Barriers to funding health IT projects need to be overcome

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eHealthNews editor Rebecca McBeth

An eHealthNews investigation reveals that around 2.3 per cent of the total budget of New Zealand’s district health boards is being invested in technology. eHN editor Rebecca McBeth explores the challenges around funding health IT projects and how they can be successfully implemented.

There are significant barriers to investment in IT within the health sector. Competition for scarce resources with those to meet clinical needs, lack of an easily quantifiable return on investment and a history of well-publicised failures all contribute to the problem.

However, while the issues are the same the world over, New Zealand’s public health sector is underspending by a significant amount at around 2.3 per cent, compared to the Gartner global industry average of 4.6 per cent. Gartner benchmarking delivers unbiased comparisons of IT performance relative to peer organisations and those considered best-in-class.

The Kiwi context

Ministry of Health chief technology and digital services officer Ann-Marie Cavanagh says New Zealand’s devolved health service delivery model means investment in health IT is made by multiple organisations.

Each of the 20 DHBs prioritises IT investment based on their business needs, and against competing investment demands, within their own organisation.

She adds that some IT investment is made at a national or regional level, where it can benefit multiple health organisations, or is funded from sources other than Vote Health.

“Delivering value from health IT investment in a devolved health sector requires a focus on understanding the value that can be realised from health IT investment and ensuring that health IT is successfully implemented,” Cavanagh says.

“The Ministry is engaged with health sector organisations to align investment at a national level, look for opportunities to increase the value from health IT investment, utilise enabling architecture and standards to reduce unnecessary fragmentation and complexity, and apply delivery processes that make implementation successful.”

People vs productivity

Deloitte partner Thorsten Engel is the consulting firm’s healthcare lead and estimates that more than 90 per cent of health IT spending in New Zealand’s DHBs goes towards simply running and maintaining the systems already in place.

If all an organisation’s IT budget is spent in this area, health professionals never see any transformational change in the way of new devices or clinical systems, as only growth and transformational spending has a tangible benefit to the organisation.

“The underlying risk is going up and the opportunity to do far better only comes if you are prepared to really look at the ways we work and use technology to enable fundamentally different ways of working,” says Engel.

“The issue is really a fundamental misunderstanding of productivity. We throw people at healthcare rather than re-engineering things and using systems,” he explains.

Engel says it is estimated that clinicians spend just 60 per cent of their time in patient clinical contact. The struggles they have with administrative tasks and clunky IT systems also contribute to a high number getting burnt out over time.

“People will say ‘I need more people’ as a solution, rather than ‘what can I do differently so the people I have got are working at the top of their clinical practice?” Engel says.

Operating close to the line

Head of the Computer Science Department at Auckland University of Technology Dave Parry says innovative organisations would be spending at least 5 per cent of their budget on IT.

This is difficult when competing for funding against clinical need, especially when health organisations worldwide are operating “close to the red line”.

“The argument is if you spend more on IT you become more efficient and you’ll be able to do more clinically, but you can’t spend money on IT because there’s no money to get over that hump as you’re already at capacity,” he says.

Also, very few studies internationally show that increasing IT spending produces more efficiency.

“Some of the studies show improvements in the quality and safety of care, but they don’t show cost savings. That implies to me that there’s a lot of unmet need so as soon as you’re more efficient you can meet more need, but it doesn’t reduce costs,” explains Parry.

He says it is easier to make the case, politically, for more clinicians or machines, than explaining a big increase in investment in IT for a pay-off several years down the track.

The many documented issues with health IT systems globally over the past 30 years is adding to the difficulties.

“There’s a relative amount of cynicism if not outright hostility to IT spend,” Parry says.

Transparency is key

CDHB general manager planning, funding and decision support Carolyn Gullery says competition for resources within a DHB must be transparent.

“We have a lot of clinical champions for digital, so we have conversations with our clinicians to say, ‘if we invest in this it means we can’t do that or we have to delay this’,” she explains.

The board invests a set amount of money each year into IT innovation and platforms such as shared care record system HealthOne and the South Island Patient Information and Care System.

“We allocate a certain amount every year and a clinical steering group decides on the priorities,” she says.

The Canterbury board opened a new hospital in Burwood in 2016 and is building an acute services building and an outpatients unit, all of which are digital ready.

While the new buildings will not have all the available technology in them from day one, they are ready to adapt to more digital services as funding for them becomes available.

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