Waikato District Health Board in New Zealand is experimenting with virtual health care delivery through a "Virtual DHB" platform to address challenges of an aging population, chronic illness, and access issues for rural communities. The Virtual DHB allows practitioners to set up virtual practices, access patient records, and conduct virtual consultations. It also enables patients to book appointments and communicate with practitioners through an online portal. The goals are to empower patients, reduce travel burdens, and gradually shift more outpatient services to virtual and community settings through this platform. Key challenges include gaining acceptance from practitioners and patients, as well as ensuring broadband access.

1. AN EXPERIMENT IN
VIRTUAL HEALTH CARE
Sai Honig, CCSP, CISSP, CISA
Information Security Manager
Waikato District Health Board, NZ

2. FUTURE HEALTH CHALLENGES OF
NEW ZEALAND
 Aging population
 Chronic illness
 Declining medical and ICT workforce
 Rural population
 Inequity of access
 Patients who want to be treated like customers with
more authority over their healthcare

3. KEY STATISTICS OF NEW ZEALAND
(OECD HEALTH STATISTICS 2014)
 NZ health sector costs increased from 8% GDP in
2004 to 9.7% in 2013
 NZ health sector productivity decreased 0.2% per
year from 2001 – overall decrease of 2.8%
 NZ health expenditure per bed is $1,128,939
against OECD average of $724,873
 Elderly share of NZ population tripled from 4% in
1901 to 12% in 1999 and forecast to be 25% by
2051

4. NZ’S MINISTRY OF HEALTH DIRECTIVES
 Focus services where greatest impact and value for
money
 Focus on those who need services the most or will
benefit the most
 Focus on specific health issues: smoking, hazardous drinking,
obesity, oral health, mental health, primary health
 Focus on specific population groups: Maori, Pacific Islander
 Deliver services closer to home
 Help people live well, get well and stay well
 Recognise that patients are customers
http://www.health.govt.nz/nz-health-statistics/national-collections-
and-surveys/surveys/current-recent-surveys/new-zealand-health-
survey/improving-health-new-zealanders

5. WAIKATO DISTRICT HEALTH BOARD
(WAIKATO DHB)
 1 of 20 districts setup to provide services
to NZ citizens and residents
 Employs more than 6500 people
 Covers a large geographical area in the
upper central North Island known as the
Waikato
 Long travel times for patients and medical
staff
 Plans, funds and provides hospital, health
and disability services to the more than
391,770 people,
 Directly or by funding and contracting other
providers
 Includes a tertiary hospital, a secondary
hospital, three rural hospitals
 Offers wide range of community-based
and health promotion services
 Provides tertiary services to Midland
region of than 846,600

6. WHAT IS VIRTUAL HEALTH AT
WAIKATO DHB?
 Traditional teleheath model of room to room
connectivity
 Person to person connectivity on mobile platforms
(mobiles, tablets)
 These integrate with clinical systems to deliver
package of care

7. CREATING A VIRTUAL DISTRICT HEALTH
BOARD (VIRTUAL DHB)
 Waikato DHB partnered with a
PaaS to create “Virtual DHB”
 Virtual DHB invites Practitioners
to setup “Virtual Practice”
 Setup schedules
 Consult with other Practitioners
 View medical records
 Conduct Patient Consults virtually
 Practitioners invite Patients
 Patients create their own portal
 Contact Practitioner
 Attend Patient Consults virtually
Virtual
DHB
Virtual
Practice
Patients
PaaS
SaaS
SaaS
Invite
Practitioners
Invite
Patients
Medical
Records

8. WHAT BENEFITS FOR WAIKATO DHB?
 Empowering patients to manage their own health
 Less travel time for patients and health professionals
 Convenient and efficient for patients – fewer “Did Not Attend”
 Discuss cases and ask advice from peers in NZ and
internationally – lessen professional isolation
 Potentially reduce referrals
 Future benefits of partnerships with external agencies
 General Practitioners, Pharmacies, Universities (medical
research), Community Health Forums
 Government agencies

9. VIRTUAL DHB
 All health professionals in care team can view
patient record
 Interoperable with Waikato DHB’s medical record
system and General Practice patient management
system
 Allows health professional to link by video with
patients over a smart device or home computer
 In Virtual DHB, NZ patients can only connect to NZ-
registered health professional
 Access to approved health advice and information

10. VIRTUAL DHB (CONTINUED)
 Links to health professional colleagues
internationally
 Patients can email queries and appointments
bookings
 Practitioners will define the Virtual Practice
 Determine criteria for suitable patients to fully manage
virtually
 Training provided to staff by Waikato DHB
 Future: Ability to load clinical photos and HD video
 Future: Bluetooth enabled connectivity to home
monitoring equipment (e.g. blood pressure, pulse
oximeter)

11. VIRTUAL DHB (CONTINUED)
 Virtual DHB is cloud-based (PaaS)
 Provider is external to New Zealand
 Provider has completed a SOC 2 Type 2 review
 Ministry of Health has mandate regarding patient
records to be maintained in New Zealand (Waikato
DHB has received conditional approval)
 Patient records entered into Virtual DHB will be
accessible by Waikato DHB’s medical record system
 Patient records entered into Waikato DHB’s medical
record system will not be placed into Virtual DHB

12. VIRTUAL DHB – LONG TERM GOALS
 January 2017 – all patients who want to use virtual
health have access to system
 December 2017 – 40% of all contact with patients
across Waikato DHB will be through Virtual DHB
 December 2017 – 30% of outpatient activity moved
from main Waikato DHB hospital to community

13. CHALLENGES
 Acceptance of use of Virtual DHB
 Practitioners
 Patients
 Broadband access – limited in rural areas
 Managing access – by Patients and Practitioners