Chris Keall: Death of the DHBs a chance to give health tech a new life


The government yesterday unveiled a plan to scrap the 20 District Health Boards, and replace them with a single national body.

It will take a while to unpack the impact on various facets of the health system, but in terms of technology choices, the only way is up.

The past two decades have seen DHBs often going their own way on technology, or sometimes banding in rival factions when it comes to technology choices.

As a result of this uncoordinated, inefficient approach, New Zealand has fallen behind other countries in terms of the technology used to manage our health system, and our healthcare.

Australians and Israelis, for example, can now check their own medical records online, because they have national, online, patient record management systems – as do many US states.

Among other benefits, that means no duplication of effort, and it provides a trove of (anonymised) data to analyse public health trends.

Here, a visit to a GP then a specialist then a hospital is a festival of entering the same basic information over and over, wasting time and introducing opportunities for error.

In many countries, people can go on to the web, see their place in their country’s vaccination queue, then book a time and place for a dose. Not here.

We had a solution on our doorstep, but it was only sporadically taken up. Why did homegrown Orion Health have to shop its patient record management software (a hit in the US) around different DHBs?

Because there was a different mix of IT skills and planning. Even at the most basic level, some had hardware that could hack it. Others had PCs that were too old to run it (in 2018, facing a cash-crunch as Obamacare won’t down, Orion sold its patient record division – its only profitable unit – to a UK firm).

The growing area of mobile health apps for remote consultations has been another area of uncoordinated bungling, and various DHBs going their own way.

The Waikato DHB took the prize here, spending upwards of $25 million on its SmartHealth app for only a few hundred video consolations between 2015 and 2017 when the Auditor-General stepped in to untangle the project.

Elected district health boards don’t always have the technical or business skills to oversee complicated procurement processes for the likes of a virtual health app. Even if they did, it’s senseless for individual DHBs to pursue their own tenders.

And, just this year, we’ve seen the patchwork of different tech solutions hurt the Covid-19 vaccination programme.

The Ministry of Health was already behind the eight-ball, throwing together a rollout management system based on software from American company Salesforce – with a cut-down, Salesforce-based solution released to wrangle the initial jabs with.

But instead, the Canterbury DHB used software made by Dublin-base multinational Valentia Technologies to manage its Pfizer/BioNTech doses – a fact that emerged after the private details of some 716 people – including names, dates of birth, and National Health Index numbers – were inadvertently made public on the web.

The MoH told the Herald that the Capital and Coast and Hutt Valley DHBs also used Valentia, but only internally for staff bookings.

Meanwhile, the northern DHBs (Northland, Waitemata, Auckland and Counties Manukau) were using a vaccine booking system created by the multinational software company ServiceNow.

Worse, the MoH said that once its Salesforce-based vaccination management system was fully fleshed out and complete, later this year (replacing the cut-down system used today, also Salesforce-based) it would be up to individual DHBs whether they used it to replace their current booking systems.

“The UK experience indicates that a national booking system was very effective for large-scale vaccination events and dedicated community hubs,” an MoH spokeswoman told the Herald.

Many would agree with that statement. While the Brits have got many elements of pandemic management wrong, their vaccination rollout has been rapid. As I write, more than 33m (or just on half of the population) have had their first jab, and some 10m their second.

It’s strange then, that the MoH would spend $38m on a national vaccine management system created by Salesforce and its partners, with no guarantee it would be fully adopted by all the DHBs.

It’s hard to imagine that tech strategists within the ministry will shed too many tears for the disappearing district health boards.

Chance to build a new system

NZRise, a lobby group for the local IT industry, wants the government to follow its own procurement rules and create more opportunities for cost-effective, proven local players.

The rationalisation of the DHBs into a single national body should provide a chance to implement that strategy, too.

Certainly, there’s a lot of scope for improvement.

Justin Gray, managing director of Datacom – our largest independent IT group, says the pending restructure provides, “The opportunity for New Zealand is to build a new health service that makes the most of the advances in technology to deliver better services to the people who need it”.

At one end of the spectrum we see advances in machine learning and digital capability that give doctors and clinicians new tools to better understand the human body and health issues, Grey says.

“At the other end, we have massive amounts of information that needs to be stored securely yet be accessible to those who need it, updated and available throughout the country at a moment’s notice so a visitor from Dunedin can get urgent treatment in Auckland without delay.

“There are tremendous savings to be made if we avoid duplication and conflict among IT systems. Having one IT system for all of New Zealand means much-needed resourcing can be pushed to the front line staff where it’s most needed.”

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