Part 5: Giving more impetus to achieving future benefits

5.1
In this Part, we describe how the sector is positioned to realise future benefits. We also make recommendations to help the Ministry and the sector.

5.2
Through the Health Information Strategy for New Zealand 2005, the Ministry and the sector have an opportunity to give greater impetus to information management and information technology improvements. The Ministry and the sector need to actively push the strategy with clear governance and commitment, and follow implementation plans that are properly resourced and managed. Some issues wtih specific initiatives need to also be addressed quickly.

The sector is positioned to realise future benefits

5.3
The sector is well-placed to make better progress by building on the existing technology base and working within a cultural environment that is now more prepared for consolidated action. There will also be benefits from the sector’s ability to link and share information more effectively and securely, because of the initiatives implemented and under way.

The sector has a good and improving technology base

5.4
New Zealand is acknowledged internationally as being ahead of other countries in some aspects of health information management and information technology.

5.5
A survey of doctors conducted by Harris Interactive Incorporated in 2000 found that 52% of general practitioners in New Zealand sometimes used electronic medical records, ahead of Canada (14%), the United States (17%) and Australia (25%), and just behind the United Kingdom (59%). More recently, a survey by the Royal New Zealand College of General Practitioners in 2003 indicated that almost all (99%) of the general practitioners that responded used a practice management system to help with recording patient and clinical consultation details, and running the business.

5.6
In April 2003, the interim research report on Australia’s proposed national health information network (HealthConnect) noted that New Zealand was clearly well ahead of Australia in its implementation and use of electronic health records in primary care. The report said that New Zealand’s investment in health information management infrastructure had positioned the country as a world leader. This infrastructure included the National Health Index, a national clinical coding system for primary care and hospitals, the early adoption of a standard for health messaging, and a national health intranet supported by privacy legislation and a national Health Information Privacy Code.

5.7
The new Health Information Strategy for New Zealand 2005 recognises that some parts of the sector are more advanced than others in using technology to deliver clinical services and for administrative processes. These include secondary care providers in hospitals, DHBs, the Ministry, and national agencies. The strategy also recognises that different parts of the sector have very different levels of information systems’ capability, and community providers and long-term residential care providers tend to have less capability.

5.8
The sector’s ability to exchange information is improving. Hospital and DHB systems are converging and becoming less fragmented as DHBs implement new systems and upgrade existing systems in areas such as patient and clinical management. Networks for securely exchanging information are evolving, and access to these networks is improving.

The Ministry of Health and the sector are more prepared than in the past to join together in leading and co-ordinating consolidated action

5.9
Our interviews highlighted that there had been some tentativeness by both the Ministry and DHBs about who should lead the implementation of information management and information technology improvements since the WAVE Report. In the devolved environment of the health system where DHBs have a high degree of independence, there was a sense that the Ministry and DHBs had been and were still building up trust in being able to work together confidently.

5.10
Our interviews highlighted that, although some tensions remained, the culture in the sector seemed to be changing, with stronger leadership of information management and information technology improvements seen as critical to future progress. DHBs, Primary Health Organisations, and general practitioners seemed more prepared than in the past to look to the Ministry for leadership. They wanted more effective leadership in setting priorities and co-ordinating consolidated action, and in supporting and empowering them to take action. In turn, the Ministry seemed more confident in taking the strategic lead and driving strategies and initiatives with close involvement by DHBs and the wider sector.

Key initiatives underpinning the sector’s ability to link and share information more effectively and securely are set to deliver benefits

5.11
The National Health Index upgrade, the Health Practitioner Index, and the Privacy, Authentication, and Security Project are initiatives underpinning the sector’s ability to link and share information effectively and securely.

5.12
Upgrading the National Health Index has already improved its reliability and usefulness in identifying patients. Further improvements are planned under the Health Information Strategy for New Zealand 2005. These include improvements to data quality, increasing the availability of the National Health Index, and work on using it effectively to support population health initiatives.

5.13
Like the National Health Index for identifying patients, the Health Practitioner Index will ensure that clinicians and others can securely identify with whom they are exchanging health information, and easily communicate with them. After a phased introduction of the Health Practitioner Index in 2005, further planned improvements under the Health Information Strategy for New Zealand 2005 include extending its use to records such as hospital discharge summaries, health messages, and standard datasets.

