Notes for reading the draft NZ Digital Health Strategyteawakairangihealth.org.nz/wp-content/uploads/2017/10/New-Zealan… · Notes for reading the draft NZ Digital Health Strategy

Notes for reading the draft NZ Digital Health Strategy

This document is a draft of the Digital Health Strategy content and is based on the discovery, literature review and engagement to date. The document is designed to capture the ‘shape’ of the digital strategy including:

Explaining our philosophical approach

The flow of information, from vision to action

Principles

Objectives

Capabilities, Enablers and Environment – how we will create and support the digital eco-system

Transformation priorities

Artefacts – videos, diagrams, frameworks, resources etc that support the communication and execution of the

strategy

Notations and explanations are made in [square brackets and blue text]; where we need additional information or more detailed information I have noted that in [square brackets and red text]. However if you have content you think is relevant and useful send it through. This draft is incomplete; there are lots of content gaps. The intent is to provide a very early view of the strategy scope and structure to prompt feedback and co-production. It is also not expected that you agree with or support all of the concepts, intent, content or information – you are expected to challenge and suggest alternatives. It is a straw-man so please beat it up. Please feel free to make suggestions and propose amendments or to add any detail you think is missing. Use Loomio to feedback and prompt discussion or respond to [email protected] If you do any of these things please DO NOT use the comments function or track changes in this document as these are difficult to navigate. Just type your amendments into the document and highlight them.

mailto:[email protected]

New Zealand Digital Health Strategy

Outline of the Strategy

The strategy has been developed by the sector through literature review, briefings to sector groups, face to face workshops and online collaboration. Over 100 stakeholders were involved in the creation of this strategy. A summary of the consultation outputs is attached to this draft document.

The NZ Digital Health Strategy (“the strategy”) is not a detailed plan, nor is it a document to sit on the bookshelf.

The strategy describes a digital eco-system that creates the conditions that support delivery of the Health Technology Vision (“the vision”) and the NZ Health Strategy. It consists of aspirational goals and enabling strategies, priorities, frameworks, guidelines and resources that will evolve and change over time in response to the changing digital world that New Zealanders we live in.

The strategy consists of:

Principles: the truths that provide a foundation for the strategy and its component parts. The component parts of the strategy may change over time; the principles will not.

Strategic objectives: the long-term aspirational goals that help to convert the vision from a conceptual future state into more specific statements where relative success can be determined. The objectives are set with the broad strategy in mind but will not necessarily align directly with individual components of it.

Capabilities: digital capabilities (services and information) that directly contribute to achievement of the strategic objectives and the vision.

Enablers: frameworks, guidelines and resources that support the creation of strategically aligned digital capabilities within the eco-system.

Environment: the broader NZ consumer and business environment that influences (enables or constrains) the success of the digital eco-system articulated in this strategy.

Transformation roadmaps: For each of the components of the strategy a description of the transformation required over the next 4 years to move from current state to a 4 year target state.

Note:

This strategy describes a digital eco-system that allows all New Zealanders to engage with the Health Sector using digital technology. We recognise that there will be those who, for whatever reason will be unable or unwilling to engage digitally or take advantage of the digital environment. There must be recourse to an analogue system that allows these people to access health care. It is not our intention to make digital capability and literacy a barrier to accessing the Health system.

The strategy can be represented by the diagram on the following page:

New Zealand Health Technology: A Living Vision

[A definition of a ‘Vision’ The vision is usually an aspirational statement about what we want to achieve in the future. For example, at the individual level you may want to be healthy, financially independent, have a loving family and interesting friends. We don’t over define the vision as it will inhibit our ability to make decisions in the present. The vision acts as a guide for our decisions but will not be used as a rule for decision making. For example; eating a single big mac may not be counter to achieving your vision but eating three every day might.] Context

The world of technology is advancing rapidly and affecting many aspects of our daily lives such as the way we shop, bank and travel. Health services are also being transformed by emerging technologies, changing what, how, where and when services are provided, as well as who provides them.

Technology is revolutionising health systems, involving more than just digital technologies: robots and other automated systems are carrying out repetitive and predictable processes, advanced analytics are providing new insights into complex health problems, and research breakthroughs in human science are making ‘personalised medicine’ a reality for more and more people.

The Ministry has worked with the Digital Advisory Board and the sector to develop a vision for health technology which outlines how we see technology shaping the way New Zealanders get well, stay well and live well in 2026. The vision underpins the New Zealand Health Strategy 2016-26 which sets the direction our health and disability services need to take into the future.

Development of the vision

The vision for health technology has been developed with engagement from over 70 health professionals and consumers. Workshops were held in Auckland, Wellington and Christchurch over four weeks in April 2017, supported by online discussions. Content for the vision was then created and themes were defined.

This is a ‘living’ vision that will be refined and adapted over time in response to changing needs and emerging technology, as well as feedback from stakeholders.

