Healthcare could ‘lead world’
The health service has been prescribed a big dose of information technology to help it get better value out of the $16 billion spent on healthcare each year.
Electronic health records (EHRs), which would create a single health record for every New Zealander, are firmly back on the agenda with the Health Ministry last week appointing international consulting firm Accenture to draft a business case.
EHRs would pull together people’s health information into a single electronic file that both healthcare providers and patients would be able to view securely online.
John Halamka, professor of international healthcare innovation at Harvard Medical School in Boston, has toured New Zealand and subsequently blogged that this country had a unique opportunity to leapfrog the rest of the world in this area.
‘‘Every person in New Zealand I spoke with felt that individual privacy, although important, was not an impediment to building a large database for societal good,’’ said Halamka, who spoke to officials, DHBs and fellow academics..
A report from the Health Ministry in August said EHRs could improve patient safety, reduce duplicate and unnecessary tests, and ensure patients didn’t have to repeatedly provide the same information to doctors.
Another benefit is that they should provide a reliable record of allergies and medications if patients are admitted to an emergency department.
‘‘An EHR will be especially useful for people who are unable to speak for themselves, due to ... dementia or an acute mental health condition or for those who relocate around our country,’’ it said.
The ministry last year paid another consultant, Deloitte, $94,640, to conduct a study into the possible benefits.
Its report suggested EHRs could address a ‘‘productivity gap’’ in hospitals, which had one doctor and 3.6 nurses per hospital bed.
Those ratios compared to an OECD average of 0.7 doctors and 1.9 nurses per bed.
OECD figures suggest the health service may be in fitter shape than those numbers suggest, and they could instead reflect the fact we have relatively few hospital beds for our population.
On other measures, the United States stands out as the poor performer, seeing no obvious gains from its massive expenditure on insurance-based healthcare.
But Kate Reid, New Zealand general manager of Kiwi software firm Orion Health, says there is still room for improvement here.
While the individual parts of the health system are well-oiled, that may not be the case if patients are managing multiple health conditions, she says.
The Health Ministry warned the challenges implementing EHRs would not be trivial, saying investments in Australia, by the National Health Service (NHS) in England and in the United States had all been problematic.
Singapore invested US$100m (NZ$139m) to establish comparable records, while Australia had invested $1.5b, it said.
Britain’s NHS spent a massive £12 billion (NZ$20b) on an ambitious system that delivered only limited benefits because of a lack of buy-in from clinicians and poor delivery by technology companies in a scheme which was later ‘‘completely re-thought’’.
Reid says New Zealand has a head start because it is one of only a small number of countries that already assigns a unique code to every patient and healthcare provider.
But Shayne Hunter, chief information officer of Capital & Coast, Hutt Valley and Wairarapa district health boards, provided a reality check in July, noting the three DHBs had about 1200 software applications to maintain and were managing a lot of conflicting priorities and ‘‘mixed messages’’.
It is also a case of second-time lucky.
EHRs had been the cornerstone of the National Health IT Plan agreed by the New Zealand Government in 2010 and were originally due to be in place in 2014, but funding was never arranged.
Potentially complicating matters, some district health boards and GP practices have since partly filled the vacuum by pressing ahead with their own IT investments.