The 2021 New Zealand eHealth year in review

As the second year of the COVID-19 pandemic began, the embrace of virtual healthcare provision continued to define this era in the eHealth sector. Telehealth, remote monitoring and electronic prescriptions saw notable developments, and yet it was the more prosaic field of online appointment booking systems and immunisation registers that defined the year in digital health.

The ramifications of the sweeping changes recommended by the Simpson Health and Disability System Review (HDSR) are still being debated but technology as an enabler of system reform will be front and centre, backed up by a pretty decent investment from the government in data and digital infrastructure of $400 million over four years.

Waikato DHB’s woes with technology continued – not its failed HealthTap project this time but an extremely serious cyberattack – and a big stink generated by Orion Health CEO Ian McCrae over the Ministry of Health’s procurement practices for COVID-19 technology rounded out the year. Progress was made on Medtech’s ambitious ALEX program in primary care, and more clarity was provided on the direction that the Hira national health information platform.

But this year, like the last one, was dominated by the pandemic. It has spurred a number of virtual health services to start up or accelerate their development, including Tend, which raised a decent $15m in January to expand its virtual and brick-and-mortar offerings. Tend has joined the CareHQ joint venture, Tamaki Health’s Bettr app and telehealth and prescription app Well Revolution in launching into this newly emerging market.

The development – and controversy – over the National Immunisation Solution (NIS) was one of the biggest stories of the year in eHealth in New Zealand. In early February, Minister for COVID-19 Response Chris Hipkins announced the solution had been built and would be available to use when the first vaccines arrived.

The NIS replaced the legacy National Immunisation Register (NIR), provided by Orion Health since 2005, and promised to allow any health worker to record vaccinations anywhere and at any time. The solution also included an inventory management system and was built using the ministry’s cloud platforms, Amazon Web Services and other technologies such as Salesforce. This would prove a somewhat controversial decision down the track.

Using the NZ COVID Tracer app became a fact of life for everyone, especially when outbreaks occurred. Fierce debate took place over its utility and intrusiveness, but by year’s end it had become just another in an arsenal of technology solutions helping to navigate the pandemic. Like vaccine passports and digital travel passes, check-in apps have now just become part of the vernacular.

In March, Air New Zealand joined Singapore Airlines, Etihad, Emirates and Qatar Airways in planning a trial of the digital travel pass developed by the International Air Transport Association (IATA).

The development of the NIS proved somewhat controversial. The Ministry of Health sent out a few mixed messages on exactly what the solution entailed – it seems the immunisation solution will ride on the back of the screening solution – and the budget allocation proved to be an issue in certain circles. ($35m for a national cancer screening and immunisation system is peanuts, but it did upset a few people.)

The NZ COVID Tracer app was also a big bone of contention in NZ. Tech heads insisted that it wouldn’t work, pushing instead for a Bluetooth-enabled wearable device that ultimately would never take off.

Air New Zealand then joined Singapore Airlines, Etihad, Emirates and Qatar Airways in planning a trial of a digital travel pass being developed by the International Air Transport Association (IATA).

Early in March, Canadian EMR vendor WELL Health Technologies bought New Zealand-founded practice management system vendor Intrahealth for $C19.25 million ($NZ21.25m). Intrahealth still has a quite a few users in NZ, especially in Canterbury, and a handful in Australia, but its business has long been centred on Canada, where the company and its founders are now headquartered.

The South Island’s HealthOne shared electronic health record continued to go from strength to strength this year, rolling out to St John ambos to view on their portable electronic devices. It’s great to see the expansion of shared care records to all aspects of the healthcare system, but it would also be good to see some data on whether healthcare professionals are using it, and if it is all worthwhile.

In the second quarter of the year, the Ministry of Health launched a new vaccination dashboard to provide vaccination statistics that it were updated every Wednesday. The dashboard provided a cumulative total of all vaccinations that have been administered and entered into the COVID-19 immunisation register up until midnight of the night before the data is published.

One of the biggest stories of the decade, which will herald huge changes in the coming one, is the Simpson Health and Disability System Review (HDSR). This will see profound changes in the organisation of the hospital system in particular, but how it will affect primary care and Maori and Pasifika health is still unclear. What is clear is that the 20 DHBs will be disbanded – in a turnabout for political absolutists, a move supported by Labour but opposed by National – and while there will be regional field offices, decision making will ultimately be centralised. In a team of just five million, surely this makes sense.

We first reported on Medtech’s quite revolutionary plans for how it deals with third-party software vendors seeking access to its database late last year, and since then, it has signed up quite a few interested parties. Given Medtech’s almost monopolistic hold on the NZ primary care PMS market, anything it decides to do will have ramifications.

