Of all the ways to think about a pandemic, the idea that it is a business model is not the most obvious. But for IT teams across New Zealand, who responded at speed to the crisis, COVID-19 continues to provide a lesson in digital transformation. This is especially true of the health technology response, said Shayne Tong, chief digital officer at Auckland District Health Board (ADHB).\n\u201cIt was just incredible, the mindset changes we had to do to survive, and it was all about organising around a common enemy, which was COVID,\u201d he says.\n[ Keep up on the latest thought leadership, insights, how-to, and analysis on IT through CIO\u2019s newsletters. ]\nRapid response to a health crisis is essential\n Auckland DHB\n\nShayne Tong, chief digital officer at the Auckland District Health Board\n\n\nFor Tong, the key word is \u201crapid\u201d\u2014rapid decision-making, rapid development, rapid iteration, and rapid outcomes. During those \u201cfrenetic\u201d first weeks of the lockdown in March 2020, Tong says that his team \u201cthrew all the traditional ways of working and processes out and just said, \u2018What do we need to do to respond to our customers, our clinicians, to make this happen?\u2019.\u201d\nThey moved to a \u201ccommand and control\u201d structure, which meant that decisions could be made quickly, and minimum viable products (MVPs) were stood up fast and then iterated upon. This approach led to achievements such as all of ADHB\u2019s outpatient clinics going virtual within a week of the country going into lockdown.\nADHB is part of the Northern Region, which comprises of three other district health boards\u2014counties Manukau, Waitemata, and Northland\u2014and which has a regional outsource provider HealthAlliance. This level of collaboration has helped when developing new solutions, such as the tech used to track new arrivals in managed isolation quarantine (MIQ). As the majority of returning New Zealand citizens enter the country via Auckland, it fell to this region to come up with a response, which could be adapted in other areas hosting MIQ facilities.\nThe mobile testing system ensures health professionals know who is staying at what facility and when they need to be tested (twice during their stay in MIQ). What began as a manual process was automated using the ServiceNow platform, and the initial solution has since been replaced with a practice management system (PMS) which integrates with the Ministry of Health border system.\nTong says teams follow strict protocols and procedures when moving data to the cloud, especially patient and clinical data, and he points out that digitising data can make it safer. \u201cA lot of what we are doing is replacing manual paper processes with automation; that information may have been faxed, it could be on paper,\u201d he says.\nEnd-to-end approaches are key to success\n\u201cWe\u2019ve got the ministry\u2019s border solution, which is in the cloud, go to our national PMS which has been rolled across the country, with our national lab solution. We\u2019ve now got for the country a fully integrated and joined-up solution for our COVID response.\u201d\nAnyone familiar with recent reviews of the New Zealand health system\u2014notably the Health and Disability System review released in June 2020\u2014will know that this is a real achievement. The health system was taken to task in the report for having disparate IT systems that didn\u2019t support collaboration across the sector.\nThe ability to create an end-to-end system for COVID was greatly helped by the ability of IT leaders to adopt a greenfield approach and deploy mobile and cloud solutions. While Tong says there had been some small public cloud deployments previously, much of the focus has been on updating legacy systems:\n[blockquote]If you have a look at our investment portfolio, a large chunk of ours goes to maintaining heritage and maintaining risk, so legacy systems. And then we are trying to put in some really large structural foundational IT in place\u2014identity, access management, our integration platforms, moving our infrastructure from the bottom of the hospital into the cloud[\/blockquote]\nA 10-year plan to transform health systems\nTong is part of the Northern Region district health boards\u2019 senior executive team, which is working on a decade-long, regional Information Systems Strategic Plan to move off legacy systems. It\u2019s \u201ca 10-year vision to basically replace everything and move into the digital 21st century,\u201d Tong says.\nWhile government investment is required to enable that digital transformation, there is also the need to introduce new innovation at the same. Tong favours the platform approach that was used for the MIQ system. This is where a group of in-house developers supported by the vendor and partners such as Deloitte and DxC continue to iterate based on the customer\u2019s changing needs, where they can turn on and off the functionality and scale it as required. Tong says:\n\nWhat we need to do is have two-speed working.\nSo, we\u2019ve got the 10-year plan, and we\u2019ll replace our big core systems and we\u2019ll become more integrated and joined up. And we still need to seek incremental and additional investment through the central government for that.\nBut concurrently, we\u2019ve got to take these learnings from COVID and we need to secure additional investment in the sector to drive some of the innovation over the near term \u2026 [to] keep creating value fast [and to] change the way we are working\u2014moving to platforms, creating development teams, bringing innovation closer to the DHBs [district health boards] and closer to our clinicians to respond to their needs.\n\nAnother report into the health system this year, the \u2018National Asset Management Programme for DHBs\u2019, noted that about $2.3 billion is required over the next decade to \u201caddress issues with legacy systems and to invest in technologies that enable services to transform to new models of care.\u201d\nAttracting tech talent to a revitalised health sector\nWith evidence for investment documented, and health IT teams regionally and nationally proving their capability under the stress of COVID, the time is right for sweeping change. The reforms outlined in this year\u2019s health sector reviews are poised to take shape.\n\u201cWe\u2019re all going to have to come together now in the health system for structural changes, and digital will enable and underpin a lot of those changes. We\u2019ve got the mindsets and the cultures and behaviours of how we can work together, how we can develop things quickly together for the benefit of the country,\u201d Tong says.\nThe momentum is there, but is the talent? Tong says data science skills are especially difficult to find at present, and it can be tough hiring people with the right mix of interpersonal skills and technical skills, who can understand the business problems as well as work on the solutions.\nBut he is adamant that health can attract the best and brightest talent, especially at this critical juncture. \u201cThere will be significant investment in the coming two, three, five years and so there is a wonderful opportunity to make a real step change in this sector,\u201d he says.