We have a significant problem here in NZ; we don’t have a great way to communicate directly with our health workers. We have lots of indirect and poorly targeted ways, and it is impossible (for example) to SMS all of the ICU physicians and nurses in one foul swoop.
Well, there is a potential solution. It is quite nuts, would take some cash, technical smarts, a lot of volunteer input, buy-in from on high, and a big grass roots movement.
Massive kudos to the team at Discourse.org who have given us the platform and hosting for free.
I am in the process of setting up the new forum (it’s daytime here).
Let’s get this thing started!
FWIW, NZ ICU consultants have been communicating to each other on a WhatsApp group for at least the last two years - a lot of the initial communication relating to emergencies (or stuff that wasn‘t covered by group phone conversations amongst the ICUs)
was done that way. Interestingly though, although the MoH helped with setting up a sort of IT bulletin board for ICU bed management throughout NZ during the H1N1 epidemic, there wasn‘t any real interest in the NZ ICU community for setting it up as a more permanent
fixture, perhaps related to the heterogeneity of ICU work. The ICU nurses have their own NZ Critical Care Nursing Organisation communication, I‘m not sure if they WhatsApp or communicate in any other asynchronous way. Overall, in general strategic and knowledge
sharing communication is from unit to unit, not individual to individual. This is not to say that your idea isn‘t worthwhile, just for your interest on the ICU scene since you brought it up.
The biggest hurdle right now will be getting a receptive audience with 100% focus on mitigating Covid19
Irony being its exactly what we need!!
Could be a good reason to pish it through asap
I envisage it being really useful to mobilize frontline potentially to areas that may be short staffed. Neonatal units up and down the country often need to borrow staff when under pressure
Agree Nathan and worth a crack. This is also what we call in telehealth ‘workplace support’. I would hope that all DHBs are looking to leverage Microsoft teams In some way seeing as we are all moving that way anyway and that could potentially be a secure platform for your idea @NathanK?
Look happy to help out., I do however think we are wallowing in communication tools . We have a wide range of communication tools, available already: yammer, whatsapp, signal, viber, teams, zoom, skype, twitter, messenger, discourse email …,
Just not sure what good will there be adding another communication channel to this busy landscape? Also what aspect of the communication system deficit are trying to fulfil? SMS broadcasts to all the relevant clinicians would only work if we had all the relevant people on the platform.
The concept of bulletin boards sound promising ( pull vs push):
Look we need to be clear what we should be using so we can have a co-ordinated response. That is going to be the biggest challenge. We we will will need to ensure all the relevant health board staff and on board and communications will need to be purposeful and not create unwanted noise for busy staff.
I like the idea and I think it’s a great problem to solve.
Why not a webapp using a cloud services? Or are you prioritising “buy” vs “build”.
I am super keen to help from the innovation ideation side.
D.
Thank you for your thoughts; this will evolve, and I’ll elaborate more. I have to admit that my sense of urgency has slackened off a little now that our PM (who I love) has closed our border. Now to answer some questions:
Great, I didn’t know that. We are small enough that it is feasible, and WhatsApp is great for immediate chat. Not so good for engaging with other specialities, multiple conversations, or richer content though.
This makes the time ripe; people are open to innovative online ways of collaborating and networking.
Everyone I’ve spoken to says that it is a dog to get up and running; lots of promise but lots of challenge too. Perhaps it can magically come together in a week, but I doubt it. Happy to be proven wrong. Also, not suitable for large (>100) teams - Microsoft recommends Yammer for that
True. This would aim meet a need that the whole morass of comms tools isn’t; allowing targeting across the whole system. At least I think that is a key problem. As a bonus it would also connect us all up in a way that facilitates networking as we can’t do that face to face any more.
Thanks Parag, will definitely take you up on that. You have already shown me that the site was unintentionally open; have closed it off for now. Yes it is messy!!! I haven’t yet worked out the best collaboration place for this, will get back to you very soon.
Discourse is a webapp using a cloud service (at least I think so). “Gifted” at present, is also open source which keeps options very open. Think of it as the perfect buy/build hybrid. Thanks for your offer of help, will take you up on that!!
We (the Ministry) are working through the myriad of options being presented to us within the context of what we believe (or are better understanding) is needed at a national level. It’s complex and we need to be sure we don’t cause confusion for the public, health professionals and those seeking to coordinate the response. As @NathanBilling asks, what good will there be simple adding another communication channel to this busy landscape, and are we clear what problem [what aspect of the communication system] we are trying to solve?
I would like us to be in a position to provide some clarity this week.
Thank you Shayne; I know that you and your colleagues are giving this all you’ve got, and we all really appreciate it. Clarity on the key problems is exactly what we as a community of clinical informaticians who love solving problems need. We also need time to solve them, which is in short supply. We look forward to hearing more.
