Since early January, Sydney Local Health District (SLHD) found itself on the very front line of the NSW COVID-19 pandemic response.

The district surged its Public Health Unit to more than 100 staff for contract tracing, surveillance, to inform decision-making and establish a COVID-19 hotline. Chief information officer, Richard Taggart and his team rapidly deployed Windows Virtual Desktop, Microsoft Teams and virtual call centre technology. 

SLHD established the first COVID-19 clinic for testing at Royal Prince Alfred (RPA) hospital, followed by 12 other dedicated testing locations across Sydney. Taggart and his team equipped these pop-up clinics with enterprise-grade 4G Wi-Fi routers, computers, printers, scanners and telephones to manage the service. 

"We also kitted out a van to be a mobile clinic in case of outbreaks," Taggart says. 

"Existing and new applications were rapidly built or modified to manage the patient flow, pathology orders and notification of results. These clinics have tested well over 200,000 people at the time of writing." 

The district also took over screening processes at Sydney Airport and established special health quarantine accommodation to provide care for returning travelers who had COVID-19 or who required additional health support. Seven new facilities were established across Sydney and equipped with the health service's electronic medical record, computer equipment and patient journey boards. 

Taggart and his team also enabled thousands of people to work remotely, tripled the telephone capacity into all facilities, rapidly deployed video conferencing, and numerous other programs to maximise the efficiency and safety of patient care. Since the pandemic began, the tech team has completed 265 initiatives and has been a key enabler of the district’s response to COVID-19. 

The ICT team also had to surge to meet demand and reached out to airline Qantas to see if any of their furloughed colleagues could be employed to support the health service response. 

“We were very fortunate to be able to employ a number of Qantas’ tech team on temporary contracts to complement our team. They brought with them new ideas and ways of work that enhanced our own,” Taggart says. 

In February, they created Australia's first integrated virtual hospital, RPA Virtual. Taggart says it has played a pivotal role in the pandemic response and due to demand, has become one of the largest virtual care services providing free healthcare in the world. To date, it has provided remote care for more than 4000 patients including 700 with COVID-19. 

"Without the combination of the virtual hospital and special health quarantine accommodation, the COVID-19 situation in NSW would undoubtedly be much worse," he says. 

Taggart says RPA Virtual was originally planned as an evaluation project and part of the organisation’s sustainability strategy to address the growing demand on its services. Like most of the health sector, he says, the increasing burden of chronic disease has led to a year-on-year increase in hospital presentations. 

If the trajectory increased at the current rate, the organisation would need to build an additional hospital by 2030 to meet the demand. 

“RPA Virtual builds upon decades of research in telemedicine and successful models overseas. It is an integrated, technology-enabled model that provides 24/7 care to a variety of patient cohorts, including COVID-19 patients,” says Taggart. 

The RPA Virtual service also includes a dedicated Care Centre, which was built on the RPA hospital campus. The centre has 19 ‘Care Pods’ that are complete with high-end computers, video conferencing capabilities and headsets. Hand over rooms allow patients to interact through video, smart boards and collaboration software. 

The tech team also adopted the organisation’s electronic medical record system to allow for clinicians in the virtual hospital to manage patient encounters remotely. Dedicated patient journey boards, analytics tools and dashboards were installed and are continually updated to facilitate cohort monitoring and service delivery. 

Taggart says that a number of patients are now provided through RPA Virtual including people who require palliative care, pregnancy services, and those with cystic fibrosis, tuberculosis, and mental health conditions. 

“Depending on the patient, wearables are provided and used with apps to monitor the patient. Regular video conference sessions with the care team are held to ensure the patient’s progress and well being,” he says. 

Taggart says that as well as being a comprehensive service in its own right, RPA Virtual has become an exemplar for how to provide virtual care in SLHD. Many external agencies are also taking note of the organisation’s lessons and there are several research collaborations and an independent evaluation underway, he says. 

“New technologies that provide improved patient monitoring are also being developed to further refine the model and we are excited by early results with artificial intelligence, particularly for wound management and monitoring deterioration.” 

Well prepared 

In the 12 months prior to the pandemic, Taggart and his team also delivered a number of innovative programs. In May 2019, they completed the roll out of electronic medicines management to all of the district’s hospital facilities, bringing an end to a 10-year program of investment, which has dramatically improved patient safety.

In October, they completed the deployment of ‘PowerChart Maternity’, which digitised the entire antenatal journey for pregnant woman and enabled the creation of a digital health record from the moment of birth. SLHD is the first district in NSW to have deployed this capability. 

Finally, in November and December last year, the district decommissioned its legacy on-premise data centre and moved to a hybrid cloud using hyperconverged infrastructure and Microsoft Azure. 

SLHD is a large and complex organisation that provides millions of occasions of service each year. Each of the services provided has expert governance and management structure to ensure they are running as safely and efficiently as possible.  

“My role as a CIO is to build strong relationships with each of our services, acknowledging their depth of knowledge and expertise, by looking for opportunities to partner and deliver value through ICT. 

“In addition to my relationships with those internal to our organisation, I also work very closely with the leadership team at eHealth NSW who provide a range of shared services across the state. This strong collaboration allows both organisations to continually innovate and share innovations with other agencies in NSW Health,” Taggart says. 

“Through COVID-19, these relationships were further strengthened as we all sought ways to respond to the crisis. This is nothing quite like a shared mission to galvanise collaboration.” 

Byron Connolly