Part 2: Background information

Inquiry into Waikato District Health Board’s procurement of services from HealthTap.

This Part provides background information that is helpful to understanding Waikato DHB's decision to purchase the HealthTap platform. It describes:

What is virtual care?

Virtual care is the use of various communication and information technologies to improve patient access to care, health engagement, and health outcomes. Waikato DHB anticipated that using virtual care would give patients more control over their healthcare, reduce the need for patients to physically travel to clinics, and give patients access to credible online health information.

Why Waikato District Health Board was interested in virtual care

Waikato DHB's interest in virtual care was driven by a need to find a way of delivering healthcare in a more cost-effective and patient-centred way.

Particular drivers for change were described in Waikato DHB's strategic business case for virtual care:

A synopsis of the major drivers is given below:

  • Impending demand for health services created by the health needs of the baby-boomer generation.
  • Increasing burden-of-lifestyle illness such as obesity and chronic disease management.
  • The increasing depopulation of rural centres with the concomitant reduction in the supply of medical services.
  • Overreliance on treatment-based medical services rather than proactive patient-based public health activities.
  • Demographic change in our current healthcare workforce will constrict supply of suitable qualified personnel over the next 15 to 20 years.
  • Reducing real funding available to public health care as a component of national GDP.

Before it implemented the SmartHealth service, Waikato DHB was already using "telehealth" services to perform virtual ward rounds in its hospitals. A virtual ward round involved a nurse taking a telehealth cart (similar to a computer on wheels) to the patient's bedside and the patient and specialist then communicating through a video screen.

About the same time, Pinnacle Healthcare, the largest primary health organisation in the Waikato region, was developing its own patient portal. Patient portals are secure websites that allow people to access their personal health information and interact with their doctor. Through patient portals, people can send secure messages to their doctor, order repeat prescriptions, and, in some patient portals, view lab results and doctors' notes.

However, our understanding is that implementing a comprehensive virtual care approach to the delivery of health services had not been attempted by any other DHB or healthcare provider in New Zealand at the time.

What is HealthTap Inc?

HealthTap is a company based in the United States that developed the HealthTap platform. It provides software that connects patients with doctors and clinicians online using video-conferencing and audio and text messaging.

The Chief Executive told us that, when he first approached HealthTap to discuss its virtual care services and products, the company was still in its start-up phase. Its Board included its investors and representatives, and HealthTap's main business at the time was with small to medium-sized practices in the United States. The Chief Executive told us that, although HealthTap had clients in almost 50 states, it was still on the cusp of preparing for larger "enterprise" customers, such as Waikato DHB.

How does the HealthTap platform work?

The HealthTap platform is an online package of modules made available through an app. There are two versions – one for consumers and one for providers. Both versions are available through Apple and Google Play's app stores. It is also available through a web-based interface.

The HealthTap platform enables patients to communicate with clinicians through video conferencing and audio and text messaging, and to access health information. The HealthTap platform also enables clinicians to create medical records of those consultations.

The HealthTap platform is a form of "software as a service", meaning that those purchasing it do not own and install the software locally but access it online. The components include:

  • a health profile that records a patient's demographic and health history information;
  • a consultation platform through which a patient and clinician can talk to each other by text, audio, or video, and the HealthTap platform also supports the exchanging of messages and attachments; and
  • a healthcare team component that enables patients to invite clinicians to join the team looking after them and that gives those clinicians access to the patient's health profile.