How can New Zealand use digital health strategies to align the healthcare system with modern needs?
Health and disability infrastructure supports the quality and the level of service that our health system delivers, contributing to our wellbeing. This infrastructure includes community-based facilities, aged residential care facilities, District Health Board (DHB) facilities (including hospitals), and privately funded health care facilities, as well as the IT landscape across the sector.
Over the past decade, it has come to light that healthcare IT infrastructure networks, and security are outdated and unable to adequately support the introduction of new systems or manage increased cybersecurity issues. This outdated infrastructure also presents challenges to users accessing and using patient or clinical information across both internal hospital locations and wider health service settings. Further, the devolved capital settings for DHBs means that IT investment is largely driven at an organisation level rather than via a national approach to implement the same systems to perform the same functions.
The mobility of the IT landscape has changed dramatically since the widespread adoption of smartphones and similar devices in the late 2000s. Clinical staff expect patient and clinical information to be accessible to view, for collegial discussion conversations with patients and to update on-the-move between patient care areas, offices and community settings. Yet realisation of these expectations is constrained by limitations in funding, infrastructure, legacy applications and the slow adoption of national data standards for interoperability.
A government report from 2020 indicated that around $2.3 billion is needed over the next decade to address issues with DHBs’ legacy systems and invest in technologies that enable new models of care. Prior to the Government’s recent health reforms, each DHB had its own priorities and many of them didn’t invest enough in data and digital technology. Last year Te Whatu Ora identified 1600 IT projects inherited from the now-defunct DHBs and in need of review. There is a multi-layered environment of clinical data generation, access and reuse within health services. It is critical to note that when health professionals find systems difficult to access or use, they resort to workarounds with paper forms, email and smartphones. This undermines the integrity of data repositories and compromises the value of information for the clinical workflow and management analysis. Working to resolve access barriers to clinical information and collegial communication is a prudent step towards aligning the system with the changing demand landscape.