisation issuing the release.

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Southern DHB has appointed engineering firm WSP to design the digital infrastructure and facility systems for the country’s first Digital Hospital, being built in Dunedin.

The DHB went to tender for the role last year, describing it as a “unique opportunity” as the consultant would have responsibility for the design and assurance of the digital infrastructure across the entire project.

Peter Ganter, director of Ganter Consulting in Australia, is working with Southern on its digital plans and says the DHB has two parallel work streams, one for infrastructure and one for software solutions.

The commercial model for the infrastructure workstream was to appoint a design consultant to lead all aspects of the digital facilities and digital infrastructure process.

Ganter says digital infrastructure is now so integrated and complex that it needs its own design and specification, as well as a strategy to implement it. WSP is responsible for designing all the active infrastructure and coordinating with the physical building design.

Once the developed design report is complete, around June July 2022, the DHB will go to market for an infrastructure delivery partner to install and supply the equipment that has been designed and specified.

Ganter started working with the southern DHB about two years ago and was involved in drafting the Dunedin Hospital Digital Blueprint.

“That became a catalyst for a broader digital transformation program as we very quickly identified that it wasn't just about infrastructure in the new building,” he says.

“To truly deliver some of the transformation that the health service was after, we needed to also introduce new software solutions across the Southern health system.”

Ganter says Southern DHB’s approach is uniquely ambitious in taking on the broader health system transformation at the same time as the new building.

“We are using the new hospital as the catalyst to do this transformation, but we will stage the implementation so that we don't have too much change happening at one particular time,” he explains.

“There are plenty of examples in Australia where they've taken on too much change at once by trying to implement a lot of new software solutions at the same time as opening the building and they haven't gone particularly well. So, we will make sure that we stagger that organisational change.”

Southern DHB plans to submit a Detailed Business Case for investment in digital infrastructure to Cabinet for approval this month.

Picture: An artist’s impression of a new Dunedin Hospital (Jacob)


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The Ministry of Health will manage a new national contract for Microsoft services for the sector, with expected savings of $27 million over the first three years.

The Ministry has contracted Spark Health as the local service provider for the Microsoft agreement.

Group manager digital strategy and investment data and digital, Darren Douglass, says the deal will support reform of the health and disability system and deliver improvements in the health system’s cyber-security protection and resilience.

The Microsoft agreement, worth an estimated $45 million annually, will cover the Ministry, Health NZ, Māori Health Authority, and district health boards (DHBs) and their shared service agencies.

From 12 November 2021, the Ministry will manage both the Microsoft and the Spark Health LSP contracts on behalf of the health sector.

“It makes sense to take a more strategic approach across health agencies as we move to a new operating model for the health and disability system,” says Douglass.
“That way we can get the most value from our investment for the benefit of health care for New Zealanders. Technology is a key enabler for the reforms and these arrangements give Health NZ and the Māori Health Authority the tools they need right from the start.”

Government agencies typically contract individually with Microsoft under a single All-of-Government Head Agreement negotiated by the Department of Internal Affairs every three years.

This agreement was due for renewal this year and as part of the renewal process a health sector-specific variation was negotiated to provide the health sector with additional concessions.

During those negotiations the Ministry of Health and DHB CIOs decided to consolidate Microsoft licence arrangements as part of the renewal process and develop a shared strategic roadmap to maximise value from the investment and ensure consistency in the use of Microsoft technology across health agencies.

“The new contract offers the public greater confidence in the technology systems and services being used across the health and disability system,” Douglass says.

“A lot of this technology underpins the digital services provided to primary and community health organisations, so it makes sense to be consistent.”

The agreement also includes the increased deployment of Microsoft cyber security technology across health agencies which will improve protection and resilience to cyberattacks on health systems and services.

Spark Health chief executive Will Reedy says the organisation was already LSP for 16 of the country’s 20 DHBs and going to a national construct will drive significant cost savings for the sector.

Spark Health’s national team of experts in Microsoft licensing will also be encouraging DHBs and other health organisations to move onto the Microsoft Azure Cloud, first to data centres in Australia, then to New Zealand when these are built.

If you would like to provide feedback on this news story, please contact the editor Rebecca McBeth.