The vision has guided the development of this strategy.

The Vision

http://www.health.govt.nz/publication/new-zealand-health-strategy-2016

Themes

The vision consists of nine themes which will help guide how we use technology to ensure better health for all New Zealanders.

Life centred

Technology empowers people to flourish by fully participating in their health care.

New Zealanders are ‘health smart’ - they have access to, and understand, all the health information they need.

Health (traditional and non-traditional), social and other support services and information are integrated with a person’s circle of care.

People connect with health services in a way that fits in best with their day-to-day lives.

Informed choice

People make informed choices about the health and social services that work best for them and have access to information to help them make those choices.

People have full access to their own health information and control over who else can access it.

People can choose services based on convenience and cost.

Health services are more convenient with ‘virtual’ options available to all New Zealanders through a range of technologies.

Closer to me

Care is provided closer to where people live, learn, work and play.

Investment in health services is carried out in a way that doesn’t create inequity for those who use them.

Better access to technology removes isolation as people and communities are more connected.

New Zealanders have confidence they can access the best value care and technology.

Sustained change & innovation

We take advantage of opportunities offered by new and emerging technologies. These technologies are improving the health services available and enabling New Zealanders to live well.

A digitally capable and enabled workforce is embracing the use of technology which impacts positively on the way people live, work and play.

The sector is enabled and has incentive to support different and flexible health services, and maximise the use of technology.

We discover, develop and share effective innovations across the system.

Technology change is considered in a New Zealand context so it adds value to our health services and is sustainable.

Value for NZ

Technology is improving people’s experience of care, health status and best-value use of resources

Social determinants of health outcomes, such as income, housing and education, inform investment decisions and support proactive and predictive intervention.

Investment targets inequities in knowledge and education, service access, connectivity and access to technology.

Value is measured and information is used to openly drive learning and decision-making that will lead to better performance.

Collaborative care

Health services, social and support services, whānau, communities and technology operate as a team in a high-trust system that works together with the person at the centre of care.

Use of technology optimises people’s navigation of the collaborative care system and the choices they make.

Technology removes geographical and social boundaries.

Responsive, predictive, personalized

Technology responds proactively to changing needs, knows a person’s preferences and anticipates their needs.

Individuals participate as full partners in their own health.

Data about individuals and their lives is used to personalise and tailor health services in a way that suits each unique individual.

Technology and real-time data drives rapid improvement and change.

Actionable insights

Data and technology improves evidence-based decisions. Health data from individuals and communities is used to inform health planning and policy and address inequities.

Real-time data from multiple health, consumer and social sources informs action, proactive monitoring, and interventions for individuals and populations.

Proactive monitoring and analysis of growing information drives continuous improvement and supports a culture of learning within health services.

Accessible, trusted information

Health information is secure, reliable, accurate and accessible when, where and in the form it is needed.

People have full access to their own health information and can provide, or prohibit, access to others.

A choice of technologies are available for people to access, use and contribute information in the way they want to.

Standards allow technology to work together and allow us to make changes easily and efficiently. Standards allow sharing of information and drive action based on access to data, common language and shared understanding.

[add in some emerging technology context – Northern RISSP has a good graphic. Emerging tech team to advise?]

Principles

1. Nurture the Eco-System

“Seeing the world as a ceaselessly complex and adaptive system… involves changing the role we imagine for ourselves… from architects of a system we can control… to gardeners living in a shifting ecosystem that is mostly out of our control.1”

Our approach is underpinned by an eco-system philosophy. The health sector has many agencies, organisations, and individuals making independent decisions as to how to engage, how to collaborate and how to allocate resources. It is porous and impossible to define or map. The interaction of agents in the health sector is that of a complex ecosystem. We cannot take a directive approach to the digitisation of the Health Sector. Our principle is to establish the ecosystem that enables the growth of a digital environment that allows for innovation, connectivity and efficiency – without losing touch with our need to provide empathetic care. An eco-systems approach means we will establish enabling constraints in the system and allow success to emerge as a result of a shared vision and connectivity across the sector.

2. People Centred Approach

[the idea of a patient centred approach is very common theme in the Australian and UK models. Patient Centered may mean ‘educating patients about their conditions, encouraging questions and collaboration, discussing how the condition affects the patient emotionally, and involving patients in treatment decisions’. However, there is a danger that in many health relationships the patient is not wanting to be part of the decision-making process and that they are looking to the health care professionals for a more paternalistic style. ‘I trust you as an expert just tell me what I need to do’.

I have re- interpreted this to mean…]

We understand that digitisation is just as capable of making patient experience worse as it is to improve it. For example, replacing human to human interaction with human to algorithm interaction can leave people feeling marginalised and alone. A Patient Centered approach includes patients and their careers. We will seek to understand the experience that patients have in the Health System and use this as a basis for innovation and improvement. Patient Centered means we will need to accommodate a broad range of experiences and seek multiple perspectives and points of view. Other users (practices, hospitals, suppliers) will need to access the impact of their decisions on patient experience. All stakeholders across the sector can use patient experience to test their assumptions about impact and identify the unintended consequences of change. Above all digitisation should not be a replacement for empathetic care.

