Hauora, Mauri Ora: Enabling a Healthier Aotearoa New Zealand - NEW ZEALAND HEALTH INFORMATION TECHNOLOGY
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NEW ZEALAND HEALTH INFORMATION TECHNOLOGY Hauora, Mauri Ora: Enabling a Healthier Aotearoa New Zealand An updated analysis of the Digital Health landscape of New Zealand.
Established in 2002 as a not-for-profit, incorporated society,
New Zealand Health Information Technology (NZHIT) is
recognised as the industry leader of the New Zealand
digital health sector. Our membership represents the majority
of digital health companies and organisations operating in
New Zealand as well as a broad cross-section of healthcare
providers, consultancies, legal, insurance, banking, Government,
regional agencies, and international companies with a shared
interest in New Zealand's Health and Disability Sector.
Our network brings together custodianship of nearly 100 percent of
New Zealand’s health related data, working collaboratively across
the sector to position digital health technologies as a key enabler
of quality health, social care, and wellbeing services. Our members
make significant contributions, developments, and investments in
innovative digital health solutions to enable the future direction of
health delivery. NZHIT provides an open environment to support
a co-ordinated, informed industry voice to maximise social and
economic value for New Zealand through digital health technology.
NZHIT: World class health and
wellbeing for all New Zealanders
fully enabled by digital technology.
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HAUORA, MAURI ORA: ENABLING A HEALTHIER AOTEAROA NEW ZEALAND
Thank you to all our Project Supporters
_PART ONE: INTRODUCTION
National Premium Project Partners Bronze Supporters
Gold Partners
Silver Partners
Sector and Industry Supporters
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HAUORA, MAURI ORA: ENABLING A HEALTHIER AOTEAROA NEW ZEALAND
Contents
PART PART PART PART
1
Introduction.............06
2
Our Healthcare........ 19
3
Recommendations....30
4
Conclusion...............62
Foreword: New Zealand Healthcare 1. Digital Health Innovation Acknowledgements..............64
New Zealand Health in 2021.....................................19 Network (DHIN).................32
References..............................66
Information Technology.......07
Our Digital 2. Supplier Engagement
Bibliography............................70
Foreword: Health System.......................22 Framework.........................39
Ministry of Health..................10
The National Health 3. Digital Health Academy
Platinum Sponsor: Information Platform (DHA)...................................45
Spark Health...........................12 (nHIP).......................................26
4. Engaging and empowering
Executive Summary..............13 The Digital consumers.........................49
Health Opportunity...............27
5. Promote our digital health
industry offshore..............58
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HAUORA, MAURI ORA: ENABLING A HEALTHIER AOTEAROA NEW ZEALAND
FOREWORD
New Zealand Health Information Technology
_PART ONE: INTRODUCTION
Today, there is an opportunity to recapture the position New Zealand once
held as a global leader in digital health innovation. Together, we can enable
improvement in the delivery of all healthcare services, helping address the
issues of equity of access and equitable outcomes, while fostering a digital
health industry that supports these changes, and is well positioned globally.
Digital health provides a unique opportunity Kate Reid
to transform our health systems and services CHAIR, New Zealand
here in New Zealand, while concurrently Health Information
Technology (NZHIT)
creating new jobs and career opportunities
Director of Digital
for Kiwis that will help support New Zealand’s
Health, Deloitte
prosperity. This ‘moment in time’ opportunity
could see Aotearoa New Zealand create a
health and disability system that will have the
world eager to adopt our enabling solutions.
Currently, the New Zealand Health and Disability
System is challenged with inequities in access
to healthcare and in equality of health outcomes.
Growing demand and consumer expectations, better understand management and recovery
increased costs for new treatments and pathways to enable consumers to more
medicines, an ageing workforce, and the historical effectively and actively sustain their wellbeing.
lack of investment in digital infrastructure are It follows that a renewed focus on digital
among the pressures highlighted by last year’s health presents us with the opportunity to
New Zealand Health and Disability Review. At enable, support and accelerate the changes
the same time, New Zealand has a burgeoning the sector recognises as being essential if
digital health industry, demonstrated by the more we are to move beyond an acceptance of the
than 160 members of our industry association. status quo and its implicit shortcomings.
1 Introduction
PART We are now beginning to witness significant
shifts in the traditional models of care, from an
However, in the absence of a truly cross-sectional
forum for digital health, we believe the sector is
almost total focus on providing healthcare, to constrained by the challenge of developing a fully
wellbeing, consumer empowerment and the co-ordinated nationwide strategy. This constraint
reduction in demand on our already stretched is further compounded by a low level of digital
resources. While diseases and injuries will literacy in the sector, systemic impediments to
never be completely eliminated, we will be innovation, disabling procurement processes,
able, through science, data, and technology, and the slow progress being made to provide
to identify and diagnose earlier, intervene New Zealanders with equitable access to their
proactively through these new approaches, and health data and supporting technology.
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HAUORA, MAURI ORA: ENABLING A HEALTHIER AOTEAROA NEW ZEALAND
_PART ONE: INTRODUCTION
NZHIT represents more than 160 structure, remit, and accountability of any new Throughout this report, we expand on these
organisations from across the sector, each governance arrangements in this report. recommendations. We recognise the impact
with ideas, experience, and solutions that, of adopting these recommendations will
We would simply note at this point that we
if harnessed for the common good, would be profound and long term. These are not
see the Ministry of Health (MoH), working in
enable a step change in the health and quick fixes, but time is of the essence. We
collaboration with other Government agencies
wellbeing of New Zealanders. In this report need to act, and we need to act now!
that impact on the social determinants of
we make a number of recommendations
health, and with NZHIT representing the voice This report is closely aligned with the key
that would comprise the building blocks
of digital health companies in New Zealand. recommendations of the Health and Disability
of this new digitally enabled approach to
healthcare in Aotearoa New Zealand. Addressing the current fragmentation in our System Review and NZHIT welcomes the
digital health landscape would require seats opportunity to work with Government to support
We believe that the implementation of these the wider implementation strategy. NZHIT is
at the table for representatives from clinical,
recommendations will require new governance
disability, Māori, consumer, private providers, committed to representing our industry and
structures to be put in place with clear
and research organisations. This sector wide collaborating with other stakeholders for the
accountabilities. Recognising that a great deal
collaboration would enable the implementation clear shared goal of enhanced health and
of strategy development is currently being
and oversight of a national digital health strategy, wellbeing of our fellow New Zealanders.
undertaken within the sector following the Health
and Disability System Review, we feel it would including but not limited to, implementing
be inappropriate for NZHIT to recommend the the other recommendations of this report:
The Importance of Partnership
1 Establish and operate a national Digital Health Innovation Network
(DHIN) driving the uptake of innovative digital systems and services.
