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Volume 12, Issue 1 – February 2018

Clinician Connect

Guest Editorial

Data: The oil of the digital era
Dr Zoran Bolevich, Chief Executive, eHealth NSW

Zoran BolevichWe have all heard the saying “data is the new oil”. Data is such a powerful driver of growth and change, it is now considered one of the world’s most valuable resources. And, like oil, it needs to be refined.

NSW Health is increasingly becoming a digital health environment, with the implementation of clinical systems, such as Electronic Medical Records, now live in 154 hospitals, and Electronic Medication Management now live in 30 hospitals across the state. As a result of this massive shift from paper-based to digital management of clinical workflows and business processes, NSW Health is collecting vast amounts of data which can – and should – be harnessed and refined to improve the quality, safety and outcomes of care our health services provide to patients.

NSW Health is on track to achieve this through the NSW Health Analytics Framework, which outlines the vision for analytics in our health system over the next five years, as well as an actionable plan to drive broader and more sophisticated use of data to better support decision-making, quality improvement, service planning and research. The Framework articulates the benefits, direction and approach to analytics for the NSW public health system and coordinates and aligns efforts to deliver on that vision. It seeks to build on many current examples of effective use of data among Local Health Districts and Pillars.

The Framework has four components, which are:

  • Vision – “Transformed health through data and insights”. Analytics will enable NSW Health to provide world-class and truly integrated healthcare by delivering data and insights that support evidence based decision-making, planning and performance. This will, in turn, support NSW Health to achieve the directions outlined in the NSW State Health Plan.
  • Benefits – Effective implementation of the Framework and greater, coordinated use of analytics for decision-making will deliver a range of benefits to consumers, clinicians, health and other service providers, the broader health system and the NSW population.
  • Implementation drivers – Three categories of projects and initiatives will drive implementation of the Framework and further development of the analytics capabilities and enablers: those that embed current analytics initiatives and system; those that accelerate areas of leading practice; and those that drive innovation in analytics delivery and use.
  • Foundational drivers – The necessary components that underpin successful implementation and the delivery of analytics.

Implementation of the Framework is currently being led by the NSW Health Analytics Steering Committee, which has overall governance and coordination responsibility for the development and delivery of analytics in NSW Health.

The Steering Committee is overseeing a number of priority actions that will drive implementation and further develop the required analytics capabilities. Reporting to the Steering Committee, five Working Groups are delivering on the actions:

  • Clinical Analytics Working Group – Supporting access to clinical analytics across the NSW health system to support informed decision-making for clinicians.
  • Corporate Analytics Working Group – Focusing on the development of workforce and business management analytics and coordinating corporate analytics activity within NSW Health.
  • Health Information and Performance Committee – Focusing on matters relating to data governance including aspects of information management, data definitions and data quality, performance reporting, and longer term strategies for collection and storage of data.
  • Strategic Analytics and Streamlined Information – Driving work relating to streamlining requests for analytics and information and the development of a strategic approach to undertaking complex analytics within NSW Health and in collaboration with other NSW Government agencies where appropriate.
  • Workforce, Skills and Training – strategic oversight of priority actions related to increasing the capacity and capability of NSW Health workforce to engage in, contribute to and benefit from the use of data and analytics.

Some of the early initiatives currently being implemented include the Analytics Navigator website for easy access to existing statewide data resources and expertise; a ‘proof of concept’ project to explore the use of real-time analytics for monitoring of safety and quality metrics; and the development of a digital health and data analytics curriculum for inclusion in undergraduate training of health professionals.

Ongoing engagement with clinicians and clinical networks will be critical to the success of these and other projects as we progress the implementation of the Analytics Framework. A Director of Data and Analytics Portfolio will soon be appointed within eHealth NSW to coordinate the projects and ensure there is appropriate communication and engagement across the system.

Chief Executive Comment

Dr Jean-Frédéric Levesque

Dr Jean-Frédéric Levesque

Applying data analytics to clinical care: promises, hopes and challenges

What is data analytics?

Data analytics is now part of our everyday lives. Without noticing it, data analytics has started to be used on our phones and in many of the services we use online. Our phones now tell us before we even ask about the time it is going to take us to drive home or to the cricket ground. They also record our footsteps and the flights of stairs we climb, ready with data when we want to assess how active we are. The same will soon apply more broadly in healthcare delivery.

