Summary

Progress with priorities for health information management and information technology.

In the modern high-technology environment, the ability to manage and exchange information quickly and securely is important. It is arguably even more important in the health and disability sector, because the quality of health services can depend on it.

Between 1991 and 2000 there were 3 successive health information strategies. Then, during 2001, for the first time a group from throughout the sector came together to consider information management and information technology needs. This group published its report in October 2001, entitled From Strategy to Reality – The WAVE Project (the WAVE Report).

The WAVE Report advised the Ministry of Health (the Ministry) of the sector’s recommendations for making more effective use of health information. The report contained 79 recommendations, including the “Top 10” priorities for action, and envisaged rapid change in 3 to 5 years, which is a demanding timetable.

We decided it was timely, around 3½ years after the WAVE Report was published, to audit whether the Ministry and the sector had made the progress they expected to make towards more effective use of health information.

Reasonable and pragmatic response to the WAVE Report, but more impetus required

Under the devolved health sector structure introduced in 2000, progress with information management and information technology improvements relies on stakeholder involvement and collaboration throughout the sector.

Recognising this, from around mid-2002, the Ministry set out to work with the sector on implementing the recommendations in the WAVE Report.

Progress on the Top 10 priorities under 4 strategic steps

The Ministry concentrated on the Top 10 priorities identified in the WAVE Report by involving the sector in 4 strategic steps:

  • strategic step 1 – supporting the priorities reflected in the WAVE Report through initiatives such as upgrading the National Health Index and setting up a Health Practitioner Index;
  • strategic step 2 – preparing and implementing planning frameworks to co-ordinate and align the sector’s improvements in information management and information technology;
  • strategic step 3 – setting up and implementing stewardship arrangements, such as national and regional forums, to ensure that the sector’s information management and information technology improvements are appropriately overseen and guided by the interests of sector stakeholders;
  • strategic step 4 – refreshing and implementing the sector’s strategy for information management and information technology.

Much of the progress made was in setting up capability for longer-term benefits

Progress was made on key initiatives at national and District Health Board level under the first strategic step. At a national level, the Health Information Standards Organisations was involved in drawing up and implementing information standards. The Ministry upgraded the National Health Index, introduced a Health Practitioner Index, enhanced the Health Intranet, and drew up draft privacy, authentication and security standards for sharing information. District Health Boards focused on planning and progressing initiatives to build their capability to electronically exchange hospital discharge summaries and referrals with primary care providers.

Progress was made in preparing sector planning frameworks under the second strategic step. The Ministry sought to co-ordinate and align District Health Boards’ planned activities to improve their information management and information technology. Common performance indicators on progress with implementing the WAVE Report were included in the District Health Boards’ annual plans. The Ministry and the District Health Boards also prepared Information System Strategic Plans using a common framework.

Progress was made in setting up sector stewardship arrangements under the third strategic step. Several groups concerned with the stewardship of information management and information technology have been set up throughout the sector, including national and regional groups to co-ordinate capital investment. Stewardship arrangements are still evolving as the various groups mature and become more effective in linking and working together.

The Health Information Strategy for New Zealand 2005 was published in August 2005 under the fourth strategic step.

Some early benefits from more effective information use have emerged

Most District Health Boards and just over half of Primary Health Organisations that responded to our survey believed that electronic information use in patient treatment had improved because of the initiatives progressed. Upgrading the National Health Index together with the introduction of standards for capturing ethnicity data had most noticeably benefited information use. The benefits of other initiatives were not yet as clear, particularly for Primary Health Organisations.

Action was driven jointly by the Ministry and the sector in the absence of an organisation to provide effective independent strategic leadership

A sector team (overseen by an Advisory Board of sector representatives appointed by the Director-General of Health) produced the WAVE Report. In the view of the WAVE Advisory Board, the most important recommendation in the WAVE Report was to set up an independent organisation to lead sector information management and information technology capability. Establishing an organisation has taken a long time.

It was 26 months after the WAVE Report was published before the Health Information Standards Organisation (HISO) became operational in December 2003. HISO was not set up to be as independent of the Ministry as recommended by the working group that advised on setting it up. The Ministry had supported HISO with resources and through funding but HISO had not attracted the expected level of funding from the sector. Also, HISO had not had a strategic sector leadership role as envisaged by the working group.

After the publication of the new Health Information Strategy for New Zealand 2005 in August 2005, HISO’s role was broadened to undertake governance, oversight and leadership of implementing the strategy. HISO has been renamed the Health Information Strategy Action Committee and now has a strategic leadership role.

Action was not guided by a detailed plan with measurable objectives

The WAVE Report was a basis from which to take action rather than a detailed plan of action. When the WAVE Report was published, the Ministry considered that the sector was not in a position, culturally or structurally, to prepare a detailed plan for implementing the recommendations. Having just been through the process of compiling the WAVE Report, the Ministry believed that more time spent planning a detailed response would have damaged the sector’s confidence in its own and the Ministry’s ability to take action, and momentum would have been lost.

While the Ministry’s response, working with the sector through the 4 strategic steps, was reasonable and pragmatic, some focus and impetus was lost by not having a detailed plan with measurable objectives.

Progress was generally less than expected, affected by changes in the sector and some difficulties

Some changes affecting the sector are likely to have slowed progress. Major changes in the structure of the health sector have taken place over the last 5 years, including decentralising decision-making to 21 community-focused District Health Boards and setting up 77 Primary Health Organisations under District Health Boards. These changes are likely to have slowed progress with information management and information technology improvements as District Health Boards and Primary Health Organisations have settled into their roles, and the information demands on them and their own information requirements have evolved.