This is an important and relevant piece of
work from NZHIT. Having had the privilege
partners are valued members of the
healthcare ecosystem. Importantly the role
to contribute as a member of the Health and they will play as we continue to navigate
2 Develop and implement new procurement frameworks to enable
digital investment decisions to be made and implemented more quickly
and effectively.
Disability System Review Expert Panel, it is
clear that digital solutions and digital health
is a foundational enabler within our health
COVID-19 challenges extends beyond the
health system. It further highlights how
closely health and economic prosperity
and wellness system and will increasingly are tightly coupled.
3 Establish and operate a national Digital Health Academy (DHA) to
fast-track health workforce digital literacy.
play a vital role in helping us to solve some of
our most urgent and biggest challenges.
We have an opportunity to systematise and
capitalise on the gains we have made over
The Review and our experience as a health the last few months. The recommendations
4 Promote digital initiatives that empower New Zealanders to take more
control over their health and wellbeing, to help address the inherent
inequities of the Health and Disability System, facilitating new more
system in the COVID-19 era has also
highlighted the power and importance of
partnership in the system. Our industry
put forward in this report are pragmatic and
on-point.
cost effective and appropriate models of care.
5
Dr Lloyd McCann
Work with other agencies such as New Zealand Trade and Enterprise
CEO and Head of Digital Health
(NZTE), to develop an integrated approach to take New Zealand’s digital
Mercy Radiology and Clinics and Healthcare Holdings Ltd
health solutions to the global marketplace.
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HAUORA, MAURI ORA: ENABLING A HEALTHIER AOTEAROA NEW ZEALAND
FOREWORD
Ministry of Health
_PART ONE: INTRODUCTION
COVID-19 has shown how much New Zealand’s Health and Disability Platform (nHIP) ecosystem that will, for COVID-19, and New Zealand’s response to
System relies on digital technologies and data to support the best possible the first time, join up digital infrastructure it, is creating an increasing level of interest
across the New Zealand Health and Disability in what our country is doing in health and
delivery of frontline healthcare and support services. It can literally be
Sector. It will transform the creation, access disability, potentially opening up exciting
the difference between life and death, and wellness and sickness. to, and use of health information and digital new opportunities and innovation funding
services. In turn, this will support people to for New Zealand-based businesses.
better manage their own health, wellbeing
It has also shown the importance of Shayne Hunter • New Zealand’s highly regarded health
and independence, help improve the Health
information for planners and funders, policy DEPUTY-DIRECTOR research sector will increasingly be able
GENERAL and Disability System’s performance through
makers, and consumers. Finally, COVID-19 to take advantage of a small but globally
Ministry of Health operational efficiencies by delivering better
was a demonstration of the wonderful representative population, linked through
data, and provide insights to drive the right
talent we have in New Zealand, the power of the National Health Index (NHI) and
actions. It will support flexibility and innovation
partnerships, and new ways of working. nHIP, to attract overseas research and
which will underpin system transformation.
The Organisation for Economic Co-operation development (R&D) interest and investment.
• There is stronger than ever interest in digital
and Development (OECD) reported in 2019 that health. This is reflected in the number Importantly, the Ministry of Health recognises the
“health data alone makes up 30% of the world’s of new and entrepreneurial businesses synergy between a health and disability sector
stored data”. 1 The day-to-day effectiveness of establishing niche positions in our Health and that can meet the challenges of the 21st century
our Health and Disability System is due as much Disability Sector and finding new markets and the nurturing of vibrant New Zealand-based
to our use of data and digital technologies, as to offshore, complementing the success of digital health industry partners. This report is an
medical technologies, drugs and laboratory tests. established players, such as Orion Health. important step in supporting this opportunity.
The Government’s 2020 Health and Disability Disability System, particularly, but not solely,
System Review pointed out the urgent need to in respect to Māori and Pacific peoples, are
invest more in data and digital technologies.2 unacceptable. The use of digitally enabled
This year the confluence of a number of services and data must be a key part of New
developments provides a ‘moment in time’ Zealand’s strategy to address equity issues.
opportunity to make a step change. Importantly, we need to engage communities
in the design and implementation of services,
• As a country we are increasingly going
and ensure everyone can participate,
beyond financial measures to track
so that there is no digital divide.
societal progress, and to consider broader
indicators of wellbeing, including improved • There is growing recognition that the system
health status and equitable access and needs to aggressively invest in data and digital
outcomes. The Government introduced infrastructure and new ways of working. This is
a wellbeing approach across the Budget not only to relieve the burden of technical debt
cycle in 2019, signalling wellbeing is but to provide the opportunity to enable major
at the centre of policymaking.3 Digital advances in service delivery. It also provides a
technologies and data can play an important platform for New Zealand to be a global leader
role in improving wellbeing outcomes. in public health service delivery and outcomes.
• The Government recognises that the • The Ministry of Health (MoH) is leading the
inequities implicit in today’s Health and development of a national Health Information
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HAUORA, MAURI ORA: ENABLING A HEALTHIER AOTEAROA NEW ZEALAND
PLATINUM SPONSOR
Spark Health Executive Summary
_PART ONE: INTRODUCTION
Spark Health’s vision is to ‘Help all New Zealanders live healthier lives In today’s world, digital technologies offer unique opportunities to strengthen
through the power of technology’. This vision clearly aligns with that of health systems and help meet the increasing demand for healthcare and related
NZHIT and its members. services. The COVID-19 pandemic has forced those engaged in the health sector
to urgently reconsider the way they work and to quickly implement new and
Dr Will Reedy
innovative ways of working to better serve their communities.
