There has been plenty of research indicating Australians in regional and rural areas are at greater risk of health problems and death from cardio vascular disease. This in turn leads to wider disadvantage across rural and regional communities, largely to the inefficient use of already scare medical resources and healthcare specialists.  

Seeking to address this, Jorge Silveira, former chief information officer with Goulburn Valley Health rallied the team to develop what has become the Hume Regional Clinical Cardiac Network Project, or Digital ECG.

“Rural clinicians, both general practitioners and nurses find the management of undifferentiated chest pain and acute coronary syndrome incredibly stressful in the absence of immediate access to specialist advice,” he says.

“Work stressors such as this contribute significantly to errors, difficulties in recruitment and retention of clinicians to rural communities”

The cloud-based, digital ECG service provides timely reporting of electrocardiographs (ECGs) performed on patients presenting to remote and rural Urgent Care Centres (UCC) with chest pain or suspected acute coronary syndrome, and support clinicians to make appropriate and timely management decisions, including treatment. It also integrates with a centralised database of ECGs for the region, supporting management of future presentations.

The first and most obvious benefit was replacing low quality, paper-based ECGs with digital. 

“The risk of mis-diagnosis reduced by having a 24/7 physician available to support the remote communities, also increasing the re-perfusion [blood-flow] capability.” 

One of the key discoveries was that over 80 percent of digital ECGs sent to the regional hospital did not require ambulance transportation. Instead, a treatment pathway was promptly established at point of care at each participating UCC. 

“The combination of above provided the ability for patients to be treated closer to home and their families, instead of having to travel up to three hours within the region, or to unnecessarily utilise rural ambulance, blocking this critical service in the regional and rural areas,” Silveira explains. 

More broadly, the initiative has seen the standardisation of clinical protocols for participating health services and the strengthening of collaboration amongst the rural hospital, regional centre, GPs and ambulance Victoria. 

And the governance and management models put in place have helped lay foundations for replicating the model to other clinical areas, as has the significant cloud elasticity and capability to support the service to scale state-wide, along with current and robust security protocols.

Power and the passion

Silveira says as the CIO of a public health service it’s important that he gathers a good level of understanding not only of the organisation, but also the community it serves - its priorities, commitments and needs – before trying to identify key pressure points and then developing a strategy to influence plans and secure investment. 

“To be an executive, it requires me to be closer to community and my organisation’s purpose, rather than only deliverables, projects and programs,” he explains. 

From here he notes he’s better able to align the organisation’s vision with short, mid and long-term proposals and decisions, ensuring that any ideas or proposals for innovation that are subsequently presented to the executive and the board are sound and genuinely ‘evidence-based'.

“To be able to influence anyone, not only the leadership team, one needs passion as passion gives us power and energy to achieve what is entrusted to us,” he says.

“And I am fortunate that I am a passionate CIO who carefully assess opportunities and invest where the best value presents, solving short or long-term challenges."

In late October 2020, Silveira joined Australian multinational Virtus Health as chief digital health officer.

 David Binning