Part 1: Introduction
1.1
In this Part we describe the structure of the health sector before explaining the scope of our audit.
Structure of the health sector
1.2
The Minister of Health has overall responsibility for the health and disability sector. The Minister works through the Ministry of Health (the Ministry) to enter into accountability arrangements with District Health Boards (DHBs), determine the health strategy, and agree how much public money will be spent on delivering health services.
1.3
DHBs are Crown entities responsible to the Minister of Health (administration is through the Ministry). DHBs are responsible for establishing, funding, and monitoring Primary Health Organisations, which are in turn responsible for providing essential primary health services to a defined population. At a minimum, these services will aim to improve and maintain the health of the population, and restore people’s health when they are unwell. (Appendix 2 has more information on the structure of the health sector.)
The WAVE Report
1.4
The ability of the health and disability sector (the sector)1 to access and exchange information quickly is increasingly important to the delivery of quality health services.
1.5
In October 2001, a report commissioned by the Ministry from the Working to Add Value through E-information (WAVE) Advisory Board brought together the sector’s recommendations to use health information more effectively. The report, From Strategy to Reality – The WAVE Project (the WAVE Report) was published in October 2001.2 Since then, Parliament’s Health Committee has expressed concern about the extent of progress. The WAVE Report envisaged rapid change in 3 to 5 years, which is a demanding timetable.
The scope of our audit
1.6
We decided it was timely, around 3½ years after the WAVE Report was published, to audit whether the Ministry and the sector had made the progress they expected to make towards more effective use of health information.
1.7
We examined whether:
- the Ministry had taken appropriate steps to lead the sector in responding to the WAVE Report (Part 2);
- the Ministry and the sector had improved the sector’s ability to use health information effectively (Part 3);
- the pace and extent of progress had been as expected by the Ministry and the sector and in the WAVE Report (Part 4); and
- the Ministry and the sector had a well-formulated strategy for continuing to improve information management and information technology, supported by a well-formulated plan for implementing improvements (Part 5).
1.8
In Part 5, we make recommendations to help the Ministry and the sector to advance information management and information technology under the Health Information Strategy for New Zealand 2005 (published in August 2005).
1.9
To inform the scope of our audit, we examined papers covering how the Ministry responded to the WAVE Report, and held preliminary unstructured interviews with Ministry personnel responsible for leading the implementation of the WAVE Report’s recommendations. We also held unstructured interviews with a cross-section of people from throughout the sector who were affected by the implementation of the WAVE Report.
1.10
The WAVE Report contained 79 recommendations, including the “Top 10” priorities. The Ministry, working with the sector, concentrated on the “Top 10” priorities and addressed them by following 4 strategic steps. Our audit focused on the progress made by the Ministry and the sector in following the strategic steps. The steps were:
- strategic step 1 – supporting the priorities reflected in the WAVE Report through initiatives such as upgrading the National Health Index and setting up a Health Practitioner Index;
- strategic step 2 – preparing and implementing planning frameworks to co-ordinate and align the sector’s improvements in information management and information technology;
- strategic step 3 – setting up and implementing stewardship arrangements, such as national and regional forums, to ensure that the sector’s information management and information technology improvements are appropriately overseen and guided by the interests of sector stakeholders;
- strategic step 4 – refreshing and implementing the sector’s strategy for information management and information technology.
1.11
Under the first strategic step, we examined progress with 8 initiatives central to enhancing the management and use of health information. They include the initiatives for which the Ministry received some additional funding and the largest WAVE initiatives undertaken by the Ministry and the sector. Figure 1 shows how the 8 initiatives we examined relate to the “Top 10” priorities identified in the WAVE Report.
1.12
We did not examine all health information advances within the sector after the WAVE Report. There were too many – covering systems spread throughout the sector – for us to examine all of them. For example, we did not look at finance, human resource, and other administrative information systems within the Ministry and DHBs, systems set up for enrolling patients with practitioners in Primary Health Organisations, or enhancements to the practice management systems of general practitioners.