We also see digital technologies as key
enablers of how health and wellness services CHIEF EXECUTIVE
OFFICER
can be transformed to meet and exceed the In managing the risks and impacts of the solutions, capitalising on the innovation potential
Spark Health
health and wellness expectations of all New pandemic, the role Aotearoa New Zealand’s of our digital health industry, and employment
Zealanders. The recommendations NZHIT set digital health companies have played, alongside opportunities. Numerous case studies from
out in this report are necessary pillars on which the New Zealand Ministry of Health (MoH) and across the sector further illustrate the successes
to build a thriving digital health ecosystem. the broader sector, has shown that opportunity and barriers in bringing digital solutions to the
Communicating these ideas as a collective is exists to make New Zealand a world-class New Zealand Health and Disability Sector.
a demonstration of commitment across the digital health technology exemplar.
digital health industry and a key motivator for Our recommendations, detailed in this report,
our sponsorship of this opportunities report. Working alongside Government agencies, provide a pathway forward. The next steps include
we envision: the creation of a governance framework, strategy,
As a New Zealand company committed to funding, and leadership to transform these
New Zealanders winning big in a digital world, • The creation of a digitally enabled
concepts into a reality for all New Zealanders.
we believe that the time is right and there is health and disability system for New
now more than ever, a unique opportunity for Zealanders that delivers improved health We recognise the need to unite the Health and
the local digital health industry to collaborate and wellbeing outcomes for all. Disability Sector, Government, the private health
with other stakeholders in delivering world • Digital technology enabling our people to sector, NZHIT, and research institutions, to
system, but we can also create a thriving export
leading health and wellness outcomes. take greater control over their health. enable the development and implementation
industry for digital health organisations.
of an integrated strategy for digital health
The recommendations outlined in this report Looking ahead, we see huge potential for the • An ecosystem that jointly promotes our
in New Zealand, while also recognising the
speak to issues that have permeated discussions local digital health industry to focus more broadly people and our innovations, invests in,
value of the industry that enables it.
across the sector for some time. The challenge, on the determinants of health and wellness for and attracts investment into, local digital
until now, has been the creation of an environment health research and development (R&D). As the Health and Disability System Review
New Zealanders that exist outside the traditional
for true collaboration focused on developing paradigm of the health system. Essentially recommended significant changes to the
We have the opportunity to enable New
a cohesive set of messages and goals that creating an environment where wellness is top sector and included a focus on digital health,
Zealanders access to more effective and equitable
resonate widely — this has now been initiated of mind for all New Zealanders, where they have we are concerned not to pre-empt the
healthcare services. This can be achieved while
through the completion of this report. their own care team at their fingertips, wherever implementation strategy that will follow. On
growing a thriving export industry, creating
they might be and whatever form that might take. this basis, we do not focus on the structure,
The COVID-19 pandemic was a wake-up call, jobs, boosting the economy, and supporting
remit or role of any putative organisation, rather
notwithstanding that New Zealand avoided its Working in collaboration with NZHIT, the our post-COVID-19 economic recovery.
the recommendations made in this report:
full and terrible impacts. However, in its wake, Ministry of Health and other key stakeholders
we need to take the opportunity to build a health This report sets out a number of
to produce this report, we are in full support
system that can weather these storms in the recommendations that offer the opportunity for
of each recommendation detailed here. It
future. We believe that through adopting the is indeed time for transformation, but that real improvements to the health and wellbeing
recommendations in this report, not only can transformation needs to be well planned and status of New Zealanders, showing how this
we build a more robust and effective health well led and we stand to play our role. can be enabled through investment in digital
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HAUORA, MAURI ORA: ENABLING A HEALTHIER AOTEAROA NEW ZEALAND
_PART ONE: INTRODUCTION
1 Establish and operate a
national Digital Health
Innovation Network (DHIN).
3 The establishment and
operation of a national
Digital Health Academy
4 Renewed focus on engaging
and empowering consumers
to address the issues of
5 Promotion of our digital
health industry offshore.
(DHA) to accelerate digital inequity of access and
literacy in the health health outcomes. • Create a strong international brand for
• A partnership between the wider Health workforce. New Zealand as a leader in digital health.
and Disability Sector and NZHIT. • Promote our digital health
• Invest in digital solutions to enable more
• Dedicated to uniting healthcare providers, companies in offshore markets, both
• A nationwide collaboration between effective models of care which enable
entrepreneurs and innovators, researchers individually and collectively.
the Health and Disability Sector and consumer choice, flexibility and informed
and evaluators, and investors to focus • Work cohesively across agencies. For
our universities, based on existing work decision making. For example, self-
on new digital technology solutions example, Ministry of Business, Innovation and
undertaken by Health Informatics New management, whānau-based navigator
to address high priority needs. Employment (MBIE), New Zealand Trade and
Zealand (HiNZ), the National Institute for communities, one-to-many technologies,
• Regular competitive bidding for funding Health Innovation (NIHI), and the MoH. Enterprise (NZTE), Callaghan Innovation, and
remote consultation, and hospital-in-the-home.
led by New Zealand based companies (in the MoH to support the Digital Technologies
• Provide programmes to improve the
partnership with one or more healthcare or • Provide all New Zealanders with easy Industry Transformation Plan (ITP).
digital literacy and skills of the entire
social agency providers), focused on the high access to information relating to their specific
health workforce. To take full advantage of this opportunity,
priority health needs of New Zealanders. health status.
industry, Government, policymakers, clinicians,
• Provide clear pathways for the health
• Ensure all consumer facing digital investments researchers, and communities need to
workforce to engage in digital roles.
are secure, certified, and digitally inclusive. collaborate for a shared vision and purpose.
