Smart system

He atamai te whakaraupapa

This theme is about:

  • discovering, developing and sharing effective innovations across the system
  • taking advantage of opportunities offered by new and emerging technologies
  • having data and smart information systems that improve evidence-based decisions, management reporting and clinical audit
  • having reliable, accurate information that is available at the point of care
  • providing individual online health records that people are able to access and contribute to
  • using standardised technology that allows us to make changes easily and efficiently.

Why is it important?

‘There is an immense opportunity for technology to assist with information sharing, gathering of health data, and identifying trends in performance that feedback into whole of system improvements.’
–Non-governmental organisation

Our system needs to become a learning system, by seeking improvements and innovations, monitoring and evaluating what we are doing, and sharing and standardising better ways of doing things when this is appropriate. Key tools to help make this shift to a learning system are data and technology.

Well-organised data collected through the health system and from elsewhere can help us to target different population groups and track their progress towards both better health outcomes and wider goals shared with other government agencies. Information we collect can improve our understanding of the cause and effect relationships between health and other social services, the effectiveness of different ways of working, and the value for money offered by different interventions. Health research and  evaluations also contribute to the evidence base for effective care in New Zealand.

eReferrals make the patient journey smoother by facilitating the transfer of information between health care providers. They support faster clinical decision-making and increase safety by making it less likely for referrals to be lost or hard to read. eReferrals allow specialists to communicate with referrers on the best treatment options. This may mean that people can be treated in the community, without needing specialist appointments. Auckland, Waitemata and Counties Manukau DHBs have been using eReferrals between GPs and hospitals since 2012. From April to June 2015, eReferrals made up 64,415 out of 86,077 or 75% of total referrals in the Auckland metro DHBs.

The world of technology is advancing very fast. Every aspect of our lives is affected. New technologies have already had a profound impact on industries like banking, air travel and retail.

In the coming years they will play a significant role in the health system in terms of what, how, where and when services are provided, and who provides them.

New technologies have the potential to generate large amounts of data that can give insights into the health system and the health of New Zealanders. Data and smart information systems can support evidence-based decisions on treatments, options and interventions. Technology can perform some tasks for us, help us communicate with each other and ultimately improve our productivity.

Shared care plans give people with complex long-term conditions ownership of their health care, supported by a multidisciplinary team. With these plans, they can set their own health goals with measurable outcomes. In Canterbury and Auckland DHBs, significant numbers of people are enrolled in shared care programmes – over 16,000 in total have active care plans. The DHBs are creating plans not only for people with long-term conditions, but also for people receiving palliative care, older people needing acute care and others needing advanced care. A health navigator takes responsibility for coordinating the care of each person with a shared care plan.

With electronic health records, people can access their own health information and gain more control of their own health. Health providers can also share this electronic information with others so that all providers give people timely and consistent care and make better decisions, within an environment that has strong and clear accountabilities for safeguarding privacy. For groups that may struggle to gain access to traditional services, this kind of electronic access to information can help provide alternatives. As information technologies become a more important and common part of health care, it will be important to make sure all groups gain equitable benefits from them.

‘The sharing of successful innovations across the whole health system and collaborative approaches enable standardised approaches to common challenges or needs.’
–Health network

Health information and services can be provided to people via voice or video through the devices they already use, such as phones and computers. These telehealth approaches can help give people in rural locations and those with limited mobility such as older or disabled people access to specialist care. They can improve management of long-term conditions, decrease hospital admissions and reduce travel costs.

Technology involves more than just digital technologies. Other technologies are revolutionising health systems: robots and other automated systems are carrying out repetitive and predictable processes, advanced analytics are providing new insights into complex health problems, and research breakthroughs in human and life sciences are making ‘personalised medicine’ a reality for more and more people. We need processes in place that enable our health system to make best use of emerging technologies where this makes sense.

Health professionals can use telehealth to deliver health services without being in the same room as the person receiving care. With telehealth, professionals can also deliver health care-related education, research and evaluation remotely. In Central Otago, doctors can support children with type 1 diabetes through a safe and secure video link to specialists in Dunedin. As a result, the children and their families do not need to make a six- to eight-hour round trip for a routine half-hour appointment. It means people living in rural or remote areas in Central Otago have access to the same specialist care as those living in the city. Currently, 17 out of 20 DHBs are actively using telehealth.

While technology brings many benefits, both to the system and to individuals, introducing new information technologies and other technologies in a fragmented way would make systems overly complex and expensive. To share new technological innovations, we must have sufficient scale and standardisation to introduce them across our system as a whole.

What great could look like in 2026

This is our vision for a smart system in 2026.

  • A culture of enquiry and improvement exists throughout the health system, which has seamless links to research communities. The system learns and shares knowledge and innovation rapidly and widely.
  • New Zealand is systematically evaluating and making appropriate use of emerging technologies in fields such as robotics, genomics and nanotechnology.
  • Data is used consistently and reliably, with appropriate safeguards, to continuously improve services.
  • New Zealanders use patient portals regularly and effectively to access their health information and improve their interactions with their doctor and other health care providers.
  • When people attend a health service for the first time, the provider already knows their details. Their journey and scheduling are integrated.
  • People at risk of particular conditions have easier access to follow-up tests and services and benefit from more individually tailored treatment and management plans.
  • The quality of health care is high as health workers spend quality time with people, make fewer errors and make better decisions.

Nelson Marlborough DHB has developed an emergency department system that demonstrates how clinicians can lead the design and development of innovations. ED at a Glance displays all of a service user’s relevant information on a large electronic whiteboard for ED staff. It allows clinicians access to a person’s existing care management plan each time they come in. Since the project was introduced in 2013, the number of visits to the ED by the most frequent attenders has fallen significantly. This frees up the ED for those who need really urgent care. In 2014, ED at a Glance won Dr Tom Morton and his team the Clinician’s Challenge – an award from the National Health IT Board and Health Informatics New Zealand for innovative uses of technology to improve care.

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