Cervical screening register went live with ‘known issues and missing functionality’, review finds

NEWS  - eHealthNews editor Rebecca McBeth

An independent review has found nearly one million notifications were not sent or even triggered for people eligible for cervical cancer screening, and the screening Register was launched "with limited functionality and several known issues".

The review into the National Cervical Screening Programme (NCSP) Register was commissioned by Health New Zealand | Te Whatu Ora and a formal action plan is now in place to address the issues.

The Register was launched in September 2023 and designed to centrally manage invitations, recalls, reminders, and clinical follow-up for all eligible people aged 25 to 69 with a cervix. 

One of several known issues at launch was "incomplete data migration from the previous register" and interviewees described it as a ‘working prototype’ with known issues and missing functionality, the report says.

Many initial requirements did not make it into the Minimum Viable Product (MVP) including; a link to the National Immunisation Register to check HPV vaccination status; interface with hospital IT systems; compatibility with SNOMED CT23 clinical coding; and email and text message notifications initiated by the Register.

The new report says there was a lack of adequate user acceptance testing prior to launch, and inadequate post go-live monitoring.

High staff turnover on the project had led to loss of institutional knowledge, and it was understaffed after implementation was completed and “funding ran out”.

“Several interviewees commented they had hoped the rollout of the Register would benefit from lessons learned during the implementation of the NBSP’s Breast Screening Register,” it says. 

The BSR is built on the same Salesforce software as the cervical screening register, but the report says they use different Salesforce environments and add-ons. Also the NCSP’s clinical pathways are much more complex, and therefore more difficult to build into a technology platform. 

The review, conducted between November 2024 and June 2025, found that around 160,000 notifications were triggered but not sent, including around 108,000 eligibility notifications not sent to people classified as "inactive" in the National Health Index (NHI), and 51,000 recall and reminder notifications withheld due to a phased rollout approach known as "cohorting." 

More than 680,000 notifications were never triggered at all, including around 650,000 eligibility notifications, of which approximately 495,000 were not triggered because the individual was deemed inactive, as they had not accessed health services for three years.

Another 100,000 reminder notifications were not triggered due to what the review describes as "case closure issues."

The issues identified include that the Register cannot look back at a person’s previous screening history, meaning it cannot automatically flag individuals as unscreened or under-screened. It also lacks the ability to send notifications by email or text message and is not yet integrated with primary care practice management systems.

“Interviewees said that one of the most significant functions not delivered was the ability of the Register to flag someone as being ‘unscreened’ or ‘under-screened’, thought to be essential to implementing the Notification Strategy,” the report says.

“The review panel was told that the NCSP’s clinical team did not have direct involvement in some of the Register’s functionality during development. It was said the implementation had lacked a ‘translator’ who could act as a go-between for the clinical and ‘technology’ teams within Health NZ and with the ICT vendor.”

The review found there was no single, unified process for identifying and documenting risks across the NCSP's clinical, operational, and digital teams, and concluded that clinical risk was not always fully understood by senior decision-makers or the IT vendor.

Health New Zealand has published an action plan in response to the review's 48 recommendations, organising implementation across three workstreams: System Integrity, Data and Integration; Service Delivery and Operating Model; and Clinical, Quality and Monitoring. Implementation is planned over two years.

For the system integrity, data and integration workstream the focus will be on “strengthening the reliability, functionality, and long-term sustainability of the Register and supporting systems, including data quality, system integration, and clinical rules,” the plan says.

The action plan also commits to phasing out cohorting, developing email and text message notification capability, and undertaking a critical assessment of the Register's long-term viability.

If you would like to provide feedback on this news story, please contact the editor Rebecca McBeth.

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