A lot of GPs in NZ (>1200) are communicating in a private facebook group
There’s also a NZ women in medicine facebook group (almost 5K members) , a GPs downunder facebook group (Aus and NZ members) and a recently set up cross Tasman doctor FB group specifically for COVID-19
Happy to post in any of those forums to encourage people to get onto whatever is decided
@shayne.hunter I think the point @NathanK is making is that communication between clinicians is pretty random right now, we have lots of different channels. FB, yammer, twitter and then the official emails from work. None of them tie us together and most are ‘chat’. One channel would have advantages for those of us ‘on the floor’. For example we know senior docs have a high level of ‘presenteeism’,. There will likely be a large number of us forced to work from home. One example of using a single comms channel would be if we got our telehealth plans sorted and we had a single point of communication we could communicate across regional boundaries and support each other to continue to run services (eg ward rounds, outpatient clinics, triage clinics). Whether that would be a priority over other stuff I don’t know…
Spot on, @Ruth_Large. If we fix the between health workers bit, it will open up an opportunity for the MoH to use it as a very handy and powerful comms channel.
I’ll rephrase the problems:
There are approx 250,000 people who work in health in New Zealand. It isn’t easy for those at the coal face to be heard; nor is it easy for those in power to reach us.
We are using social media in an ad-hoc way in health, with limited effectiveness and lots of siloing; also gathering together in physical groups is getting really tricky
Any solution has to be fast, scalable, and outside of traditional structures to work
For this problem set, Discourse is ideal. And a grassroots approach sidesteps many barriers. It may fail, but it is worth a solid crack. If anyone can pull it off, it is us.
It is time to get organised. All contributions of necessity will be voluntary and unpaid. Kudos might come later, but no guarantees.
I’m now going to post a bunch of bite sized calls for assistance as topics. Please volunteer to own one and run with it. If I’ve already spoken with you about an aspect, I’ll volunteer you into it.
The request was for the Ministry to endorse Discourse, but it’s not clear what that means . However, there is no reason why the clinical community can’t use use Discourse as a primary channel for communication if they want to. As I said, we are working through needs/solutions now. It’s not a straightforward exercise. I don’t think there will be a single channel. I am sure the Ministry will see Discourse as a valuable channel.
For those who dont know me, Im a Auckland based Vascular Surgeon. There is already an existing solution for comms that is ready to go immediately - Celo. I have an obvious conflict of interest as I’m a part-owner/shareholder of the software/app (& Celo’s Director of Clinical Strategy) so please excuse the ‘plug’. Infact, I have held off on talking about it for this reason however, given the unprecedented circumstances, and the fact that an obvious solution lies directly in front of us, I thought I’d speak up.
The Celo app will allow all health professionals/clinicians to seamlessly (and in a privacy-compliant way) communicate (individually or in groups), send documents/photographs and safely share patient details. It is a secure, cloud-based, encrypted, digital platform which is the only health specific product that is approved the DIA (Dept of Internal Affairs). No information is permanently stored on the device, regardless of whether the device is DHB owned or personally owned. Several DHBs and private organisations are already using it for clinical use.
In response to the rapidly developing COVID situation, we have developed a new feature called Celo Broadcast. I have attached information on this feature (PDF) Celo_broadcast (2).pdf (2.5 MB) . We are already responding to and deploying Celo Broadcast to health organisations in Australia and we have no doubt that this is a valuable approach for the NZ organisations as well.
Given the unexpected crisis situation we are facing, we are happy to onboard users without a Celo enterprise license to securely communicate with their colleagues and connect all DHBs together on a single secure network to allow for cross-DHB & cross-sector comms between any clinician across NZ.
I’ve been meaning to give Stephen Vlok (the CEO of Celo) a call, and will do shortly.
What Celo can do is displace (and improve upon) WhatsApp. What it can’t do is manage complex networks of people with multiple long form discussions across silos. That is Discourse. However, the two can be complementary. I’ll give him a call now.
Got it sorry, misunderstood. I’m not suggesting endorsing one platform or another just suggesting there may be a need for one. To avoid confusion and duplication the best thing in my mind is for CILN to provide a resource as/when the MoH may require. One thing we don’t want to do is create more noise! Keep up the great work @shayne.hunter!
So is this the work of the registered service practitioner index (RSPI) group?
If so its complex in the detail.
The RSPI is critical to any coms program we introduce.
We are trialling CELO in Canterbury for coms in the hospital (RMO SMO) to GP space but it needs the RSPI which would include and be
real time for teams intra-hospital. You need to know who is the, RMO / SMO, for renal today to know who to message.
I think RSPI is sitting with the minister but in the SI with ISSLA