But what are we talking about when we talk about data analytics? Well, definitions vary, but overall definitions of data analytics tend to include the use of automated analytic processes based on advanced informatics capacity so that data is collected and pooled with other data to support a decision. In healthcare, these decisions would pertain to diagnostic, therapeutic and supportive care options but also more broadly pertain to patients’ participation in healthcare and management of healthcare resources.

The rapid proliferation of data over the past decade and the equally rapid development of tools and techniques to capture, manage and analyse data has resulted in many differing views on the definition of ‘analytics’. The application of analytics to health also has many broad interpretations, from the type and sophistication of the analytical technique, to the nature of its use.

“Health analytics is the use of data, technology and quantitative and qualitative methods aimed at gaining insight for making informed decisions to improve health outcomes and health system performance.”
NSW Health Analytics Strategy.

Promises and hopes of data analytics

As clinicians, data analytics can impact our work through various ways. If integrated into electronic patients’ records, these tools can support the provision of more timely information about patients’ clinical information but also quickly analyse information to provide a more refined assessment at the point of care to support decision making. For example, laboratory testing results, already available electronically in many health records, could be analysed to not just provide the current level of a biological parameter but also to provide an assessment of its variation. In a similar manner, the information already available about patients’ use of healthcare could be analysed to provide to clinicians with an assessment of how their use of healthcare differs over time.

In addition, data analytics may help to better integrate various data sources to support clinical decisions, such as decisions to admit a patient to hospital from the emergency department based on the previous history of the patient but also potentially based on currently available services in various healthcare settings. If data about treatment options are integrated into these data systems, data analytics can suggest these options automatically without clinicians having to ring other services. They could spend more time discussing the currently available treatment options with patients.

Data analytics can also be used to reflect on clinical practice without needing to make every clinician a data analyst. This is important since we have seen in recent years a proliferation of data systems and portals that claim to make data available to clinicians to support their decisions. However, the reality is that clinicians are time-short and do not always have the data literacy to be able to interrogate this data to modify their practice. Data analytics can automate assessments and reveal findings that are out of norms or would require attention. As such, they can contribute to tackle unwarranted clinical variation.

In a similar fashion, patients’ decisions about their care, both in terms of selecting options of care or in terms of managing care from home, can be supported by data analytics that will assess their health information.

Readying healthcare systems for the challenges of data analytics

Data analytics tools will quickly emerge and will be integrated into various electronic health records at an increasing pace in the coming years. However, their implementation and use in clinical practice will require efforts to ensure that they complement clinical care and support it in a way that does not disrupt or generates clinical risks. There are various challenges to this and they relate to financial, cultural, organisational and ethical aspects. Some of these systems may enable healthcare resources to be used more efficiently. They may however clash with organisational culture and processes. Data security issues and the ethics of applying some of these analytical tools to appropriately support patients and clinicians' decisions with appropriate informed consent will need to be addressed.

These challenges in implementing data analytics and the need to further the development of meaningful data to support clinical care create a need for the Agency for Clinical Innovation to participate in the NSW Health Analytics Strategy in a proactive way. Through the work of the Clinical Analytics Working Group, the ACI will work with clinicians to guide NSW Health into this. Broadly, this clinical input into the design and implementation of data analytics tools is crucial.

Clinical networks and advisory groups will be invited to participate in designing a process to support reflective practices and accountability. They will be invited to participate in the assessment of new data and tools and in the co-design of meaningful algorithms and visualisations. They will be conveyed to support the redesign of clinical processes and technology enabled models of care and the championing of investments in hardware, software and humanware.

Aged Health Network Update

Network Manager

Welcome – nursing subgroup co-chair

The Aged Health Network nursing subgroup welcomes Angela Millard as the new co-chair. Angela is a clinical nurse consultant in aged care, who works in Orange Health Service, Western New South Wales Local Health District (WNSWLHD). She is passionate about improving the care of older people, particularly Aboriginal and Torres Strait Islander people, and the recognition of cognitive impairment.

Angela Millard

In addition to her nursing role, Angela is the chair of the Care of the Confused Hospitalised Older Persons (CHOPs) working party and Vocational Intervention Program coordinator at Orange Health Service. She participates on a range of WNSWLHD committees, including the Dementia Delirium Network and Aged Care Reference Network. Angela also works with the WNSWLHD and Far West LHD falls coordinators on reducing falls and appropriate bed rail use.

