Govt announces a single national health board

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#2695874 21-Apr-2021 10:38

Agree with the sentiments that it is fraught with peril and risk and it's going to take strong leadership to get it right, both in establishing and running this organisation.

I also see it as an opportunity to get IT right. Should be a blank canvas right, with no (or minimal) legacy systems to support or adapt, and a great opportunity to leverage contemporary technologies? Although not without its complexities of course with legacy data imports, security and privacy considerations.

Sometimes I use big words I don't always fully understand in an effort to make myself sound more photosynthesis.

frankv

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#2695876 21-Apr-2021 10:42

Geektastic: I love this idea:

“We will treat people before they get sick so they don’t need to go to hospital, thereby taking the pressure off hospitals,” Little said.”

I wonder what OS his crystal ball runs?

An example that is in use today, at least in the Waikato (my father described his "treatment" to me recently): If someone's heart problems worsen, fluid is retained, mostly in the lower limbs. That extra fluid in turn causes a fairly rapid weight gain (a couple of kg in few days). If nothing is done, they may have a heart attack a couple of days later. So a simple and inexpensive way to "treat" heart patients is for them to weigh themselves daily. If they rapidly put on weight, they call a nurse and get triaged and if necessary referred for investigation and treatment.

This is similar to what was being used with great success by a health insurance company (sorry, don't recall the name) in the USA back around 2003 or so -- I saw a presentation on it at a user group meeting. It was saving the insurance company millions of dollars by reducing hospitalisations for heart attacks, because the patient could be treated *before* they had a heart attack, with usually no hospitalisation. The insurance company would give the patient (for free!) an IIRC USB-enabled scale and an app to send the data to the company, who would monitor the trends and call the patient. (Nowadays I'm sure you could embed it all in a Wifi scale).

esawers

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#2695922 21-Apr-2021 10:48

rogercruse:

Will this be another KiwiBuild sized disaster in the making?

While it should be a good thing, I have a feeling we are going to get screwed over (again)

Are they promising better service, cheaper healthcare for all, or just a bad change management programme

Knowing this government it will be means tested healthcare.

wellygary

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#2695923 21-Apr-2021 10:49

floydbloke:

Agree with the sentiments that it is fraught with peril and risk and it's going to take strong leadership to get it right, both in establishing and running this organisation.

I also see it as an opportunity to get IT right. Should be a blank canvas right, with no (or minimal) legacy systems to support or adapt, and a great opportunity to leverage contemporary technologies? Although not without its complexities of course with legacy data imports, security and privacy considerations.

Most health records are held at the GP level and I don't see this changing much,

At Hospitals there are still truckloads of Paper, ( its cheap) .. so there is little incentive to move to a full digital notes based system

MaxineN

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#2695924 21-Apr-2021 10:49

This is bold. I will remain skeptical and I will believe it when I see it. But this is not something you just glance over. Have to give credit where it's due. Well done.

Ramblings from a mysterious lady who's into tech. Warning I may often create zingers.

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#2695926 21-Apr-2021 10:53

1101:
Geektastic: I love this idea:

“We will treat people before they get sick so they don’t need to go to hospital, thereby taking the pressure off hospitals,” Little said.”

political BS, that all . Talk is easy, actions are hard AND ridiculously expensive.

So he will bring waiting lists down to zero then ? No one will be waiting for treatment, no one waiting for surgery .
That wont ever happen, because it would require a huuuuge govt spend up .

All that will happen from all this, is centralized control . That wont solve any of the big issues with our health system.

My amazement was caused by his suggestion that we could somehow predict, say, a person’s cancer in 10 years and treat it before they got sick...

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#2695928 21-Apr-2021 10:55

Having some experience of single authorities for health in the form of the NHS, it’s certainly no automatic panacea. Hopefully it’ll be worth the $500 million cost.

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#2695937 21-Apr-2021 11:20

Geektastic: Having some experience of single authorities for health in the form of the NHS, it’s certainly no automatic panacea. Hopefully it’ll be worth the $500 million cost.

It requires good managers who understand health and it certainly cannot have politicians running it like the NHS

It needs to be run like the police or the judicial system ie independent of politics

frankv

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#2695986 21-Apr-2021 11:31

Batman:
DjShadow:

I hope I heard it correctly that all our patient notes and such will be in one place, seems like a pain if you move doctors that all that data has to be transfered.

That's the plan. Surely it can't be that hard but it can be of you hire the wrong guys

Having worked in exactly this area, I assure you it's nothing to do with the quality of the staff.

There are legal/bureaucratic issues centring around privacy and data ownership... in my case it took an entire year to get approval to allow other regional DHBs to see patient data belonging to our DHB. This as part of a project to regionalise our data... i.e. the whole point of the project was to allow staff at other regional DHBs to see our patient data. And despite the exact same data already being faxed/emailed to the other DHBs, who would load it onto their information systems. In the last 5 or so years several regional systems, each consisting of 3-6 DHBs, have been set up, because it was believed that it would be very long-term, if not impossible, to get 23 DHBs to agree on a single national system (and agree on who pays how much for it, and who runs it). So it was better to cover 95% of inter-DHB patient movements now, rather than 100% at some vague distant point in the future.

