Silence follows health report

District health boards have rejected suggestions they scrap a major electronic health records project and are refusing to comment on a government proposal to radically overhaul information technology.

Eight DHBs are shopping for a system which would hold a record of a person's health history that could be accessed by all health professionals and even patients themselves.

A report by a ministerial review group, led by former Treasury head Murray Horn, recommends the project be dropped and DHBs instead replace their patient administration systems with software that is interoperable, allowing hospitals to share information they already collect.

But Bennett Medary, managing director of The Simpl Group which is managing the procurement process on behalf of the DHBs says they will push on with the health records project.

The Horn report calls for less fragmentation and duplication of health services, better use of resources and money, and more engagement with patients and their families.

But existing records systems are not designed to support these changes, Mr Medary says. "Simply replacing existing systems as they are currently configured and deployed, even if they're fully interoperable, is to risk investing in a broken business model. It might be new, but it's broken."

The eight DHBs have overcome "silos" in the health sector in order to collaborate and are investigating how healthcare can be better delivered before deciding on a system, he says. "We actually agree with many of the points in the report. We're encouraged to continue."

The report warns the DHBs' health records initiative "will have national implications", could cost more than expected and take longer to complete, especially if an overseas solution is selected.

The Dominion Post has reported the system could cost at least US$300 million if it were implemented nationwide.

Mr Medary says the cost and timeframe of the project are valid considerations but the report's authors appear to have prejudged what the system should be. "They are kind of putting preferences around the selection criteria for example, that it should not be from overseas. But we don't have any preferences at this point."

The report is critical of how health IT is delivered: "The sector is currently inundated with too much information and too many IT projects". IT services are fragmented, "hostage to parochial interests" and DHBs have a tendency to "look for IT solutions without getting the fundamentals right".

The report makes several recommendations, including that the planning and funding of national health IT services be transferred to a National Health Board. It also suggests a Crown entity be set up to provide shared services to the 21 DHBs and consolidate back-office functions such as HR and payroll systems.

Several DHBs including Capital and Coast, Northland and Canterbury DHBs have refused to comment. Some said they had not had time to read the report through, while others preferred to respond via submissions to Health Minister Tony Ryall.

The Cabinet will consider the recommendations and feedback is welcomed.

The eight DHBs involved in the electronic health records project are Canterbury, Nelson Marlborough, Wairarapa, South Canterbury, MidCentral, Whanganui, Northland and Counties Manukau.

Waikato University computer science professor Steve Reeves says a nationwide health record system should be approached with caution, as it raises many technical, ethical and security issues. Complex IT projects are often over-promised and under-delivered, he says.

Plans by the Health Ministry to electronically transfer patient notes among GPs are also addressed by the Horn report, which recommends the initiative and other primary-care IT projects be consolidated to avoid duplication. The ministry is seeking submissions from health practitioners.

About 375,000 patient records are transferred between practices each year, by fax or standard mail.

HORN'S DIAGNOSIS

A lack of strategic leadership has led to fragmented IT services that are "hostage to parochial interests". Health IT solutions are "over-simplified" and ignore fundamentals such as clinical processes.

THE PRESCRIPTION

DHBs replace patient administration systems with software that allows hospitals to share patient records. Establish a National Health Board to plan and fund national IT health services. The Health Ministry's IT division should only support the ministry's IT needs.

Set up a Crown entity to provide shared services to DHBs and consolidate back-office functions such as HR and payroll systems. Reprioritise a $150m programme to improve connectivity, information and payment systems in the health sector.

Integrate and rationalise primary-care IT projects such as the electronic transfer of patient notes among GPs, and electronic referrals.

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