ICT funding should be examined against health reform expectations – report

eHealthNews.nz: National Systems & Strategy

ICT funding should be examined against health reform expectations – report

Wednesday, 15 November 2023

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NEWS - eHealthNews.nz editor Rebecca McBeth

Historical under-investment in health ICT, compounded by a lack of investment coherence across former districts, has resulted in significant tech debt that complicates the task of integrating data and digital services under Te Whatu Ora, a new report says.

A report from the Ministerial Advisory Committee for Health Reform Implementation provides an assessment of the data and digital service’s progress towards the health reform objectives.

It acknowledges that this is a “complex area with a history of underinvestment that has resulted in a build-up of technical debt”, and recommends that the level of data and digital funding “be closely examined against reform expectations and the organisation’s ability to meet those expectations financially and in terms of capacity and capability”.

The report, dated August 2023, says the merger to create Te Whatu Ora represents the largest ICT programme ever undertaken in New Zealand.

“Progress is being made in some areas, especially in terms of access to, and use of, data, cyber security, and architecture development,” it says.

“Progress against the Horizon 1 Roadmap, however, indicates potential issues with planning and prioritisation of initiatives and understanding the capabilities and capacity of Te Whatu Ora data and digital and of the organisation as a whole.”

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Chief data and digital Leigh Donoghue tells eHealthNews interviews for the assessment were completed in April and May 2023.

“Some of the uncertainty of direction and structure is a reflection of that point of time. We were in formal consultation for the new structure then, and six months is a long time in the life of a new organisation,” he tells eHealthNews.

He says the level of IT investment in the New Zealand health system is less than in comparable health systems and has been sub-optimised in many ways because it has gone into supporting local solutions, leading to complexity and tech debt.

“We need to set realistic reform expectations in terms of the pace of change,” says Donoghue.

“We need to move forward deliberately and consistently, but we also need to do it in a way that does not put at risk existing services that are stretched even further through clinical workforce shortages.”

He compared the pace of the digital journey to travelling on a road that is full of rocks and potholes.

“You have to fix the road to go fast: that is the tech debt and the legacy landscape that we are working with.”

Donoghue says Te Whatu Ora consumer facing services are built on modern cloud-enabled platforms and the team can move fast in that area.

Clinical systems is a complex landscape with thousands of applications, and many point-to-point interfaces, which makes things harder.

Corporate systems are a mixed state, with a national finance system that has accelerated over the past 15 months, while HR, rostering and payroll systems remain complex.

“Our ability to move forward quickly depends on the legacy state and the level of investment that we make, as well as our capacity and capability to step up and meet the challenge,” Donoghue says.

The assessment report says that as well as the new Operating Model, there are three documents that together set out the data and digital strategic direction and initiatives; the Data and Digital Strategy, the Data and Digital Horizon 1 Roadmap, and the draft Architecture Blueprint.

“These documents are aligned around one vision and five priority areas. However, they then break down into a somewhat confusing collection of themes, goals, flagship initiatives, roadmap initiatives, guiding principles and customer needs and priorities, reflecting a lack of clarity and focus,” it says.

In a preliminary response, Donoghue says that before the 28 health entities came together under Te Whatu Ora, there was no national picture of the ICT landscape, and no due diligence of the assets, workforce, projects or financial structure.

“Given mixed capability and performance across previous entities, including inconsistences in documentation, reporting, and risk assessment, the scale of this challenge is also still emerging,” his response says.

A new operating model and structure for data and digital went live in November 2023. Governance arrangements are now in place alongside a strategy and roadmap that includes simplification and standardisation.

“We have stopped proliferation of new IT products and services (we inherited over 1500 projects) and are replacing end-of-life systems with fewer, better national platforms,” Donoghue says in the response.

Donoghue tells eHealthNews the new organisational structure means data and digital is now making investment decisions through a national lens based on national priorities.

The team is still working through the inventory of 1500 current projects, some of which involve minor enhancements or upgrades, and a number have been completed.

“There was an enormous amount of activity, but it was not necessarily coordinated or optimised. We are looking at how we align and harmonise by bringing new national approaches,” he says.

The report notes that national and regional tensions will require careful management as regional solutions have been identified and are being developed and regional views may not align with central views.

Donoghue says data and digital is working through the change required for that national approach, as until recently local management structures meant that many teams were caught between delivering projects and supporting operations.

“The task is to ensure that we create clarity around the role of each of the respective areas and are responsive to local needs of frontline care,” he explains.

The report also identifies challenges around loss of organisational knowledge as people move around the system or leave due to restructuring, as well as attracting and retaining skilled staff as the service “faces difficulty matching renumeration levels offered elsewhere”.

Donoghue says staffing is a challenge across industries and health is not immune.

“It is important that the value of our workforce is being recognised and that we reflect that through what we pay people, which is not easy against a very tough fiscal backdrop.”

He says the focus has rightly been on addressing pay issues for clinical staff initially, but Te Whatu Ora is now working through the enabling services such as data and digital to ensure they are recruiting and retaining skilled people.

One of the report’s seven recommendation is that the expected status of Hira at the end of Horizon 1 be clearly stated and that the programme be closely monitored. It notes that there has already been a programme reset to “reduce the financial burn rate and increase the value produced by focusing on delivery”.

Donoghue says the Hira programme set really ambitious goals and probably sought to tackle too many problems at once.

This year a reset was initiated to refocus the programme, align it with the broader digital transformation roadmap and maximise investment.

“I see very focused goals now: we are in the best shape that we have been with the Hira programme,” he says.

Picture: Te Whatu Ora, chief data and digital Leigh Donoghue