5.14
The framework of standards for privacy, authentication, and security that the Ministry has been working on to support electronic exchange of health information is nearly complete.

Recommendations to help the Ministry and the sector

5.15
Building on the progress made so far, the Health Information Strategy for New Zealand 2005 provides an opportunity for the Ministry, DHBs, and the sector to give greater impetus to information management and information technology improvements.

Clear governance and commitment

5.16
We consider that the governance, oversight, and leadership role of the Health Information Strategy Action Committee, and how well that role is undertaken, is critical to successfully implementing the Health Information Strategy for New Zealand 2005.

5.17
The Health Information Strategy Action Committee is accountable to the Minister of Health, and the Ministry will support it with resources to ensure that the strategy is successfully implemented. The Health Information Strategy Action Committee will produce an annual business plan and report on progress with the sector’s implementation of the strategy every 6 months to the Minister and stakeholders.

5.18
In our view, progress reports need to clearly demonstrate whether the implementation of the strategy is delivering the expected benefits. The benchmark targets in the new Health Information Strategy for New Zealand 2005 are a good starting point for evaluating whether the strategy is being successfully implemented but need to be underpinned with more quantifiable measures.

5.19
The Health Information Strategy for New Zealand 2005 also recognises that commitment from the sector will be needed. In our view, it is essential that the whole sector supports the strategy for it to be successful. As well as ensuring that the strategy is funded, DHBs will need to be prepared to take on responsibility for leading some of the Action Zones, the Ministry will need to be prepared to give DHBs responsibility, and Primary Health Organisations and primary care providers will need to be more organised in engaging with the strategy.

5.20
Our work highlighted that parts of the sector, particularly Primary Health Organisations and general practitioners at primary care level, do not feel adequately engaged in information management and information technology improvements, and do not have a clear picture of how they benefit delivering health services. For example, most (72%) of Primary Health Organisations that responded to our survey believed that the Ministry had not adequately involved them in shaping the Health Information Strategy for New Zealand 2005. This is despite sector representatives, supported by the Ministry, compiling the strategy in consultation with sector groups such as the Independent Practitioners Association Council.

Sound and properly resourced implementation plans

5.21
The Health Information Strategy for New Zealand 2005 indicates that the 12 Action Zones within it provide the basis for a sector implementation plan. Our survey and interviews indicated that there was support throughout the sector for a practical and sustainable sector implementation plan for information management and information technology improvements. The strategy includes an overall implementation “road map”. In our view, this needs to be expanded and supported by detailed implementation plans for each of the strategy’s component Action Zones.

5.22
The “road map” and the Action Zone implementation plans are more likely to be successfully implemented if they are prepared in keeping with the principles of good business planning. They should be simple, specific, realistic, and complete. Taking each of these principles in turn, our work has highlighted some important issues that should be addressed.

A simple “road map” should guide implementation of the Health Information Strategy for New Zealand 2005

5.23
A good implementation plan is simple in that it is easy to understand and to act on, communicating its contents easily and practically.

5.24
Most of the people we spoke to throughout the sector agreed that a simple “road map” showing the integrated health information system that the sector was aiming for would be useful in communicating and clarifying understanding.

Action Zone implementation plans should be specific

5.25
A good implementation plan includes specific actions and activities, with specific dates of completion, specific people responsible, and specific budgets.

5.26
We consider that the Action Zone implementation plans for the Health Information Strategy for New Zealand 2005 should be very specific to avoid confusion about roles and accountabilities and unclear funding arrangements, as encountered after the WAVE Report. The strategy contains high-level objectives, steps, and timelines for the Action Zones. It notes that specific goals will be defined during work on projects under each Action Zone. We consider that the strategy needs to be underpinned by more detailed and specific implementation plans for each Action Zone.

5.27
On funding, the Health Information Strategy for New Zealand 2005 notes that the Action Zones will need focused effort and resources. It identifies 3 funding sources. These are re-allocating existing capital funds in the sector to the Action Zones, directing money set aside for future projects to the Action Zones and, where it is made available, allocating new money to the Action Zones. We consider that it is vitally important that realistically assessed levels of funding are met with resources from throughout the sector.

