New Zealand’s health IT strategies and policies are seemingly confused and ineffective, says HealthLink chief executive Tom Bowden.
In a wide-ranging document addressed to “health IT opinion leaders”, he is severely critical of government, though he doesn’t single out any one government agency for criticism.
HealthLink was formed in 1993 as a public-private partnership. It specialises in the development of e-health infrastructures and services, and is active in New Zealand, Australia and Canada.
Bowden’s document is entitled Rethinking New Zealand’s Health IT Strategy and Delivery — a candid viewpoint.
He says that despite having created one of the world’s best IT-enabled primary care systems, New Zealand’s innovation has stalled. Very few new services are now being introduced, and there are significant problems ahead of the health sector unless the barriers to delivery of good information technology are removed, he says.
“New standards that have been developed are not being implemented. Very few new services have been developed of contemplated. A sector that has counted upon innovation is seeking little of no tangible progress year on year. There is no widely agreed strategy that will support investment in development of services.”
Bowden says that over the past six years there has been a major increase in central government’s role in delivery of e-health. “A number of government-funded agencies have attempted to play an active role in the development of new services . . . There is significant fragmentation of the process, and the complex range of government agencies has left little room for involvement by the private sector organisations that led the way prior to 2001.
“Promised additions of key infrastructure have not been delivered (a health provider index, data dictionary are examples). A coherent IT strategic plan is a thing of the past . . . The small amount of funding available is being expended upon projects under the direct control of government agencies rather than being used on the ‘frontline of care’ where users can make better purchasing decisions and create a competitive market for services.”
Bowden says HealthLink is not trying to apportion blame but that automation needs to be improved to unblock a log-jam of unimplemented infrastructure and standards that prevent integration companies from delivering new services.
He highlights three main issues:
— Lack of strategic direction.
— Lack of clarity of government’s role in IT.
— Lack of funding.
“Even Ministry [of Health] staff find the current strategy relatively unhelpful. A senior Ministry staff member recently described HIS NZ’s 12 action zones as the usual laundry list of solutions to the perennial basket of problems.
“There is no proposed architecture for sharing of records; there is no visible effort being put in to gain public support for automation of healthcare processes; and there is no significant level of investment being made to help general practices embrace automation to improve their ability to deliver coordinated care.”
Bowden is critical of the lack of clarity on where the boundaries are between the role of the State and the private sector. This, he says, is having a harmful affect on a number of fronts.
“It appears that government bodies are attempting, unsuccessfully, to take on the private sector role of innovation. State-funded organisations are trying to become system integration companies, using public funds to do so, and competing with existing industry players.”
He says the Health IT Cluster, a largely government-funded entity, is at the centre of much of this activity.
“Over the past few years in New Zealand, there has been little in the way of new national infrastructure delivered, and the only IT capability being delivered to support front-line primary care delivery appears to be despite rather than because of government’s initiatives.
“We have become gravely concerned at the slowing up of key national initiatives (public health initiatives, screening programmes, infectious disease surveillance, and national reporting projects). Delays are often imposed by staffing these projects with consultants, who spend entire projects learning about technologies that are relatively well understood within private sector organisations.”
He says ambiguity over the government’s role, and disquiet at the number of government-related entities dabbling in IT projects means that major IT players are avoiding investment in health IT.
On funding, Bowden says New Zealand should be investing between $50 million and $150 million a year in development of IT systems and services to support the primary care strategy.
“Unfortunately, the reality is that very little is being invested, simply because, in our view, there has not been significant cost justification developed to do so. Today, leading companies operating in the sector believe that less than $20 million is being spent on primary care IT systems.”