COVID-19 Update: 26-Mar-2020 (Enigma)

Over the last 24 hours we have been working with a number of our key customers who have replied, informing us of their ‘Essential Service’ provider status, and asserting that our services formally play an essential part of their service delivery. As such we are now deemed to be part of the supply chain for Essential Service providers, and are also therefore now considered an Essential Service provider ourselves.

All of our staff are working full-time from our home locations, and for the most part we do not believe we will need to move around, or operate from our office location in order to continue to deliver those services.

We have already been making all reasonable preparations to ensure continuous delivery of our services, but with this new determination and with formal responses from these key customers, we have been empowered to notify our up-stream service providers of our change in status.

We would likely only need to invoke special privileges (of movement and of staff placement into facilities), in the event of any service failure, where we would need to put staff on-site to assist with hands-on diagnosis of faults, to remedy and rectify such a fault.

That is where our focus has been placed – we are in the process of notifying, and assessing the ability of, our providers who:

  • Provide access to our co-located equipment
  • Provide connectivity and network services, and associated power and co-location
  • Provide hardware service and support, including replacement units under service warranty

 
This is ongoing work, but so far we have received positive responses from our providers as we are commonly not the only Essential Service provider which they have had to deal with.

It should be noted that we have also been working with MBIE around confusing and conflicting statements on their COVID19.govt.nz website – relating to the provision of services by a company who delivers both essential and non-essential services. Currently their site expresses a misleading expectation that those with mixed collections of essential and non-essential services must not deliver non-essential services. We have received confirmation directly from the MBIE helpline that in cases like ours, the intention was not to restrict the delivery of non-essential services if they do not create a situation where staff would be required to continue to be on-site. The wording of their current advice was geared more towards a ‘productive industry’ such as a factory which creates both essential and non-essential goods. They do not want staff continuing to be required to travel to a factory for the production of those non-essential goods. Their wording is NOT YET clear enough to be able to distinguish, for service sector industries like ours, where there is no expectation or requirement for staff to be on-premises for either Essential or Non-essential services.

If we were to need to respond in the manner outlined above, such a critical service failure would affect both our Essential and Non-essential services equally. To be clear, we would be mobilising limited, and key staff members *for the benefit of the Essential Services*, but that the benefit delivered to those services would also have a positive by-product effect of delivering greater uptime, also for those Non-essential services, since they are all serviced using the same equipment and services.

The delivery of Non-essential services alongside those Essential Services does not, in any way, impact or create any increased level of risk to our delivery of Essential Services. From our perspective, we will be equally aware of any issues which might affect either group of services, and they continue to be monitored and managed ‘as-one’.

If this situation changes, then we will be capable of segregating our services into groups, but it is not our intention to do so at this point in time.

Any questions or issues, then please contact Chris Wiltshire, General Manager – Enigma Solutions Ltd.

Thank you. Stay safe, stay well.

COVID-19 Update: 24-Mar-2020 (Enigma)

A further update from Enigma as we’re all responding to the 48 hour notice period of a Level-4 COVID-19 alert:

Enigma continues to be committed to delivering services as-usual in so far as: servicing our existing work, keeping our services up and running and available to customers and fully maintaining our services, network and systems. All of our staff are fully capable of working from our home offices. Our support lines will remain open and available.

Our system and network monitoring has always provided alerts and notifications of both proactive maintenance requirements as well as any critical failures. Our staff will remain diligent in our monitoring of these systems, we are able to respond to almost all alerts remotely without needing a hands-on response. Since we are not operating any face-to-face customer or public facing services the impact of having to work remotely on our core business has been minimal.

While we do deliver services into the Health and Private Sectors, we have not been able to find any specific instances which we believe would mark our work as meeting the Government’s definition of ‘Essential-Services’. If you feel that we have misinterpreted that, if you deliver Essential Services, and if you in turn rely on our services to deliver your Essential Services, then please get in touch with me to let me know.

Backups:

As a final preparatory step, we are implementing temporary changes to our backup-services to enable us to take our backups, off-site without any need for a personal visit to our data-centre. We normally perform full daily backups, duplicate to tape, then shift those tapes off-site to our fireproof tape-safe (within our office).

As a temporary alternative, we are currently commissioning a cloud-based extension of our backup services using Amazon AWS based storage services (located in Sydney – Australia), we will digitally ship the backup content over there. 

Our backups are encrypted before they are written to disk, they remain encrypted throughout their life. When they are at rest within Amazon’s storage they sit on a further encrypted volume. Our retention of those backups within Amazon’s services is currently designed to be 16 days (just over a two week period), after which they will be removed from Amazon’s services.

