Healthcare IT is too often left out of the resilience conversation

Across the Nordics, Resilience planning for power, water and defence has moved to the top of the agenda. Rightly so. But what happens to critical healthcare systems when crisis actually hits? 

By Brian Fisker, Vice President, Systematic Healthcare.

Brian has spoken about this topic before in an interview with the Norwegian online media Dagens Medisin. See the interview here.

Picture this. It is winter. A major power outage hits several municipalities at once, and it lasts for days. A district nurse sets out for her scheduled visits to residents who depend on daily care. She manages to get there without power.

The real problem is whether she can document the visit and find the information she needs once she arrives, without access to the care record.

For many Norwegian municipalities today, the answer is uncertain. That worries me.

Resilience is everywhere in the debate, except in healthcare IT

This year's Arendalsuka, Norway's annual week-long political festival where government, industry and civil society debate the issues of the day, hosted more than 400 sessions on resilience.

That is a fair measure of how high the topic sits on the agenda in the Nordics right now, driven by an unsettled security situation in Europe and a warning from the Nordic tech sector about rising cyberattacks on critical infrastructure, set out in the report "A Call for Nordic Digital Resilience".

Healthcare IT is missing from that conversation.

Resilience is being discussed in meeting room after meeting room. At the same time, many Norwegian municipalities are choosing new electronic care record systems for home care, and robustness against downtime is not always a core requirement in the procurement. 

This is a societal problem, not a departmental one

When I talk about a care record system needing to withstand downtime, I mean disruption that hits broadly and lasts a long time: the power grid failing across a whole region, the national internet connection going down, the water supply failing.

A system that depends on stable power and network access to function at all is not robust enough for the reality home care staff can find themselves in.

Some countries are further ahead, but the job is not finished

In Denmark, where Systematic also supplies the defence and healthcare sectors, resilience has been part of care record procurement for longer, driven partly by EU rules that set specific robustness requirements.

Copenhagen Municipality is a good example. The municipality itself took the initiative to specify a range of resilience features in its home nursing system, starting from one central question: how do you ensure safe follow-up for the most vulnerable residents in a worst-case scenario, when the nurse is out in someone's home rather than at a desk?

The question municipalities should keep asking suppliers

I think municipalities should keep putting this question to their suppliers, not just during procurement, but on an ongoing basis:

The answer should not be left to a subcontractor.

Resilience has to be part of the architecture itself, from the first line of code. As a supplier, we are responsible for the system working well on a normal day, and equally responsible for it still working on the day that is not normal.

How we approach this in practice

In our system, a district nurse can have full access to the care record with no network connection for up to seven days. That is a long time, but once that limit is reached, society as a whole needs to move into a different phase and find more lasting solutions for how the most vulnerable residents are cared for. Neither we nor anyone else has a complete answer to that yet.

We have also built mobile printers into our solutions, because paper still saves the day when power and connectivity are unavailable for an extended period, so the nurse always has the information she needs on the visit.

From the unthinkable to the plausible

What we used to call unthinkable has become a real possibility. That is why home care and healthcare IT belong on the resilience agenda alongside power, water and defence, and why robustness should be a standing requirement in municipal procurement processes, not an afterthought.

Brian Fisker is Vice President at Systematic and has worked in healthcare IT for more than 20 years. He has been closely involved in developing Systematic's care record systems for both hospitals and municipalities.