NZ goes back to basics

It was always on the cards but New Zealand has confirmed that it will not follow the lead of certain other countries we might mention and purchase or build a single electronic health record for its citizens.

Some may argue that it actually makes sense for such a small but relatively widespread population to have a single record, but even back in 2015 when the idea was first floated, there was a recognition that there were perhaps easier, less expensive ways of digitising the health system using existing technologies.

It looks likely that New Zealand will instead pull together its four regional systems and underpin them with a national health information platform (nHIP)). This makes a lot of sense, as in two of those regions there is already what amounts to a functioning shared record for most people.

It is perhaps the South Island experience that has shown why a new, single EHR is not necessarily the way to go. While it has taken time, the South Island has managed to use existing technologies such as its acute care clinical workstation and GP and pharmacy systems to open a window to data held in other systems. Through HealthOne and Health Connect South, hospital clinicians can see a patient's primary care data while GPs can see not just hospital data but community pharmacy and some community nursing data too.

The greater Wellington or Central region has a similar set-up through its shared care record, although it uses patient portals rather than an extract to share GP data. The Midland region is working on its eSPACE program, and the Northern region, covering Auckland, has decided against going with a single EMR covering primary and secondary care and looks likely instead to follow the rest of the country. Auckland's public hospitals are still on paper, so it still has quite a way to go.

A lot of this has come about because in primary care in particular, New Zealand has certain advantages that it has cleverly harnessed. A single national health identifier is one, an openness to using patient portals is another, as is the decision some years ago to set up the GP2GP system so patient medical records can be transferred electronically as patients move practices. For most of the last two decades there has also been one major GP software supplier and one secure messaging provider.

This doesn't make the system perfect and patients still don't have access to much of their data digitally. And as RNZCGP medical director Richard Medlicott told the Emerging Tech in Health conference this week, primary care data is still very much produced and used on a PHO basis, rather than nationally. He is also somewhat surprised to see how slow the uptake of the New Zealand ePrescription Service has been, and he is rather disappointed that the hoped for National Primary Care Data Service may take a bit longer to get up and running than first expected.

As is often the case, it is the price that appears to be holding this initiative back, but if it actually does cost just $10 million over five years, that amounts to an absolute pittance. Australia would spend more than that on workshopping the idea.

So despite the chaos that NZ's Ministry of Health has seen over the last five years or so, with several rounds of restructuring, the disbanding of the National Health IT Board and what appears to be significant underfunding of the health system since about 2009, New Zealand does seem to be getting on with it.

In Australia, we are getting on with it too but we are still grappling with some serious interoperability challenges. Next week in Brisbane, HL7 Australia is holding a workshop to tackle some of these technical dilemmas through the localisation of HL7 standards covering pathology, diagnostic imaging and referrals. Pulse+IT will be attending and we'll bring you all the news over the next few weeks.

Meanwhile, despite the outcome of Australia's federal election showing that you should never trust public opinion polling or market research ever again, we've made the decision to keep running our thoroughly unscientific and yet quite interesting polls anyway. Last week we asked: Will there be major changes in digital health policy this year? Our readers said a big no to that, even before the election result was known. 82 per cent said no while 18 per cent said yes.

This week, our poll question is: Do you think NZ's decision not to pursue a single EHR is the right one?

To vote, sign up to our weekend edition or Pulse+IT Chat, or leave your thoughts below.

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