2
• Prioritise digital education within the
The development of a
syllabuses of all clinical training.
more effective supplier
engagement framework. • Reward on-the-job digital capability skills uplift Medical Technology
through professional development and foster
Medical technologies and devices are This intersecting of digital and
clinical-industry internships or job placements.
increasingly data dependent, software medical technologies creates value
• Reduce costs and eliminate delays in
enabled and integrated. The breadth of in not only improved patient outcomes, but
progression from established need to
Medical Technology includes reusable efficiency of care e.g., hospital workflow,
implemented solution. This will help address
devices, implantables and equipment used remote patient monitoring, flexible equipment
the current sector fragmentation.
in every setting across the health continuum. servicing, and device upgrades. “Increasing
• Promote provider/supplier partnerships to Increasingly new technology and incremental sophistication and reach of software
enable co-design and innovation, with fast and device improvements utilise digital tools to enabled devices requires the expertise
effective transition to full implementation. collect, interpret and store the data from and confidence of healthcare workers to
• Refocus funding from capital to operating devices to enhance diagnosis and treatment. get optimal value from medical devices.”
expenditure.
• Access the local and international Erin Currie
expertise of NZHIT members to help Chairperson
inform and drive policy development. Medical Technologies Association of New Zealand
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HAUORA, MAURI ORA: ENABLING A HEALTHIER AOTEAROA NEW ZEALAND
_PART ONE: INTRODUCTION
Our recommendations are aligned with 6. The work of the Department of Internal Affairs
these current Government initiatives: (DIA) in conjunction with Digital Identity
New Zealand and several Government
1. The recommendations of the Health and
agencies and organisations, including the
Disability System Review, in respect to
MoH, in establishing the Digital Identity Trust
governance, digitally connected services
Framework. Its aim is to “help New Zealand’s
and the work of the Transition Unit.4
transformation as a digital nation, where
2. The recommendations of the Productivity everyone can prove who they are digitally to
Commission report, Technological change organisations in a secure and trusted way.” 11 12
and the future of work, specifically in
7. The Strategy for a Digital Public Service,
reference to fully realising “the potential
to enable digital transformation in the
of disruptive technologies for economic
public service, growing the economy
productivity and social prosperity.” 5
Working together to lead the world in digital transformation of the health sector through digital innovation and improving
3. The work of the MoH in leading the New Zealander’s wellbeing. 13
development of a national Health Information
8. The Ministry for Business Innovation
Platform (nHIP), including interoperability,
and Employment and NZTech's Digital
Establish the certification, and standards development.6
TO R IND Technologies Industry Transformation Plan
SEC US
National Health
4. The report Digital Skills Aotearoa: Digital (ITP) recognising how “digital technologies will
H Innovation TR
LT Network Y Skills for our Digital Future, analysing the be vital for our future and economic wellbeing
A
current digital skills in New Zealand’s and will help drive future productive growth.” 14
HE
Transform the Change the workforce. This report highlights the need
In conclusion, we are currently presented with
level of digital approach to to significantly increase digital literacy and
a unique opportunity to position Aotearoa New
literacy in the engaging with skills across all sectors in New Zealand.7
Zealand as a global leader in digital health
workforce suppliers
5. MoH initiatives aimed at enhancing innovation. Collectively, we can improve the
World Leading the consumer experience through delivery of all healthcare services while also
the development of applications addressing issues of equity, access, and health
Digital Health
with an increasing focus on outcomes for all New Zealanders. Supporting
Outcomes
consumer health literacy. 8 9 10 the digital health ecosystem will also help create
Promote our new jobs and career opportunities, further
Engage and
digital health supporting New Zealand’s economic prosperity.
empower
industry
consumers
offshore
U
T
O
R E
N
PE M
OP
LE E RN
GOV
Diagram courtesy of Advanced Management Systems Limited (AMS)
16 17HAUORA, MAURI ORA: ENABLING A HEALTHIER AOTEAROA NEW ZEALAND
New Zealand Healthcare in 2021
_PART TWO: OUR HEALTHCARE
Following our relative success in dealing with the COVID-19 pandemic,
Aotearoa New Zealand has enjoyed a significant amount of positive
global attention.
However, we know that New Zealand, as with all offers the promise of better planning and
other OECD countries, continues to face major preparing for healthcare both for isolated crises
challenges in the sustainability of health and (for example, the COVID-19 pandemic) and over
disability services, and the equity of their delivery. the long-term, reports McKinsey.19 In addition,
the Global Digital Health Partnership (GDHP),
While life expectancy is increasing, rates of
a collaboration of governments and territories
non-communicable and chronic disease are
alongside the World Health Organisation
also increasing and many more New Zealanders
(WHO), of which New Zealand is a member,
now manage multiple health conditions.15
recognises that the best use of evidence-based
The percentage of adults reporting good or
digital technologies will improve the health
very good health decreased 5.2 percent from
and wellbeing of citizens around the world.20
2013 to 2018. Meanwhile, adults with high
levels of psychological distress increased two However, the OECD reports that health
percent during the same time period.16 As sectors invest far less in information and
the cost of healthcare rises,17 the demand for communications technology (ICT) than other
healthcare services is increasing faster than sectors of the economy. They suggest the
our ability to fund and resource the delivery of sector is at least a decade behind other sectors,
care. Due in part to historical paradigms, we which represents a considerable amount of
struggle to scale the provision of services. missed economic and health benefits.21
Better health has been shown to promote
economic growth. A recent study by the
McKinsey Global Institute examining COVID-19
global impacts on the economy and health,
recognises that “better health promotes
economic growth by expanding the labour
2 Our Healthcare
force and by boosting productivity while also
PART delivering immense social benefits. However,
in recent years, a focus on rising healthcare
costs, especially in mature economies, has
dominated the policy debate, whereas health
as an investment for economic return has
largely been absent from the discussion.” 18
Scientific and technological innovation can
help improve the health and wellbeing of the
world’s population by up to 10 percent and
18 19HAUORA, MAURI ORA: ENABLING A HEALTHIER AOTEAROA NEW ZEALAND
_PART TWO: OUR HEALTHCARE
An international comparison of New Zealand’s Our healthcare system is also influenced by other
Software and Databases % Gross Fixed Capital Formation (GFCF)
resource intensity per hospital can be made using modern pressures. A significant proportion of
OECD 2018 data. Currently, New Zealand has 1.22 New Zealanders live in socioeconomic deprivation
60
doctors and 3.8 nurses per bed compared to the and this is recognised as highly relevant in
50
OECD average of 0.75 doctors and 1.8 nurses addressing health status. However, we have
per bed.22 23 24 While New Zealand’s resource not been able to develop the interconnectivity
40 intensity in hospitals is high, health expenditure necessary to achieve a more holistic approach.