Some changes affecting the sector have added impetus to progress. The New Zealand Health Strategy, The Primary Health Care Strategy, and The New Zealand Disability Strategy all highlight the importance of improving the sector’s capability to manage and exchange high-quality information quickly and effectively. New funding arrangements for District Health Boards and Primary Health Organisations also depend on accurate information about health needs. External factors such as the increasing availability of broadband internet access have also helped.

Some difficulties have been encountered around effectiveness of leadership and clarity of responsibilities for improvements. While the Ministry had been prominent in driving certain initiatives, there were some areas where different parts of the sector would have liked more effective leadership from the Ministry. These included clearer strategic priority setting, quicker and more definitive decision-making, and greater empowerment. Most of the District Health Boards and Primary Health Organisations that responded to our survey believed that the absence of a written strategy defining responsibilities and accountabilities under the strategic steps had hindered progress.

There have been some difficulties with funding, and the sector’s capacity for implementing changes. Funding pressures on the Ministry and District Health Boards have meant that the level of investment in information management and information technology following the WAVE Report is likely to have been less than anticipated. The sector’s capacity for implementing changes alongside maintaining normal business has also been stretched.

There have been difficulties caused by District Health Boards’ different levels of maturity in information management and information technology. This has sometimes limited progress. For example, some District Health Boards have patient management systems that were not designed for the sort of information flows envisaged by the WAVE Report and need to be upgraded or replaced before the full benefits envisaged can be achieved.

The sector is now in a better position to more quickly address remaining information priorities

The Health Information Strategy for New Zealand 2005 provides a good basis for the sector to build on the action that has been taken so far and make better progress. There is a good and improving technology base to build on, and culturally the Ministry and the sector are more prepared to lead and co-ordinate action together. The strategy needs to be quickly implemented, and some important issues on specific initiatives need to be quickly addressed.

Recommendations

In our view, our recommendations will hasten the implementation of the Health Information Strategy for New Zealand 2005 and contribute to achieving the strategy’s objectives.

Health Information Strategy Action Committee

We recommend that the Health Information Strategy Action Committee:

  • obtain and act on regular feedback from stakeholders throughout the sector on how well it is undertaking its role and what it is achieving, to help ensure that it build and retain credibility with the sector;
  • ensure that benchmark targets in the Health Information Strategy for New Zealand 2005 are underpinned by more specific measures to assess whether the targets are being achieved, recognising the need not to overload the sector with performance indicators;
  • ensure that all parts of the sector, including Primary Health Organisations, clinicians, and other health providers, are effectively consulted and involved in implementing the Health Information Strategy for New Zealand 2005 Action Zones by ensuring that:
    • existing stewardship arrangements are used effectively to involve the sector; and
    • new mechanisms are put in place to effectively involve parts of the sector for which suitable mechanisms do not currently exist (for example, Primary Health Organisations);
  • guide implementation of the Health Information Strategy for New Zealand 2005 with a simple “road map” that is communicated to the sector, showing:
    • the integrated health information system that the sector is aiming for;
    • the overall implementation period;
    • where projects and initiatives fit in;
    • major milestones along the way; and
    • how benefits would build up for different parts of the sector and for patients;
  • put in place an implementation plan for each of the Health Information Strategy for New Zealand 2005 Action Zones;
  • ensure that each Action Zone implementation plan is split into constituent projects, with specific measurable objectives and responsibilities, and realistic budgets and completion dates; and
  • in compiling and overseeing implementation of the Action Zone plans, ensure that:
    • the funding and resources required to successfully implement improvements under each of the Action Zones are realistically assessed, and made available from throughout the sector;
    • the sector’s capacity for undertaking the required changes is reviewed so that progressive goals and milestones are realistic and achievable;
    • external expertise is effectively contracted in (where required) to support the changes; and
    • clinicians are consulted, to ensure that activity is driven by business needs and remains clearly focused on better health outcomes.

Health standards sub-committee of the Health Information Strategy Action Committee

We recommend that the health standards sub-committee of the Health Information Strategy Action Committee:

  • secure more funding and resources from the sector, for preparing, implementing, and evaluating standards; and
  • monitor and report regularly to the sector on the funding and resources directed towards preparing, implementing, and evaluating standards, and on progress made.

Infrastructure sub-committee of the Health Information Strategy Action Committee

We recommend that the infrastructure sub-committee of the Health Information Strategy Action Committee:

  • act quickly to make the Health Intranet more effective by addressing the operational issues that have been identified, including raising the profile and use of the network throughout the sector; and
  • give priority to endorsing and launching the privacy, authentication, and security standards.

Ministry of Health

We recommend that the Ministry of Health:

  • continue to support through funding and resources the work of the health standards sub-committee of the Health Information Strategy Action Committee in preparing, implementing, and evaluating standards;
  • evaluate the effect of the ethnicity data protocols on data quality to assess if any further follow-up action, such as additional training, is needed;
  • and District Health Boards resolve, as a priority, how to fund and procure appropriate Application Programme Interfaces to improve use of the National Health Index; and
  • quickly finalise the guidelines for using the Health Practitioner Index, and communicate the availability of the guidelines to the sector to ensure that early benefits from the Health Practitioner Index are realised.
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