Part 4: The rate of progress since the WAVE Report was published

Progress with priorities for health information management and information technology.

4.1
In this Part, we discuss:

A changing environment has affected the rate of progress

4.2
The WAVE Report was published in an environment of health sector reforms and advances in technology. There have been other changes affecting progress with information management and information technology improvements.

Restructuring the sector, particularly establishing Primary Health Organisations, is likely to have slowed progress

4.3
Major structural changes to the organisation of health and disability services, initiated by the New Zealand Public Health and Disability Act 2000, have been introduced during the past 5 years.

4.4
Between 2000 and 2002, decision-making was decentralised to 21 community-focused DHBs responsible for the purchase and provision of health services. Also, between July 2002 and January 2005, 77 Primary Health Organisations were set up under DHBs. Primary Health Organisations grouped together doctors, nurses, and other health professionals to provide essential primary health services to defined populations. DHBs are responsible for funding and monitoring Primary Health Organisations.

4.5
This re-structuring is likely to have slowed progress with information management and information technology improvements as DHBs and Primary Health Organisations have settled into their roles, and the information demands on them and their own information requirements have evolved. For example, we found that awareness of the WAVE Report and of subsequent changes under the Ministry’s strategic steps approach was low among Primary Health Organisations, including those that had been set up for at least a year.

4.6
Slightly less than half of the Primary Health Organisations (47%) responded to our survey, with a slightly higher response rate from smaller and more recently set up organisations.

4.7
It had been unclear to most (94%) of the Primary Health Organisations that the Ministry had been following the strategic steps to implement the WAVE Report. Two-thirds (66%) did not know whether the strategic steps had been the right steps to take, and most (94%) believed that the Ministry had not adequately engaged them in implementing the strategic steps.

4.8
Lack of awareness of the WAVE Report and how it had been implemented was also the main reason cited by some Primary Health Organisations for not responding to our survey.

4.9
The Ministry has updated the sector on progress with health information initiatives after the WAVE Report through liaison with sector stewardship groups, speeches at the annual e-health conference, and quarterly newsletters. Our survey indicates that these mechanisms have not been effective in engaging Primary Health Organisations and raising their awareness of progress after the WAVE Report.

New health strategies and funding arrangements emphasise the importance of information and are likely to have spurred progress

4.10
During the past 5 years, the Ministry has introduced new health strategies emphasising the importance of information as a tool underpinning the delivery of better health outcomes.

4.11
The New Zealand Health Strategy published in December 2000, The Primary Health Care Strategy published in February 2001, and The New Zealand Disability Strategy published in April 2001 all emphasise the importance of the sector being able to manage and exchange high-quality information quickly and effectively. New funding arrangements for DHBs and Primary Health Organisations also depend on accurate information about the health needs of defined populations of people.

Increasing broadband availability has helped

4.12
Information technology is renowned for rapid change in terms of innovation, the increased capability of hardware and software, and price accessibility. The emergence of broadband Internet access, allowing large volumes of data to be sent or received at high speed, was not covered in the WAVE Report. However, this area has since advanced as part of wider health network and e-government initiatives. Broadband Internet access makes sharing information easier and quicker; for example, between remote hospitals and between general practitioners, hospitals, and other providers.

4.13
The availability of broadband Internet access to the health sector has increased with the PROBE (PROvincial Broadband Extension) initiative. The Ministry of Education and the Ministry of Economic Development jointly set up PROBE to give high-speed Internet access to all schools and provincial communities. The Ministry was represented on the PROBE steering group and requirements for securely transmitting health data were included as part of the initiative.

4.14
In areas like the West Coast, the local DHB is pushing ahead with improving its information management and information technology capability using the opportunity created by having broadband Internet access through the PROBE initiative.

The Meningococcal B epidemic has hastened progress with the National Immunisation Register

4.15
In mid-2002, a programme of vaccinations to help reduce the rate of Meningococcal B disease was scheduled, with a start date in July 2004. This gave the National Immunisation Register a very clear business focus and hastened work to implement it.