Angela is actively involved in resource development and education across Dubbo, Bathurst and Orange Health Service promoting and actively improving delirium care and standards of care. She is a member of the Australia Association of Gerontology, with a specific focus on rural and remote research.

Brain Injury Rehabilitation Network Update

Working towards establishing specialist employment services in NSW for people with brain injury

The Vocational Intervention Program (VIP) was a three-year program trialling two return-to-work pathways for people with brain injury. VIP was initiated in response to the concerns about low employment participation rates following severe traumatic brain injury in NSW.

This project was funded by the NSW Government departments of icare and State Insurance Regulatory Authority. The ACI provided project management, governance, research and clinical resources to support service delivery partners.

Two pathways were trialled at six sites, partnering Brain Injury Rehabilitation Programs with local vocational providers.

  • Fast Track – an early intervention approach for clients able to return to the same employer
  • New Track – commencing a vocational program through a 12-week work trial placement.

Program participants

75 clients participated in VIP across the six sites: 29 on the Fast Track pathway and 46 on the New Track pathway.

Outcomes

  • Fast Track: 22/29 (76%) participants achieved sustainable employment with their previous employer.
  • New Track: 21/46 (46%) participants completed a work trial placement. Six individuals were offered paid work with the host employers, five continued volunteer work and 10 progressed to a job-seeking program.

Lessons learned

  • Following a graduated return to work process using specialist resources and consistent follow up achieves favourable outcomes for Fast Track clients.
  • New Track placements provide great opportunities for people to assess their own work abilities post injury.
  • Clients suited for the New Track pathway should be identified at an earlier stage post-injury to improve engagement.
  • Service partnerships allow for knowledge sharing and development of processes through case experiences.
  • To be successful, service partnerships require a structured program and commitment at all levels of the partnering organisations.
  • Plans for program sustainability need to incorporate contingencies for provider staff turnover.

A funding application is under consideration to extend the implementation of the VIP to a statewide program. For further information contact: Philippa.mcrae@health.nsw.gov.au

The Vocational Intervention Program finalist at the 2017 CASE Awards

The ACI was delighted that VIP was nominated for a Care and Service Excellence (CASE) Award. The CASE Awards recognise and reward outstanding service delivery in the NSW workers’ compensation industry.

VIP was one of five finalists in the ‘excellence and innovation in injury management’ category. This is the first time a brain injury project or service has featured in the CASE Awards.

Project staff from the Brain Injury Rehabilitation Network and Keystone Professionals (a vocational service partner in VIP) attended the gala awards night, held on 29 November 2017.

The event was a great opportunity to raise awareness of the specialist needs of people with severe brain injury within the workers compensation environment and to meet vocational providers who could potentially partner to deliver future VIP services.


New Track pathway participant hard at work

Centre for Healthcare Redesign School Update

Program Manager

Redesign School 10th anniversary celebration

2017 marked the 10th anniversary of the Clinical Redesign School in NSW Health. To celebrate this significant milestone, the Centre for Healthcare Redesign (CHR) invited alumni, NSW Health staff and executives, redesign leaders and members of the original school development team to come together in Sydney in December 2017. This was the first time Redesign alumni and past teams were reunited, and a great opportunity for some long overdue catching up!

Some of the 2011 alumni members reunitedSome of the 2011 alumni members reunited. Photo: D Thomson.

Over the past decade, more than 500 participants have graduated from the CHR Clinical Redesign School, implementing over 300 projects that have contributed to improved patient outcomes and service delivery across NSW Health.

In 2016, the qualification for the school transitioned to a Graduate Certificate in Clinical Redesign, in partnership with the University of Tasmania. This was in recognition of the significant work and learning from the program.

This program has a proud history of supporting and facilitating innovation and change in healthcare, which was evident during the reunion celebration. Highlights included Katherine McGrath, former Deputy Director General, who spoke of her initial ‘school’ vision to grow ‘redesign engineers’ as internal consultants for service improvement and change across NSW Health. Several alumni also shared their own success stories about redesign journeys improving patient care – demonstrating how the program is achieving its objectives.

The Minister for Health, The Hon. Brad Hazzard, awarded certificates to current graduates and reiterated the ongoing importance of the School in supporting health staff to improve services across NSW.