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South Canterbury District Health Board (DHB) has moved its payroll into the cloud with AMS Pulse. While a long-time user of AMS payroll and core HR software, SCDHB is an industry leader in making the move to the cloud. According to SCDHB Project Lead, Stacey Porteous the benefit of shifting to AMS Pulse is already being felt:

“The immediate benefit has been the reduced load on our IT Team,” Stacey explains. “We have also identified a number of costs savings, making it an even more cost-effective option moving forward.”

South Canterbury is the first of a number of AMS DHB customers who will shift to the AMS Pulse cloud environment this year. According to AMS CEO Joseph Yip it is a significant milestone for the 40 plus year old kiwi software company that already hosts a number of Government agency payrolls in the cloud.

AMS continues to innovate after 40 years
“AMS software currently pays over 50% of workers in DHBs. We are constantly looking at ways to innovate and make a more effective solution.” he explains. “AMS Pulse lets us create a secure, New Zealand hosted, cloud environments for DHBs.

“It also enables us to share functionality across the Health Sector including the management of industry wide regulatory requirements such as Multi Employer Collective Agreements and Remediation and Rectification.”

Co-design approach to health functionality
AMS is continuing to build on its health-centric functionality. AMS runs a number of co-design forums to develop new functionality. The aim is to create a more standardised approach to health workforce management and enable other DHBs to benefit from improvements being made.

SCDHB is based in Timaru and employs over 900 people including full time, part time and contract employees. AMS is based in Albany on Auckland’s North Shore and has been providing software solutions to New Zealand health care, government, corporate and insurance organisations since 1974.

More information on AMS for the Health Sector can be found here.

Picture: AMS CEO, Joseph Yip

Microsoft New Zealand has welcomed the signing of a three-year cloud services agreement that will see the Accident Compensation Corporation (ACC) do more with data to help prevent re-injuries and address inequities of care around New Zealand.

Under this agreement, which will focus on Microsoft Azure cloud services, ACC will migrate its New Zealand operations to Azure. It’s the first government agency to sign this kind of commitment since the All of Government Agreement was inked between Microsoft and the Department of Internal Affairs earlier this year.

“We’ve had a long relationship with Microsoft, which stood us in very good stead during the huge disruption we and all organisations faced in 2020. We’ve been investing in Microsoft 365 over the past couple of years, rolling out Teams and Sharepoint and refreshing our remote access solutions, and within the first week of lockdown we scaled this to our entire team of 3,800 people. Not only did we not miss a beat in terms of the services we provided New Zealanders, we saw a real bump in employee engagement,” said Peter Fletcher, Chief Technology and Transformation Officer at ACC.

“This new agreement reaffirms and builds on that partnership to enable more linked-up use of data, so we can provide better pathways through care and deliver more equitable health outcomes for all regions and ethnicities in Aotearoa.”

An example of the potential benefits of ACC’s cloud strategy will be using artificial intelligence (AI) to develop targeted programmes that prevent re-injury. One of the greatest challenges ACC has identified is the frequency of patient re-injury while they’re on the road to recovery. Through the Microsoft Azure platform, ACC will have access to massive data analytics capability that will reveal patterns in the likelihood of injuries recurring and help identify why this happens. Individualised programmes can then be developed to help patients stay well, depending on their injury and lifestyle.

“We’re hugely excited to be renewing our relationship with ACC and taking it to the next level with this cloud agreement. Nothing is more important than our health and wellbeing, as the past 18 months have shown us, and I want to congratulate ACC on leading the way in cloud and AI to help all New Zealanders stay safe and healthy. With greater insights, we’re not only helping prevent injury and creating more joined-up pathways through our health system, but saving our healthcare providers time that can be spent seeing more patients,” says Vanessa Sorenson, Managing Director of Microsoft New Zealand.

ACC is also looking forward to the arrival of Microsoft’s forthcoming hyperscale datacenter region, which will enable sensitive patient data to be stored within New Zealand’s borders. As New Zealand’s population grows, the virtually unlimited capacity of public cloud will also enable ACC’s data storage and processing capabilities to scale up along with it, without needing to invest in new infrastructure.

“Thanks to this agreement, we’ll have the flexibility to manage data in a way that meets the needs of our organisation as well as our regulatory requirements, and which provides even greater security for personal information at less cost. It’s a win-win-win for our teams, our partners and for all New Zealanders,” Fletcher said.