4.16
Deadlines for setting up and implementing the register became driven by the requirement to begin the programme of vaccinations, and initial implementation became focused on the systems required for recording vaccinations. To meet drug-licensing requirements for the Meningococcal B vaccine, the Ministry had to be able to record all vaccinations in a database within 24 hours of a vaccination being given, including those given at primary care practices and at schools.

Difficulties encountered since the WAVE Report was published

4.17
Our survey of DHBs and Primary Health Organisations, and our discussions with the Ministry and other stakeholders within the sector, highlighted some difficulties in improving information management and information technology since the WAVE Report was published.

4.18
There have been difficulties with leadership and responsibility, funding and resourcing, and rationalising the different levels of information management and information technology maturity between DHBs. Most DHBs (16 out of 20) and most Primary Health Organisations (94%) that responded to our survey reported having encountered difficulties.

Effectiveness of leadership and clarity of responsibilities

4.19
The sector told us it would have liked more effective Ministry leadership in some areas, and greater clarity about responsibilities and accountabilities.

While the Ministry has been driving many initiatives, there are areas where the sector would have liked more effective Ministry leadership

4.20
Our survey indicated that there was general recognition in DHBs that the Ministry had been prominent in driving all but one of the initiatives we examined. Depending on the initiative, between 16 and 21 out of the 21 DHBs believed that the Ministry had so far been driving each initiative, either on its own or jointly with the sector. The exception was work on the ability to exchange electronic discharges and referrals, where DHBs believed that their Chief Information Officers, Chief Executive Officers, and HISO had mostly driven this initiative. We note that the WAVE Report recommended that DHBs should be putting in place the systems to ensure hospitals and health service providers could connect, and electronically share information such as referral letters and discharge summaries.

4.21
Most (around 90%) of the Primary Health Organisations that responded to our survey also thought that the Ministry had been driving the upgrade of the National Health Index and setting up the National Immunisation Register. However, the Ministry had been less prominent in leading the other initiatives. Opinion was split on whether the Ministry or DHBs had been driving the preparation and implementation of ethnicity data protocols. For the remaining initiatives, most Primary Health Organisations (around two-thirds) thought that there had been no clear leadership from the Ministry or DHBs.

4.22
The sector representatives we spoke to commonly expressed the view that, in some respects, the sector would have liked the Ministry to exert more effective leadership after the WAVE Report. Some DHBs commented that they would have liked more leadership in strategic priority setting and expert advice. A few industry representatives commented that they would have liked to have seen quicker and more definitive decision-making from the Ministry, for example, in processing business cases and letting contracts to advance initiatives. Some Primary Health Organisations and general practitioner representative groups commented that they would have liked more leadership in supporting and integrating primary care with activity to implement the WAVE Report recommendations by empowering them to take action.

There is some confusion in the sector about responsibilities and accountabilities

4.23
Most DHBs (15 out of 21) and most Primary Health Organisations (81%) that responded to our survey believed that the absence of a written strategy defining responsibilities and accountabilities had hindered progress.

4.24
The Ministry has provided information on roles and responsibilities at a strategic and project level, but most (18 out of the 20 that responded to this question) DHBs we surveyed believed that roles and responsibilities for improving information management and information technology throughout the sector had not been adequately defined.

4.25
There was also some confusion about accountabilities. Eight out of 21 DHBs indicated that they were unclear about how they were expected to monitor and report on their progress with information management and information technology improvements. Most (16 out of 21) also believed that the key performance indicators in their annual plans had not been effective in prompting action and assessing the effect of action.

4.26
Like the DHBs, most Primary Health Organisations (78%) believed that roles and responsibilities for improving information management and information technology throughout the sector had not been adequately defined. There was also confusion about accountabilities at Primary Health Organisation level, with around three-quarters indicating their DHB had not set them clear requirements for improving information management and information technology.

4.27
As noted earlier, DHBs are responsible for funding and monitoring Primary Health Organisations but few (4 out of the 18 that responded to this question) said that they had specified information management and information technology capability requirements in Primary Health Organisation contracts. Around half of the DHBs (7 out of 15 that responded to this question) required Primary Health Organisations to regularly report on progress with improving their information management and information technology.

