Health requires a 'blueprint for change', says DHB group

District Health Board collaborative says Horn review must deliver real transformation

A group of District Health Boards collaborating to build a new shared information system is continuing to pursue its vision, despite a recommendation to the Minister of Health that the project not proceed in its present form.

"There's a lot of good stuff in the Horn report, and stuff the Health Management System Collaborative (HMSC) finds encouraging," says the chief executive of the consultancy leading the scoping of the project, Simpl Group's Bennett Medary.

Medary says it is good that the Horn report, written by a ministerial review group led by Dr Murray Horn and released on Sunday, has recognised the HMSC effort. It is also positive that the report has acknowledged it is a misconception to think HMSC is searching for an "enterprise" solution rather than one based on standards and interoperability.

He says the focus of the HMSC is on "genuine transformation". The group, involving seven or possibly eight District Health Boards (DHBs), started searching for the kinds of savings the Horn report focuses on — in procurement, deduplication and sharing, he says. However, that vision changed as the group came to realise that the real savings to be had from implementing new systems lie in transforming the way health services are delivered.

"The focus of the HMSC is on genuine transformation, on doing things better," Medary says. The HMSC's discussions have moved beyond IT.

The Horn report said the HMSC project requires many health stakeholders, from primary care, pharmacies, rest homes, and NGOs, to agree to integrate or replace their current systems. Therefore, it said, costs could be higher than expected and need closer examination.

The review recognised the importance of implementing the safe sharing and transfer of patient electronic health information. However, it also noted that any decision by the HMSC will have national implications.

"We would, therefore, advise against proceeding with the current HMSC proposal and suggest it be refocused on replacing end-of-life hospital PASs (patient administration systems) with systems that meet HISO standards and allow easy sharing of electronic information with other providers," it said.

Medary says the drivers of the report, including overcoming fragmentation, the better use of resources on a local, regional and national level, deduplication and bringing things together at a national level all make "perfect sense". He adds that Horn's statements around the driving service delivery and an IT strategy and architecture are also welcome.

However, the real productivity gains in health are not about shared services and procurement, Medary says. He characterises these as "first order, lower level" gains that may be enough to fund some of the costs of IT renewal. The HMSC is looking in the "quantum gain area", he says, where IT supports changes in workflows, boosts resource utilisation and delivers accuracy in supply and demand management as well as delivering improved services.

Medary says this approach is needed to overcome the operating and capital deficiencies that the Horn report identified in the health system.

"Procurement and sharing were the original drivers of the HMSC," Medary says, "however, they were found not to be enough and by no means the end-game."

He says that transformation is the bit that has been underplayed in the report.

"There is an essential need to deal with service delivery transformation," he says.

Medary says simply replacing existing systems as configured now risks investing in a broken business model. The existing system is partitioned in the way it is because of current investment and that affects service delivery.

The HMSC is focusing on how to do health better, Medary says, and the report encourages HMSC to continue to seek engagement with the likes of IPAC and primary health providers and users through the HISAC consumer forum to ensure there is a "blueprint for change".

He says it is will be a mistake to invest seven to 10 years of capital into systems that "have their scope set by the past" and will fail to deliver a sustainable health system.

Horn recognises there are a number of initiatives under way and seeks to align these to support its objectives, he says. The HMSC expects the minister will now seekresponses and dialogue from the health sector about how to go forward before taking the issues to Cabinet.

Medary says Horn's two technology priorities — an electronic health record and a consumer portal — are fine and in synch with HMSC. To pursue that issues about how to develop systems and an integration layer need to be addressed.

But even then, these are "just tools to be used", he says.

"By whom, how and what are they enabling?" he asks. "That's where the productivity gains lie."

Medary warns that the danger of legacy investment is that it may pull people working in the right direction back into the past.

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