[This approach challenges the idea that we can develop personas or scenarios as a proxy for real patient experiences. I personally believe these are very restrictive, as they make it hard to recognise and challenge embedded assumptions. It also challenges the idea that we can infer or extrapolate experience from data. Personas and extrapolation tend to be very clear and coherent whereas the real world is messy and ambiguous.]

3. Connect and interoperate

“The future is already here — it's just not very evenly distributed2”

Connectivity and interoperability is a key enabler of success. There are many examples of organisations, individuals and networks who have successfully used digital resources to create strong efficient and low-cost services. Connectivity will allow success to permeate across the network and for risk to be contained. Connectivity will allow opportunities to evolve into innovation and for insulation against threat. We will focus on enabling connectedness across the health sector, and across other agencies in the public and private sector.

Connectivity needs to be balanced by privacy. Always being connected (individually) can be intrusive. Per the above, a consumer would decide how connected to the system they are based on how involved they wish to be.

1 The Age of the Unthinkable: Why the New World Disorder Constantly Surprises Us and What We Can Do About It, Joshua Cooper Ramo,

2009. 2 William Ford Gibson

4. Digital by default

We will move to a ‘digital as default’ situation, and provide services that meet the evolving expectations of citizens and businesses. Digital services can empower consumers and broaden their engagement with providers. From the health provider side digitisation means moving all operations to paperless where feasible, and includes eReferrals, ePrescribing, eOrders, and eVitals.

5. Reduce the Cost, Increase Value

This strategy describes how digitisation can support many attributes of a successful health system. The reality of the situation demands that we do more with less. Any of the initiatives undertaken within this strategy must reduce the cost of service provision as well as gain a beneficial impact on the participants within the system. The principle of judicious use of resources must be at the heart of all decisions.

[other than financial, how do we measure value?]

6. Privacy and Security by Design

We treat patient’s medical data and personal information as their personal property. We will not access it or use it without

their consent. Security and privacy will be a foremost consideration when providing platforms for information sharing and

data access. We recognise that trust by consumers in the privacy and security of the health system is paramount. We will

ensure consumers are confident about sharing their data to improve care and health outcomes. This includes maintaining

privacy when aggregating data for the purposes of developing policy, economic modelling or other macro interventions.

We recognise that trust by consumers in the privacy and security of the health system is paramount. We will ensure

consumers are confident about sharing their data to improve care and health outcomes.

[how do we balance providers need for information in order to offer advice or diagnose and treat an person with a

person’s right to withhold information. Information withheld can directly impact quality and safety of health delivery.]

7. Learn by Doing

The digital eco-system already exists, there are any agencies, individuals and organisations already providing excellent examples of digital technology enabling better, more cost-effective service. By acting in a way that allows for collaboration, cooperation and innovation we will create these things.

In a complex health environment, we often need to be prepared to set some parameters, make assumptions and then act rather than try to remove uncertainty by exhaustive analysis or planning.

The outcomes, whether success or failure, then inform the next action.

[examples]

Strategic Objectives

[A definition of ‘Strategic Objectives’

Strategic objectives are long-term aspirational goals that help to convert our vision from a broad statement into more specific statements where relative success can be determined. The objectives are set with the principles and areas of focus in mind but will not necessarily align directly with them.

I have written the objectives to describe the impact we are seeking upon the health system. We are not using objectives to merely describe the ideal future system. For each objective we will provide information that describes how we will know when we have achieved that objective. We might call these KPI’s but that sounds to definite and corporate, I think the term Key Results will suffice.

Strategic objectives will be self-similar at different scales, meaning that we can describe the relationship at the personal level and it will be the same at the business level or strategic level. We call this fractal scaling.

Also of note is that some of these concepts around objectives are amorphous, in that we know what they mean but we can’t categorise or directly measure them. For example: honesty is a concept that most people understand; but we would be foolish to try and break honesty into its component parts or try and compare two ‘honest’ people to see who is more ‘honest’. Honesty has what we call, necessary ambiguity, this means that the concept can easily be applied across many domains and at any scale without having to redefine it. We can check if someone has a criminal record (objective measure) or check references (subjective measure) but we cannot directly measure honesty.

By defining key results, our aim is to move from amorphous or ambiguous statements to firm measurable things.

The main criticism of many government strategies is they lack measurable targets and/or too many KPI’s we should be need to be careful here.]

Our Strategic Objectives

Our objective is to enable a digital health environment where:

1. Digital services lower the cost of healthcare in New Zealand.

Digitisation of services allows for greater service provision per unit of cost. Investment in digital technology must be seen to reduce cost and improve service.

