New Zealand’s public health system is run on patchwork IT, often with no effective backups, and is experiencing more frequent and more serious service outages, with risks of unsafe data sharing and breaches.

That’s the verdict from Te Whatu Ora/Health New Zealand in its briefing to the incoming Minister of Health, Shane Reti, with the report warning that the public health system is in need of significant resources.

“Many assets are at, or close to, end-of life – and we are still uncovering new issues.”

Te Whatu Ora/Health New Zealand was established in July 2022, replacing 20 district health boards, eight shared services agencies and some of the functions from the Ministry of Health. It’s responsible for the planning and commissioning of services and the functions of the former district health boards to remove duplication and provide national planning.

Its briefing to the incoming minister is a stark assessment of a health IT system in disarray – and one which isn’t likely to be fixed anytime soon according to Te Whatu Ora.

It says the digital portfolio it inherited is a patchwork of about 4,000 systems that are not integrated, and are often out-of-date, with no effective backup.

More serious and more frequent service outages are being experienced due to the significant resources required to maintain legacy systems, particularly those reaching end-of-life, while ‘significant’ data gaps and limitations, including different data structures, make integration labour intensive, compounded by legacy work practices that risk unsafe data sharing and breaches.

“These challenges impact our ability to target investment, and deliver consistent, high-quality care,” Te Whatu Ora says.

The report warns the solutions won’t be quick or easy, noting they will take ‘many years’ and require a re-think on how infrastructure investment is delivered on.

The briefing document follows on from a damning report into Te Whatu Ora’s data and digital services last year.

That report, by the Ministerial Advisory Committee for Health Reform Implementation, noted historical underinvestment 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 the organisations which are now part of Te Whatu Ora.

It called for the level of data and digital funding to be ‘closely examined’ against reform expectations and the organisation’s ability to meet expectations financially and in terms of capacity and capability.

The new briefing document suggests things have moved on from that report, at least slightly, with Te Whatu Ora saying it is now positioned to at least understand the state of health infrastructure across New Zealand.

It is, however, grim reading.

“We inherited a physical and digital infrastructure portfolio with significant historic under-investment, variable quality across the country and many assets at or close to end-of life – and we are still uncovering new issues.”

Capability and investment have varied across the old district health boards, and there is significant technical debt to be dealt with.

Immediate priorities include standardising and automating the national data collection and building national consistency to mitigate the risk of privacy breaches and improve reporting and innovation.

Also flagged as an immediate priority for data and digital is the simplification of the clinical application landscape by limiting the proliferation of ICT systems and moving to fewer, more robust systems, and a move to accredited cloud priorities.

There’s no detail in the briefing document about what clinical applications Te Whatu Ora plans to standardise on, nor the cloud providers – or indeed a timeline for the process.

Instead, Te Whatu Ora says the restructuring of New Zealand’s health landscape has already enabled it to better respond to risks such as regional and local projects that were affecting clinical delivery, such as the problematic implementation of radiology information systems in the central region, specifically Hawke’s Bay.

Last year a damning review into Hawke’s Bay radiology service detailed a slew of technical, cultural and governance issues. The report was prompted by a whistleblower.

An IT system plagued with technical problems resulted in prior patient studies not being visible, scans for the same patient not being linked and reports failing to be delivered to clinicians.

The briefing for Reti from the Ministry of Health – which is focused on policy, strategy and regulation, is more optimistic, saying ‘overall, the health system serves New Zealanders well’.

It flags the potential of digital, data and emerging technologies like artificial intelligence, to improve efficiency and effectiveness of health care delivery and improve sustainability of delivery.

“While some of the workforce and parts of our system are quick to adapt and innovate, our health systems and settings do not yet support us to take full advantage of new and emerging technologies.

“More work is required to enable agile adaptation to advancements through our models of care, and address known risks such as the potential for a digital divide and data privacy concerns,” the Ministry of Health briefing says.

It calls for the setting of priorities for infrastructure renewal to modernise the health system and harness the opportunity of new technology and innovation and says there’s also a need at the primary and community care level for new models and approaches, rather than legacy systems, to manage the increasing complexity of health issues and make the most of developments in technology.

“Significant investments have been made recently in digitisation and health infrastructure, particularly as part of the consolidation of services to establish Health New Zealand (Te Whatu Ora),” the Ministry says.

“More focus is required to modernise and complete the digital integration projects that support an innovative and joined-up health system.”

The Digital Health Association industry body has also jumped into the fray, calling for the New Zealand government to establish an independent, standalone ‘Digital Health Agency’ to drive the uptake of health technologies.

Ryl Jensen, Digital Health Association chief executive, says prioritising digital health technologies would be ‘a game changer’, but that a separate digital health agency is needed as digital health is currently treated as ‘a vertical’ within the health sector, when it is a ‘horizontal’, touching every corner of the health system.

“Due to its complex and technical nature, digital health requires experts to govern and lead it. Without this type of governance for digital health, the criticality of it can be underestimated,” Jensen says.

The agency proposed by the Digital Health Association would be responsible for providing digital health governance, establishing a national digital health innovation network or hub, creating a digital health academy for the health workforce and creating a digital health mental hub.