Findings from the government’s recently released Health and Disability System Review reveal the poor state of our District Health Board (DHB) assets, especially their IT systems.

The findings are part of the government’s move to address a chronic lack of underfunding and planning in the health service and develop a comprehensive National Asset Management Plan (NAMP).

The systems audit part of the review found IT strategy, governance and asset management operate at a basic level using legacy systems, incompatible devices and outdated infrastructure, “creating ongoing challenges for users to access and use patient and clinical information, both internally in a hospital setting as well as in a wider health service setting”. The infrastructure, networks and security are also inadequate to support new systems and manage increased cyber security issues, said the report. Ten DHBs were found to have poor financial management systems, four had poor to very poor pharmacy management systems and one had a very poor clinical portal. The slow adoption of systems compliant with national data standards was limiting information sharing across clinical settings and with consumers, while the Covid-19 response highlighted the need for better integration of IT and telehealth applications to facilitate the provision of health services at scale, concluded the authors.

In an interview with Health Informatics New Zealand, Dr Ruth Large, Waikato’s clinical director for information services and virtual healthcare, said a technical debt often remains hidden from view, but the Covid-19 pandemic exposed the problem as DHBs raced to adopt better digital ways of working, including telehealth. “You can’t just put a video conferencing solution on top of aged infrastructure as it falls over. It’s like trying to put the roof on a house without doing the foundations first.”

The Ministry of Health (MoH) is working with DHBs, which are responsible for maintaining and renewing their assets, to address many of the issues identified in the report, said former health minister David Clark. “This includes reviewing DHB asset management plans, following up on remediation issues and developing an asset risk, assurance and monitoring framework.”

MoH estimates $2.3 billion will be required over the next 10 years to address issues with legacy systems and to invest in technologies to support much-needed new models of care. The next steps include future capacity planning and the modelling of investment scenarios. The NAMP should be finalised and released in 2022.