Brislen on Tech: Triage for Health IT
In 2002 the Mobile Surgical Unit (a surgical suite on wheels) was unveiled and I was lucky enough to take a tour around it.
The truck itself is 20m long and weighs 42 tonnes and was designed so surgeons could rock up to a regional hospital, conduct a few days' worth of vital surgery and then move on to the next town. The patients would be left to recuperate in their local environment which would increase their chances of coming out of surgery well. There's data to back it up - take the surgeons to the patients rather than making the patients leave their security to go in to the big city for surgery.
I chatted with the man who put it all together and asked when we would get another one.
"Oh that'll never happen," he cheerfully told me. "DHBs spend money on things they can show the minister when he or she turns up. They can't guarantee the bus will be there when he arrives so there's no way they'll fund another. I'm surprised they paid for this one."
And so it is that New Zealand has one mobile surgical unit instead of a fleet. The Minister might not see the bus when he comes to visit.
I will not miss the District Health Board model when it finally gets that toe tag strapped on and is slid into the chilled morgue drawer.
This is the perfect example of silos getting in the way of outcomes and as a corporate participant (I have worked in and around them for many years now) I can tell you, silos are a barrier to growth, resistant to change and impossible to root out once they take hold. DHBs are the prime example of this in that we have 20 DHBs with 20 CIOs and 20 IT systems and I bet 20 different ways of doing the same thing.
This is quite wasteful, I believe.
Fortunately I'm not the only one and the minister has announced some seriously sweeping reforms. No more DHBs, no more Ministry of Health deciding what gets funded and what doesn't, no more competing infrastructure… instead, we get two national health services (names to be decided) and a focus on prevention rather than just a massive number of ambulances at the bottom of the cliff.
I was particularly heartened to hear the minister list technology issues as being long overdue for attention.
As a nation we have chronically underfunded the health system's IT capability for many years. A report from the Ministry of Health in June last year outlined the problem. IT strategy and governance operated only a basic level. Core applications such as financial management systems, patient admin systems and pharmacy management systems were described as "poor" in half of all DHBs. National data standards were not a priority and the physical kit (infrastructure, networks and security) were "outdated and not adequate to support the introduction of new systems" or manage cyber-security matters.
And that's just present state stuff. Never mind the massive amounts of digital change coming down the pike aimed squarely at the health sector. We can't book patients in to see a GP effectively across the country, let alone introduce AI and machine learning to review histology of tumour dissection or any of the other cool things that should be on our radar.
Having one overarching tech policy and buying agency will in and of itself deliver savings across the country, but there's so much more to consider than just that.
With effectively a blank sheet of paper we can re-write the rulebook for digital enablement for our clinics and hospitals, our public health workers and above all else our patients.
The money saved by not duplicating and recreating the wheel can be better spent on treating those who need treatment, and that's no bad thing.
New Zealand Health IT (NZHIT) has published a report on the future of our health sector's IT needs and it's a useful starting point.
There is some short term pain to be had certainly but in the long run we have an opportunity to move the health service away from being an ambulance at the bottom of the cliff to being a nurse practitioner at the top, enabled with the latest diagnostic tools, a clear patient history and the ability to make a difference in people's lives.
And maybe we'll get some funding for a fleet of surgical buses to bring medicine to the patients instead of the other way round.
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