Funding and resourcing difficulties

4.28
In our view, the investment in information management and information technology since the WAVE Report is likely to have been less than expected. The sector has had difficulty resourcing improvements while continuing with normal business. DHBs and the Ministry have had some problems recruiting and retaining suitably experienced staff.

Funding pressures have meant that the level of investment is likely to have been less than expected by the WAVE Advisory Board

4.29
Based on initial work by the WAVE Advisory Board, the Ministry estimated that it would cost the sector between $60 million and $100 million to implement the WAVE Report’s recommendations.

4.30
The Ministry did not separately allocate funding for implementing the WAVE Report. Funding for national projects was sought on a project-by-project basis, and DHBs were expected to implement the WAVE Report’s recommendations from existing funding allocations.

4.31
The overall level of sector investment to implement the WAVE Report is not known, but is likely to have been less than the estimated $60 million to $100 million.

4.32
The Ministry has invested around $4 million in upgrading the National Health Index, and $2.7 million in setting up the Health Practitioner Index. It has spent another $6.6 million on the National Immunisation Register (although not directly referred to in the WAVE Report, it contributes to primary care information). The Ministry has also funded HISO up to $300,000 a year.

4.33
Twelve out of the 16 DHBs that reported having encountered difficulties indicated in their survey returns that funding improvements in information management and information technology since the WAVE Report had been a problem. Many DHBs have been operating at a deficit and referred to funding pressures which meant that information management and information technology initiatives had to compete for funding with other health service initiatives. The combined operating deficit of the 21 DHBs has been reducing in the last 3 years. Some Primary Health Organisations also referred to difficulties with funding work in information management and information technology.

The sector’s capacity for making improvements alongside existing business information demands has become stretched

4.34
It is unlikely that additional funding of information management and information technology improvements at DHB level would have led to greater progress among all DHBs.

4.35
Eleven out of the 20 DHBs that responded indicated that, if additional funding was available, they had the capacity to undertake extra improvements to their information management and information technology. However, the other 9 DHBs indicated that they did not.

4.36
Smaller DHBs in particular felt overstretched because they have the same information demands as larger DHBs, but fewer resources.

4.37
Some DHBs expressed frustration that their ability to respond to the WAVE Report and the initiatives had been less than the expectation inherent in the report, and continued to be less.

4.38
The capacity of Primary Health Organisations and general practitioners to improve on their information management and information technology, while meeting their existing demands for business information, was also stretched. Many Primary Health Organisations were still setting themselves up to provide the service use data required by their contracts, which some were not yet able to fully provide. General practitioners run independent businesses focused on patients, and many considered new information initiatives as an added compliance cost without providing any positive advantage to their business.

4.39
Looking ahead, Chief Information Officers estimated that around 30 information initiatives were likely to place demands on DHBs in the next 2 years. Chief Information Officers believed that DHBs were able to respond to about 2 initiatives a year, alongside the ongoing operational demands of the DHB.

Recruiting and retaining expertise had sometimes been a problem for District Health Boards and the Ministry

4.40
Four of the 16 DHBs that reported having encountered difficulties said that recruiting and retaining suitably qualified information management and information technology staff had been a problem. This was partly because of a shortage of available skills in the market, and partly because of the remuneration they were able to offer.

4.41
The New Zealand Health Information Service within the Ministry’s Corporate Information Directorate, which is leading strategic information changes, had also encountered some resourcing difficulties. It had used contracted and seconded staff to provide interim expertise as it had built up the team to work on strategic changes and support the implementation of the Health Information Strategy for New Zealand 2005.

District Health Boards’ different levels of maturity in information management and information technology

4.42
Some DHBs expressed the view that the different levels of information management and information technology maturity in DHBs had limited progress. For example, the West Coast DHB had old patient management systems that had not been designed for the sort of information flows envisaged by the WAVE Report. Until these systems are replaced, the full benefits envisaged by the WAVE Report will not be achieved. The West Coast DHB was replacing its patient management system as part of wider information management and information technology improvements.