Action Zone implementation plans should be realistically based on the sector’s capacity for change

5.28
A good implementation plan includes realistic goals, budgets, and milestone dates.

5.29
Part 4 of our report describes how the sector’s capacity for information management and information technology improvements has become stretched. In our view, the implementation plans for the Health Information Strategy for New Zealand 2005 Action Zones must be based on staged goals, budgets, and milestones, which are assessed as realistically achievable within the sector’s capacity.

Action Zone implementation plans should be focused on business needs

5.30
A common view among the DHBs, Primary Health Organisations, and bodies representing general practitioners that we spoke to was that information management and information technology improvements had not been focused clearly enough on meeting the information needs of clinicians. The Health Information Strategy for New Zealand 2005 emphasises that health information must support the delivery of health care.

5.31
We consider that Action Zone implementation plans for the Health Information Strategy for New Zealand 2005 should be prepared and executed in close consultation with clinicians, including those in the primary care sector. This will help to ensure that improvements under the Action Zones are driven by business needs and remain focused clearly on delivering better health outcomes.

Quickly addressing issues on specific initiatives

5.32
Our work identified some important issues relating to the initiatives we examined, which need to be addressed.

The setting of health standards needs to be better resourced and the effects of standards need to be evaluated

5.33
HISO had difficulty attracting sector funding for preparing and implementing standards, and did not achieve the funding and staffing levels recommended by the working group that advised on setting up HISO. Also, partly because it was relatively recently that standards began to be endorsed or approved, there had been little follow-up of how successfully standards were being implemented. For example, although work on data quality indicators is under way, the effect of the ethnicity data protocols in improving ethnicity data quality has not been evaluated.

5.34
We support the work the Ministry has in hand to produce ethnicity data quality indicators.

Buying upgraded Application Programme Interfaces to get full functionality from the improvements to the National Health Index should be a priority

5.35
Some of the Chief Information Officers we interviewed were concerned that the full improved functionality from the upgrades to the National Health Index was not available to users because the estimated cost was greater than expected for a key component. They told us that upgraded Application Programme Interfaces for DHBs were needed. Without these, users could not use all of the new fields included in the National Health Index for searching and matching NHI numbers, and general practitioners had to access the NHI Online Access for Health (NOAH) application separately rather than it being integrated with their practice management systems.

5.36
The Application Programme Interfaces had been removed from the NHI Upgrade Project in early 2005 while the question of whether the Ministry or DHBs were responsible for funding them was resolved. The Ministry does not have a plan for when and how the Application Programme Interfaces will be upgraded. In our view, the Ministry should give priority to resolving this issue with DHBs.

Guidelines on using the Health Practitioner Index are urgently needed

5.37
Introduction of the Health Practitioner Index is under way. However, the sector was poorly informed about how the Health Practitioner Index was to be used. Preparing user guidelines is part of the Ministry’s work programme, and it is holding ongoing discussions and workshops with the sector on how the Health Practitioner Index might be used.

5.38
We support the work that the Ministry has under way. In our view, these guidelines need to be finalised and communicated to the sector quickly to ensure that early benefits from the Health Practitioner Index are realised.

Enhancing the Health Intranet and finalising the Privacy, Authentication, and Security Project need to be given added impetus

5.39
The Health Intranet has a poor profile in the sector, which is restraining the intranet’s use as an effective network for exchanging health information. In March 2004, the Health Intranet Governance Board, which is to be subsumed within the Health Information Strategy Action Committee’s infrastructure sub-committee, considered operational issues facing the Health Intranet. It identified 6 main challenges facing the network. These were cost, technology, application availability, system integration, training and awareness, and promotion and marketing.

5.40
Recommendations under each challenge were proposed in a paper to the Governance Board. Although there has been some progress, such as improved access to the Health Intranet for some Primary Heath Organisations, and general practitioner take-up of broadband access being encouraged, generally progress with addressing the challenges has been limited since March 2004.

5.41
We support the Health Intranet Governance Board being subsumed within the Health Information Strategy Action Committee infrastructure sub-committee. We also support the work that this sub-committee has under way to address the operational issues facing the Health Intranet.

5.42
The Privacy, Authentication, and Security Project is taking a long time to complete. The Ministry recognised that the standards, codes of practice, and guidelines that it will deliver were urgently required when the project began in July 2003. The Ministry finalised the standards in January 2006, and plans to launch them in mid-2006. We consider that the Ministry should give priority to this important project.

5.43
We support the privacy, authentication, and security standards being prepared.