The new AWS Asia Pacific (Auckland) Region will consist of three Availability Zones (AZs) and join the existing 81 Availability Zones across 25 geographic AWS Regions at launch. The Region will be owned and operated by a local AWS entity in New Zealand. 

The new AWS Asia Pacific (Auckland) Region will enable even more developers, startups, and enterprises as well as government, education, and nonprofit organisations to run their applications and serve end users from data centres located in New Zealand, ensuring that customers who want to keep their data in New Zealand are able to do so. 

AWS also released an economic impact study (EIS) that estimates it will create 1,000 new jobs through investment of NZ$7.5 billion in the new AWS Asia Pacific (Auckland) Region with an estimated economic impact on Aotearoa’s GDP of NZ$10.8 billion over the next 15 years. 
 
“AWS supports thousands of organisations across New Zealand in their drive to innovate, succeed, and grow globally. AWS Cloud technology is providing new ways for government to further engage with citizens, for enterprises to innovate for their next phase of growth, and for entrepreneurs to build businesses and compete on a global scale,” said Adam Selipsky, CEO, AWS. 

“Our investments reflect AWS’s deep and long-term commitment to Aotearoa. We are excited to build new world-class infrastructure locally, train New Zealanders with in-demand digital skills, and continue to help local organisations deliver applications that accelerate digital transformation and fuel economic growth.”
 
Each Availability Zone has independent power, cooling, and physical security, and is connected through redundant, ultra-low latency networks. AWS customers focused on high availability can design their applications to run in multiple Availability Zones to achieve even greater fault tolerance. The AWS Asia Pacific (Auckland) Region will enable local customers with data residency preferences to securely store data in New Zealand, while providing even lower latency across the country. 
 
According to the newly released EIS, AWS plans to invest NZ$7.5 billion in Aotearoa over the next 15 years through the new AWS Asia Pacific (Auckland) Region, which includes capital expenditures on the construction of data centres, operational expenses such as ongoing utilities and facility costs, and purchases of goods and services from regional businesses. 

The EIS estimates that spending on construction and operation of AWS infrastructure in Aotearoa is expected to increase New Zealand’s GDP by approximately NZ$10.8 billion over the next 15 years. The EIS also establishes that the new AWS Region should bring direct and indirect economic benefits like new employment and sales for the data centre supply chain and related sectors. In total, an estimated 1,000 new full-time equivalent (FTE) jobs will be created in Aotearoa from this investment.
 
Customers and AWS Partners welcome the news of the AWS Asia Pacific (Auckland) Region
Customers in New Zealand will continue to join the millions of active customers using AWS every month in over 190 countries around the world. New Zealand organisations choose AWS to run their workloads to drive cost savings, accelerate innovation, and speed time to market, including Air NZ, ANZ Bank, Bank of New Zealand (BNZ), Contact Energy, Education Perfect, Halter, New Zealand Department of Conservation, Lancom, New Zealand Ministry of Health, New Zealand Ministry of Justice, Orion Health, Sharsies, The Clinician, TVNZ, UneeQ, University of Auckland, Vodafone, Xero, and many more.
  
The Clinician is a digital health company with a cloud-native health platform, ZEDOC, that automates collection and analysis of healthcare data and delivers multimedia educational materials to patients. Medical staff use the real-time data, such as eConsent, history, patient measures, and blood pressure and oxygen levels, to quickly flag symptoms such as depression from hypertension or an intolerance to medication. 

“ZEDOC uses AWS’s analytics and machine learning services to intelligently analyse hundreds of thousands of patient interactions every month, providing critical new insights for enhancing remote patient engagement and ensuring equitable access for all communities,” said Tamaryn Hankinson, co-founder of The Clinician. 

“AWS has enabled us to easily scale for public sector deployments in places like Singapore with strict health data privacy standards. An AWS Region in New Zealand will enable the expansion of our digital health services across the private and public health sector locally, ensuring we respect the data sovereignty needs of all communities.”

Source: AWS media release

Sector updates are provided by organisations to eHealthNews.nz and have not necessarily been edited or checked for accuracy. Any queries should be directed to the organisation issuing the release.

Do you have an item to add to sector updates?

Email your information to us at updates@hinz.org.nz

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