per capita was just below the OECD average.25
30 Consumers are increasingly demanding greater
While we should be cautious in making a broad access to and control of their health data, policy
20 interpretation of this data, as countries vary in makers and managers are looking to stretch
their healthcare system contexts, we can question budgets through increased effectiveness and
10
whether these resources have been effectively efficiency, and clinicians are seeking more timely
0
converted into improved health outcomes. and accurate support. All are seeking leadership to
New Zealand continues to have high rates of address these challenges with effective long-term
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people do not enjoy a first-class health system.28
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outcomes. In 2017, the Productivity Commission
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identified the importance of information The more than 160 members of NZHIT are
flows in improving both health outcomes convinced that digital health innovations and
and measuring health sector productivity.26 solutions can make a difference – this is
Additionally, the MBIE found that the delay their report.
ICT Services % Output
in the implementation of new technologies
can be a factor in reduced productivity.27
3.0
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1.5
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20 21HAUORA, MAURI ORA: ENABLING A HEALTHIER AOTEAROA NEW ZEALAND
Our Digital Health System
_PART TWO: OUR HEALTHCARE
What is Digital Health? Not Welcome in
New Zealand “The current fragmented use of
“The field of knowledge and practice associated with the development and use of digital
digital technologies and silo
technologies to improve health. Digital health expands the concept of eHealth to include ARANZ Medical (AML) is a
digital consumers, with a wider range of smart-devices and connected equipment. It also healthcare informatics company that has
systems is unsustainable.”
encompasses other uses of digital technologies for health such as the Internet of Things, been developing innovative technology- Technical Working Group Update.36
artificial intelligence, big data and robotics.” WHO definition.29 based solutions to improve healthcare
since 1995. All of AML’s research,
Digital health is the use of digital technologies and accessible data to improve health and
development and manufacturing
wellbeing. This includes emerging technologies, for example, artificial intelligence (including
is conducted in Christchurch, New
chatbots and robotics), blockchain, the Internet of Things (IoT), nanomedicine, 3D bioprinting,
Zealand with 99 percent of sales
virtual reality (VR), and more.
exported to more than 40 countries.
The Silhouette suite of products first
found success in international clinical
A health and disability system based on “The presence of legacy systems, incompatible trials, by enabling reliable, highly accurate
infrastructure leveraging new technology and fully devices and outdated infrastructure has created measurements and images to be captured
ongoing challenges for users to access and at distributed investigator sites and
utilising data has been identified as one of the
use patient and clinical information across both stored on a centralised server. Silhouette
three key enablers to system-wide improvement.30
internal hospital locations and wider health is now known in the industry as the gold
The Health and Disability System Review service settings,” says a 2020, District Health standard for imaging, measuring, and
outlines how “data and digital technologies – documenting in clinical trials. To date,
Board (DHB) asset management report.33
the ways of working and platforms required more than 160 trials have used Silhouette.
Previously, New Zealand has had an outstanding
for a digitally enabled, information rich, data- Silhouette is increasingly being used in
history of innovation in digital health due to
driven system, and tools that are easy to use, telehealth applications, with the largest
the early introduction of a National Health
inclusive and provide confidence to consumers installation across 40 sites for the United
Index (NHI) and the early adoption of digital
and clinicians”, will be a vital component of States Department of Veterans Affairs,
Primary Care systems. Local startup companies
one of the world’s largest healthcare
an efficient and effective health system.31 collaborated with healthcare professionals to
providers, where AML has recently
produce some of the world’s most highly regarded
While there are many innovative individual won a national contract in association
solutions.34 However, few have gone onto global with the major multinational, Cerner.
technology solutions currently employed
success, and only a handful have managed
in the Health and Disability Sector, New Meanwhile, procurement barriers
to scale to a sustainable export business.
Zealand is a long way from achieving the have been so large in New Zealand,
“digitally enabled, information-rich, data- It is widely acknowledged that health systems that for now, effectively all of the
driven system” advocated in the Review.32 remain ‘data rich but information poor.’ The OECD company’s marketing focus is
states the key barriers to building a modern health offshore, says CEO, Bruce Davey.
Information Technology strategy, governance system are not technological. “The key barriers…
and asset management have been are found in the institutions, processes and
identified as operating at a basic level. workflows forged long before the digital era.”35
22 23HAUORA, MAURI ORA: ENABLING A HEALTHIER AOTEAROA NEW ZEALAND
_PART TWO: OUR HEALTHCARE
In New Zealand, enabling a healthier Aotearoa OECD Gross Domestic Spending
is currently limited by the following: on R&D % of GDP
• The devolved structure of the Health
and Disability Sector leading to 2017 (latest data)
fragmentation, lack of scale, and hindered
Estonia 1.280
collaboration and co-operation.37 38
New Zealand 1.347
• Different levels of Information Technology
(IT) capability and readiness across Australia 1.787
DHBs and other providers.39 Singapore 1.919
• A lack of consistent and effective Ireland 2.105
investment in the development of data
France 2.203
standards. This dramatically limits the
ability of health providers to share data.40 OECD Average 2.342
• Healthcare providers often see IT as a cost Denmark 2.732
burden rather than an enabler or strategic
Sweden 3.363
investment.41 As a result, there is continual
underinvestment in IT infrastructure.42 Switzerland 3.293
For example, currently it is estimated that
DHBs spend 2.3- 2.5 percent of their annual
budget on digital products and services. It
is estimated 90 percent of this is to support
aged and outdated systems; 43 by comparison,
the OECD average is closer to five percent.44
• Privacy laws and regulations are too frequently
used as a reason to deny innovation.45
• Current procurement processes are slow,
expensive and mitigate against innovation.46
• Relatively poor R&D spending compared
with similar OECD countries.47
24 25HAUORA, MAURI ORA: ENABLING A HEALTHIER AOTEAROA NEW ZEALAND
The National Health Information Platform
(nHIP) The Digital Health Opportunity
_PART TWO: OUR HEALTHCARE
While some progress has been made at a regional level with several The New Zealand tech sector is a significant contributor to the local
DHBs working together to provide a more integrated approach, economy, creating many jobs and exports. The health technology
these systems still do not provide nationwide solutions. sub-sector has considerable potential because of the well documented
benefits of digital health and its related technologies.
