Failing health IT system could learn from Air NZ
The big review of our health system has been completed, before the Covid-19 pandemic exposed major issues with its systems. Robin Gauld asks if an expert technology and logistics business like Air New Zealand could help reform our desperately needed health systems.
It has been reported that the final report of the country's much-anticipated health review has been completed, to be presented to the Government when requested. It remains unclear when that will be.
Covid-19 appears to have taken priority, and that’s reasonable. Yet timing of the Health and Disability System Review report’s presentation and release should make little difference as recommendations will not be actioned until after the next election. Arguably, it should be released immediately. The report was likely completed just as Covid-19 was appearing.
As such, it requires a postscript. Covid-19 has exposed some of the cracks in the system. Here’s what the postscript should say:
For over three decades, we have had various reviews of health information management and systems, usually mid-election cycle, each making similar recommendations. These have tended to be picked up by government then dropped again following subsequent elections.
As a result, information systems are in a sorry state. There are multiple, parallel legacy systems, a lack of system architecture (liken this to building a house with no designer, or multiple-competing designers) and inability to easily share data across the country or between different services. Patients mostly have limited ability to understand and navigate the health system using technology.
Covid-19 has revealed the urgent need to rectify the situation. Air New Zealand has led the world with its app, aimed at linking services and schedules, with information available to passengers and the airline in real time.
We recommend, in this unfortunate downtime for the airline, procuring assistance of its IT, logistics and scheduling teams. While it would likely be aghast at what it found, we are sure that, with will and backing, it could bring to health what it has already achieved with air travel.
For more than 80 years, GPs and general practice have worked and been funded in roughly the same way (predominantly, government payment per enrolled patient, called ‘capitation’, along with patient charges). Covid-19 has seen an immediate shift to online and phone consultations with few patients seen in-person.
The new way of working is a belated step in the right direction. Many consultations do not need to be in-person; it is very convenient for many patients (no travel time or sitting around the waiting room etc); and it means GP services can be provided from anywhere into areas previously not possible (eg after-hours in Invercargill, long a thorny issue and where patients often go to the public hospital emergency department for treatment).
The shift, however, has precipitated a drastic income drop for many GPs, with fewer patients being billed, raising questions about sustainability of the traditional model. We recommend that the Government now considers full capitation for GPs. This could be done on an opt-in basis, as not all GPs would wish to participate.
An addition of 5-10 percent to the health budget could fully capitate a good proportion of GPs, taking away patient charges and giving capacity to consult with patients using whichever channel is appropriate. Public hospital specialists (salaried) are also now working remotely. Their services could be directly linked and coordinated with GPs via the technology and logistics work we recommend Air New Zealand undertake.
Of course, Covid-19 has revealed the need to invest in public health infrastructure, as noted widely in the past weeks. We strongly support this and recommend immediate attention. We also recommend re-orienting the health system and DHBs along lines noted elsewhere.
Again, Covid-19 has highlighted the unacceptable variations around the country and need for a different model. This demands urgent attention.
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