Our aim is that, by performing these changes, we will hold location independent backups for DR purposes. Our primary backup content will continue to reside within our own networks; this extra step has been taken to improve resilience in the case of any catastrophic loss of the production hosting environment. 

In addition to this, we will be switching from full, daily backups, to one full-weekly backup, followed by incremental backups for the remainder of the week.

 

Our office number (09-9129100), and our DDIs continue to work as normal, as does our support line: 0800 PREDICT – If you have any questions, concerns or queries, please get in touch.

We wish you all the best; for you, your teams, your families and customers.

Chris Wiltshire – General Manager.

COVID-19 Update: 21-Mar-2020 (Enigma)

Email to staff (21st March 2020):

Hi Everyone,

Today (Saturday 21st March) the PM raised our Covid-19 alert level to ‘2’.
https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12318673

You might want to visit that link, read and listen to what this means for everyone.

Importantly, to us all individually and to Enigma; this heightened level means that we have been asked to implement greater self-isolation practices, and for all businesses to put into place any available plans to ‘work-from-home’. Not all companies can do this as fully and as effectively as we believe we can. In our case, this means that from Monday, until further notice, we will all be working from our home environments for the foreseeable future.

I would expect each of you to have what you need in order for you to effectively work from home on Monday morning, even if this means arranging to collecting items from the office *over this weekend, before Monday morning*.

… Vish will continue to travel to the office daily, in order to manage the required backup tape swaps, and to continue to store the tapes in the office each day. In order for Vish to be as socially-distanced as every other one of us, this means that the rest of us cannot be in the office at the same time as Vish. – Please, from Monday morning, avoid dropping into the office without making arrangements to be in there (through me).

Our office cleaning will continue as normal, with a full clean taking place each weekend. Vish, in the meantime, you will need to perform your own additional cleaning on a daily basis (while you’re the only one in the office). – Please wipe down with disinfectant and a paper towel: commonly used door handles, kitchen surfaces, bathroom sink areas, alarm keypad, your desk surface etc. This is to keep the office as clean as possible from any potential contaminants which you might bring into it while you’re there. If you end up having to take time off because you become ill, then we want anyone else who has to go into the office to have confidence that you’ve been keeping it as clean as possible please.

So, please do whatever prep you need to before Monday’s 09:30 meeting, and we’ll see you online, from your homes.

Thanks, any questions, please give me a ring: 021624717.

Chris.

COVID-19 Update: 18-Mar-2020 (Enigma)

Last Updated: 18 Mar 2020.

Enigma has assessed likely impacts from COVID-19 and how they might affect our ability to deliver services.

We believe that we are well positioned and fully capable of delivering continued and uninterrupted services to you, at our normal levels, through the COVID-19 pandemic.

  • Last week we implemented strengthened distancing measures for our staff at work, and will continue to do so for the immediate future.
  • We are well prepared to be able to work remotely, and have conducted a full-office work from home day, with no discernible negative impact.
  • We have a reliable infrastructure which requires a minimum amount of hands-on attention and intervention on a week to week basis.
  • We have extensive system monitoring and reporting which is a well established and core aspect of our approach to meeting service level expectations.
  • Our entire phone system, all normal extensions and calling groups work while we are working remotely, things like extension dialling and transferring calls are not impacted.
  • Our staff are well used to using remote meeting tools (our preference is ZOOM), and use these routinely.
  • We have a shared knowledge base (our wiki) which is accessible to our staff from home.
  • Our support systems are web-based.
  • We have a company wide ‘Slack’ environment which enables our developers to collaborate well, remotely.

Our staff will remain available to you, our customers, as normal, through all normal channels. We will be maintaining our normal working hours, and a normal full working week.

Should any of our individual staff members become ill during the pandemic, we will obviously prioritise their health and safety and their recovery. We will assess the impact on any in-flight development work and make required adjustments. Our team has sufficient breadth in their product knowledge and cover to be able to cover all aspects of production products.

If anything were to change, we will let you know at the earliest possible opportunity.

Currently all 10 of our full-time staff, and our two regular contract-based workers are fighting fit; we have had no direct, first hand concerns as of yet.

All further updates will be posted to this URL. https://www.enigma.co.nz/covid-19

COVID-19 – Enigma’s response and policy.

In light of growing local concerns around COVID-19 and the potential for Auckland-based community-spread, Enigma has developed a policy aimed at keeping our staff, their families and our customers safe from impact (which Enigma might create, or be reasonably in control of).