Currently, these systems have limited
interoperability between healthcare providers “In the health sector, the potential benefits of
with few interfaces between public and private digital technologies are abundant. Ensuring
providers. Despite recent advances, the public access to the right information by the right “Technology is critical for the future
often struggle to access their medical data.48 people at the right time can improve safety,
prosperity of New Zealand and
Significantly, the MoH has recently taken a effectiveness, and efficiency of care. Digitally
enhanced health services can improve access
is the fastest growing segment
strong lead by announcing the development
and help move away from reactive towards of our economy, generating
of the national Health Information Platform
(nHIP). When implemented, this whole-of-sector proactive approaches to preserving health. Health eight percent of our GDP and
ecosystem will provide a nationwide standards- workers could be relieved from time-consuming nine percent of our exports.” 49
routine tasks and interact better with their
based, interoperable and data driven foundation. NZTech Annual Report 2020, Wellington,
patients. Consequently, people could become NZTech, 2020.49
There is widespread support in the Health more engaged, improve selfcare skills, and more
and Disability Sector for the nHIP, with some effectively coproduce health,” 50 reports the OECD.
encouraging early signs of suppliers collaborating
Aligning with New Zealand’s current direction
on integrated approaches to solution building.
to improve the health and wellbeing of all New Coupled with a national accident insurer, Accident
The development of the nHIP presents major Zealanders, the WHO states that “the use Compensation Corporation (ACC) and a small
opportunities for New Zealand companies, and scale up of digital health solutions can population, New Zealand is well positioned to be
specifically start-ups and small to medium revolutionise how people worldwide achieve an effective pilot model for full interoperability.
enterprises (SMEs). A common, standards- higher standards of health, and access services to The recent Interoperability Roadmap: Accelerating
based and interoperable ecosystem will promote and protect their health and wellbeing.” 51 the shift to a fully interoperable digital health
certainly open the door to local innovation. ecosystem from the Health Information Standards
One of New Zealand’s key advantages is our
Organisation (HISO) proposes a two-year
Certified systems will no longer have to existing high quality health data, including our
timeline to achieve specific goals related to
join a queue (anecdotal evidence suggests National Health Index (NHI). This NHI is a unique
interoperability, “accelerating the shift to a fully
this can often be five years or more) to be seven-digit identifier assigned to everyone
and, in due course, enabled to go global. For interoperable digital health ecosystem that
the next system installed at a DHB. New who uses health and disability services in
example, some local companies including enriches the experience for consumers and the
Zealand will enjoy a flexible, connected Aotearoa New Zealand. The NHI enables the
Orion Health, MedTech, and ARANZ Medical health and disability workforce through better
environment, where we can look forward to exchange of patient information, providing an
have shown what can be achieved. However, connectedness and use of information.” 54
the next wave of digital health innovations. excellent foundation to develop a technologically
New Zealand needs many more innovative
enabled digital health ecosystem.52
Consequently, this will offer New Zealand companies to flourish on a global scale, so
the opportunity to be an international centre economies of scale can be achieved. This will New Zealanders have universal access to
of excellence for digital health innovation lead to significant benefits, both in revenue healthcare and its health system is largely
where startup technologies are supported and productivity, for the country as a whole. funded (71 percent) by the taxpayer.53
26 27HAUORA, MAURI ORA: ENABLING A HEALTHIER AOTEAROA NEW ZEALAND
_PART TWO: OUR HEALTHCARE
Figure 1: The potential benefits of digitally-driven innovation in the health sector are abundant 55
It Took a Pandemic
An example of fast, cost effective messaging standards. This
MORE EFFECTIVE, EFFICIENT AND PEOPLE-CENTRED SERVICES digital enablement is illustrated in the process did not require a multi-
Faster access to critical information. recent work by the MoH, the Institute of represented committee and the standards
More proactive approaches to preserving health and better Environmental Science and Research were mandated for use by all involved.
patient involvement. (ESR), New Zealand laboratories,
If the same method could be applied
and the systems provider Sysmex in
Clinical process optimisation. for all laboratory and pathology testing,
response to the COVID-19 pandemic.
interoperability would be greatly improved.
The national notifiable disease centre, Consequently, a higher quality of data
ESR, rapidly implemented Sysmex’s Eclair would be usable for multiple purposes, from
Clinical Data Repository (CDR) as a single population health to disease management.
database for all COVID-19 results. There
MORE ACCURATE SURVEILLANCE AND ENHANCED Our national COVID-19 response showed
are eleven different reference laboratories
RESILIENCE IN THE FACE OF CRISIS how experts from different organisations
across New Zealand that are performing
successfully (and quickly) collaborated
Faster detection and better response to public health emergencies, SARS-CoV-2 PCR testing. Every time a
making decisions on standards and
e.g., the COVID-19 crisis. Better public health interventions. COVID-19 test is performed, the result is
solutions to co-design and deliver
sent directly via electronic means to the
working systems. This response also
new Eclair system. The data integrates with
further highlights how we can be agile,
New Zealand’s contact tracing system and
dynamic, developing the best solutions,
guides daily reporting by MoH executives.
with the right teams at the right time.
To establish the single repository, decisions
BETTER HEALTH SYSTEM MANAGEMENT
were made rapidly, including data and
Monitoring of health system performance.
Better resource allocation.
Enhanced planning and access to care.
POWERED-UP RESEARCH AND INNOVATION
Analysis of vast amounts of data for better diagnostics and treatments.
Real-world evidence for assessing long-term effects of therapies.
