It’s no secret that our underfunded and overburdened health system has often struggled to leverage technology to best effect. So layer on top of that a major coronavirus pandemic requiring the sector to move fast to save lives and how did we do?

“We didn’t break anything,” says Shayne Hunter, the Ministry of Health’s deputy director-general data and digital, whose job it was to co-ordinate the technology and digital platforms used to run everything from contact tracing to the procurement of personal protective equipment (PPE) for frontline health workers.

“Some things could have been done differently,” Hunter told an IT Professionals NZ web conference last week as he reflected on life at the coalface of health tech in 2020, which he described as “one bizarre year”.

“Some things could have been done faster,” he admits. 

“But by and large, I’m comfortable we’ve done the right thing. I think we’ll look pretty solid on our decision making and financial management,” he says.

The Ministry of Health’s Shayne Hunter

The approaching storm

No country’s health system was ready for a pandemic like this.

“I think we’ve always known that there would be some sort of pandemic that would actually be really significant globally. But of course, no one’s really ever taken it seriously,” says Hunter, who was chief information officer (CIO) for Capital & Coast, Hutt Valley and Wairarapa DHBs before joining the ministry early last year.

The first inkling of the approaching storm came back in December when director-general of health, Dr Ashley Bloomfield started hearing overseas chatter about coronavirus.

“Come February, it was pretty clear that what we were dealing with was going to be a bit of a public health crisis,” Hunter says.

The National Health Coordination Centre, which has been activated for emergencies, including last year’s measles outbreak, the Christchurch mosque attacks and the Whakaari/White Island eruption, was quickly made operational. As the scale of the crisis became apparent, the centre was mirrored by an all of government group to manage the pandemic’s impact on everything from border security and immigration to policing and financial support for our crippled tourism sector.

The initial problem was that there was very little data to go on. No one had encountered this particular type of coronavirus before, so scientists and public health officials were in uncharted territory.

“I can remember Ashely coming in and saying to us, the good thing about this virus is that unlike the flu, you have to be symptomatic to be infectious,” Hunter remembers. 

“And within two weeks, we discovered actually that wasn’t the case.”

The infections mount up

As infections started to crop up around the county, Hunter and his team scrambled to develop an effective contact tracing system, bringing together data sets that previously were held separately and getting phones and computers for hundreds of contact tracers tasked with hunting down close contacts of the Covid-19 infected.

“We stood up a system for contact tracing within a week, and then iterated it, in very short to weekly sprints for a period of time to get that to a point where it was more than a minimum viable product,” he says.

“We did in six weeks something that arguably would have taken us, I would say, at least 18 months.”

An important early development was establishing principles in conjunction with Cabinet that would inform the response to the pandemic from a technology point of view.

“That really empowered us to get on and do what we need to do,” says Hunter, who prepared his team to make swift decisions involving millions of dollars of technology investment.

“I said, look, I expect that this is going to generate funding, I really want us to make sure that we leverage this money to put in place really important foundations, and minimise the level of regrettable spend.”

With contact tracers hitting the phones, a parallel stream of work was underway to ramp up testing for the virus and to prepare hospitals and intensive care units for a potential influx of virus-stricken patients.

At one point Hunter himself was diverted to focus his attention on securing ventilators, swabs, test kits and PPE, the crucial supplies that would be in short supply due to unprecedented global demand in the following months.

Privacy and pragmatism

As the Ministry of Health sought to gather data to inform the pandemic response, it worked closely with the Office of the Privacy Commissioner, whose officials “put in enormous hours” helping with privacy impact assessments.

A health information standard was quickly created to mandate what data could be gathered. It soon needed some adaptation when there was a backlash against a plan to gather vehicle registration plate details at drive-in testing stations in a bid to more easily track down people with positive tests.

“We quickly found out that a lot of people weren’t comfortable coming in to get testing, because they were concerned about what we might do with that information,” says Hunter. 

“They might have a car without a warrant, it might not be registered. So pretty quickly we removed it from the standard. So it was very, very dynamic.”

