This document discusses challenges facing the New Zealand health system and opportunities to improve information technology (IT) governance and implement shared services. It notes a highly complex health system with over 3,000 GPs, 82 health organizations, and IT investments accounting for over 9% of GDP. Questions are raised about coordinating change across stakeholders and leveraging scale through a common approach to services. The key barriers to shared services need to be addressed and next steps identified to make progress on this. Strong IT governance is important, clarifying decision rights, accountability, investment priorities, and architecture to encourage better coordination and outcomes from IT.