4.43
When Counties Manukau DHB collaborated with neighbouring DHBs, it found that being further ahead in information management and information technology meant waiting for the other DHBs to catch up before the full benefits of collaboration could be realised.

Progress with the key initiatives has generally been less than expected

4.44
The WAVE Report envisaged rapid change in 3 to 5 years, which is a demanding timetable. For example, the National Programme for Information Technology in the United Kingdom’s National Health Service has an 8-year timetable, from 2002 to 2010.

4.45
We looked for measurable objectives and targets to use as a baseline to assess the rate and extent of progress made by the Ministry and the sector.

4.46
In planning individual initiatives such as the National Health Index upgrade, the Ministry set milestones for phases in the work. We used these milestones to assess whether the speed and extent of progress had been as expected by the Ministry.

4.47
We used views expressed to us by the sector to assess whether progress so far had been as expected by the sector.

4.48
Some of the recommendations from the WAVE Report relating to the key initiatives had specific and measurable timetables. We used these timetables to assess whether progress had been as expected by the WAVE Advisory Board.

Progress had generally been less than expected by the Ministry

4.49
For 5 national initiatives, we compared milestone dates achieved against those planned in the Ministry’s original business cases or project management plans for the initiatives. In all cases, the milestone dates achieved were later than those originally planned. Initiatives such as the Health Practitioner Index and the National Immunisation Register had been revised along the way.

4.50
Within its portfolio of information projects, the Ministry had identified that the top risk to project delivery was undertaking too many projects with too few resources. The Ministry had identified that this was placing appropriate planning, thorough monitoring of delivery, and quality at risk.

Upgrading the National Health Index

4.51
The Ministry’s programme to upgrade the National Health Index started in March 2003, with an expected completion date of 31 December 2004. The programme was completed in November 2005. It included a number of projects. Figure 16 shows that some of the major component projects had taken longer than originally planned by the Ministry.

4.52
The main delays had been to the online search engine and the NHI Online Access for Health (NOAH) application, which allows online access to the National Health Index. Interdependencies meant that the delays on these projects sometimes affected the other component projects.

Figure 16
Completion of component projects of the National Health Index upgrade

Component projects of the National Health Index upgrade were completed later than planned

Component project Planned* completion date Actual** completion date Difference
(months)
Training programme Nov 2004 Dec 2004 + 1
Duplicate resolution programme Jun 2003 Sep 2003 + 3
Public interactions to raise awareness Dec 2004 Apr 2005 + 4
Redesign of Link Manager application for linking and unlinking records Aug 2004 Apr 2005 + 8
New information fields:
  • Phase 1
  • Phase 2
Dec 2003
Jul 2004
Dec 2003
Apr 2005
0
+ 9
NHI Online Access for Health (NOAH) Oct 2003 Oct 2004 + 12
New search engine Nov 2003 Dec 2004 + 13
Overall programme Dec 2004 Nov 2005 + 11

* Dates taken from May 2003 Programme Execution Plan.
** Dates taken from Programme Status Reports.

4.53
The main causes of the delays were:

  • extended prototyping of the online search engine to address technical issues; and
  • protracted contract negotiations with the NOAH software developer, and difficulties with engaging users in testing and piloting.

4.54
The original budget for the National Health Index upgrade programme was $2.9 million. Extra resource requirements caused by the delays and changes over time to the scope of the programme had increased the budget by $1.1 million to a total of $4 million. The main changes were related to a software application called Link Manager. Extra licences had to be purchased and additional features added for managing National Health Index records.

4.55
Some upgrades had been removed from the scope of the project. For example, upgraded Application Programme Interfaces were removed in early 2005 because the estimated cost was more than had been budgeted for. The interfaces would have fully integrated NOAH with general practitioners’ systems, and enabled full functionality from the new search engine. In Part 5 we discuss this further.