1.13
As part of our audit, we conducted a survey of DHBs and Primary Health Organisations during April and May 2005. We surveyed managers responsible for improving information management and information technology, not health practitioners. Appendices 1 and 2 explain our audit methodology and the structure of the sector.
Figure 1
The initiatives we examined and the WAVE Report’s “Top 10” priorities
| 1. Set up an independent organisation to lead information management/ information technology capability |
|---|
| Initiative we examined: Health Information Standards Organisation |
| In December 2002, the Minister of Health announced the formation of a national standards organisation (the Health Information Standards Organisation) to lead the creation and implementation of information management and information technology standards required for the health and disability sector. |
| 2. Collect reliable ethnicity data |
| Initiative we examined: Protocols for gathering ethnicity data |
| In August 2002, the Ministry started work on a set of ethnicity data protocols that were issued in February 2004 to facilitate a standardised approach to collecting, recording, and using ethnicity data throughout the health and disability sector. |
| 3. Implement the National Provider Index |
| Initiative we examined: Health Practitioner Index |
| The Health Practitioner Index is a tool for controlling which practitioners are authorised to access which health information. It is a national system holding information about health practitioners and non-practitioners (for example, hospital admission clerks and medical centre practice managers), handling health information, and about organisations providing health services and the locations of the facilities from which services are provided. Work began in 2003 and phased implementation is under way. |
| 4. Fix up the National Health Index – allow primary provider access, improve ethnicity data |
| Initiative we examined: National Health Index (NHI) |
| The NHI is an index of information associated with a unique NHI number that each person using health and disability services in New Zealand should be assigned. In early 2003, the Ministry began a programme of work to upgrade the NHI and address issues such as people being registered more than once on the NHI with duplicate NHI numbers, poor online primary care access and limited public awareness about the NHI and its purpose. |
| 5. Gather primary care information |
| Initiative we examined: National Immunisation Register |
| The National Immunisation Register is a system for tracking the immunisation status of children to inform delivery of vaccinations and provide information on local, regional, and national immunisation coverage. After work dating back to 2001, the register was used throughout DHBs for Meningococcal B vaccinations between July 2004 and June 2005. It is being made available to record other childhood immunisations. |
| 6. Fix up pharmacy and laboratory data and provide primary care with access |
| No specific initiative examined – we looked at progress reported by DHBs in increasing the number of general practitioners using electronic prescribing and exchanging test orders and results with laboratories electronically. DHBs provided reports on progress in these areas in response to key performance indicators set in their annual plans. |
| 7. Clean up messaging standards |
| No specific initiative examined – we looked at work on standards for electronic messages containing health information undertaken by the Health Information Standards Organisation. |
| 8. Sort out Health Event Summaries – with data dictionaries, electronic discharges, and referrals |
| Initiative we examined: Electronic hospital discharges and patient referrals |
| DHBs have been focusing on building their capability to exchange hospital discharge summaries and referrals electronically, and key performance indicators in their 2003-04 and 2004-05 annual plans have required them to report on progress. |
| 9. Launch health portal |
| Initiative we examined: New Zealand Health Network (Health Intranet) |
| Building on a concept first conceived around 1998 in South Auckland, the Ministry has been enhancing a Health Intranet to facilitate secure, interactive exchange of information between health providers and assist delivery of integrated health services. |
| 10. Make integrated care work by: developing standards for data exchange, security and network infrastructure |
| Initiative we examined: Standards for privacy, authentication, and security |
| The Privacy, Authentication, and Security Project has been running since 2003, with the objective of setting, in consultation with the sector, a set of privacy, authentication, and security standards to support the electronic exchange of health information, and deciding how to implement the standards. |
1: Unless otherwise specified, when we refer to “the sector” we mean the health and disability sector shown in Appendix 2. As part of our audit we surveyed District Health Boards and Primary Health Organisations, and interviewed the other stakeholders listed in Appendix 1.
2: WAVE Advisory Board to the Director-General of Health, (October 2001), From Strategy to Reality - The WAVE Project, Health Information Management and Technology Plan, Wellington, ISBN 0 477 01957 9.
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