Today, 10th March, Enigma has implemented a number of changes to policy and to our office setup:

  1. No casual visitors will be allowed to enter our office space. – Couriers etc will be greeted at our office door.
  2. All booked appointments will be expected to execute hand-hygiene measures upon arrival, visitors will be limited to our entry area, meeting room and bathroom areas. General office space and kitchen areas are out of bounds.
  3. Enigma staff will be prohibited from attending meetings at Hospital, DHB, PHO or clinic settings (except where this is absolutely imperative).
  4. Enigma staff are strongly encouraged to make every effort to arrange remote meetings wherever possible. We have good teleconferencing and online meeting tools which should enable us to carry on with all business meetings remotely.
  5. Office and personal hygiene policies and procedures have been circulated to staff in an effort to keep our office space ‘a clean and safe zone’.
  6. While we will be happy to wave and say hello, we won’t be shaking hands for the immediate future.
  7. Staff have been requested to consider whether travel is necessary, and also to be considerate of any mass-public-gatherings they attend.
  8. Staff have been requested to execute good personal hygiene at home (and in transit) and to encourage good practices across their families and direct contacts.

This position and our stance will be reviewed weekly.

If you have any questions about this, please contact chris.wiltshire@enigma.co.nz
A copy of our internal policy document is here: Covid-19-Policy_v1.01 – for anyone with shared interests / common concerns.

(Please also note our anti-spam requirements, linked to from the bottom of each and every page on this website)

 

Enigma – Proud to have delivered ‘Biggest NZ nationwide study’.

Yesterday, the NZ National Heart Foundation published a web article titled ‘Biggest NZ nationwide study has global impact’.

It outlined the findings of a two-year-long, national, randomised trial to examine the effect of providing ambulatory oxygen to patients suspected of suffering a heart attack. This has long been a practice observed due to its suspected benefit, however this benefit has never been confirmed.

This study is the largest randomised trial to date in NZ, involving 40,000 patients, and it was made possible by leveraging off of the ANZACS-QI system, a national cardiology registry provided by Enigma to the NZ Ministry of Health, and deployed into each NZ hospital, nationwide.

The core ANZACS-QI registry system has been extended, using funding from the ANZACS-QI Registry Trials Group to include a ‘studies module’ which provides bolt-on templates for a range of associated studies.

The studies module allows patients from the core ANZACS-QI cohort to be included in appropriate research cohorts, and for additional, study-specific information to be collected on them, perhaps including study-specific workflows and additional subsequent (post-discharge) data capture. It also provides the potential for external healthcare providers to contribute additional information on patients after they have left the hospital setting.

For this study, data relating to Oxygen-as-a-therapy was retrospectively collected on all patients who were entered into the ANZACS-QI Acute Coronary Syndrome (ACS) data collections, on a single randomised day each month. Oxygen fields were present on all days, for all patients, but were made mandatory for patients who entered the hospital system on those specific, randomly selected days. In this way, the normal clinical practice of providers was not affected nor influenced in any way, by the presence of the study.

For more details on the study’s findings visit: https://www.heartfoundation.org.nz/about-us/news/media-releases/biggest-nz-nationwide-study-has-global-impact

Enigma is proud to have played a part in this and wishes to acknowledge and thank the NHF for their support of this study.

Enigma – Proud major sponsor – Saddle Sore 1600 for Aran Animal Rescue.

Today Enigma has proudly agreed to be a major sponsor for Chris Wiltshire, General Manager of Enigma for his attempt to ride and complete a ‘Saddle Sore 1600’, motorcycle endurance ride for charity.

Chris will have to ride a minimum of 1600km, within a 24 hour time period and within a set of reasonably strict conditions. – This is not a race. He hopes to achieve an internationally recognised award from the Iron Butt Association (IBA) called the Saddle Sore 1600(km). This is the metric variant of their well known SS1000 (1000 miles). The ride is scheduled in NZ for some time in Mid-to-Late February, weather and work dependant.

He is performing this attempt, with a long term friend; Jon Mitchell who is also riding for charity. Chris has chosen to help raise funds for Aran Animal Rescue (http://www.arananimalrescue.org.nz/) and Jon is helping to raise funds for a cancer related charity (TBC). He has set a fundraising target of $1 per km, hoping to raise $1600 for the rescue.

Aran is made up of around 10-12 primary volunteers who manage to save around 200 dogs from slaughter each year from pounds who can’t otherwise re-home them. Aran work to locate, collect, foster, then find permanent homes for them all. They are dependant upon raised funds to help to pay for transport, food, pound fees etc.

