‘Technology black spots’ compounding inequities in health

eHealthNews.nz: National Systems & Strategy

‘Technology black spots’ compounding inequities in health

Tuesday, 27 February 2024

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NEWS - eHealthNews.nz editor Rebecca McBeth

New Zealand’s health IT ecosystem has ‘technology black spots’, with variation within services and between regions compounding inequities in how care is delivered across the motu.

Health NZ – Te Whatu Ora chief data and digital Leigh Donoghue spoke at a Digital Health Association (DHA) AGM on February 27 where he said this fragile and fragmented technology landscape is challenging and expensive to maintain.

He said incomplete electronic health records limit the ability of clinicians to make effective care decisions, as well as the ability of consumers and whānau to manage their own health.

He said the reality is that the health system is coming from behind due to significant underinvestment in IT over a long period of time. Spending was also not optimised because of the fragmented structure.

An inventory shows the public health system has the largest and most complex IT ecosystem in NZ with more than 6000 applications sitting on 1,000 physical servers.

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A quarter of all databases are out of support and more than half are on extended support.

There are around 1000 devices that are more than 10 years old and 43 percent of virtual servers are also out of support.

Donoghue said staff have had to fly to Australia to buy old hardware on eBay because it is no longer available in New Zealand, but is needed to keep systems supported.

Half of the critical hardware in use is beyond its intended lifecycle, and all of this creates high vulnerability to incidents and outages.

“We have had a number of service outages since I have been here: single points of failure”

He said the norm in New Zealand is not to have any disaster recovery and so most systems, even mission critical hospital systems, have no backup.

Donoghue compared the IT infrastructure to Wellington’s water system which has 40 percent leakage, saying it is less visible, but also creates a tax on the system, which slows down clinicians, and impacts the quality of care.

“This is the reality that we have to work with,” he told the DHA audience.

“There are pockets of excellence and pockets of innovation, but as a health system, we have too much inconsistency and too much fragmentation.”

Over the past six months Health NZ data and digital has restructured around four core domains and a number of enabling areas.

The focus now is on extending ‘consumer IT’, simplifying ‘clinical IT services’ and ‘corporate IT services’ and building ‘data services’.

He said the digital modernisation programme within Health NZ will provide the base for large scale service transformation and trialling new models of care.

While the old approach was to put in a system, then leave it for the next 15 years until it reached its end of life, the future is evolving towards a platform agile approach with continuous enhancements.

“It's a profound shift and a much more modern way to operate,” he said.

There is also a lot of work around commissioning and changing funding models to create the right incentives in the system.

“I'm incredibly conscious that we are hard to do business with and this is one of the instructions I have given our procurement team - to simplify,” said Donoghue.

He told the industry audience that Health NZ needs to make it simpler, faster and cheaper to contract with them in order to refocus on outcomes.

“Our challenge is to provide the platforms that enable industry innovation,” he said.

Health NZ has made progress in the core foundations and will see significant further progress this year.

Donoghue described the Hira programme as an evolution of thinking about summary care records that is reflected globally.

“I really like the direction that Hira has taken. It is a modern approach that will profoundly move us forward.”

Donoghue also addressed media stories over recent months in which he said his data and digital team had been called ‘woeful and wasteful’, and accused of stifling innovation.

He said his team is incredibly committed to an important cause and that industry has an essential role to play in helping to modernise healthcare in New Zealand.