Ethnicity data protocols

4.56
In August 2002, the Ministry scoped an ethnicity data improvement project with the main objective of enabling better decision-making to reduce health inequalities by collecting and storing standardised, accurate ethnicity data.

4.57
Key outputs from the project were a set of protocols for collecting ethnicity data, a training package for collectors, and a set of indicators for monitoring data quality. The protocols and training package were produced later than expected (see Figure 17). However, they were well received by the sector. Overall, the 88 representatives from DHBs and Primary Health Organisations who received the initial training rated it as having provided them with the necessary knowledge to train others.

Figure 17
Planned and actual completion dates for ethnicity data protocols

Ethnicity data protocols were completed later than planned

Activity Planned* completion date Actual** completion date Difference (months)
Protocols endorsed by HISO Sep 2003 Dec 2003 + 3
Notification of protocols to key stakeholders Sep 2003 Feb 2004 + 5
Implementation of training programme Nov 2003 Nov 2004 + 12
Publication of quality indicators From Nov 2003 Ongoing + 21***

* Dates taken from July 2003 implementation path.
** Dates taken from HISO minutes, published protocols, and training evaluation report.
*** As at August 2005.

4.58
The Ministry told us that delays were caused by the need to ensure sector acceptance and support. Work continues on the quality indicators.

Setting up the Health Practitioner Index

4.59
After work in mid-2002 to confirm the need and sector support for the Health Practitioner Index, the Ministry set out to create the index as a database covering health practitioners, organisations and physical health service delivery facilities.

4.60
The business case in June 2003 proposed implementing the database of practitioners in January 2004, followed by implementation of the database of organisations and facilities in April 2004.

4.61
Under a revised, phased approach, implementation of both databases started in June 2005, with completion planned for September 2005 (see Figure 18).

Figure 18
Planned and actual completion dates for the Health Practitioner Index

The Health Practitioner Index was completed later than planned

Activity Planned* completion date Actual** completion date Difference (months)
Request for proposals issued Jun 2003 Jan 2004 + 6
Preferred vendor selected Aug 2003 Jun 2004 + 10
HPI populated with practitioner data ‘go-live’ Jan 2004 Phased implementation + 15-20
Organisations and facilities indices ‘go-live’ Mar 2004 Jun 2005-Sep 2005

* Dates taken from June 2003 Business Case, signed off in September 2003.
** Dates taken from Project Status Reports.

4.62
When the Health Practitioner Index went “live” in June 2005, it had been populated with data on 3 types of practitioner (pharmacists, dentists, and occupational therapists) and was available to the Accident Compensation Corporation.

4.63
The Ministry plans that the Health Practitioner Index will eventually hold data on 15 types of practitioner. Data agreements were being finalised with the organisations responsible for registering the remaining 12 types of practitioner, which will allow their data to be used in the Health Practitioner Index. Data on more types of practitioner will gradually be added to the Health Practitioner Index as data agreements are signed.

4.64
The Ministry plans to make the Health Practitioner Index available to all DHBs and other organisations in the health sector that need to authenticate practitioner access to their applications and information. By November 2005, Health Practitioner Index data had been made available to Hutt Valley DHB, the Medical Council of New Zealand, Accident Compensation Corporation, the Pharmacy Council of New Zealand, the Dental Council of New Zealand, the Occupational Therapy Board, and Health Payments, Agreements and Compliance (part of the Ministry).

4.65
The Health Practitioner Index is a complex project, both technically and because it depends on data from stakeholders throughout the sector and the preparation of standards from HISO. Specifying the complex requirements for the databases took longer than expected, and delayed putting out the requests for proposals for creating the databases.

4.66
The proposals exceeded the Ministry’s budgeted costs and planned timeframes, and negotiations were extended to arrive at an affordable solution before a developer was appointed.

4.67
There have also been delays in securing support from some of the practitioner registration authorities and signing data agreements with them. These complications and delays have resulted in the expected cost of the Health Practitioner Index rising from $2.1 million in the original business case to $2.7 million.

