Presented by Dr Murray Milner Chair, National Health IT Board

1. Governance and ICT Investment
in Health
HINZ 2013
Dr Murray Milner
Chair, National Health IT Board

2. Key themes from HINZ 2012
• The Health and Disability Act was amended to enable DHBs to act
regionally
• The National Health IT Plan is being implemented regionally
o to deliver improved economies of scale and scope
• Successful implementation of ICT in such a complex environment
requires strong governance and leadership
o regional governance for effective decision-making
o regional delivery organisations for clear accountability for delivery
o powerful leadership for programme/project management, commercial
management and system integration.

3. One year on
•
What have we learnt?
•
What needs renewed
vigour?
•
What should we do
differently?
•
Is the right governance
in place?

4. Areas of progress
• More recognition of the importance of ICT in the
provision of sustainable health care
o the four DHB ICT lead CEs asked to attend NHITB
meetings
o a good problem to have
o DHB engagement is critical for successful ICT outcomes
• Updating the National Health IT Plan
o focus on end 2014 goals
o provision of insights beyond 2014
o sharp focus on priorities.

5. Sustainability of the health system
• Need to do more with less
• ICT enables this in other
sectors
o why not health?
• Delivers increased safety,
convenience, flexibility
and quality.

6. CRISP: A case study
• Four regional applications for six DHBs
o more than $50 million over five years across six DHBs
• A troubled programme of ICT development
o but is it?
• Illustrates the need for:
o fundamental governance processes to be rigorously established
and applied
- regional decision-making
o strong engagement at all levels of the DHBs
- Board, Chairs, CEs, CFOs, COOs, CIOs, SMOs, lead clinicians
o commitment of adequate and capable resources
- removal of regional versus local conflicts.

7. What we have learned from CRISP
1. Clarity around
fundamentals for
regional versus local
success, eg, improved:
• Clinical pathways for
patients across the
region
• Improved models of care
• Better use of assets and
skilled personnel
• Patient convenience,
flexibility and safety

8. …CRISP learnings
2. Leveraging collective purchasing
power and economies of scale
• Six DHBs for the price of two
3. Establishing best practice ICT
implementation
• leveraging off all-of-Government
initiatives
• integration of back-up, restoration and
data recovery
• Shift ICT resource focus from
hardware to health informatics.

9. What needs renewed vigour?
• Change management
• Capital and asset management
• ICT Risk management

10. Change management
• Still too much focus on ICT and not enough on Change
Management
o Change is the only way to ensure that benefits will be achieved
o Can't sit back and hope that change will occur
o Require active change management in the way healthcare is
delivered
• Need to define measure able benefits from ICT enablers
o Ensure that the benefits are achieved
• Without change:
o Quality and safety improvement will not be realised
o System sustainability will not be improved.

11. Capital and asset management
• Need to focus on change in approach to ICT asset
management
o Regional programmes of work offer considerable economies of
scale and collaborative clinical engagement
• Why have the Health Benefits Limited initiatives been
challenging?
o Economies of scale and scope should be very attractive to DHBs
• Why is the Windows COE upgrade requirement such a
drama?
o Asset lifecycle management is a prime accountability for any
organisation

13. ICT risk management
• End of life products – all over the sector
• Poor and untested back-up and recovery for critical applications
• Poor implementation of disaster recovery
• Use of unlicensed software
• Widespread use of software customisation.

14. What can we do differently?
• More commitment
• Focus on information, not data
• Leverage off All-of-Government initiatives.

15. Commitment
• We need increased commitment to:
•
•
•
•
•
•
•
•
•
•
strong, decisive governance
deciding to do something, then executing well
system enhancement as compared to local enhancement
achieve sound regional outcomes
always deliver measureable benefits
driving the hard changes to maximise benefit
improving asset and capital management
leveraging economies of scale and scope wherever possible
leveraging wider Government initiatives
implementing good practice consistently.

16. Data versus Information
• Digitally enabled health care is universal
o all patient data needs to be collected at source in
digital form in real-time or near real-time
o eliminate transcribing errors and delayed data
collection
• Ensure all data is associated with
unique identity
o NHI and/or HPI
• Enable data to be readily processed to
deliver intelligent information
o independent of how or where it was
collected
o with appropriate authorisation.

17. Leveraging all-of-Government initiatives
• Government mandate for all government entities
• Health Minister is keen to leverage advantage
o leveraging health volume to achieve improved costs for health
and the wider government sector
o has been demonstrated through CRISP
• A range of economically viable capabilities
o Infrastructure-as-a-Service (IaaS)
o moving to Platform-as-a-Service (PaaS)
o Desktop-as-a-Service (DaaS).

18. Is the right governance in place?
•
Northern
• customer and supply accountabilities being re-aligned
• rising out of the “Dark Ages”
• Midland
• started along a useful path
• needs to execute better to ensure regional decision making
• Central
• slow to get good regional governance in place
• slowly getting good regional governance and delivery operational
• South
• slow to get started with a different approach – South Island Alliance
• making faster progress with regional initiatives now than other three
regions.

19. Conclusions
• Investment in health informatics is a journey
• we need to learn best practice as we undertake this journey
• As a sector we are making good progress
• but we can definitely do better
• The next year will be very challenging
• we have much to do with challenges everywhere
• we must leverage every advantage open to us
• we must apply good practice everywhere
• Poor investment in ICT will not deliver the outcomes we
all want.