2. Digital capabilities are improving health service efficiency and performance.

The experience of people within the health system is fluid, seamless and without duplication. Digital services assist navigation by providing insight into options and the overall journey through the health system.

[Anecdotally, we have evidence that many not-for-profit organisations spend a lot of time simply helping people navigate the system and determine options, can we get any evidence of this..?]

3. Accessibility to digital information and services is increased for all New Zealanders.

More people utilise digital services to navigate the health system and seek a broader range of services. Accessibility increases and disparities decrease.

The system allows individuals and their carers to navigate the health system, access their information when and where it is needed, and maintain trust in the accuracy and security of their information. Digital services reduce the barriers to access across the socio-economic divide. Better utilisation of data allows the network to identify and target communities who are struggling to access and benefit from the New Zealand the health system. Healthy people can engage effectively in the health system. People can access health information, check their health information and find ways to maintain and improve their health without having to be a patient.

This will require training and education in operating in a digital environment. User centered design dased on recognised standards will help with that transition.

4. Clinicians have access to information that allows for informed discussions and decisions resulting in improved health outcomes.

Clinicians will be able to access accurate information at the point of contact, wherever that may be. This will include ‘virtual consultations’. Patients and their carers can assign rights to clinicians to access, use and share information.

5. Digital services provide a platform for inter-agency cooperation and integrated public services.

A digital eco-system will allow for cooperation between agencies by setting standards for interoperability and transparency.

[the above will enable cooperation but does not create the conditions for cooperation, these are created by having shared objectives and KPI’s, these are beyond the scope of digital strategy do we need to acknowledge this?

Aligns to GCIO/MBIE efforts on digital government]

6. Data is shaping policy, research and planning.

The ability to use detailed health information to develop policy, understand the society level impacts of change and to provide insight is huge. The digital strategy will enable the utilisation of this data by establishing standards and providing a platform for information sharing across agencies.

7. The digital health strategy creates the conditions for innovation to thrive.

Innovation is a symptom of a system that is construed by factors such as resource scarcity, the need to solve problems and a change in perspective. Our role is to establish the eco-system where innovation is encouraged, rewarded and shared.

Key Result Areas

A definition of ‘Key Result Areas’

These concern the evaluation of the success of our activity and are tied inextricably to our objectives. When our KRAs are being met, we should by definition be achieving our objectives. These KRAs differ greatly depending on the activity in question. Some activities are by their nature quantitative and output-based, and so are relatively easy to measure. Others are more amorphous and harder to define. The difference in all these types of activity explains why our KRAs are so varied in the way they are presented.

Our Key Result Areas for our Strategy

[We will be determining these in the last part of the strategy development process?]

Enabling the Eco-System

[placeholder for a video explaining how we can set the starting conditions for a diverse and healthy eco-system. I would like to use the example of an actual eco-system as it fits nicely with the narrative and is a very good example of a complex adaptive system, that exhibits the same qualities of emergence as the health eco-system.

This simile can also be used for explaining the maturity model - Within the eco system there will be dominant species and less dominant species. The system works for the benefit of all regardless of their relative evolutionary maturity.]

For each of the capabilities, enablers and the digital environment we will define the current state, future state, and transformation needed over the next 4 years to move from current state to a 4 year target state. [I have filled in below the current state where possible based on work.]

Digital capabilities

Digital capabilities are services and information that directly contribute to achievement of the strategic objectives and enable our transformation. We see these as the key components of our strategy as without them the health technology vision will not be realised. It is these areas that we seek to align investment in as the creation of capabilities will mean the emergence of conditions that move the eco-system closer to our objectives. Some capabilities will be outside of the direct control of the Ministry, others may be within our control.

Customer experience

Current State:

- Provider centric/paternalistic

- Siloed information and systems

- Difficult to navigate and access

- Limited to specific health information and services; no social and personal information

- No one is sure what services they are entitled to receive

- Little to no recognition of the private health delivery being used by 1/3 of adults and in New Zealand – no continuum view.

- No visibility of access to alternative health care

Future State:

- Patient centred

- Seamless access to information and services

- Microservices, delivered in a broader social and individual context

- Customer experience/expectations are measured as part of the delivery of any service – changes are made based on the feedback

- Customer can choose their level of participation in their health delivery based on access, knowledge, and “value” to them

Transformation Needed:

- UX co-design by engagement across a broad range of New Zealanders

- Consistent applications of standards, ensure open APIs

- Social, personal and health data integration

Collaboration and workflow

Current State:

- Provider centric


- A large DHB has approximately 600-800 apps being supported (this number excludes different versions of the same apps). Health alliance support approximately 2000 apps.

- Low EMRAM rating

- Unknown community maturity rating

- Disconnected workflow and messaging approach

Future State:

- Online workflow across the whole eco-system

- EMRAM 6+ rating [is ERAM the right tool?]

