Massive health IT project inches forward as former Tuanz boss Ernie Newman prescribes palliative care

Thursday, 19 July 2018

The Electronic Health Record project could be the health sector's most ambitious and expensive information technology investment.

A huge 'on-again/off-again' information technology project that would see a single Electronic Health Record created for each New Zealander is inching forward again, with the Government asking the Health Ministry to do more work on a business plan.

The project has been tipped to cost several hundred million dollars and was at one point scheduled to be completed by 2014 after 10 years of discussion.

But problems with separate a health IT system called the National Oracle Solution (NOS) – whose costs have now ballooned out to $119 million – have raised doubts about the ability of the health sector to successfully deliver large information technology projects.

Health Minister David Clark said the Health Ministry had completed an 'indicative business case' for the Electronic Health Record (EHR) project.

Consultant and former Tuanz boss Ernie Newman says previous ministers have shown a lack of leadership, describing the health sector as 'broken'.

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'They are doing further work before the business case is put to Cabinet for the decision on whether the project proceeds to the detailed business case stage,' he said.

But Clark acknowledged there was 'much to learn from the widely-reported problems' with the separate NOS project, which originally had a budget of $47m.

The Health Ministry says the proposed EHR system is a key project that would give consumers, healthcare providers, and policy and health planners better access to health information.

It would mean patients wouldn't need to repeat their 'health story' whenever they saw a new doctor, and healthcare providers would get the full picture about patients from which to diagnose and treat them, it says.

Clark would not reveal how much the indicative business case said the project might cost, but ministry documents have previously said Singapore and Australia had invested $150 million and $1.5b, respectively, in comparable schemes.

Some of the touted benefits of the EHR project have been delivered through less comprehensive 'patient portals' operated by individual GP practices that were used by 472,894 patients as of September.

But former Telecommunications Users Association chief executive Ernie Newman, who has consulted for four District Health Boards, said EHRs were a crucial element in creating a modern health system.

Health Minister David Clark has ordered more work on the business case for Electronic Health Records before it goes to Cabinet.

The former government had 'abandoned the project part way done', he said.

In a bleak speech to the ITX technology conference in Wellington last month, Newman described the health service as 'broken' saying 'every element is out of touch with the 21st Century'.

'If the New Zealand public health service delivery system presented for medical treatment it would be sent straight to palliative care,' Newman said.

'Efforts to coordinate IT systems from bases developed by individual District Health Boards meeting their own needs in isolation, have resulted in tensions between local, regional and national imperatives that are almost beyond resolution.'

He also questioned the former government's decision to disband the National Health IT Board in 2016, saying the coordinating body had been showing signs of gaining traction.

Newman's assessment contrasted somewhat with an upbeat assessment of Kiwis' health released by director-general of health Ashley Bloomfield on Wednesday.

Bloomfield said most New Zealanders rated their health as being 'good, very good or excellent' and they were living longer.

That reflected 'positively on the ongoing endeavour of our dedicated health workforce across the country and those working closely … to improve services and outcomes', Bloomfield said.

Bloomfield's 100-page report noted the Health Ministry was developing a 'digital health strategy' and said new technology was opening up new ways to improve access to healthcare, but made no direction mention of the EHS or NOS projects.

The NOS system was designed to replace all DHBs finance and supply chain systems and was promoted by sponsor NZ Health Partnerships as the 'sector's biggest opportunity to reduce non-labour costs and in doing so improve patient care'.

Health Partnerships said four DHBs got access to the 'core functionality' provided by NOS on July 2 – which was more than year behind schedule – and that was performing well.

New Zealand is not the only country to have sometimes struggled with large health IT projects.

The project to provide Australians with an online health record, My Health Record, which has reportedly cost more than $2b, has been dogged by controversy after the Australian government chose to switch it from an 'opt-in' to an 'opt-out' model because of low take-up.

Director-general of health Ashley Bloomfield says positive assessments by Kiwis of their health reflects positively on the sector.

Some Australians have chosen to opt-out because of privacy and security concerns, despite an assurance from Australian health minister Greg Hunt that My Health Record has 'military-grade security'.

But some Australians reported long delays trying to do that when the three-month window to opt-out opened on Monday, because of the volume of opt-out requests.

The British government terminated a project to create a national system of electronic records across the National Health Service in 2011 after reportedly spending about £12.7 billion (NZ$25b) on it.

Newman agreed the issues he highlighted to the ITX conference were 'international'.

'But the reality is health is stuck 50 years behind the times compared to how it interacts with its 'customer base', compared to any other sector,' he said.