By Sarah Putt

New Zealand Editor, Computerworld

Major report into national health system highlights need for long-term digital and data strategy. The government says no action is anticipated before the election.

If 150 million Eftpos transactions can be processed monthly, and 60% of adult passport renewals can be processed online, why do we have a national health system where people can’t do something as simple as update the address that’s linked to their National Health Index Number?

That’s the question posed in the Digital and Data section of the Health and Disability System Review, a 274 report that examines every aspect of New Zealand’s health system. The IT-related section champions the use of digital technology to enable better healthcare, for example through telehealth initiatives, but notes that the health service needs to get the basics right first. “The system needs a clear long term digital and data strategy and plan to ensure a cohesive, effective modern health and disability system. Continued piecemeal approaches will not be sufficient,” the report says.

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For example, the report notes that that there is no mandated standard primary health care data set. While nearly all primary providers use computer systems, they are from a range of independent providers and are not “sufficiently joined up” to support collaboration nor produce the kind of consistent data that is useful to inform research, policy and service development.

Cybersecurity is also raised as issue due to “ageing and fragile infrastructure, and lack of resources to maintain good security hygiene and robust practices for security operations management … The lack of a centralised identity management solution means most systems do not have audit capabilities to monitor and report on inappropriate access to information. Getting this right would be critical to build whānau and community trust to improve data accuracy and sharing across the system.”

Better systems interoperability and data sharing can be achieved, with a solution to tackle this issue understood to be currently before Cabinet for consideration. The National Health Investment Platform (nHIP) is a programme of work that has been designed around delivering work in flexible tranches in which an MVP (minimum viable product) is created and iterated upon.

The first tranche is focussed on connecting demographic, medicines and immunisation data and sharing it with providers and consumers. According to the report, the launch of this initial tranche was scheduled for July. In mid-June, Computerworld New Zealand asked the office of the Minister of Health for an update on the nHIP business case, and received this reply on 25 June:

Cabinet gave approval in 2019 for a business case to be developed for a National Health Information Platform (nHIP). The business case was due to be submitted to Cabinet in February, but development was delayed due to the onset of the COVID-19 pandemic. The [July] Tranche 1 launch date referred to in the Health and Disability System Review was dependent on the business case being submitted to Cabinet in February.

Budget 2020 allocated $5.35 million in operating funding for the project in the 20/21 fiscal year, largely to enable the completion of the business case. When the business case is completed it will go back on Cabinet’s agenda. An updated indicative launch date for Tranche 1 of the project will be set if and when Cabinet approves the business case. That is now unlikely to happen before the election.

NZ Health IT CEO Scott Arrol says while it is understandable that further action on the nHIP business case has been delayed due to COVID-19, it should now be fast-tracked “so the country gets ahead of the curve in creating a health system we can be proud of and one we can rely on when the next pandemic comes along.”

Arrol told Computerworld New Zealand that the entire sector is aligned around nHIP and it’s important to seize the momentum, noting that the business case for nHIP is “keyboard-ready. … We can’t afford for further delays to occur. Crikey, we’ve already been waiting nearly 20 years for this level of validation to finally occur. There is a swelling level of frustration across the health sector from clinicians right through to patients that now is the time to be bold and brave and definitely not a time to be risk averse as there’s far more to be gained,” Arrol says.

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When asked if the report’s recommendation that reducing the number of District Health Boards (DHBs) to eight to ten will make a difference, Arrol noted that lack of investment in IT is behind many of the shortfalls in delivery. “There has been a real stepping up of the leadership of IT people, so I’m hesitant to say that going from 20 to eight DHBs is going to be the panacea.”

He used the phrase “taking a knife to a gun fight” to illustrate the constraints that IT leaders in DHBs are faced with. Arrol referred to a government stock take of the physical infrastructure of DHBs, which noted that their IT assets were begin maintained "in an environment of accumulated underinvestment".

Arrol estimates that most DHBs spend about 2.3% to 2.5% of their budget on IT, while the global average is that IT makes up 4.8% to 5% of the overall health budget. He would like to see IT spend be ring-fenced, so it doesn’t get spent on other things. “We’ve got to ring-fence the IT budget and multiply it by two,” he says.

Meanwhile, the Clinical Informatics Leadership Network (CiLN), whose members include 360 clinicians, has written an open letter to the director general of health Ashley Bloomfield. In it, CiLN calls for investment in clinical informatics roles and the development of a digitally literate and capable health and disability workforce. “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,” the letter says.

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