- Measured community maturity rating

- Patient centred

- Seamless access to information and services

-


- Investment in lifting EMRAM maturity

- Community maturity measure and targets

- Enabling standards and architecture, ensure open APIs

Data Insights

Current State:

- Provider centric

- Siloed information and systems, data collection approach

- Low level of social license for information use

- Limited to specific health information; limited social and personal information

- After the event or backward looking

-

Future State:

- Distributed API based data access across health and social data

- Seamless access to information

- Consumer trust and confidence

- Insights are available to the person & their provider(s), captured by various sensors, inputs, and indicators based on context, environment, needs, and consumer wishes


- Sector wide data access based on consistent standards, open APIs


- Consumer is able to determine the devices, applications, people able to access their health data to enable the insights they require

Accessible Trusted Information

Current State:

- Provider centric


- Mixed level of social license for information use

- Limited to specific health information; limited social and personal information

-

Future State:

- Access to information to support consumers, clinicians, planners and industry




- Complete and current information is available wherever the consumer and provider are


- Electronic Health Record programme

- Regional consolidation of health data – extended to public, private, NGO, etc data sources



- Consumers control(?) or transparency of who and what is accessing their data within the health system

National Digital Services

Current State:

- National Digital Service supporting sector – key systems such as NHI, HPI, NES etc

- Constrained access, use limited to health providers (no consumer, limited industry access)

- Under investment

Future State:

- Modern national digital services supporting eco-system – key services for identity, interoperability, workflow etc


- API based access



- Modernisation of key national digital services – identity, interoperability, workflow

- Streamlined access credentialing and approval



- Define consumer and provider digital identity and access models supported

Access and connectivity

Current State:

- Mixed access coverage – network and device coverage and availability

- Siloed information and systems not designed for use on mobile devices

- Limited consumer access to health services

Future State:

- Reliable and appropriate coverage and availability

- Device responsive micro-services

- Access to information via APIs to support consumers, clinicians, planners and industry


- Address access gaps

- Build device responsive apps and services

Sector wide data access based on consistent standards, open APIs

Digital enablers

Digital enablers are frameworks, guidelines and resources that support the creation of strategically aligned digital capabilities within the eco-system. We see these as key components of our strategy as without them the digital capabilities will be unaligned and consistent. It is these areas that the Ministry will seek to lead through the creation and monitoring of clear requirements that participants in the eco-system must implement to ensure consistency and effective delivery of the capabilities.

Interoperability

Current State:

- Interoperability commitment and Vision for Interoperability

- Interoperability standards defined, not widely adopted

- Key standards defined – HL7 FHIR, SNOMED etc

- Reference architecture lacking – there is an interoperability RA. However, it needs to be reviewed and updated

- 140 health IT and medical device companies operating in NZ and 52 signed up to NZHIT Vision on Interoperability


Commitment to Interoperability

1. Consumer Trust: Consumers can trust the quality, security and privacy of their health data. Consumers can access their own health data; create new data as part of their health record; and see who has accessed their data, what has been accessed, and when and why.

2. No Blocking: We are custodians of health data and will make it available to others whenever consistent with the other principles and permitted by law. We will not unreasonably block or hinder access to the health data we hold.

3. Data Sharing: Health data will be shared across the health and social care continuum with appropriate user authorisation, to support clinical decision-making and enable the provision of the right care, in the right place, at the right time and by the right people.

4. Standards: We will implement agreed national interoperability standards and policies and adopt recognised practices related to health data including privacy, security, information governance and service management.

5. Common Capabilities: We will utilise agreed national information common capabilities such as those providing identity, directory and health record services.

This Commitment to Interoperability will underpin, and be operationalised through, existing sector processes and structures. The Ministry of Health will provide leadership in collaboration with sector and industry partners.

We will actively align relevant processes and practices to the interoperability principles. These will include developing required interoperability standards and certification processes; delivering required national information common capabilities; aligning health ICT strategy and architecture; and aligning existing investment planning, procurement, ICT solution design, implementation and service management practices and activities.

Future State:




- Certification regime in place, supported by standards “sandbox”


- Introduction of standards certification




- Review and update of standards, with the sector, to ensure currency and practicality

Architecture and Standards

Current State:

- HISO standards in different stages of currency and adoption

- Key standards defined – HL7 FHIR, SNOMED etc

- Traditional standards adoption approach

- 140 health IT and medical device companies operating in NZ and 52 signed up to NZHIT Vision on Interoperability

Future State:

- All HISO standards current and adoption is “baked into” the timely system/application change process

- Certification regime in place, supported by standards “sandbox”

- Mix of traditional standards development and agile “emerging standards” approaches


- Introduction of standards certification

- Review and update of standards, with the sector, to ensure currency and practicality

- Encouraging new standards prototyping

Information governance

Current State:

- Health Information Governance Guidelines published

- GCIO Information Governance Maturity framework

- Varying levels of information governance, typically low

- Limited capability and capacity

Future State:

- Health Information Governance Guidelines maturity baseline met and target defined and measured

- Exec level awareness and organisational capability in place


- Health Information Governance Guidelines maturity baseline target defined

- Process of assurance in place across sector organisations

- Lift sector capability

Privacy, Security, Trust

Current State:

- Nearly half of respondents to the World Internet Project 2015 survey (45%) agreed that there is no such thing as privacy online, and they accept that situation. However, a majority (68%) are active in trying to protect their online privacy.