Another issue has been the disparity of patient information systems in use, which in turn is a consequence of the DHB market competition model implemented as part of Rogernomics in the 1980s. At that time, patient records were all paper, and the attempt at establishing a national health computer system had been a disaster. So every DHB went their own way, with no central plan or coordination, and it's no surprise that 35 years later their information systems are all different and incompatible. There *is* a data language called HL7 that is widely used, but there are many versions which are more or less incompatible with each other, and the multiple patient management systems, patient information systems, lab information systems, radiology information systems, and so on often speak different versions. There's significant effort within a DHB to get everything talking, let alone between DHBs.

And, finally, there's never enough money in Health. There's always a new kidney machine or CT scanner or whatever that is desperately needed (and needs to be integrated into the existing systems), and IT is low on the totem pole. Lots of alligator shooting, and no swamp drainage.

antonknee

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#2695990 21-Apr-2021 11:51

sbiddle:

antonknee:

Can't help but think this is a good thing. The DHBs ostensibly are meant to ensure healthcare is appropriately delivered for their local communities but they seem highly ineffective. Seems like this will reduce a lot of overhead and bloat in the health sector.

The risk however (and we don't know lots of the details) is that it may achieve none of this. What if reducing the overhead and bloat simply results in regional care being made worse and people being forced to travel say from Northland to Auckland for treatment as local treatments are cut and the focus moves away from local care?

This is already a thing. I grew up in Rotorua, and our Lakes DHB consistently cut services at Taupō and made patients travel to Rotorua. Then they cut services at Rotorua and made people travel to Hamilton to use Waikato DHB’s services.

My grandfather is currently undergoing treatment which is not available at any of Rotorua/Tauranga/Hamilton and so has to make the 3 hour trip to Middlemore in Auckland.

What if it enables efficiencies and for care to be provided where it’s needed courtesy of a national view, rather than regional silos who can’t deliver anything effectively anyway?

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#2695991 21-Apr-2021 11:54

1101:

So he will bring waiting lists down to zero then ? No one will be waiting for treatment, no one waiting for surgery .

Zero waiting lists is a fantasy.

There will always be waiting lists, because there is a large latent demand. If we had ten times the capacity for doing surgery, there would be ten times the surgery done, but the waiting list would be just as long. The difference would be that the quality of life of people on the waiting list would be better -- they would be waiting less time for smaller, less life-changing, operations.
Queues provide efficiency for the queue server (but not the queue members). This is basic Operations Research. If you have a long enough queue, your queue server is never idle. Long waiting lists mean that your expensive surgeons are working 100% of the time.
More basic Operations Research; even if you have a server that processes faster than the average queue arrival time, there will sometimes be times when two or more people join the queue at once. If you have N queue servers, there will sometimes be an occasion where N+1 people join the queue. So the average queue length will never be zero. And, if you have lots of queue servers to get the average queue length close to zero, those servers will mostly be idle, making it a very expensive system.

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#2695994 21-Apr-2021 12:05

Geektastic:

My amazement was caused by his suggestion that we could somehow predict, say, a person’s cancer in 10 years and treat it before they got sick...

Primary health care provider: "Do you smoke?"

Patient: "Yes"

Primary health care provider: "Let's get you on this quit smoking program"

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#2695995 21-Apr-2021 12:13

MaxineN:

This is bold. I will remain skeptical and I will believe it when I see it. But this is not something you just glance over. Have to give credit where it's due. Well done.

This is a good way of putting it!

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#2695996 21-Apr-2021 12:15

Earbanean:

Geektastic:

My amazement was caused by his suggestion that we could somehow predict, say, a person’s cancer in 10 years and treat it before they got sick...

Primary health care provider: "Do you smoke?"

Patient: "Yes"

Primary health care provider: "Let's get you on this quit smoking program"

I listened to some of it.

It's about barriers to people seeking health care at their GP because of *costs.

So people don't go to GP and then suddenly find that they are in hospital.

Something like that.

The Maori health minister also said stuff about now all Maori can see their GP and not worry about costs ....

Not sure what that means in terms of who gets subsidized who doesn't who has to pay who is free etc

* - I hear that most places are short of GPs ... that also needs to be addressed - otherwise ....

Bung

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#2696047 21-Apr-2021 12:28

antonknee:
This is already a thing. I grew up in Rotorua, and our Lakes DHB consistently cut services at Taupō and made patients travel to Rotorua. Then they cut services at Rotorua and made people travel to Hamilton to use Waikato DHB’s services.

My grandfather is currently undergoing treatment which is not available at any of Rotorua/Tauranga/Hamilton and so has to make the 3 hour trip to Middlemore in Auckland.

What if it enables efficiencies and for care to be provided where it’s needed courtesy of a national view, rather than regional silos who can’t deliver anything effectively anyway?

The problem for a lot of people is not having to travel but being subject to the uncertainties of elective surgery. I was bumped off list a few times but lived only 20 mins away. One time the other person being bumped was on the way from Napier with no way of being contacted until he arrived at Wellington hospital.

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