Privacy, authentication, and security standards

4.68
In July 2002, the Ministry drew up terms of reference for the Privacy, Authentication, and Security Project, and a project management plan was prepared in July 2003. The objective of the project was to prepare, in consultation with the sector, a set of privacy, authentication, and security standards to support electronic exchange of health information, together with a rationale for implementing the standards.

4.69
The Ministry and the Accident Compensation Corporation jointly sponsored the project. They agreed that common privacy, authentication, and security standards were required throughout the sector as a priority to avoid different and conflicting approaches by planned system work such as the Health Practitioner Index, National Health Index upgrade, and the National Immunisation Register.

4.70
The Ministry and the Accident Compensation Corporation also hoped that the initiative would demonstrate leadership to the sector, and that the sector in general would adopt the privacy, authentication, and security standards as New Zealand health standards.

4.71
Work on the standards and the rationale for their implementation was contracted out at a cost of $269,000, jointly and equally funded by the Ministry and the Accident Compensation Corporation, with delivery scheduled for December 2003. There were some delays and, in March 2004, the joint Ministry and Accident Compensation Corporation steering group accepted the standards framework.

4.72
The contract outputs included a proposed “road map” for advancing work on privacy, authentication, and security standards, recommending immediate publication of the standards framework and further work with the sector to enhance and adopt the standards between March 2004 and May 2005.

4.73
The Ministry decided that the complexity of the proposed standards framework meant that it needed to be reworked so it could be implemented by the sector. Since March 2004, the Ministry had been working the framework into a set of privacy and security standards for the sector, with codes of practice for developers, providers, and users of e-health applications, and network and telecommunication service providers.

4.74
A lack of resources has delayed the completion of this work. However, the Ministry finalised the standards in January 2006, and plans to launch them around mid-2006. Codes of practice and guidelines will be prepared when requested by the sector.

Setting up a National Immunisation Register

4.75
In April 2001, the Ministry produced a business case for a project to set up an immunisation database at a cost of up to $1.25 million, progressively extending a reporting and enquiry service to immunisation providers by December 2002.

4.76
A prototype immunisation database was successfully completed in July 2002. An independent project review recommended a pause to realign the project with broader business needs. Initial approval of the project focused on the information technology component, and the scope did not encompass wider business needs.

4.77
Because of the July 2002 review, the Ministry decided to establish a National Immunisation Register by modifying Kidslink (a system created by Counties Manukau DHB to track immunisations). The budget for preparing and distributing access to the National Immunisation Register was $5.27 million.

4.78
The first project plan for the National Immunisation Register was produced in June 2003. Under this plan, the roll-out was scheduled to begin in Counties Manukau in November 2003 with Kidslink being put on the National Immunisation Register.

4.79
The project plan was revised in April 2004 by adding the requirements needed for recording Meningococcal B vaccinations. Under the revised plan, using the National Immunisation Register for Meningococcal B vaccinations started in Counties Manukau DHB in July 2004 and finished in June 2005 with Nelson Marlborough DHB. As at November 2005, more than 2.8 million Meningococcal B vaccinations had been recorded on the National Immunisation Register.

4.80
The National Immunisation Register went “live” for other childhood immunisations in Counties Manukau in April 2005, and the Ministry expected the expanded National Immunisation Register to be available throughout the rest of the country by December 2005. As at November 2005, the National Immunisation Register had cost $6.6 million.

Progress has generally been less than expected by the sector

4.81
Within the DHBs, Primary Health Organisations and bodies representing general practitioners that we spoke to, there was some frustration that the initiatives progressed after the WAVE Report had not yet more directly and demonstrably improved the delivery of health services. There was a feeling that improvements seen so far had come more from local improvements driven by funding and operational needs rather than from the initiatives.

4.82
A common view was that it was not clear what some of the initiatives meant for health providers or how they helped health providers deliver better health outcomes.