- More respondents to AUT and World Internet Project 2015 were concerned about companies checking on their personal online activity than about government checking.

- Comparing the importance of various forms of media as information sources, online information sources now rate very much higher than offline media. More than half of respondents (56%) rated the internet very important, compared to 16% for television, 12% for radio, and 11% for newspapers.

- HISF published

- Health Information Governance Guidelines published

- Security is a priority for the Government Chief Information Officer and therefore adoption based on risk assessments is mandated for all government agencies.

Future State:

- HISF and Health Information Governance Guidelines maturity baseline met and target defined and measured

- Exec level awareness and organisational capability in place


- Health Information Governance Guidelines maturity baseline target defined

- Process of assurance in place across sector organisations

- Lift sector capability

Digital environment

The digital environment is the broader NZ consumer and business environment that influences (enables or constrains) the success of the digital eco-system articulated in this strategy. We see these as key components of our strategy that will impact on our ability to deliver this strategy but which cross multiple sector participants, and are broader than the health and disability sector. In some of these areas the Ministry will seek to lead through influencing and driving change; in others the delivery will be dependent on other sectors and organisations.

Legislation, Policy and Regulation

Current State:

Future State:


Vibrant innovative industry

Current State:

Future State:


Digital Models of care

Current State:

Future State:


Digital literacy

Current State:

91% of New Zealanders are active internet users. 70% spend 2 hours or more per day online, with 58% spending 3 hours or more.

52% of New Zealanders logged in to secure areas on Government or Council websites, and 55% paid taxes, fines or licenses online in the past year (2014-2015)

The only ex-users of the Internet in the AUT & World Internet Project 2015 survey lived in houses with incomes under $50,000

Almost three-quarters (72 percent) of all adult New Zealanders own or have access to a laptop or notebook for their private use

70% New Zealanders have a smartphone (2015 stat) (up from 48% in 2013)

Approximately two-thirds of all adult New Zealanders now own or have access to three or more devices

Patient Portal figures show: More than 297,000 people from 445 general practices can use a patient portal, and more than 4,000 patients a month are registering

80% NZers would like access to their full health record online? (Accenture survey)

Less than 10% of New Zealanders have access to their health records online and this is restricted to GP data only

1 in 20 Google searches are for health-related information. In 2017, Google added a health feature for over 900 commonly searched for health conditions, including an outline of the condition, symptoms, treatment – commonly called Dr Google

There are more than 250,000 mobile health apps available and a PwC 2016 study showed healthcare apps having some of highest downloads

Nielsen Consumer and Media Insights (CMI) data shows that in 2017 393,000 Kiwis own wearable device an increase of nearly 100% in a year – around half aged 20-39 and have higher than average incomes

All New Zealand DHBs utilize telehealth technologies to some degree, particularly video conferencing which is used in 19 DHBs

16 DHBs using VC for direct clinician patient-interactions, mostly between secondary sites and smaller regional sites and some directly to patients in their home.

Only 5 DHBS had VC capacity that either met or mostly met the demand. Eight had or were developing investment plans to meet unmet demand

Three DHBs providing remote telemonitoring support.

Future State:


Workforce capability

Current State:

Future State:


Investment and funding models

Current State:

Future State:


Implementing the Strategy

The greatest loss of time is delay and expectation, which depend upon the future. We let go the present, which we have in our power, and look forward to that which depends upon chance, and so relinquish a certainty for an uncertainty. – Seneca

The Digital Strategy is not intended as a directive. There are many stakeholders who have resource allocation decisions to make based on their own needs and the needs of their stakeholders. The intent is that this strategy will provide the gravitational pull required to create a strong digital ecosystem.

Waiting is failure, we can all act locally, in a small way to improve the current situation.

All agencies can act now to improve their current situation in respect to digital technology.

Communication is the key to a strong eco-system.

By increasing the level of communication and understanding between agencies, we can make better decisions about how and when to allocate resources.

By continually engaging with users of the health system we can gain a better understanding of the impact of change and the likely impact of future change. We will also gain a better understanding of unintended consequences and spot the weak signals that indicate opportunities for innovation.

No two agencies are starting from the same point.

Taking a maturity mode approach allows agencies and organisations to make decisions that are in their own best interests while establishing the ability to share information, and allow for interoperability.

