GUEST EDITORIAL: Health IT - Visions, Programmes, and Case Studies

Dr Peter Davis, Professor of Public Health, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand

In this inaugural issue of Health Care and Informatics Review Online, we have four papers that cover the range of health information technology (IT) issues in New Zealand - a statement of vision, a programme outline for the sector, and two case studies.

In his statement of vision for the sector, Mike Rillstone, the Ministry of Health’s chief advisor on IT, outlines an evolutionary approach towards "the ultimate goal of electronic health records and a fully integrated health information system". It may be surprising to the observer that a country of four million, with a health sector dominated by a substantial taxpayer contribution, should only now be drawing up an agenda that will place New Zealand somewhere close to the potential that the IT revolution can deliver. Hardly an ambitious target technically, but clearly a managerial and political challenge. For example, Rillstone mentions the possibility of a data warehouse documenting patient subsidy payments - general medical services (GMS) benefit - but these receipts have been collected since the 1940s. What this suggests is that, beyond the pure IT and information management (IM) functions, we need to consider the importance of such data for the management of the health system.

Paul Cressey describes some of the key steps on the road to the vision outlined by Mike Rillstone - namely, the establishment of health information standards. Without such standards, how can data be compared? A quote from Florence Nightingale indicates that this was a concern in 1863. Again, we have been slow to follow up on transparently useful initiatives in data capture and management. Paul lists the major recommendations for improving the quality of health information in New Zealand. It will be useful to see how this compares internationally.

Two case studies follow - one more broad brush, drawing on the experience in South Auckland, the other focused on a well-argued success story in oncology. In the first case (South Auckland), the reader would be eager to know more about the system established in child health, together with some data. Increasing reported immunisation rates from 40% to 94% is a success in anybody’s book - but why is such a scheme not nationwide in scope? Evaluation, lessons learned for others, implementation issues, would all be useful.

Finally, a clinical information system in oncology. Andrew Miller makes the important point that such a system is more than a paper substitute since it contributes to a range of management tasks. Admirably, this paper addresses the issue of using such systems for quality assurance, including the comparison of clinician patterns. Similarly, the important point is made that having computing experience is not enough; implementation of these systems requires a range of abilities and circumstances, including influence over decision-making.

All in all, a solid beginning. In future papers, we might see more fully documented case studies, more empirical evidence, more evaluation, and more reference to an international literature.