GUEST BLOG: Ian Powell – Health system IT: 0 steps forward; two steps back

There were several constant messages I received or witnessed from hospital specialists when I was executive director of the Association of Salaried Medical Specialists for over three decades.

Up there with the more frequent was their frustrations with the poor quality of information technology in Aotearoa New Zealand’s health system. The failure to develop a shared national electronic patient record was a big part of this frustration.

Hospital specialists would “die” for an electronic patient record system

Specialists saying they would “die” for such a system was not uncommon; figuratively of course (or at least so I thought at the time).

A national electronic patient record system would have been a powerful enabler to enhancing the quality of care that they could provide for their patients.

Broadbrush overview: struggling to overcome fragmentation:

A big driver of this situation was the seriously flawed ideological decision to require public hospitals to compete, rather than collaborate, with each other and the private sector in the 1990s. Fragmentation was an inevitable outcome, including IT systems.

National health minister Simon Upton was the intellectual architect of failed market experiment

Following the end of this failed ‘market experiment’ district health boards (DHBs) were established on 1 January 2001 under new cooperative-based legislation.

DHBs and a new restructured Ministry of Health were confronted with the immediate challenge of inheriting a fragmented health system. This considerable challenge included fragmented IT systems.

Understandably this took time but, by the time of the change of government (from Labour to National led) in 2008, clinically led DHB engagement was making promising progress towards a national electronic patient record.

There were some great ‘brains’ involved in this constructive process. The task was difficult but there appeared to be light at the end of the tunnel. But…

Health Minister Tony Ryall fatally shifted IT reform from DHBs to top-down central government

However, new Health Minister Tony Ryall centralised the process which had the effect of slowing it down and making it more bureaucratic instead of relational.

In the 2010s DHBs found themselves under increasingly disenabling pressure due to a combination of underfunding and an increasingly top-down leadership culture from the health ministry.

This culture continued after Labour’s return to the government benches after the 2017 election. Arguably it got worse (definitely from July 2022).

Labour health minister Andrew Little’s health restructuring and leadership culture further impeded IT development

Throw in the disruption of the Covid-19 pandemic and Labour’s disastrous health restructuring and surprise, surprise, today little has changed.

A noble exception

Except that when it became clear in the 2010s that the national structure established to take over IT reform was not going anywhere sufficiently useful, the five South Island DHBs got together and developed their own electronic patient record system.

This was achieved very much ‘below the radar’. Given the problems with the corrosive culture of health leadership in central government (‘the centre’) this was a pragmatically sensible approach.

David Meates, chief executive of the largest of the South Island DHBs (Canterbury) that developed a shared electronic patient record

This was an impressive achievement. Had the prevailing health leadership culture in central government been different there would have been encouragement from the ‘centre’ to extend this innovation nationally.

Unfortunately, however, the culture was not up to it. Worse still, the culture proved to be obstructive.

Budget cut causes more IT strife

Fast-forward to 2024 and the health system finds itself in further strife as Health New Zealand (Te Whatu Ora) is now instituting an IT budget cut.

The driver is the Government putting balancing an underfunded budget with the healthcare needs of the ill as well as the wellbeing of the health workforce.

In other words, patient needs and the health workforce are seen as balance sheet liabilities.

This is revealed in yet another quality investigative article by Marc Daalder (Newsroom, 12 July): Budget cut threatens health information sharing.

Daalder reports that “Programmes to share health information between hospitals, GPs and specialists and across district boundaries have been scrapped or put on ice due to funding cuts.”

Elaborating further:

Digital health advocates are concerned the health system may remain stuck in the 20th century, relying on paper records and phone calls for information-sharing rather than an integrated digital system after the Government cut $381 million in planned digital investment in the Budget in May.

He reports Ryl Jensen, Chief Executive of the Digital Health Association, who sums up the concerns well:

How can it not hurt? When you reprioritise funding, you’re going to lose time and you’re going to lose people and you’re going to lose knowledge and you’re going to lose momentum. And we were starting from behind in the first place.

She points out that Health New Zealand staff on fixed-term contracts within the data and digital teams have not had their contracts renewed. Consequently:

We’ve lost a lot of institutional knowledge. We’ve lost those people that can mobilise projects. Let’s say, at the end of the year, we are able to get some funding back for the 10-year investment plan. Who’s actually going to do it?

Important work under threat include digitising the health system, centralising laboratory results, and bringing together the former DHBs IT systems.

Stepping back, not forward

 

The phrase “take two steps forward and one step back” is a metaphorical expression. It means making progress, but also experiencing some setbacks or challenges along the way.

Not just Ryl Jensen and the Digital Health Association but, in fact, the country’s whole health system would “die” (figuratively at least) to see this rate of progress in IT development.

Instead what we are experiencing is zero steps forward and two steps back.

 

 

 

Ian Powell was Executive Director of the Association of Salaried Medical Specialists, the professional union representing senior doctors and dentists in New Zealand, for over 30 years, until December 2019. He is now a health systems, labour market, and political commentator living in the small river estuary community of Otaihanga (the place by the tide). First published at Otaihanga Second Opinion