Not long after National came into government, Health Minister Tony Ryall identified $700 million in savings to be made in the public health sector. Nearly three years on, some of the changes that are expected to lead to those savings are coming into play.
The National Health IT Plan is still a work in progress with two government bodies collaborating closely on delivering the benefits. The first is the National Health IT Board, responsible for overall information services governance in the sector and for all clinical applications and related business intelligence. The other is Health Benefits Ltd (HBL), a stand-alone Crown company set up to help district health boards save money by reducing administrative support and procurement costs.
HBL was given the role of identifying $700 million in savings over the five-year period to July 31, 2016.
Its first-year target was $30 million. The data has yet to be finalised but communications and engagement manager Mark Reynolds says a substantially higher figure is expected.
“There is a significant variety within information services across DHBs, both in terms of maturity, systems stability and approaches,” he says. “The sector is characterised by under-investment in information technology, with some systems reaching end of life and upgrades being deferred.
“By taking a whole-of-life approach for all DHBs, HBL will be able to create benefits through cost avoidance or reduction in duplicated effort/waste.
“Our work to date has been around establishing a roadmap for change and options analysis work, including data gathering and working with DHB sector experts to test the accuracy and relevance of our data and options.”
Reynolds says a business case for HCL’s information services work is expected to be completed later this year “but within the next couple of months we expect to share with the DHBs our business case in the finance, procurement and supply chain areas”. This will include looking at options for finance ERP in DHBs (15 of the 20 DHBs use Oracle financials.)
“A key workstream within the information services programme will be collective negotiation of contracts. These include DHB contracts with significant suppliers of commonly-used products, large account resellers and other application providers. A master services agreement is currently being developed and will be rolled out to standardise contracts across the sector.”
Reynolds says that because of the diversity within the health sector and complexity of IS and MIS functions, every proposed initiative requires careful analysis and a data capture phase prior to developing its business case. “It is not an overnight process.”
HCL’s scope within information services encompasses all management, governance, technology and infrastructure for the sector, as well as applications and business intelligence for the business support functions with DHBs. This includes services such as library, service desk and all knowledge management.
Graeme Osborne is the director of the National Health IT Board.
“In the past, the Ministry of Health has bitten off too much,” he says. “Our job is to get others [in the sector] motivated. It is a major achievement that we now have the sector behind a single plan. It is very hard to get the health sector to agree on things. “We’ve got a group of clinicians helping to set priorities so we can agree on an IT approach.”
One issue is the ministry’s health payments engine in Dunedin. Osborne says they are putting in better controls and pairing off some transactions that are the weakest and putting them into a stronger environment.
“But there’s an argument about whether the ministry should be handling this. We are also looking at the DHB systems. Should they be in a regional environment?”
The sector is using a mix of financial systems: Oracle, ProClaim, CMS and CCPS.
Osborne says electronic health records are the logical way to go in the future, but have so far been unobtainable. He points to why the take-up has been unsuccessful in the UK with the botched attempt to create nationwide, electronic access to patients’ health records by medical staff. The reasons include technical immaturity, lack of interoperability, lack of policy to support sharing confidential information, organisational readiness, change required to current work practices, as well as the political context of the programme.
Health is personal, he says. One argument resolved in New Zealand is who owns the patient’s data. It is the individual, not the doctor.
“By 2014, New Zealanders will have a core set of personal health information available electronically to them and their treatment providers, regardless of the setting as they access health services,” he says.
Priority programmes for this year and next are eMedicines; regional information platforms for DHBs; national solutions such as oncology, cardiac health, health identity and connected health, along with integrated care initiatives.
In a recent booklet, the Ministry of Health says that if people have electronic access to their own health information, they will be more likely to seek care and health problems will be found and treated sooner.
Last month, the South Canterbury DHB began to run its IT systems at the Canterbury DHB. A new clinical workstation lets clinicians at both DHBs view patient information through a single, secure web-based system.
Health professionals use their computers to log on to clinical workstations to get a fuller picture of a patient’s information, including laboratory results, radiology images and discharge information. The health professional clicks on a patient’s National Health Index Number and all the clinical information they need is available.
The new information system provides access to discharge summaries in real time, meaning patients receive follow-up care much sooner and are more likely to make lasting lifestyle changes.
Osborne says the West Coast DHB will come on board early next year to the common system, with the Southern and Nelson/Marlborough DHBs to follow.
“A similar project is planned for the six DHBs in the lower North Island,” he says.
“The South Canterbury project was budgeted at $1 million over two years. They did it all in one year for hundreds of thousands of dollars.”
Concerto, from Orion Health, seems to be the clinical workstation of choice – 14 DHBs have selected it.
“We have convinced Orion to get it down to four regional versions,” Osborne says. “That reduces the need to produce many multiple versions of upgrades. The other six DHBs have accepted the proposition.”
Two new projects are due to be announced on September 2.
The first is GP2GP, a new electronic system that allows a person’s medical records to be transferred immediately if they change doctors. Previously, their medical records would have been mailed to the new practice, where they would have to be re-entered into the practice management system.
Data is entered in a new common format. Osborne says 75 practices (there are 1200 in New Zealand) have participated in a trial. It’s expected to take a year to roll it out to all practices.
The second is an ePrescribing service, which is currently in trial. When a doctor writes a prescription is will be transferred immediately to a pharmacy system, which the pharmacy the patient chooses can then download.
Ultra Fast Broadband (UFB) will be very important, Osborne says. “It will allow more hosted systems in the short term.”
UFB will enhance the use of video-conferencing, which is increasingly being utilised for remoted diagnosis and monitoring. It also allows digital images such as x-rays and scans to be shared.
Around 25 percent of the health programmes are now being run through a DHB regional model. The country has been divided into four regions, with a single IT programme director for each region.
“We put out the draft national plan and they build a regional plan to fit,” Osborne says.