Significant opportunities for systems integrators and cloud service companies will arise from the New Zealand Government’s intention to revolutionise its Health system, adopting principles from Australian jurisdictions to address ongoing issues of social inequality and economic sustainability.
Abolishing the current “fragmented” and decentralised system is the government’s first response to the June 2020 Review of the Health & Disability Sector. The reform will see the creation of Health NZ and a counterpart Māori Health Authority to oversee all operations, procurement, and administration. Currently operations are administered separately over twenty District Health Boards (DHBs), hampering the effectiveness and efficiency of health service delivery.
The scope of reference for the review when commissioned in 2018 identified key drivers and challenges which are considered in the government's response:
- Inequities in service delivery, particularly for Māori, Pacific Peoples and those with a disability.
- Changing demographics (particularly ageing population).
- Increasing prevalence of chronic (lifestyle) disease e.g. diabetes and cancer.
- (Economic) sustainability – particularly boosting primary and community-care engagement to prevent poor future health outcomes.
- Rapid rate of technological change promising to transform current models of care.
Centralising health functions is expected to create improvements by expanding specialist and tertiary coverage over a greater geographical area. It will also help to remove duplicate HR and administration systems, with a Whole of Government (WofG) shared services arrangement envisioned.
The 2020-21 NZ Half Year Economic and Fiscal Update notes the current system regularly runs an average $NZ600m annual deficit due to this lack of coordination, providing the government with a strong economic incentive for reform.
By focussing on primary and community care (e.g. local GPs, dentists, midwives, pharmacists and mental health) the new system will adopt a more preventative model, reducing the number of people seeking specialist care and hospitalisation. The reform foresees the creation of “seamless and accessible locality networks” which will enable:
- Sharing of digital health records between providers,
- greater use of digital technology to enable care closer to home, and
- tailoring of local services to meet community needs.
This vision implies significant opportunities for systems integrators and cloud service companies to build and host messaging and health records systems, telehealth services and equipment suppliers (IT systems, telecommunications, end-user hardware and peripherals such as IoT devices), and data collection and analytics suppliers to help craft personalised or tailored services.
At the secondary and tertiary level of care broad regional networks will be administered nationally, allowing workforce planning and administrative decisions to be made with complete datasets based on shared systems.
Similar to Australia?
The new approach has drawn comparisons to overseas public healthcare systems such as the British NHS. New Zealand appears to be also taking cues from Australia which has seen a massive uptake of health technologies through its shared services and centralised agency approach.
By centralising the functions of health service delivery and administering them through broad local and specialist networks, the proposed NZ the model resembles the NSW system of Local Health Districts coordinated under the NSW Ministry of Health and its service agreements. Under this model, eHealth NSW provides a coordinating mechanism, managing a consistent and standardised data and digital ecosystem across the state.
The Australian Department of Health provides strategic coordination between the various jurisdictions on initiatives such as the MyHealth Record under Australia’s Federal system, the Australian Digital Health Agency (ADHA) has also been involved helping to ensure digital service delivery consistency across the Commonwealth.
Digital Health implications
A recent joint review by the New Zealand Health Information Technology Industry Group and the Ministry of Health assessed the nation’s digital health ecosystem. In the foreword, Deputy-Director General of the Ministry of Health, Shayne Hunter said the review outlined the “urgent need to invest more in data and digital technologies”.
The creation of a national Health Information Platform (nHIP) will be the first step in joining up the fragmented digital infrastructure of New Zealand’s health system.
The review’s whitepaper made recommendations to move digital transformation forward in the sector, they are contrasted below with similar approaches taken in the Australian context:
1.Establish a Digital Health Innovation Network to enable cross-sectoral collaboration between industry, researchers and providers on emerging technology uses and needs.
eHealth NSW has operated an Innovation Portal since 2017, hosts Partnership Summits with industry and establishes research hubs in universities according to its ten-year strategy.
The ADHA Framework for Action outlines many examples of innovation collaboration such as industry partnerships and showcases.
2.Procurement reform to reduce time delays, promote public/private partnerships and co-design and “refocus funding from capital to operating expenditure.”
Interoperability is a key ongoing responsibility of the ADHA to help overhaul procurement within the digital health space.
State jurisdictions have prioritised the creation of platforms to enable procurement of innovative apps. eHealth NSW has focussed on core clinical systems upgrades reflecting the need to focus on operating expenditure to ensure efficient outcomes.
3.Establish a Digital Health Academy to improve digital literacy and workforce digital capability.
In 2020 the ADHA released the seven-year Digital Health Workforce Roadmap, anticipating that frontline and executive healthcare workers would increasingly lack data and digital literacy as advanced technologies such as predictive analytics quickly become the norm in clinical settings. The Roadmap calls for the creation of centralised digital education system for workers to ensure smooth adoption of these technologies.
4.Focus on addressing inequities and accessibility issues through technologies such as telehealth, “hospital-in-the-home” and ensure security and inclusiveness in “consumer facing digital investments”.
Digital inclusion is increasingly being recognised as a core issue across Australian jurisdictions in all sectors. In response to the COVID-19 pandemic, the Sydney Local Health District established RPA Virtual Hospital to provide high quality, personalised care across the state 24/7.
The NZ Health reform will be coordinated through the Department of Prime Minister & Cabinet’s Implementation Unit which has published an implementation roadmap.
Consultation and engagement will be ongoing until July 2021, with necessary legislation expected to be passed by July 2022. Interim entities will be established and planning and capability building will continue until the legislation comes into force. After the legislation is enacted, the current DHBs will be transferred to the new agencies and locality networks will be progressively established.
By 2022 the ADHA expects electronic medical records, telehealth, and secure messaging systems to have been “fine-tuned” across Australia. This foundation will pave the way for increased adoption of IoT, genomics data, robotics, and AI in healthcare.
Taken together these initiatives present a diverse range of opportunities for suppliers to the Australasian public health market over the coming years.