ITP Techblog

Ashley Bloomfield became one of the heroes of the Covid-19 crisis with his calm and pragmatic approach to organising the health sector's pandemic response.

Now the director-general of health is being called on to fix our creaking health IT systems which doctors and clinicians consider to be holding back delivery of basic health services and acting as a barrier to the deployment of new health tech, such as wearables and even implants.

In an open letter to Dr Bloomfield, over 360 clinicians urge him to capitalise on the recent injection of funding into tech initiatives such as Covid tracing systems, to extend to the wider health system.

"COVID-19 and the rapid changes in our health system have exposed what clinicians have said for years, that our large technological debt is hindering care for our patients," write the members of the Clinical Informatics Leadership Network.

"Our technological debt is, at least in part, secondary to a continued lack of clinical informatics partnership, on top of inadequate investment in our health system's data and digital infrastructure."

Health review an opportunity for change

The call for action on technology in the health sector comes as a major review of the sector recommends a reduction in the number of district health boards, the establishment of a new health authority, Health NZ, ending elections for DHB members and creating a dedicated Māori health authority.  

Those proposed changes will be evaluated by a small group of ministers in the coming months, with a 3 - 5 year work plan implementing the structural changes required. That could allow opportunities to harmonise the use of technology and digital services across the health sector, with more central procurement and technology policies.

Health minister David Clark described the review recommendations as a "once in a generation opportunity" and he agreed with the "direction of travel" of those recommendations.

The Health and Disability System Review: Final report, released today, includes a section on Digital and data. Its recommendations to move from an "ecosystem of tens of thousands of systems that do not easily connect, to a system that routinely shares data and more effectively supports all those working in or using the system will require a staged approach".

The Digital and Data recommendations include:

- The Ministry should continue to be responsible for national data collections and the Health Information Standards Organisation.

- Health NZ should focus on aspects of digital that are required to manage and support improved delivery and performance of the system, such as developing and implementing the digital plan and ensuring appropriate interoperability and cybersecurity management.

- The Māori Health Authority should take a leadership role on Māori data sovereignty, Māori population health analysis and analytics, and ensure that the digital plan includes priorities that will help address equity issues for Māori.

- Priority should be given to developing data and interoperability standards that ensure data flows across the system and supports better clinical outcomes, empowered consumers and data-driven decision-making.

- Consumers should be able to control and access their own health data and information given the importance of Tier 1 services for improving equity, priority for digital investment should be given to initiatives that will accelerate interoperability between Tier 1 services. nHIP initiatives are one option for this.

- Digital systems in both Tier 1 and Tier 2 should support more delivery of virtual care and this should be prioritised to serve rural and other communities with access challenges procurement processes for service providers and suppliers of digital systems should be encouraged to adopt agreed digital and data standards. 

- A digital procurement framework that aligns procurement processes with the scale and risk associated with the investment should be adopted and decision-making rights clarified throughout the system.

Don't slip backwards

The clinicians lobbying for change will no doubt agree with the tone of the report, though the devil will be in the detail. They see an urgent need to move on upgrading IT systems and embedding digital literacy "before people and organisations slip back into old ways of working". They point to the Government's own National Asset Management Programme report released last week, which also has a section devoted to information technology.

It tells a story of outmoded software systems, siloed purchasing decisions at the DHBs and a lack of coordination and standardisation on developing and roll-out of technology and applications.

Warning signs are also coming from the DHBs themselves. The NAMP report notes:

"Another review in 2018, in the Northern Region, found over 1,200 applications across its four DHBs. Yet only 10 per cent of these applications appeared to be up to date, with the rest obsolete or becoming obsolete."

Many DHBs are running outdated and unsupported versions of Windows on their devices posing a cybersecurity threat in the process. 

With a more streamlined health sector, the opportunity may soon exist to improve the delivery of services supported by the innovative use of technology and digital services.