Chris’ ‘givealittle’ page is here: https://givealittle.co.nz/fundraiser/saddlesore4aran
Updates on his effort will be posted on his Facebook Event page: here.

If you would like to help to sponsor Chris, please visit those pages to see what it’s all about. – Thank you.

Further details on the SS1600 type of event can be found here: http://www.ironbutt.org/rides/ss1600k.htm

ANZACS-QI’s Auckland and Northern Region gain integrated TestSafe access.

Enigma is delighted to have enabled TestSafe access for the Auckland and Northern Region’s ANZACS-QI users. Historically this access has been available only for CMDHB’s ‘Acute Predict’ users and dates back to around 2010 – (pre-TestSafe days). Over the past few years there have been several efforts to work through the permissions required to ‘flick the switch’ for the other DHB’s within the TestSafe catchment area.

Fair to say that the wheels turn slowly… Over four years later, we received the formal go-ahead which we required, and last week ‘flicked the switch’ to provide this same service to the others in the region. This represents a rather large milestone for us, and as such we’re delighted.

What this means for the end users – it’s simple really; they don’t need to transpose results from one screen, into another window. The systems are now ‘connected’ and at the click of a button the ANZACS-QI system is able to perform a back-end lookup into TestSafe, and pull the relevant labs directly into the ANZACS-QI Registry’s forms.

It saves valuable time, reduces effort and removes transposition errors. It will help to capture the highest possible quality Registry data.

We’d like to thank the staff at health Alliance who helped significantly with this most recent effort to work through the required processes. In particular we need to recognise Adele Nairn (health Alliance), without whom we would not have achieved this. We’d also like to thank Sarah Thirlwall (CMH), Leanne Elder (CMH), Barbara O’Shaughnessy (WDHB) and Stuart Bloomfield (WDHB) for the various parts which they played in sponsoring work, organising assistance and completing the PIA work too.

For more information on ANZACS-QI, feel free to click here: http://www.enigma.co.nz/predict-medical/anzacs-qi/

Embedded Browser – too old (when used inside of the PMS).

So, in recent years, there have been many advancements in browser standards and technologies which they support; two major ones are CSS 3.0 and the use of HTML5. Neither of these technologies are supported by older browsers such as MSIE7 and MSIE8.

Both MSIE7 and MSIE8 have been defunct for some time now, and are well past their ‘end of life’ with Microsoft. This means that they no longer provide updates, security patches or support for these old browsers. There is no way that anyone in any business or professional setting ought to still be running these browsers if they are capable of connecting to an internet based source of content. (Legacy APP support on an isolated network might be the only excusable reason to want to run these versions).

In some settings, a ‘WebBrowser control’ is used within other applications to allow the desktop based application to access, and view web based content. In particular, Microsoft provided such a control, and allow MSIE to be invoked in an embedded manner within other applications. This is the approach used by both Medtech and MyPractice.

The ‘WebBrowser control’ ships with some standard, default settings which force certain behaviours unless altered. The good news is that on a per-application basis, registry entries can be added to the machine which uses these controls, to nominate what emulated version the current desktop browser ought to be run as. This is where things get a little confusing and certainly more detailed…

If you’re running Windows 7, Windows 8 or Windows 10, the chances of you running MSIE8 as your desktop browser are almost nil. However, the WebBrowser control’s default settings force even these newer browsers to run in an emulation mode, pretending, and limiting the browser’s function to that of MSIE7. Clearly this is a hampering default setting and one which severely limits the usefulness of the embedded browser.

This is a major issue for software development companies who maintain modern approaches to development and deployment. Enigma, as one of those companies is focussed on delivering the best in terms of usability and end-user-experience as well as security. This means that we need to be able to use the most modern application development approaches and frameworks. – Simply put, we cannot while your embedded browsers are being forced to continue to run in this MSIE7 compatibility mode.

So, we’re forced to find a way to allow you to use your native browser, the one installed on your desktop, your current version. – A linked popup window appears to be an interim solution. It’s not the most appropriate answer, but it will allow us to continue with delivering decent software, in an integrated manner. We’ll only have to take this approach until the PMS vendors have figured out a suitable way to allow all form vendors to make use of the latest versions within the PMS.

Some FAQs:

— But, can’t that happen now? You mentioned Registry settings?…
Yes, it can. By adding a changed registry setting, your PMS vendor can opt into allowing the very latest browser which you have installed on your desktop to be used within the PMS. This is something which they are capable of delivering out to you within a version update.

