How do we establish a consolidated foundation for the future?
Te Whatu Ora's Data and Digital (D&D) division is pivotal in enabling the health system's reform agenda in New Zealand. The integration of 29 organisations into a coherent and efficient digital system represents the largest ICT programme ever undertaken in the country. However, this task is complicated by a legacy of underinvestment, leading to significant technical debt and a lack of clarity about the current state of digital services.
NZ's health sector has historically underinvested in technology, with only 2.5-3% of the total health spend allocated to IT, compared to 5-8% in other advanced health systems and 10% in digital leaders. This underinvestment has resulted in fragmented and outdated IT infrastructure.
Technical debt in Te Whatu Ora's IT systems extends beyond the immediate financial implications. Outdated infrastructure poses risk. Eventually, the deferred costs for upgrades and maintenance emerge, often necessitating emergency expenditures at the worst possible times. This debt includes over 6,000 databases on 1,000 physical servers, 70,000 devices, and a complex network infrastructure. This scenario not only incurs high maintenance costs but also introduces substantial risks of data loss, cyber breaches, and system failures.
In response to these challenges, Te Whatu Ora is focusing on standardising and consolidating its IT systems to form fewer, more robust national platforms. The new operating model, effective from November 2023, organises the D&D division into five major delivery functions: Sector Digital Channels, Integration & Delivery, Cyber Security, Data Services, and Digital Enterprise Services. This model aims to streamline IT operations, improve cybersecurity, and enhance data services across the healthcare system.
Despite these initiatives, several challenges remain. The national and regional tension in implementing IT solutions needs careful management. The reliance on contractors and the difficulty in attracting and retaining skilled staff pose significant hurdles. Additionally, the rapid pace of change in both the health and technology sectors adds layers of complexity to the integration efforts. The current IT landscape's technical debt exacerbates these challenges, making the system harder to protect and less efficient.
NZ’s journey towards digital modernisation is complex and fraught with challenges. However, with careful planning, robust governance, and adequate investment, the sector can leverage technology to enhance healthcare delivery and achieve its reform objectives.