The Minister for Health, The Hon. Brad Hazzard
The Minister for Health, The Hon. Brad Hazzard. Photo: D Thomson.

In the afternoon, the focus was the future of clinical redesign in healthcare and the ACI Chief Executive Dr Jean-Frédéric Levesque outlined further opportunities for the course in the coming years. Plans are underway to launch an official alumni program in 2018, to continue to build and support redesign and innovation leaders across NSW Health.


Tony O’Connell, a founding member of Redesign, shares stories about the School’s inception. Photo: D Thomson.

Institute of Trauma and Injury Management Update

Institute of Trauma and Injury Management awarded best practice-based conference abstract

Institute of Trauma and Injury Management (ITIM) Clinical Review Officer Kelly Dee, ITIM Research Fellow Pooria Sarrami and ITIM Manager Christine Lassen were pleased to win ‘best practice-based abstract’ at the 13th Annual Injury Prevention Conference, hosted in Ballarat, Victoria in November 2017. Their abstract was titled, Secondary and tertiary injury prevention in trauma patients: Clinical Review Committee’s current practices and future directions.

The abstract and presentation provided an opportunity to publicise the ITIM Clinical Review Committee (CRC) at the premier injury prevention conference for Australia and the Asia Pacific.

The ITIM CRC’s role in statewide injury prevention was through review of clinical cases from local health districts, pre-hospital and retrieval services, research groups and regulatory agencies, and the Clinical Excellence Commission’s root cause analyses investigations.

Since the conference, the CRC has linked in with other agencies involved in injury prevention and trauma case reviews, such as the Department of Justice and Regulation, Victoria and interstate trauma agencies. These links have helped to streamline the CRC’s review processes and identify gaps in patient management in the NSW trauma system, leading to further opportunities for secondary and tertiary injury prevention.

Musculoskeletal Network Update

Network Manager

Launch of the NSW Paediatric Rheumatology Network website

On Thursday, 16 November 2017 the NSW Paediatric Rheumatology Network website was launched at an event held at John Hunter Children’s Hospital. The Network is an initiative of the Sydney Children’s Hospitals Network, in collaboration with the ACI and Arthritis & Osteoporosis NSW.

The website aims to improve access to trusted medical information, help families access support and services in NSW, and share individual and family stories of living with and managing paediatric rheumatology diseases.

The launch event brought together children and families living with paediatric rheumatology diseases; executive and clinical staff from John Hunter Children’s Hospital, The Children’s Hospital at Westmead, Sydney Children’s Hospital Randwick, Arthritis & Osteoporosis NSW and the ACI; and the Newcastle Permanent Charitable Foundation, which generously funded the website build.

Key presentations included Dr Jeffery Chaitow (Director, Rheumatology, Sydney Children’s Hospital Network), Anne Senner (Clinical Nurse Consultant, Rheumatology, Sydney Children’s Hospital Network) and patient advocate Jo Turner, whose son Bailey lives with juvenile idiopathic arthritis. Jo spoke about the advocacy work she has done to gain rheumatology services for children, young adults and their families, and how proud she is that this website is now a reality for those she represents.

The website is another step in implementing the ACI Model of Care for the Paediatric Rheumatology Network. This model of care seeks to provide understanding of the need for and treatments of a range of paediatric rheumatology conditions. It also provides a description of the way services will be provided across NSW that ensures equity of access to care, no matter where families live.

For more information contact Anne Senner, Clinical Nurse Consultant, Sydney Children’s Hospitals Network on 0472 868 036 or anne.senner@health.nsw.org.au

Paediatric Rheumatologist Associate Professor Davinder Singh-Grewal with Bailey and his mum Jo Turner, admiring the website. Photo: Newcastle Permanent Charitable Foundation

Pain Management Network Update

Network Manager

Early intervention for injured workers

The ACI Pain Management Network has entered into a three-year partnership with icare to design and implement a pilot project to examine whether improving early access to pain management assessment and treatment services facilitates early return to work for injured workers.

As part of this pilot, 150 people who have been injured at work will be offered the opportunity to be fully assessed by a multidisciplinary pain management team and learn the skills to manage pain without relying on harmful opioid treatment that as a result of inadequate intervention and lack of access to evidence-based treatments.