A diverse eco-system, Based on agreed standards.

Appendix A: Consultation outputs

[This is clearly, a cut from the Areas of Focus document. The information below shows the ‘Direction of Travel’ in terms of the things we will focus on. In this respect it is very similar to the Australian Health Strategy roadmap diagram, https://www.digitalhealth.gov.au/about-the-agency/publications/australias-national-digital-health-strategy/My%20Health%20Record%20%20Timeline.pdf

Note: Privacy, security, confidentiality and consent are implicit within each area of focus.

Big Data/Analytics. We will take advantage of the offering of big data. We will enable consumers to share information that

they have collected via mobile devices such as smartphones and wearable technologies, and through the ‘Internet of

Things’. The culmination of all of this data will be analysed and used to inform predictive modelling using large sample

sizes which can uncover nuances and patterns that couldn’t be previously determined. The use of big data at a meta level

should be differentiated from clinical decision support systems. Big data will give medical professionals the ability to

analyse information against consumer history, and the data of others, in order to understand as much about an individual

as possible, as early in their life as possible.

Consumer Driven Healthcare. We will support the drive to consumers sourcing information and guiding their own health

interventions. We now have access to information that was previously difficult, if not impossible, for consumers to obtain.

This has helped drive something of a shift in traditional roles for patients and medical professionals. There are now

consumers that can focus on their own concerns, learn about their conditions, and ultimately become ‘consumer

specialists’. In addition, consumers have the inherent knowledge of their own symptoms and the experience of living with

a disease. Even with the sophisticated diagnostic tools available today, health care professionals operate at a severe

disadvantage without consumers’ input. With all this in mind, we recognise that this will not necessarily represent the

average consumer. There will still be many consumers who will neither wish, nor be able to play the role of ‘specialists’,

and will still rely heavily on the expertise of medical professionals and the health system.

Collaborative Care Teams. We will support our healthcare labour force to work in collaborative, integrated teams to

achieve the goal of delivering consumer-centred, safe and effective care that meets the growing and complex needs of an

https://www.digitalhealth.gov.au/about-the-agency/publications/australias-national-digital-health-strategy/My%20Health%20Record%20%20Timeline.pdf

https://www.digitalhealth.gov.au/about-the-agency/publications/australias-national-digital-health-strategy/My%20Health%20Record%20%20Timeline.pdf

aging population. We will develop an integrated healthcare workforce that can operate within a digitally enabled

environment.

Cross-sector / joined-up government. We will, where possible, create inbuilt interoperability and access for other sectors

(such as education, justice, and social development) in order to create the best outcomes for New Zealanders.

Consumer at the centre. We will remove barriers and enable consumers to access the majority of health services when

and where they see fit, and ensure access to information and data is readily available. Investments will support an

integrated health system to deliver consumer-centred health experiences. The needs of consumers will fundamentally

drive the design, development and implementation of solutions.

Digitisation. We will move to a ‘digital as default’ situation, and provide services that meet the evolving expectations of

consumers and businesses. Digital services can empower consumers and broaden their engagement with providers. We

recognise there are issues with this: digital convenience often comes at the expense of meaningful engagement as digital

transactions substitute physical interactions. In addition, digital channels often develop in isolation, resulting in

inconsistency and dislocation between digital and physical channels (for example: when consumers visit providers, they

(the consumer) often cannot complete an interaction they began online). From the health provider side digitisation means

moving all operations to paperless where feasible, and includes eOrders, ePrescribing, eReferrals, eTransfer of Care and

eVitals.

Digital Services. Consumers are expressing their wish for more responsive government and public services. We will have

robust, stable and reliable digital services that are flexible so that they can continuously respond to changing needs. Public

services need to be agile and flexible enough to implement service design as it forms, to back the best solutions (not the

costly failures), and to be able to adapt to an ever changing and challenging environment.

Enabling Foundations. We will focus on taking advantage of the enabling technologies such as the ‘Internet of Things’,

mobile apps, and of greater connectivity. We will leverage off these to drive radical change in how consumers interact

with the health system.

Innovation. We will promote innovation by enabling it both internally (within our health operations), and through the

organisations that we partner with. We will achieve this not through exhorting people to ‘be innovative’, but rather

through creating the right series of conditions that allow innovation to come to fruition.

Interoperability. We will ensure that as many organisations as possible can access the information they need. We will

work with many parties to help the health system to innovate, and to create and capture data that will be accessible to

primary and secondary providers, the private sector, and community agencies. This will enable information sharing,

electronic collection of health data and enhanced ability to identify trends.

Mobility. Information does not just need to be reliable, real-time, and accessible, it also needs to be mobile. Where

possible and appropriate, we will enable the healthcare workforce to operate wherever they need to, using a variety of

mobile devices.