28 29HAUORA, MAURI ORA: ENABLING A HEALTHIER AOTEAROA NEW ZEALAND
Recommendations
_PART THREE: RECOMMENDATIONS
Digital technologies offer unique opportunities to strengthen health systems
and help meet the increasing demand for healthcare and related services.
In managing the risks and impacts of the International evidence shows that due to the
COVID-19 pandemic, the role local digital complex, technical, and multi-faceted nature
health companies have played, alongside the of digital health, creation of a sector-wide
MoH and the broader sector, has shown an governance structure is important.58 59 60 61 62
opportunity exists to make New Zealand a However, this governance structure evolves,
world-class digital health technology exemplar. NZHIT seeks a place at the table working
with the MoH, and the other Government
We have the opportunity to enable New
agencies that have roles that impact the social
Zealanders access to more effective and equitable
determinants of health. We will collaborate with
healthcare services. This can be achieved while
other stakeholders such as HiNZ, and clinical,
growing a thriving export industry, creating
disability, private provider, Māori, consumer,
jobs, boosting the economy, and supporting
and research institution representatives.
our post-COVID-19 economic recovery.
An iterative agile development approach will
Accelerating digital transformation requires
enable us to respond rapidly to the emerging
strong clinical, technical, project and change
needs, priorities and goals of a national digital
management, as acknowledged in the
health programme. This approach will also
Health and Disability System Review. 56
help manage the risk of the complicated
The required hierarchy and accountability will task of implementing an interoperable and
need to be clearly defined, with the MoH adding connected digital health ecosystem.* Agile
significant value as a key stakeholder in providing development also ensures efficient use of
leadership, policy, regulations, standards, available resources, delivers value early, and
and legal and national health frameworks. provides fiscal savings as a result.63 64
Good digital health governance has been As part of this movement towards a more
identified as the foundation for stakeholder co- collaborative approach to addressing
ordination, uniting efforts and avoiding sector the sector’s challenges, NZHIT makes
3 Recommendations
PART fragmentation. It also improves the functioning
of health information systems to support
the following recommendations:
broader health goals and can transform the way
healthcare is delivered. Ultimately, good digital
health governance enables a move from being
care-focused to being actively health-focused.57
* Agile project management values and techniques allow project teams to work on smaller increments, review their work often, and
include feedback right away to avoid costly failures. Agile government is inspired by agile software development. Agile government
procedures reframe traditional decision-making by involving internal and external users as part of processes from day one and elicit
continual feedback loops.
30 31HAUORA, MAURI ORA: ENABLING A HEALTHIER AOTEAROA NEW ZEALAND
_PART THREE: RECOMMENDATIONS
1 Establish and operate a national Digital Health Innovation
Network (DHIN).
Harnessing International Innovation
The London Health Innovation Network (HIN) the Department of Health, the
is the Academic Health Science Network Department of Business, Enterprise
• A partnership between the wider Health It is proposed that the DHIN will in due (AHSN) for South London, one of fifteen and Innovation, Enterprise Ireland, eHealth
and Disability Sector and NZHIT. course merge with the Christchurch Health AHSNs across England.67 These are uniquely Ireland, HSE, Infocom Development
Innovation Hub and work closely with innovation established to connect NHS England and Authority (IDA), the Health Research
• Dedicated to uniting healthcare providers,
partners such as Waitemata DHB’s Leapfrog, academic organisations, local authorities, Board, and Science Foundation Ireland.
entrepreneurs and innovators, researchers
National Institute for Health Innovation and industry, to increase the adoption of
and evaluators, and investors to focus In Asia, Singapore has also launched a
(NIHI), the Ministry of Awesome (MOA), innovation across large populations.
on new digital technology solutions new platform to make it easier and faster
and other sector innovation initiatives. The London HIN is an NHS team that for healthcare institutions to implement
to address high priority needs.
Although targeted at the health sector, works flexibly across the health and new tech. Start-ups and SMEs will be able
• Regular competitive bidding for funding
the DHIN will, where relevant, liaise with care sector, industry, academia, and in to test their innovations in the Centre for
led by New Zealand based companies (in
Government agencies such as the Ministry of partnership with South London residents to Healthcare Innovation Start-up Enterprise
partnership with one or more healthcare
Social Development (MSD), ACC, and Oranga accelerate innovation and improve care. It Link (CHISEL) sandbox, recently launched
or social agency providers) focused on the advises, supports, and connects teams to by the Centre for Healthcare Innovation
high priority needs of New Zealanders. Tamariki (Ministry for Children) whose services
collectively deal with our people's health, social successfully adopt innovation. (CHI).69 Firms work with a healthcare
The Digital Health Innovation Network (DHIN) needs and wellbeing. NZTE will also be a key institution to access real use cases for the
The Health Innovation Hub Ireland (HIHI)
will oversee and enable the adoption of digital trial, so their solutions can be customised
stakeholder, providing marketing support to works across the health sector with Irish
innovation within the Health and Disability to the local context and population.