This project involves six partners and a full economic and research evaluation will be completed at the end of the project. For more information, please contact Jenni Johnson, the Pain Management Network Manager.

Patient Experience Symposium 2018

NSW Patient Experience Symposium 2018 featuring Jessica Rowe

The Symposium Program Committee is pleased to announce that the 2018 NSW Patient Experience Symposium (PExS 2018) is now an accredited Patients Included event! PExS 2018 is committed to incorporating the experience of patients as experts in living with their condition while ensuring they are neither excluded nor exploited.

Join the ongoing Twitter dialogue on the conference charter using the #PatientsIncluded or #PExS2018 conference hashtags.

PExS 2018 will be held 9-10 April 2018 at the Hilton Sydney. The program features Jessica Rowe OA, one of Australia’s best-known media personalities. Jessica is a journalist, TV presenter and three-time bestselling author. She co-hosts Network Ten’s morning chat show Studio 10 and is an ambassador for beyondblue. In 2015 Jessica was honoured as a Member of the Order of Australia for her mental health advocacy work and her contribution to Australian media. A self-confessed ‘Crap Housewife’, Jessica has gathered a strong and loyal following with her #craphousewife movement, uniting and celebrating other mothers who, like Jessica, sometimes feel like they are not the perfect mother, wife or cook. Jessica will be sharing her work for mental health and anecdotes from her personal experiences.

Register for the conference

Primary Care and Chronic Services Update

Program Manager

Regina Osten

+61 2 9464 4637

regina.osten@health.nsw.gov.au

Development of a consumer enablement guide for healthcare providers

The Primary and Chronic Care team has recently completed consultation on the draft document – Consumer Enablement: a guide for healthcare providers.

Consumer enablement means the extent to which health consumers understand their health conditions and have the confidence, skills and knowledge to manage their health and wellbeing. A person’s enablement encompasses their ability to:

  • access health services
  • obtain, understand and act on health information
  • actively participate in decisions about their healthcare
  • make healthy choices in their life.

The concept of enablement is not new; most healthcare providers in NSW already apply some enablement techniques and approaches in practice. However consultation with clinicians and managers across the state has indicated need for a resource that:

  • clarifies the concept of enablement
  • brings together the evidence about what is effective, for who, and when
  • provides information, evaluation and links to evidence-based resources, tools and practical approaches clinicians can use in practice.

A previous consultation was held on the concept of a consumer enablement framework using a prototype. More than 200 consumers, clinicians and managers provided feedback via workshops and focus groups.

The prototype was then developed into the draft document and published for consultation in February 2018 with feedback invited via an online survey. More than 50 responses have been received to date from a range of organisations and individuals.

The Primary and Chronic Care Services team thanks everyone who provided feedback and ideas during this process.

The consumer enablement document will, together with feedback from consultation, inform the development of a web-based resource for healthcare providers.

For further information or enquiries, please contact Angela Wicks on angela.wicks@health.nsw.gov.au, +61 2 9464 4638, or Joanna Goodenough on joanna.goodenough@health.nsw.gov.au, +61 2 9464 4685.

Stroke Network

Network Manager

Kate Jackson

+61 2 9464 4614

kate.jackson2@health.nsw.gov.au

Stroke Network

Stroke Network appoints new medical co-chair

The Stroke Network is delighted to announce the appointment of new Medical Co-Chair Richard Lindley.

Richard has a wealth of experience. He is Professor of Geriatric Medicine at The University of Sydney and Honorary Professorial Fellow at the George Institute for Global Health. He qualified from medical school in Newcastle upon Tyne (England) in 1986 and trained in general, geriatric and stroke medicine in England, Scotland and Australia.

Richard Lindley

In 1990 Richard was appointed as research fellow for the International Stroke Trial with the Edinburgh Stroke Group and has continued to participate in collaborative clinical research over the following decades, including roles in about 40 randomised controlled trials. He runs a large portfolio of clinical research in stroke, rehabilitation, vascular disease, global health and prescribing.

Richard is former President of the Stroke Society of Australasia, Board member of the Stroke Foundation (including chairing the Clinical Council, and co-chairing the Australian Stroke Coalition), and co-chair of the development of national guidelines in Scotland and Australia. Richard also serves as Associate Editor for the Australasian Journal of Ageing.

