The document summarizes key learnings from a study trip to five countries over two weeks. It discusses high-level takeaways regarding similarities in health issues between host countries, the importance of involving stakeholders, and observations about different healthcare systems, including examples from England, Scotland, Denmark, the US, Canada, and New Zealand. The summary highlights that cultural relationships are important before solutions, technical solutions are not always best, and some countries like Canada and Denmark are models to learn from.

1. Key Learnings – Study Trip 2006 Five countries over two weeks 18 meetings England, Scotland, Denmark, USA, and Canada Learning: Good programme, too tight timeframe, more time in future in Canada, Denmark, and Scotland

2. Key Learnings – Study Trip 2006 Key Highlights Context of host countries Key health issues very similar Culture & relationships before solutions/tools Money not always the best or only lever Involve “key” stakeholders Learning: It’s true what they say about British rail!

3. Key Learnings – Study Trip 2006 Key Highlights Emergence of expert patients Best technical solution can be too much NZ and Denmark top ranking – international study Local, regional, and national views/collection Learning: There are honest people in New York!!!

4. Key Learnings – Study Trip 2006 Key Highlights Key message is sometimes what’s NOT said NHS QoF and QMAS - interesting lesson Most $ investment goes to NHS England Most practical goes to NHS Scotland Learning: Carry your passport or picture ID in the States – you’ll need it

5. Key Learnings – Study Trip 2006 Key Highlights Most intellectual and technical goes to Denmark Most fragmented – USA Canada – clear architecture, clinician focus Learning: The ones we should watch – Canada and Denmark.

6. Key Learnings – Study Trip 2006 Bits and Pieces NHS England- “Choose and Book” – don’t believe everything you read NHS England – GPs giving away after-hours care NHS Scotland – some clever and practical applications (e.g., e-referrals) NHS Scotland – strong consumer involvement ethos. Learning: 15% tip goes on top of your official bill in the States

7. Key Learnings – Study Trip 2006 Bits and Pieces NHS England – programme driven by PM (watch this space in 12 months!) Medcom (Denmark) useful organisational model Denmark – has universal “citiizen number” Veterans Affairs- “close system”, integrated system, in house IT development shop. Veterans Affairs – has “My VA Health” Learning: 15% tip goes on top of your official bill in the States

8. Key Learnings – Study Trip 2006 Canadian Infoway – architecture for access to information (warrants a good look) Canadian Infoway – federal body with $$ and operating as a “strategic investor” USA – pockets of brilliance ( VA, KM, Puget Sounds), still waiting for a national strategy Personal Health Record- watch out for Microsoft and Google Learning: Leave your check-in luggage unlocked when travelling to and from the States!!

9. Other observations New Zealand has a great story to share but: Demographics & workforce issues will demand changes Courage to move on Responsible relationships Process is as important as the product

10. Concluding remarks He aha te mea nui o teao He tangata, he tangata, he tangata Crisis made up of 2 words – danger and opportunity If we want to be fast we go alone, if we want it to last we bring others with us.