No health IT strategy, or too much? Take your pick

Health IT strategy got a check-up in Auckland last week and was found to be more than a little septic.

Speaking at the Health Informatics NZ (HINZ) seminar in Auckland last week, Hutt Valley District Health Board chief executive Chai Chuah said the sector was riddled with policies and strategies, many of which were just words without any substance.

"Hardly anyone pays any attention, so is it any wonder why we are so fragmented."

Chuah warned against enthusiasts. "Beware of enthusiasts. They're so knowledgeable and ahead of the pack that the rest can't follow. Therefore, they can't be leaders."

National health policies needed to be aligned, he said. Particularly, a national picture of what constituted an electronic health record was needed.

The seminar, titled "Linking Systems to Strategy", featured eight speakers, all of whom are leaders in their respective parts of the sector.

Chuah's outspoken criticisms were backed up by less direct comments from the other speakers.

"We have a rather fractious landscape in Health," says Vino Ramayah, executive chairman of Medtech Global.

A question to the first speaker of the day rather typified the disparity between the Ministry of Health and the other parties. Deborah Roche, the ministry's deputy director general, health and disability systems strategy, spoke about understanding the requirements of the health system for information sharing.

Her presentation was largely based around statistics, which led Counties-Manukau CIO Phil Brimacombe to ask: "What does your job actually mean?"

Roche replied and Brimacombe said: "I need time to digest that."

Technology use, Roche said, should be cost-neutral. There were big disparities among the 21 district health boards.

"Why does Fly Buys know more about your movements than does a hospital?" she asked. There needs to be better understanding of the ownership and the use of information, she added.

Two main themes emerged at the seminar. The first was who should own data about patients. Should it be the clinician or the patient? There were several views but an informal consensus emerged that it was more about controlled access to the information rather than ownership.

The second theme was patient-centric health, were the patient had access to personal health information and took some responsibility for using that appropriately.

Some thought that, eventually, the patient would access personal health information through portals. That, in turn, raised the issue of privacy. The attendees thought, in general, there needed to be much more public debate about that.

The overall state of the health system was cause for concern.

"I think we're buggered," said Professor Murray Tilyard, professor of general practice at Otago University. "Who's going to be there to care for me when I'm 80?"

Bev O'Keefe, chairman of the general practitioners' leaders' forum, said major investment in the culture was needed. "Many DHBs are struggling just to keep their hospitals alive."

Peter Moody, a senior Wellington doctor, was adamant that the development of information technology had saved general practice from oblivion. "I can now measure things."

Paul Roseman, CIO at Procare Health, said health had done relatively badly by its IT vendors by driving prices too low. People were consequently having to be inventive at making money, not always to the benefit of the system.

The final speaker was Alan Hesketh, deputy director general of the ministry's information directorate.

"I increasingly believe there is no such thing as an IT strategy," he said. "What we need is a change strategy. We need to be aligned with health as it goes forward."

He pointed out that 9% of GDP is spent on health, which as a sector employs 120,000 people.

Hesketh took the audience through a basic IT 101 without revealing much of the ministry's future direction.

He commented about shared services, which he said some in health thought were dirty words.

"I have to ask why do 21 DHBs have 21 accounting systems."

However, he outlined nine steps that were necessary to enable shared services, some of which were very prone to causing failure.

"We need to think of different models to make our spend more effective," he said. "And we need to understand the business value before we look at electronic health records. There are so many stakeholders with different needs that there will probably never be a single electronic health record.

"Ideally, we will be able to exchange information through standards."

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