Each week, he provides clinical services two days a week in acute geriatric medicine, acute stroke and rehabilitation at Blacktown Hospital, Sydney.

Richard’s key priorities are implementation of the Australian Stroke Clinical Registry (AuSCR), data-driven service improvements.

Welcome Richard, we look forward to having your valuable experience as Co-Chair of the Stroke Network!

Telehealth

Network Manager

Donna Parkes

+61 2 6809 8675

donna.parkes@health.nsw.gov.au

Telehealth Network

Australian Telehealth Conference 2018: Virtual, connected and co-designed

There is a new vision for the Australian Telehealth Conference 2018 (ATC 2018), coming up in Sydney April 11-12, with strong themes of design thinking, co-design and patient-centred care.

ATC 2018 is one of the annual conferences of the Health Informatics Society of Australia (HISA), Australia’s longest established digital health peak body. HISA organisers say the conference themes reflect world trends towards co-creation in healthcare – viewing consumers not just as ‘users’ but as ‘makers and shapers’ of health services, including telehealth.

Look out for appearances by speakers on social developments in medicine, co-design and design innovation, including Professor Trish Greenhalgh, University of Oxford (UK); Professor Deborah Lupton, University of Canberra; and Dr Larry Chu, former CEO of Stanford Medicine (US).

Professor Trish Greenhalgh, an internationally recognised academic in primary healthcare and a trained general practitioner, will address why so many telehealth programs fail. Trish leads a program of research at the interface between social sciences and medicine, with strong emphasis on the organisation and delivery of health services. Her research seeks to celebrate and retain the traditional and humanistic aspects of medicine while also embracing the unparalleled opportunities of contemporary science and technology to improve health outcomes and relieve suffering.

For traditional telehealth watchers, the event will also feature speakers from around Australia who are successfully embedding new technology.

For more information, including the full ATC 2018 program, view the conference website

Australia Day honours list

Congratulations to the NSW Health employees recognised in the 2018 Australia Day honours list. We would like to acknowledge the following recipients who have made significant contributions to the ACI.

Medal (OAM) in the General Division

Dr Friedbert Kohler OAM: SWSLHD’s Director of Rehabilitation Medicine for Braeside, Liverpool and Fairfield Hospitals was awarded for services to rehabilitation. Dr Kohler is a member of the ACI Rehabilitation Network and Research Interest Group.

Member (AM) in the General Division

Associate Professor Peter Haertsch AM OAM: A specialist plastic and reconstructive surgeon based in ISLHD and SLHD, Associate Professor Haertsch was awarded for significant service to medicine in the field of plastic and reconstructive surgery as a clinician and administrator, and to medical education. Associate Professor Haertsch is a member of the ACI Burns Network.

Professor Fiona Mary Blyth AM: A Medical Epidemiologist at Concord Hospital, Associate Dean, Concord Clinical School and Professor of Public Health and Pain Medicine, Professor Blythe was awarded for significant service to medical research and education in the field of public health, pain management and ageing, and to health policy reform. Professor Blyth is a member of the ACI Musculoskeletal Network and works with the ACI Pain Management Network.

Officer (AO) in the General Division

Dr Diana Elaine O'Halloran AO: A WSLHD Board member, Dr O'Halloran was recognised for distinguished service to medicine in the field of general practice through policy development, health system reform and the establishment of new models of service and care. Dr O’Halloran is Co-Chair of the ACI GP Clinical Advisory Group.

Dr Helen Mary Somerville AO: Formerly at CHW and now WSLHD, Dr Somerville was awarded for distinguished service to medicine, particularly developmental paediatrics, as a clinician, and through advocacy roles for the care and treatment of people with intellectual disabilities. Dr Somerville was a founding member of the ACI Transition Care Network and Intellectual Disability Network.

Professor Paul Mitchell AO: Professor Mitchell established the Blue Mountains Eye Study more than 20 years ago and was awarded for distinguished service to ophthalmology as a clinician, particularly in the management of age-related macular degeneration, through research into public health and ophthalmic epidemiology, and as an educator. Professor Mitchell is a member of ACI Ophthalmology Network and ex-governing body.

Public Service Medal (PSM)

Cathryn Cox PSM: Executive Director Health System Planning and Investment, Ministry of Health. Ms Cox has contributed to multiple ACI programs.