The digital dilemma

One area of intense debate in the tech sector during lockdown was around the Covid Tracer App and digital contact tracing efforts. The ministry faced criticism for moving slowly on deploying a Bluetooth-based app for detecting and recording close contacts and tech entrepreneur Sam Morgan abandoned his efforts to help develop the Covid Card device, frustrated at what he saw as incompetence and a lack of urgency to progress the technology

“The thing that people have been really critical of, which I’m happy to defend, is the speed with which these things came together,” says Hunter.

He points out that digital contact tracing is never going to be a “silver bullet” solution and releasing a Bluetooth app too soon could have caused more problems than it solved.

Says Hunter: “People don’t understand how you could overwhelm the contact tracing people with a whole bunch of information, data and work and take them away from doing what is the most important thing for them to do, which is actually to get on tracing close contacts as opposed to what we call casual contacts.”

He admits the system of getting QR codes assigned and distributed to businesses was clunky. But the ministry has been working on tracing technology behind the scenes, including the Bluetooth wearable devices which are being trailed in Rotorua as well as the Google and Apple exposure notifications on smartphones that could be incorporated into the Covid Tracer app in future.

Work is also underway on streamlining the process of getting a test for Covid-19, with online pre-registration, text responses and possible app integration as well.

Hunter is thankful the health sector was well on its way in migrating systems to the cloud ahead of Covid-19’s arrival.

“I really dread to think what this would have been like 10 years ago. I even hate to think what it would have been like five years ago,” he says.

Cloud-based services were able to be ramped up quickly which helped the process of bringing together disparate sets of data from across the health system.

What’s changed? Covid’s health tech legacy

The speed at which the health system had to move to cope with the crisis has accelerated development that will outlast the pandemic and help transform how citizens receive their healthcare.

E-prescriptions: “We were sitting around 32% of prescriptions being generated electronically [prior to Covid-19]. That’s now moved to close to 90% and our goal this year is to get to 100% for general practice,” says Hunter.

Immunisation programme: Seasonal flu cases have been at record lows this year with international travel grinding to a halt. But the health sector has received funding and begun the process of preparing for a major immunisation programme once Covid-19 vaccines are available for distribution in what will be one of the largest vaccine programmes in the country’s history.

Business continuity: With most government workers sent home and partners in industry keen to protect their workers, the ministry had to rapidly switch to remote working. Software developers at Rush Digital, which built the Covid Tracer app, didn’t meet the team at the ministry until after the app had launched. Hunter says the ministry now has a “more resilient technology environment” as a result of the necessity of remote working.

A health app everyone has: With around 2.3 million registered users of the Covid Tracer app, we don’t just have an effective system to aid contact tracing, but a way to engage people with health information longterm.

“That presents us with an opportunity going forward in terms of being able to leverage that channel for people accessing things like their lab results, their immunisation details and other information about them in the health system,” Hunter says.

An agile approach: Hunter says the haste required to stand up platforms and tools required an agile approach to projects and software development, which will be sustained. 

This is the beginning of our sort of new operating model. What have we learned is necessity is the mother of invention,” he says.

Getting minimal viable products together quickly is a facet of that, as is breaking down silos to encourage more collaboration across various health sector agencies.

Social licence earned: Concerns over privacy and data security could have crippled efforts to contain the virus, as it has threatened to do in other countries. But from efforts to better leverage the National Health Information platform to aid contact tracing and testing, to getting millions of Kiwis to download the Covid Tracer app, public trust and confidence was earned and maintained.

“We can share data safely,” says Hunter. 

“With privacy in mind, procurement and delivery at speed, I think we absolutely learned that we can do that and we need to do more of it.”

The new normal

Ultimately, says Hunter, Covid has changed everything in the health sector, from how business cases should be developed to procurement processes and methods for delivering health services.

But beyond Covid, the health sector faces a funding crisis with an ageing population set to put more strain on the system than ever before.

“The way the system is funded is going to have to change in order to support a different kind of model of care and just generally, our operating model around how we deliver,” says Hunter.

Digital technologies will have an increasing role to play. But as Hunter fielded dozens of calls and emails from people during the pandemic trying to sell him widgets and gadgets to magically solve his problems, one thing became abundantly clear.

“Technology is just an enabler,” he says. 

“Understanding what the problem is, understanding what you’re trying to achieve is the most important thing.”

Related reading:
What it takes to keep healthcare up and running in a pandemic
The new online-only GP with big plans
Cloud-based public agencies had an edge in the Covid response – AWS