Could you please tell us a little bit about yourself and your work pre-COVID-19? I have been the Chief Nursing and Midwifery Information Officer (CNMIO) for Sydney Local Health District since 2015 and have worked in this District for the past 16 years. I fell into nursing informatics by accident when the specialty started to take off in Australia in 2014. I am very interested in data and how well designed systems can have a positive effect on patient and clinician experience.
I was the first CNMIO in NSW and the third in Australia. My role has a strong governance focus where I advocate for patients and clinicians when digital systems are being designed and implemented. I am very much a strategic thinker and this role enables me to strategically focus on workforce development and capability, increase research opportunities as it relates to digital health, and to build strong relationships with the University of Sydney and other academic partners.
Pre-COVID-19, you would often see me running around going from meeting to meeting and I would spend a lot of time getting from one meeting to the next – at times this meant driving between facilities. A normal day in my calendar would read: meeting, travel, meeting, travel… Looking back, I knew I could achieve a lot more if I didn’t have to move from meeting to meeting.
And then 2020 hit and we got the feeling very early that this year was going to be big.
In five words or less, what was your reaction when you heard of the restrictions put in place?
How will we work?
We were so used to being together physically as a team and having the opportunity for connection. Human contact is a really important part of our work. Very quickly when the restrictions came up and more and more people started to work from home, all the social constructs you had in place were removed. Looking back, it’s the little “corridor” conversations that I miss most and virtual platforms cannot replicate those moments. It was a disruptive time with so many unknowns for us working in healthcare. We did not know how many people would be affected or if we would need to be redeployed into clinical roles. We are now all asking when will we return to normal and what will the new normal look like, as we know it is going to be different.
How did you overcome the challenges of COVID-19?
I worked hard and tried to focus on the long game. What got me through is seeing the possible happen. I have never seen such rapid technological advancement happen in a period of six months! And to have a part in that has been so rewarding. The first couple of months when we were getting into restrictions and watching the first wave start , not knowing how big that wave was going to be and hearing reports that we were going to see possibly thousands of patients was concerning. It was great to see how the health system came together and worked really hard to flatten the curve – it made me very proud of NSW Health. We have absolutely demonstrated to the world what a universal health system can do and why public healthcare is so important. People are tired but there is optimism out there now and reassurance that things are being well managed.
Sydney Local Health District was very quick at planning. rpavirtual launched alongside more work on wearables, there was a rapid deployment of Zoom, and overall a huge increase in capability because staff began using new technologies.
Did you find many positive aspects/outcomes?
With most large international crises opportunities present themselves. From my perspective, the rise in virtual care has been very positive and exciting. One of the projects that I have been working on alongside our District’s Skin Integrity Lead, Dr. Michelle Barakat-Johnson is looking at an artificial intelligence application called Tissue Analytics to assess and monitor wound care using clinical photography. We are doing research on its usability and applicability in Australia at the moment. When we first thought of the project it was late last year and COVID-19 wasn’t even on the radar. We developed a protocol and got ethics approval and then COVID-19 hit. We initially delayed the project but it soon became apparent that its use could assist virtual models of wound care. The app takes a photo of a wound, analyses it and sends the information back to the clinician so they can document the wound and track progress. But four weeks after COVID-19 it dawned on me that we needed to look at other use cases and incorporating that into the project. The app has a patient facing component where patients can take photos of their wounds at home and send it to clinicians to monitor and assess virtually. We were able to not only look at our cohort of patients that were part of the research but extend the it into community and also help some of the outpatient clinics that needed to move to virtual care. To me, this is amazing. The feedback that we have had from the patients has blown us away. We didn’t appreciate how positive the patients would take it. But they keep a library of their images and they can now track the improvement in their wounds and it empowers them to be a true partner in their clinical care.
Everything that ICT have done has been really positive. It was hard work – implementing technology to streamline process like visitor screening, COVID-19 screening clinics, putting in apps to register patients really quickly, rapid EMR development, rapid deployment of hundreds of laptops and the list goes on. I think ICT services has completed well over 260 projects (big and small). There have been some projects that would have taken us months to complete and we have managed to implement them in weeks. That is something the team should be really proud of.
What surprised you about your work during the pandemic?
The biggest surprise to me initially was the rapid reliance on Zoom and other virtual platforms to be able to do my work. We have proven that we can do the vast majority of our work using virtual platforms and this will mean a new normal after COVID-19. I still think that there is a need for face to face meetings and I hope to see a good balance on the other side of the pandemic.
Another big surprise was how quickly we adapted our Electronic Medical Record training that we provide to our staff. Pre-COVID-19, we relied heavily on face to face classroom training. We have now developed a virtual way of providing training that we will continue with moving forward – we have proven that it works
If you had to build a health service from scratch knowing what you know now, what would that look like?
If I was to relook at a health service I would probably say, I want a fair bit of it to be virtual because I think we now know that many patients can be cared for successfully in this way. We have proven that it can work and the next few years will see some amazing and innovative virtual models of care developed.
Is there anything else that you would like to add?
It has been an interesting year to work in health. The way that our system has pulled together has been amazing. It really is a privilege to be working in health at the moment. I am, however, very much looking forward to “after COVID-19” and seeing what the new normal will look like.
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A huge thank you to Aaron Jones for sharing his story!