companies and establishing international businesses to creatively solve problems
Sector. Currently, our innovation ecosystem is beachheads. It is also vital the DHIN engages and improve patient care.68 Harnessing The Health Tech Catalyst has been created
fragmented, restricted, has high barriers, lacks with the Non-Governmental Organisation this innovation, through the development of in the United Kingdom (UK), to unite health
strategic focus, and is underfunded.65 66 (NGO) and community provider sectors. new healthcare technologies, products, and care providers, technology companies and
The DHIN should reference proven international services, it also creates new jobs and exports. public sector organisations to collaborate
The following diagram represents the NZHIT
approaches. For example, the publicly funded, Operationally, HIHI is a partnership of clinical on challenges, ideas and lessons relating to
Innovation Lifecycle. Ideas are generated by
and academic centres from across the digital solutions. Its aim is to accelerate the
National Health Service (NHS) England has established health technology companies or
country. It works directly with three hospital flow of innovations deployed into frontline
fifteen Health Innovation Networks (HIN) each start-ups. Investment is made into a successful
groups and the network can also access all care; creating commercial opportunities for
serving a population roughly the same as New piloted version of the technology, evaluated by acute and community hospitals, pharmacies, its participants and positively impacting the
Zealand's. London’s HIN has provided input in Government or institutions which in turn allows primary care centres, and healthcare centres. health and wellbeing of citizens. The initiative
the development of this report and has offered the company further development and reach of has a series of innovation accelerators
to assist in establishing a New Zealand DHIN. their product. This enables local and global market The HIHI national team includes Health
to support businesses for example, a
expansion, with reinvestment into the company and Safety Executive (HSE) assigned staff
Business Surgery, Virtual Growth Labs to
to expand their products and/or services. from pharmacy to clinical research nurses
promote shared learning, and a service
and biomedical engineers. The team is
design to support ambitious fast growing
further strengthened with members from
start-ups and ventures, and designed to
academic and corporate backgrounds. The
bring breakthrough ideas to market to
Government group tasked with overseeing
achieve commercial success at scale.70
HIHI – National Oversight Group – includes
32 33HAUORA, MAURI ORA: ENABLING A HEALTHIER AOTEAROA NEW ZEALAND
NZHIT Innovation Lifecycle
1 2 3 4 5 6
_PART THREE: RECOMMENDATIONS
LOCAL LOCAL GLOBAL
INNOVATE DEVELOP VALIDATE
LAUNCH EXPANSION EXPANSION
Idea Generation Research and Confirmation of Embed in Processes Expand to Local Beachhead Strategy
Development Outcomes from Partners (DHB,
Productise PHO, NGO etc.) NZTE Engagement
Conceptualise Research
Proof of Concept
Investment to Sustainable Further Investment
Design Testing
Expand Functions
Grow Staff and Global Market Rollout
Collaborate and Partner Validate Benefits Business Operations
(DHB, PHO, NGO etc.)
Prove and Enhance in
Bid for
a Variety of Situations
Innovation Funding
Feasibility Assessment
Showcase Benefits
34 35HAUORA, MAURI ORA: ENABLING A HEALTHIER AOTEAROA NEW ZEALAND
_PART THREE: RECOMMENDATIONS
The DHIN would oversee three specific and into mainstream care. Internationally, where The proposed Innovation Launchpad will: There are some notable examples of the
related digital health innovation workstreams: the impact of COVID-19 has been considerably engagement of academic institutions with health
• Provide commercial and clinical advice, and
greater and is ongoing, similar, and more radical providers regarding research and evaluation
• A National Accelerator training for companies, including first stage
changes have become systemised and will likely agendas. Specifically, the Waitemata DHB
• An Innovation Launchpad innovators, potentially working in collaboration
remain in place in a post-pandemic world. Leapfrog programme, the National Institute for
• An Evidence Generator with Callaghan Innovation to extend the
Health Innovation (NIHI) at Auckland University,
Health Tech Activator to include digital IT
The proposed National Accelerator will: and the Health Innovation Hub in Christchurch.
and software solutions and companies.
However, further opportunity exists through the
• Oversee regular competitive bids
It is notable that COVID-19 has • Provide formal regular reviews for selected DHIN to instigate a locally delivered, but nationally
for innovation funding.
seen fresh impetus in some areas innovators at first stage development. designed approach to research and evaluation.
• Award companies funding, based on the of innovation, especially relating to • Connect innovators and industry
priority needs of the health system. the adoption of telehealth. It is also partners with potential trial sites.
• Ensure that the business proposition notable that in some countries where
the impact of COVID-19 has been • Provide a ‘sand-box’ for rapid Better Experience for All
is economically viable and offered prototyping and collaborations.
considerably greater and is ongoing, Aceso Health is a two-year-old
opportunities in offshore markets.
similar, and more radical changes, The Innovation Launchpad will focus on working digital health start-up with a
• Provide clinical, managerial and have become systemised and will with individuals, start-ups and New Zealand mission to improve the experience of
financial advice of selected bidders. outlast the end of the pandemic. In based health IT organisations with ideas and care for both patients and providers.
• Broker collaborations with healthcare New Zealand there are signs that early-stage prototypes. The Launchpad will offer They are focused on their work in New
providers to act as early adopters for these welcome innovations are being organisations insights into the use, barriers, Zealand, while also taking their learnings
the innovation, as necessary. discarded now that the immediate uniqueness, and viability of their concepts. and solutions offshore. Aceso’s cloud
crisis is in abeyance. It would indeed delivered software integrates with the
• Encourage the formations of industry The proposed Evidence Generator will: existing systems of their providers.
be ironic that New Zealand, held up
collaborations to solve health challenges. • Work with academic institutions to It enhances their capability and
as an exemplar of a health system
• Mandate the use of international and/or in the fight against COVID-19, create standard templates for evaluating functionality to help ensure patients
New Zealand standards, when available. could see its relative digital health healthcare digital innovations. are at the centre of their care journey.
• Encourage the participation of venture standing fall further below most other • Evaluate early implementations of digital "Digital is not a road, nor is it
countries in a post-pandemic world. solutions. This will assist the sector in a destination. The system, our
capitalists to provide funding.
making procurement decisions and support procurement, and the way we account
• Promote the wider deployment of for it must become more flexible. We
companies in their ongoing solution
successful innovations to the sector. must get comfortable with digital as
Preference will be given to submissions targeting development and offshore marketing.
Candidates will be encouraged to develop an operational expense. We need an
improved equity of access and outcomes, and • Vector with other initiatives, such as the appetite for more risk, a willingness
solutions with the potential to scale. This will Health Navigator assessment process
addressing the issue of increasing demand. to try new things and become
help address the demand curve challenge, for consumer related applications.
Examples of these areas of focus may include okay with the occasional failure,”
focussing on digital solutions that can transition
systems to support new community/whanau- says Aceso CEO, Gabe Rijpma.
from one-to-one to one-to-many models of care.
Another potential area of focus is telehealth. based models of care or the treatment of
The COVID-19 pandemic has seen a substantial chronic care patients in their homes. The aim
adoption in the use of telehealth, but scalable is improving care for those with long-term
solutions are required to embed this approach conditions, while reducing demand on hospitals.
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