From Reactive to Proactive
In May 2021, the Waikato District Health Board (DHB) hospital computer systems and telephone lines suffered a ransomware attack. The unidentified group obtained sensitive data about patients, staff, and finances. The group issued an ultimatum to the Waikato DHB, however the Waikato DHB and New Zealand Government ruled out paying the ransom.
Due to this event, the New Zealand Ministry of Health approved a NZ$75 million cyber resiliency project. In addition to this, the New Zealand government has approved a $257M digital health investment of which $87 million is targeted to address replacing ageing technology and digital capability deficits. How can new technology help us do better? Treating Health IT as Critical Infrastructure
The reason these investments are being made now is because historically IT health systems have not been treated as critical infrastructure. The new crown entity Health New Zealand has the opportunity to change this. Information technology will have to be treated as a critical enabler in achieving a health and disability service that is people-centred, equitable, accessible, and cohesive. But what has yet to be determined is the roles that data, technology, and digital solutions will play1.
The Future of Health
Firstly, you need digital investments to accelerate systems that better support new ways of working. To enable that, New Zealand needs to acknowledge that health IT, like roads, is critical infrastructure – and must be treated as such.
Infrastructure needs to be viewed beyond bricks, mortar, and physical hardware. Infrastructure must now include data. And this data helps determine what you should invest in. All decisions need to be data-driven.
Richard MacGeorge of the New Zealand Infrastructure Commission, Te Waihanga, has also stated the need to get the thinking right first: “We are bringing wellbeing more into the way we are thinking about infrastructure.” He questions the assumption that health services have to be carried out in a healthcare facility and questions what the role of the hospital will be in 2050: “Is the current model going to be continued for the next 20 or 30 years or is it likely there will be some fundamental change?”2
First, let’s imagine what the future of health will look like in 50 years’ time. The healthcare infrastructure of today will unlikely be sufficient for the IT infrastructure demands of tomorrow and compound this with increasing lifespans and chronic conditions means new types of services will be required which will necessitate a change in where and how services are delivered. Kelvin Keh, of UniServices at the University of Auckland, expects we will see more forms of personalisation where services are tailored to particular demographics to enable better outcomes. This will likely be a mix of services within clinical settings, at home, and in the community.3
Health New Zealand reforms need to be approached as a massive people-and-process change exercise, focused on equity and underpinned by technology which, while complex, has interoperability and accessibility at its core.
Identify Shovel-Ready IT Projects
New Zealand doesn’t need twenty different ways of delivering health services requiring bespoke systems. As we’ve seen bespoke processes and IT systems have largely outlived their usefulness in this respect. Instead, our health service needs help to standardise IT systems to support easy integration and sharing of information into the future, adopting commodity IT services where it makes sense and using ‘community IT’ services where it doesn’t.
The goals, at a high level, must address issues around data and its use by staff and patients:
- Improve access to accurate data in a timely manner, in a form that is easily consumed and updated.
- Enable medical staff to spend their time resolving patients’ health issues, not transposing charts and notes.
- Enable patients to access this information equally and freely, with appropriate support and guidance about its interpretation.
In 2022, anything less is not acceptable.
To enable the health system to better adopt an agile way of implementing innovative solutions I suggest establishing a Health CIO group, with a committed budget allocated to modernising the IT infrastructure (inclusive of data) necessary to support a modern health service. The digital infrastructure of our health systems should be treated in the same way as roads and water infrastructure projects are treated. What I mean here is that the development, implementation, and maintenance of these systems should have a committed investment stream to support the realisation of this outcome. Some of these projects should be considered as the digital equivalents of ‘shovel-ready’ infrastructure projects.
Looking Ahead: The Time Has Come for Strategic Infrastructure
This is a once-in-a-generation opportunity. Health New Zealand requires a bold, brave approach and a commitment to building a foundation which allows IT to positively contribute to a secure, efficient, and quality healthcare system for all New Zealanders for generations to come. Moving forward, patient centric systems which provide flexible access to services must be the main emphasis — and, even more importantly, ensuring the data, and infrastructure to support it, is resilient and sustainable for the future.
Rather than centring only on improving hospitals, there needs to be equal focus on moving health into the community, and changing in the system of funding health services. If this is achieved, then I believe technology and community-based services that aligns with and adapts to the future of health can become a reality for New Zealand.
1 See “Digital’s role in the Health Reforms,” presentation by Shayne Hunter, Deputy-Director General, Data & Digital, Ministry of Health New Zealand, ITP, 9 Sept 2021.
2 After Covid: Will our health system change?| Newsroom
3 New Zealand’s Strategic Use of Healthcare Tech & Infrastructure (pulsara.com)