— So, why have they not done this?…
There may be more than one single reason, but the easiest to explain is that there is concern over whether all forms which have been previously deployed will continue to work in this latest version. So until they have managed to talk to all form vendors to assess their readiness, they appear reluctant to change these settings.

— Is anything being done about this?
Yes, there have been a series of discussions which date back over 18 months on this topic. Also, we have started to make plans to use this popup method of window-linking between the window within the PMS, and the popup window. Using this approach, we’re able to talk back to the PMS, to perform our approved methods of integration with the PMS, using data, and writing back etc; while making the most of the newer capabilities and functions of your more modern browser.

— So this is a temporary thing?
Yes, we very much hope so. – There are some potential issues with this approach which make it a little more clumsy for end-users, you might lose sight of where your window is etc; also if you close the patient within the PMS, there is nothing we can do apart from simply close the browser content, we will attempt to warn you that you have a patient based window still open before you close it, but if you do close it, and if you have already entered content into the popup window, then you will lose that work, sorry. Arguably, this is no worse than the current workflow, if you close a patient with an open embedded window, and accept it can be closed without first saving / submitting that work, you could lose that too.

— How long until this is sorted properly?
We cannot give you an idea of timeframes as the work is outside of our control.

— Which PMS versions is this currently a problem in?
At the time of writing: We have experienced MSIE7 version mode being forced in Medtech32, MSIE8 mode is being forced within Evolution. – Neither MSIE7 or MSIE8 is new enough to support our current needs, we will use popup windows in all PMS systems where their embedded browser versions are not new enough to support current development approaches. MyPractice does not apply any version-mode limitations.

If you need further information on this topic, please contact the team @ Enigma: helpdesk@enigma.co.nz

The value of ANZACS-QI for NZ

ANZACS-QI_Logo_Blue_large

ANZACS-QI is a National system delivered within NZ to all of the public and private Coronary Care units and Cathlabs. It forms a National Registry to collect data on all patients who present with suspected Acute Coronary Syndrome, as well as those who are treated within Cathlabs, and who receive device implants as part of their cardiac-care treatment. The system is based on the PREDICT platform and was developed by Enigma in conjunction with Dr Andrew Kerr with funding from CMDHB. It was further developed later, with the NZ Cardiac Network, under contract with New Zealand’s Ministry of Health and has been delivered nationally in partnership with NIHI.

The following excerpts are taken from an editorial article [Mark Webster; ‘Early angiography and revascularisation for acute coronary syndromes in New Zealand’, NZMJ – 8th Jan, 2016] – Full article is available here with subscription: https://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2016/vol-129-no-1428-8-january-2016/6678

Excerpts taken from the referenced editorial article:

 

ANZACS-QI is a rigorous, prospective and comprehensive database on all patients with ACS undergoing angiography. … The 3-day target time for angiography in ACS patients was an excellent choice as a KPI: clinically relevant, achievable and with the potential to save money. This has proven to be the case.

 

ANZACS-QI is now providing a wealth of information about the management of coronary disease in New Zealand. Merging data from other sources, particularly the national mortality, hospital discharge diagnosis codes and pharmacy registries, creates a powerful tool for predicting longer-term outcomes. …

 

 

The potential for ANZACS-QI extends well beyond short-term audit and quality control of local practice. Research can be under-taken by adding database fields for the duration of a study, and national registries used to collect relevant endpoints. … New Zealand is now well placed for such research; being small and somewhat isolated is, for once, to our advantage. Beyond the usual randomised trials with individual patient consent, there is also the potential to undertake systems research, comparing ‘routine’ practices applied to large groups of patients.

 

In summary, ANZACS-QI is an example of money well spent in a public health service looking to achieve both optimal clinical outcomes and efficient health service delivery. Without good data, it is easy to repeat the mistakes of the past. As Lord Kelvin said “to measure is to know”. It is vital that we evaluate our practice in an ongoing and rigorous manner … ; it is also important to maintain a healthy scepticism regarding our currently-held beliefs.

Further information on the ANZACS-QI system is available here: http://www.enigma.co.nz/predict-medical/anzacs-qi/

Further information on the extensions of this base system to service research / study requirements is available here: http://www.enigma.co.nz/predict-medical/anzacs-qi-registry-trials/

About Mark Webster: Mark works as a Consultant Cardiologist, Director, Cardiac Catheterisation Laboratories Auckland City Hospital and is Hon. Associate Professor of Medicine, University of Auckland.