Little’s big ask: Health IT mountain awaits those brave enough to forge solutions

• Health minister Andrew Little says the reforms are to include a “coherent and ambitious system-level digital strategy”.
• The Ministry of Health, the new Māori Health Authority and the new national agency Health New Zealand will together define the strategy.
• The reforms are seeking: IT systems that talk to each other, digital-first patient care, improved day-to-day practice and decision-making, and integration of data to improve consumer experience.

In his speech at the Beehive, unveiling his sprawling ambitions for the health system, health minister Andrew Little said he wants a national health IT system that is “smarter – so that it works effective­ly, intelligently, cohesively, and makes the most of the money and resources available”.

Between now and July 2022, the Transition Unit in the Department of the Prime Minister and Cabinet will conduct a “preparation, consultation and engagement” phase.

The 85-page Cabinet paper and minutes released with the minister’s speech, cites the system’s COVID-19 response as an exemplar behind the reforms’ aim to impose a “digital first” approach to patient care.

This approach is, where appropriate, designed to help improve equity of access and enable person and whānau-centred care.

“Virtual models of care, such as telehealth, enable consumers to access safe and effective services from wherever is most convenient for them – as we have seen first-hand during the COVID-19 pandemic response,” the document says.

It points to the difficulty the sector has had in scaling up digital ap­proaches that have been piloted and shown to be successful.

The new national agency, Health New Zealand, will monitor the performance of health services and drive improvement and innovation, Mr Little said.

Patient safety is paramount, so the tech industry mantra of "minimum viable product" has a much higher threshold where healthcare is concerned

The paper acknowledges investment will be required in the reforms’ bid to improve digital systems and technology. It envisages improved day-to-day practice and decision-making and integration of data to improve the consumer experience.

Currently, the country’s DHBs use shared services organisations for most health IT services. The four such organisations, healthAlliance, HealthSource, Southern Alliance and TAS, will be transferred to Health NZ, the paper says.

Mr Little states the health system needs a “coherent and ambitious system-level digital strategy”, which the ministry, the new Māori Health Authority and Health NZ will define together. People with “strong digital expertise” must hold executive positions and be on Health NZ’s board.

Alongside the existing framework standards, he sees a case for devel­oping a single set of national data requirements to encompass the infor­mation needs for shared national outcomes and priorities. These would be transparent and available for benchmarking between areas.

“This should also tackle key gaps in data, such as in relation to primary and community services,” Mr Little says.

Come July 2022, when implementation of the reform’s sweeping plans are under way, health IT should be part of that.

“We will be able to plan for things like IT systems that talk to each oth­er, for capital investment, procurement, and other issues that benefit the whole health service,” Mr Little said in his speech.

We hold the documents so you don’t have to! Our coverage of the Little reforms references a number of documents which we have gathered together on our website

Quite a lot, actually.

In 2019, the Government abandoned the proposed single, national Electronic Health Record and set in motion adop­tion of a standards-governed, decen­tralised, National Health Information Platform (nHIP).

Also in 2019, the Health and Disabil­ity System Review Panel’s interim re­port tacitly endorsed the nHIP approach. In September that year, the Government approved funding for de­vising a business case for tranche 1 of nHIP, even before the release in 2020 of the review’s final report, which has led to the wider health system reforms.

Deputy director-general, data and digital Shayne Hunter told New Zea­land Doctor Rata Aotearoa the ministry is working to develop the business case including tranche 1’s scope and time­frames. Tranche 1 will be dependent on government approval of the detailed business case, his email response said.

During development of the business case, the ministry will work closely with the Transition Unit, Mr Hunter says. The three stages of nHIP are expected to be rolled out over five years, he says.

The platform is also getting a re­name. Mr Hunter makes reference to the new name, Hira, though it is un­clear whether this is an acronym.

And of primary care’s digital readi­ness for the coming changes?

Health IT champion and Wellington GP Richard Medlicott and health IT business leader Peter Jordan see the sector, especially general practice, as be­ing better prepared to meet Mr Little’s expectations around integrating into the new digital ecosystem.

Dr Medlicott expects Health NZ will have to shop around to find and acquire centralised systems to manage the country’s hospitals. But, in general practice, IT vendors and practices have workaround application programming interfaces (APIs) for practice manage­ment systems, so are closer to the nHIP goal of secure and safe interoperability of information systems.

APIs are go-between programs that enable disparate systems, like PMS systems, to exchange infor­mation.

Mr Jordan, a solutions architect at Patients First, and chair of the New Zealand chapter of health IT global interoperability standards organisation HL7, cites PMS developer Medtech’s ALEX API, which any health organisation is free to use to safely con­nect with the company’s PMS products.

Dr Medlicott says pharmacy systems are also relatively up to speed on the new ecosystem’s requirements.

However, as in other areas where re­form was announced, the funding to revamp health IT systems, and who will get what funding, remains to be decid­ed by the Government.

Dr Medlicott calls the amount of money spent on primary care compared with secondary care, including health IT, “a pittance”. He hopes primary care doesn’t miss out on health IT funding.

Dr Medlicott says he would not want general practice to bear all the cost of fit-for-purpose systems directly, or in­directly through costs passed on from the likes of PMS vendors.

Mr Jordan’s main concerns are logis­tical, not conceptual, especially with addressing the patchwork of systems used by DHBs and their hospitals.

It seems a no-brainer to consolidate the DHBs’ IT capability, he says, so there aren’t 20 sets of departments do­ing their own design and developing. But, “what worries me is, how you’re going to get from the existing position, where there are hundreds of small to large and bespoke apps, to…four, or even one single system”.

“How do we get there from where we are now and still hope to have function­ing hospital systems? That's a big con­cern for me,” he says.

While new systems that comply with the ministry’s Health Information Se­curity Framework standards and nHIP requirements go live, existing systems can’t simply die.

Patient safety is paramount, so the tech industry mantra of “minimum vi­able product” has a much higher threshold where healthcare is con­cerned, Mr Jordan says.

Like most experts in health IT, he says he embraces nHIP, and hopes it gets the funding it needs to be a fully realised success.

“We want to improve IT services to improve people’s health out­comes, fundamentally, that’s what it’s all about,” he says.

New Zealand may benefit from a na­tionalised health IT board and an actual health IT plan, which was last seen in the 1990s, so “in some ways, we could be going back to the future”, he says.

Mr Jordan ends his conversation with New Zealand Doctor a bit dizzied by the prospect of heights yet to be climbed.

“It’s a little bit like Mt Everest in the 19th century,” he says. “People saw it there and said, ‘I want to climb that mountain’, but they had absolutely no idea how to get there and didn’t have the equipment.”