In April, it signed up with Auckland PHO ProCare to integrate ProCare’s ProFusion product with Medtech’s Application Layer Exchange (ALEX) platform. ProFusion is a clinical service platform that enables a range of clinical programs across ProCare’s GP network.

In May, Orion Health CEO Ian McCrae gave vent to his fury over the Ministry of Health’s procurement practices for the National Immunisation Solution (NIS). In a letter to Auditor-General John Ryan, Mr McCrae said the reported $38 million price tag for the new system, using Salesforce and AWS technology, was a “scandalous figure” and that an upgrade to the existing National Immunisation Register (NIR), which Orion provides, was all that was needed.

That’s debatable, but there’s no doubt that the ministry has been a bit ham-fisted in explaining its IT strategy. For example, it should have made much more noise about the very successful work it did with the managed isolation and quarantine (MIQ) system, using existing technology like TestSafe and working with Sysmex and the pathology labs to get the COVID testing regime to be one of the best in the world.

In the end, the auditor general formally rejected the request that his office audit the procurement. Mr McCrae was none too pleased, continuing to argue that the procurement process was conducted with a predetermined outcome in mind, and that Orion Health could have delivered a solution for a fraction of the cost.

The OAG did, however, take a look at the roll-out of IT systems to support the Covid-19 immunisation program, finding it was facing challenging timeframes with some aspects being finalised just in time for each stage. The Auditor-General said the audit showed the health sector was working hard to roll out the program but a significant scale-up was required to achieve the government’s vaccination goals. Some aspects of the IT systems were being finalised ‘just in time’ for each stage of the roll-out, with the national booking system and new distribution systems both scheduled to be deployed shortly before the program opened up to group four.

In the May budget, the government announced it had allocated $400 million over four years to invest in data and digital infrastructure for the healthcare system, including money to begin the first tranche of Hira, the national health information platform. According to the Ministry of Health, tranche 1 of Hira will run to January 2024 and will provide access to a virtual electronic health record as needed by drawing together a person’s latest health data from trusted sources to create that data. Tranche 1 will also deliver technology enablers such as digital identity and interoperability services.

It also announced it would invest up to $55.6 million in the national breast cancer screening program, including money for new IT infrastructure, and to support the change to human papillomavirus (HPV) testing for cervical cancer. Associate Health Minister Ayesha Verrall said the current ageing IT infrastructure puts the program at risk as it lacks the flexibility to be easily upgraded to meet the needs of the community, and is no longer supported well by vendors.

The biggest story of the year was undoubtedly the cyber attack on Waikato DHB, which saw all of its information services knocked out and even landline phone services affected across its five hospitals. The early suspect was a phishing attack, which turned out to be correct, with the attackers demanding a ransom, which CEO Kevin Snee said would not be paid.

A group claiming to be behind the attack then contacted NZ media outlets with evidence of stolen patient information, along with staff and financial records. All IT systems were still down a week later, although the hospitals were functioning at about 80 per cent capacity. Most systems were restored in early June.

ProCare announced that the Auckland region Your Health Summary (YHS) shared electronic health record is now being used by 147 general practices with almost half a million primary care health records uploaded since it went live in April 2020. The system, which uses Valentia Technologies’ Indici data extraction utility and is hosted in Valentia’s cloud, is an opt-in, read-only service that aims to give a summary of a patient’s long-term health conditions, allergies and medications. It is managed by ProCare on behalf of the three District Health Boards (DHBs) in the metro Auckland region.

In July, MoH went live with its new Skedulo-based online booking system, Book My Vaccine, opening up appointment bookings for people between 60 and 65 who are the first tranche in group 4 of NZ’s staged roll outs. Deputy director-general for data and digital, Shayne Hunter, said all DHB systems had now migrated over to the national system, which was procured and configured in under six weeks. Pilots were held at Auckland and Canterbury DHBs in June. Skedulo was developed as a native solution for home healthcare companies built on Salesforce’s data model. It is connected to the Covid-19 Immunisation Register (CIR) and the inventory and distribution systems.

The South Island’s Health Connect South (HCS) shared electronic clinical record will be integrated with the New Zealand ePrescription Service (NZePS) to allow hospital clinicians to view dispensed medications from across the country. There are also plans to allow referrals to be sent from secondary care out to the community through the system, and in the longer term, plans are afoot for an interactive dashboard for emergency departments. HCS reported in September that it had achieved a milestone of two million patient records accessed by clinicians across the region in a single month. The system has been live across all five South Island DHBs since 2018.

In October, the government announced it was preparing to roll out vaccine passes, setting up a My Covid Record website that will give people access to COVID-19 test results and proof of vaccination certificates. Prime Minister Jacinda Ardern said Cabinet had agreed to using vaccination passes as a way to ensure greater safety of people at high-risk events and venues. The system officially launched on October 15. Deputy director-general for data and digital Shayne Hunter said the Ministry of Health was also building an app that will verify the certificate to ensure it hasn’t been fraudulently created.

