Health NZ: Confusing, lacking clarity and coherence

Published on the 06/12/2023 | Written by Heather Wright

Health NZ data and digital: Confusing, lacking clarity and coherence

Damning report calls for funding to be ‘closely examined’ against expectations…

A damning report into Te Whatu Ora Health New Zealand data and digital services has laid bare a lack of coherence in roadmaps and operating models, along with a lack of clarity around governance, investment planning and tech innovation.

The report from the Ministerial Advisory Committee for Health Reform Implementation, completed in August, notes historical under-investment in health ICT resulting in a build up of technical debt, and a lack of clarity around the current state of data and digital services and resources across each of the 29 organisations now part of Te Whatu Ora Health New Zealand/Te Aka Whai Ora Maori Health Authority.

“There remains an overall lack of clarity on priorities for the near and medium terms.”

“Together, these issues complicate the task of integrating data and digital services and resources, including people, into a coherent system that is efficient and effective,” the report notes, recommending the level of data and digital funding be ‘closely examined’ against reform expectations and the organisation’s ability to meet those expectations financially and in terms of capacity and capability.

The merger of New Zealand’s district health boards is ‘huge’ and represents the largest ICT program ever undertaken in New Zealand, according to the report.

The 2022 Budget saw $600 million allocated for data and digital infrastructure and capability for the New Zealand health sector, with Te Whatu Ora Health New Zealand aiming to ‘simplify and unify’ the sector’s technology through a national data platform.

But the report, which aims to provide an assessment of the Te Whatu Ora data and digital (D&D) service’s progress towards the health reform objectives, paints a picture instead of confusion and a lack of coherence and consistency, with the underinvestment and technical debt complicating the task of integrating services.

It notes that there are three documents setting out the data and digital strategic direction and initiatives, but says while they’re aligned around one vision and five priority areas, they ‘break down into a somewhat confusing collection of themes, goals, flagship initiatives, roadmap initiatives, guiding principles and customer needs and priorities, reflecting a lack of clarity and focus’.

That clack of clarity and focus is a strong theme throughout the report.

“Many artefacts have been developed to describe strategy, operating model characteristics, technical architecture and planned initiatives, for example,” it notes.

“D&D are on the path to developing a clear understanding of their capability and capacity in terms of people, processes and technology across the system. While significant progress has been made, there remains an overall lack of clarity on priorities for the near and medium terms.”

Details of the planning and prioritisation processes across the three organisations involved in the reforms – Te Whatu Ora Health New Zealand, Te Aka Whai Ora Maori Health Authority and the Ministry of Health Manatu Hauora – are ‘unclear’ and progress against the Horizon 1 Roadmap indicates potential issues with planning and prioritisation of initiatives and understanding the capabilities and capacity of Te Whatu Ora data and digital and of the organisation as a whole.”

The report notes a number of areas of interest it wasn’t able to pursue, due to ‘the state of flux’ throughout Te Whatu Ora’s data and digital services.

Those include confirming details of planning and prioritisation processes across the three organisations; developing a full understanding plans, progress and issues around the Hira national health information platform, and identifying progress on system integration.

While efforts to identify the current IT system landscape are underway, the report says it’s unclear how advanced that process is.

In it’s first annual report, released this week, Te Whatu Ora says it inherited a complex legacy ICT landscape, with each DHB and shared services agency having different digital strategies, priorities and solutions, and with varying degrees of maturity, quality and consistency.

“Establishing a single data and digital entity is one of the most ambitious areas of the reform program and reflects the largest IT system rationalisation and redevelopment attempted in Aotearoa New Zealand. While ambitious, the establishment of one entity provides an opportunity to modernise the health system and transform the delivery of healthcare in New Zealand.”

The annual report says ‘significant’ work has been undertaken to align and focus the work program, including nationalising and rationalising 4,000+ applications across the environment.

“Whilst work is underway, there is significant investment required to complete post-merger acquisition and transition activities, maintain the reliability and operation of these systems during that process, and progressively modernise our systems.”

It notes around 1,7000 initiatives were underway when Te Whatu Ora took over, with a review completed in late 2022 pausing those not linked to the future national direction and priorities.

The report says a national Whanau, Clinician and Consumer Digital Council has been formed to shape data and digital technologies.

“Some of our work programmes are well advanced and others are still at the early stages of development (informed by service planning and emerging priorities),” the annual report says.

A business case for the national data platform which will consolidate data environments into one platform to provide a connected environment across New Zealand, has been approved and work is underway to develop the platform.

The report says Te Aka Whai Ora is leading development of the Maori data sovereignty framework.

The new National-led government has said Te Aka Whai Ora will be abolished, with National criticising the body for adding yet more bureaucracy. It has promised to replace it with a Maori health directorate inside the Ministry of Health.

Te Whau Ora recently revealed that work is underway to build the Hira connector plan, while will provide a single, secure point of access to the APIs supported by Hira.

Providing access to patient summaries will be made possible through the connector plane, Te Whatu Ora says, with the connector plane enabling information making up patient summaries to be securely accessed, shared and updated.

Hira is in its first phase of implementation, due for release by mid-2024.

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