4.83
Sector representatives from primary care were included on HISO and the steering groups for the National Health Index upgrade and Health Practitioner Index projects. However, our survey showed that among Primary Health Organisations there was poor awareness of the objectives of HISO, the Health Practitioner Index, the Privacy, Authentication, and Security Project, and the Health Intranet. Those who were aware of these initiatives were frustrated that the Health Practitioner Index and the Privacy, Authentication, and Security Project were taking a long time.

4.84
The Health Intranet has also made less progress than expected by many within the sector. Users connect to the Health Intranet by subscribing to a Health Intranet service provider accredited by the Health Intranet Governance Board (now called the Health Network Governance Board).

4.85
While there is support for the Health Intranet in principle as a network for securely exchanging health information, the DHBs and Primary Health Organisations that we spoke to noted that it is not widely used by them or by general practitioners, outside of providing information to the Ministry.

4.86
The Health Intranet is seen as having excessive security requirements, being too costly and slow, and not giving access to enough useful applications. Most general practitioners and hospitals use a separate secure messaging system, provided by an accredited Health Intranet service provider and which can be linked into the Health Intranet, to exchange Health Event Summaries and laboratory and radiology results.

4.87
Some DHBs (for example, West Coast and Canterbury) are also using alternative networks to exchange clinical information, which they find cheaper and faster than the Health Intranet. Although these networks include generally accepted security safeguards they may not fully comply with the Health Network Code of Practice.

Progress has generally been less than expected by the WAVE Advisory Board

4.88
It was not possible to fully analyse whether progress to implement all of the recommendations of the WAVE Report had been as expected. Many of the recommendations were not defined enough to be measurable.

4.89
We analysed the few recommendations relating to the key initiatives where timescales were specified, to assess whether the intended action had happened as quickly as expected. We present our analysis in Figure 19. It shows that progress to implement these recommendations had generally been slower than expected in the WAVE Report. The notable exception was general practitioner use of electronic clinical software, where the expected progress was achieved.

Figure 19
Progress on measurable recommendations from the WAVE Report

Activity WAVE Report’s expectation Progress
Capability for connectivity between hospital and health providers DHBs should implement capability including that for electronic exchange of referral letters and discharge summaries within 2 years. Eight DHBs send more than 60% of hospital discharges electronically. DHBs that do not currently have the capability are introducing it or are planning to introduce it with new systems. No DHB exchanges more than 10% of patient referrals electronically, but several are working on electronic referral systems.

Expected by October 2003. Implementation ongoing.
Standards for Health Event Summaries (electronic discharges and referrals) Preparing standards for transmitting Health Event Summaries between providers during the next 6 months, starting use within 12 months, distributed within 3 years. In consultation with the sector, the Health Information Standards Organisation began working on standards in late 2004. It expects to complete and release the standards in early 2006.

Expected by October 2004. Expected early 2006.
Encouraging general practitioners to use electronic clinical record software Supporting and encouraging general practitioners not currently using electronic clinical record software to do so within the next 12 months. A survey by the Royal New Zealand College of General Practitioners in 2003 indicated that 99% of practices were using specifi cally designed practice management system software.

Expected that by October 2003, 71% of general practitioners would be using electronic practice management systems to record and store some clinical data. The survey showed that in 2003, 72% of general practitioners used their practice management system to store full clinical notes.
Encouraging hospitals to implement clinical data repositories. Encouraging hospitals to implement clinical data repositories or an integrated clinical interface within 3 years. DHBs are at various stages of improving their systems for holding clinical data. In their 2003-04 and 2004-05 annual plans, a third of DHBs reported investing in new or upgraded patient management and clinical information systems.

Expected implementation by October 2004. Implementation ongoing.
Running an awareness campaign on the National Health Index. Running an awareness campaign on the National Health Index. Awareness information was included in enrolment information for Primary Health Organisations in 2002. National Health Index brochure and poster distributed to hospitals and general practitioners’ waiting rooms in April 2005. Also articles placed in publications such as New Zealand Doctor.

Expected by December 2001. Poster and brochure distributed in April 2005.

1: We have separately examined progress with e-government initiatives and will publish a report on the subject in 2006.

2: Figure 1 lists the initiatives we examined.

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