Open government. Data will be easily accessible, visible and available for reuse by the consumers, businesses, researchers

and individuals. Where possible we will publish information online. We will collect and analyse data to create value-added

information. This will inform sound policy and enable us to make evidence-based decisions.

Personalised Medicine. Medicine to date has been focussed on delivering to the ‘average’ of a situation – leading to a

large variability in outcomes. We will focus on delivering to the consumer as an individual, not as an ‘average’, and will aim

for greater precision in medicine. We will take advantage of scientific breakthroughs in our understanding of how a

person’s unique molecular and genetic profile may determine their medical needs.

Prevention. We will create and access information and enable the ICT capability to support and improve the targeting of

screening, immunisation and other public health initiatives.

Privacy. We will ensure that the open and free exchange of necessary patient information and public-health-related

metadata does not in any way compromise the privacy rights of health consumers. All activities will take place within the

confines of the relevant privacy rules, codes, and legislation.

Real-time information. The timely provision of information should not be a barrier to the execution of work. We will

utilise systems that will update in real-time, enabling our workforce and consumers access to the most current information

available.

Self-help and self-care. We will empower consumers of health services to make informed choices about their conditions

and treatment options.

Smarter procurement. We will look to create common and shared capability around procurement. This does not

necessarily mean a single purchasing point, but rather a coordinated approach. Where possible we will encourage

contestability, list pre-qualified suppliers, standardise contract frameworks, develop technical standards, and create

economies of scale.

Standards-based environment: We will create minimum standards for key tasks, while allowing innovation, localisation or

specialisation of other components of the technology environment. This will allow the interoperability of systems and help

to reduce integration costs. Common architecture and standards will ensure the exchange of information across disparate

systems and diverse providers both within and outside the health sector.

Telehealth. Where possible we will make use of information or communication technology to deliver health or medical

care from a distance, in particular to support the people of New Zealand who live in rural or remote areas. This will ideally

include all modes of telehealth, such as live video, asynchronous transfer, remote patient monitoring, and mobile health.

Trusted health information. This does not necessarily mean a single source of universally accessible information.

Information could instead be based around a single standard rather than a single source. Where possible, we will have

multiple databases / sources that all operate from the same standards.

Workforce development. We will create a productive workforce using ICT enabled enterprise tools and technologies. We

will ensure our digital tools and solutions connect and support business operations and our staff are skilled in their use.

We will work with others in the sector to integrate this digital capability even at the professional qualification and training

levels through universities and Industry Training Organisations.

Appendix B: References

Australian Digital Health Agency, Australia’s National Digital Health Strategy, 2017

Central Region District Health Boards, Regional Services Plan 2017-18, 2017

Deloitte, Independent Review of New Zealand’s Electronic Health Records Strategy, 2015

Midland District Health Boards, 2017-2020 Regional Services Plan Activities and Initiatives, 2017

National Health Service, Five Year Forward View, 2014

National Health Service, Personalised Health and Care 2020, 2014

National Health Service Scotland, eHealth Strategy 2014-2017, 2015

National Health IT Board, National Health IT Plan, 2010

New Zealand Ministry of Health, Digital Health 2020, 2016

New Zealand Ministry of Health, Emerging Technology Symposium Presentation, 2017

New Zealand Ministry of Health, Ministry on the Move – Internal Technology Strategic Vision, date unknown

New Zealand Ministry of Health, Indicative Business Case: Enabling Next Generation Care through an Electronic Health Record Platform, 2017

New Zealand Ministry of Health, National Health IT Plan Update 2013/14, 2013

New South Wales Government, Digital+, 2016

New South Wales Government, eHealth Strategy for NSW Health, 2015

New South Wales Government, ICT Strategy, 2012

New Zealand Government, The Business Growth Agenda – Building a Digital Nation, 2016

Northern District Health Boards, Northern Regional Health Plan 2017/18, 2017

Nuffield Trust / KPMG, Delivering the Benefits of Digital Health Care, 2016

Nuffield Trust, Report to Northern Regional Health System, date unknown

Queensland Government, Advance Queensland, ICT Modernisation Plan, 2016

Queensland Government, Department of Transport and Main Roads, ICT Strategic Plan, 2016

Queensland Government, Department of Science, Information Technology, Innovation and the Arts, Queensland Government ICT Strategy, 2013

Queensland Health, Digital Health Strategic Vision for Queensland 2026, 2017

Southern District Health Board, Information Services Strategic Plan FY 2016-2019, date unknown

South Island Alliance, Te Waipounamu South Island Health Services Plan 2017-20, 2017

State of Israel, Ministry of Health, Israel’s Digital Health Strategy, 2016

Wachter, Robert M, Making IT Work: Harnessing the Power of Health Information Technology to Improve Care in England, date unknown

Documents

Notes for reading the draft NZ Digital Health Strategyteawakairangihealth.org.nz/wp-content/uploads/2017/10/New-Zealan… · Notes for reading the draft NZ Digital Health Strategy