Specifications for what is now being called My Vaccine Pass specifications were published publicly in November, when the MoH announced it had contracted Auckland firm MATTR to build the vaccination passes for use domestically and internationally. MATTR is also developing and supporting the Verifier App.

Rounding out the year, December saw the official demise of not-for-profit IT services organisation Patients First. Patients First was set up over a decade ago to provide a number of interoperability services, most notably the GP2GP electronic medical record transfer system. All of Patients First’s services will be transitioned to the Ministry of Health by December 17.

Primary care

Auckland PHO ProCare partnered with the University of Auckland and the University of Otago to run a large-scale population health study on the effects of multi-morbidity on the risk of hospitalisation or death from heart disease or stroke. Data collected by ProCare on more than 550,000 Aucklanders will be anonymised and linked with regional blood test results from the TestSafe clinical data repository as well as national health databases to track patients over time. The researchers say it is the first of its kind bringing together both primary care and secondary care data on long term conditions.

Check-in kiosk and queue management vendor Jayex Healthcare became the first third-party application to go live in the production environment of Medtech’s new Application Layer EXchange (ALEX) platform. Fellow PMS vendor MyPractice announced it was also due to start using the methodology for its partnership program this year.

A study published in the New Zealand Journal of Primary Healthcare in September that surveyed 160 GPs, practice nurses and nurse practitioners found that the COVID-19 pandemic had boosted uptake and acceptance of the benefits of electronic prescribing, but also highlighted some of the technical deficiencies in existing systems. The University of Otago study found that while most GPs were resoundingly in favour of the shift to ePrescribing, some reported being ill-prepared and left struggling with technical issues.

The latest Ministry of Health figures show that more than 900 of the 1000 general practices in New Zealand are now using NZePS, compared to about 300 before the pandemic.

Secondary care

Ten hospitals across New Zealand are now linked in to the ICNET infection surveillance database hosted by Canterbury DHB, using Baxter Healthcare’s ICNET on the public cloud. Canterbury has been using ICNET since 2012 but has worked with the ACC and Baxter over the past two years to support uptake of the platform to provide other DHB infection prevention teams with real time surveillance

The five Te Manawa Taki (TMT) DHBs signed a contract with Alcidion Group to pilot the OPENeP closed loop electronic medication management solution from Better Meds, which is distributed in NZ by Alcidion. The new solution will replace Taranaki DHB’s MedChart implementation, and if successful at the trial site at Hawera Hospital, will be rolled out to the other DHBs.

Private hospital provider Southern Cross Healthcare completed the roll out of its Orion Health clinical notes solution in April, and then set its sights on electronic vital signs and medication management.

Kaweka Health announced in September that it would implement Orion Health’s hospital information system at its new $70m private surgical hospital in Hastings, due to open next year. It will also roll out the Get Well patient engagement platform distributed in Australia and New Zealand by Hills Health Solutions.

All four Northern region DHBs are now on a single instance of the Orion Health regional clinical portal, with Northland DHB recently going live with the upgrade. Waitematā and Counties Manukau DHBs upgraded to Orion Health’s Clinical Portal 8 in 2018 and Auckland went live last year.

Some of the more interesting software, apps and new players in the market that caught our eye this year included:

• The FluTracking public health surveillance system is certainly not new, but the data it provided this year and last were quite incredible. 150,000 Kiwis and Aussies take part in the survey and it provided quite extraordinary evidence that the measures taken to reduce COVID infections had a huge effect on flu infections, with flu figures plummeting.
• Bay of Plenty District Health Board went live with the Core Schedule vaccine clinic staff rostering module, having already used it in its community-based assessment centres during the pandemic. Hawkes Bay DHB also implemented the module to support its Covid-19 vaccination program.
• Medtech made an interesting move by acquiring DrInfo, which markets a population health, audit and compliance tool used by over 50 per cent of New Zealand general practices. The healthcare technology investment firm behind Medtech, Acclivis Group, then bought Sydney-based community pharmacy software vendor Z Software in its first Australian investment.
• Whanganui DHB went live with the Electronic Request Management System (ERMS) for eReferrals, the first North Island DHB to do so. ERMS has been used by South Island GPs for more than a decade to pre-populate referral forms and deliver them to hospital departments and specialists.
• Auckland DHB announced it will roll out the TrakCare patient administration system (PAS) from InterSystems, with the cloud-hosted solution set to begin implementation in January 2022. The solution will replace three patient management systems used by the DHB.

Click here for Pulse+IT’s New Zealand top 10 articles for 2021.