Govt announces a single national health board

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#2696048 21-Apr-2021 12:28

wellygary:

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

Yes, there are truckloads (actually warehouse-loads) of paper. But DHBs have all been moving as fast as they can to electronic (the word digital has different connotations in health... e.g. DRE) patient information systems. However, given the size of the paper repository, it will either take a huge effort and cost to (e.g.) scan all those paper documents (and many of them will never be read again), or it will take decades before they are all obsolete. So most DHBs are running some sort of hybrid system; typically current results and documents are stored electronically (oops... nearly used digitally), and paper is retained for historical data.

Firstly, the paper system is actually expensive to maintain. All those documents have to be stored, and be accessible. There are many people whose job is just to retrieve the paper, update the paper, and put it back again. Years ago, Waikato DHB was paying thousands of dollars a month for off-site warehousing of paper. Interesting factoid: As part of going electronic, they did some analysis and found that a lot of the paper was duplicates.

Secondly, only one person can hold the paper at a time. In hospitals, there are continual emails being sent asking whoever has ABC1234's notes to please forward them to e.g. surgery, because without them the patient can't have his operation. And that's essentially $20K down the drain.

Thirdly, there is far too much scope for human error in paper systems. In my work, I found that about 10% of *electronic* documents were associated with the wrong patient, date, clinician, or service (including a male cervical cancer, and a couple of pregnancies). I'm absolutely sure that the paper system is *much* worse, just because finding a document once it has been mis-filed is impossible.

Finally, research shows that spending on hospital IT has a tenfold return in efficiency improvements for the clinical staff. Less missed operations, less missed appointments, better treatment, shorter stays, etc. Better IT improves pretty much every hospital efficiency metric. This is finally percolating up to senior management.

shrub

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#2696058 21-Apr-2021 12:47

Hopefully this will cull a bunch of middle managers on fat salaries out of the system to free up funding for more preventive health care.

frankv

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#2696066 21-Apr-2021 13:04

antonknee:

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.

To be fair, when Taupo's hospital was set up, it was probably a pretty rough 3-hour-plus trip to Rotorua, and an overnighter to Auckland. It's not unreasonable for health services to take advantage of improvements in transport.

I guess the question you need to answer is how much extra you (and every other taxpayer) would be prepared to pay each year to ensure that all the grandfathers around the country could be treated in their home towns? Even if you settled for within an hour's drive of home, I think it would be an astronomical amount.

And it might not even be possible. For example, the problem Whanganui DHB ran into with obstetrics was that, to provide a 24/7 service, they needed 3 obstetricians, to allow for leave and training and so on. But, to maintain their registration, specialists have to do a certain number of their specialist operations each year. And there weren't that many needed in the WDHB district. So their obstetrics service is AFAIK provided by one obstetrician, and sometimes patients have to go to PN hospital.

So, to provide the service that your grandfather needed, the hospital would need to have 3 specialists. And probably a couple of million dollars worth of machines and infrastructure. And so would all the other small hospitals. But there wouldn't be enough operations in the area for all those specialists to maintain their registration. Should we lower our standards so that it's possible to staff those small hospitals? Rotate the staff between the big & small hospitals? Have those expensive specialists commute to and fro?

afe66

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#2696076 21-Apr-2021 13:22

Health NZ otherwise known as Auckland and the others Health.

Expect local decision making to be devolved to auckland. Now faceless decision making will be made 100s if not 1000km away.

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#2696077 21-Apr-2021 13:26

afe66: Health NZ otherwise known as Auckland and the others Health.

Expect local decision making to be devolved to auckland. Now faceless decision making will be made 100s if not 1000km away.

That sounds worse that what we already have ...

JaseNZ

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#2696083 21-Apr-2021 13:39

Best move that could have ever been made to our health system.

Its currently archaic and full of so many people clipping the ticket its not funny.

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1101

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#2696085 21-Apr-2021 13:41

shrub: Hopefully this will cull a bunch of middle managers on fat salaries out of the system to free up funding for more preventive health care.

It will save so little money it wont be at all noticeable .
A few salaries is a drop in the bucket .
"Vote Health for 2010/11 stands at just under $13.574 billion. "

NZ needs to get real over health costs & govt spending. Its a hole that will never be filled .
DHB's racked up huuge debt ( $885m ? ) because they couldnt run on the money given. So nothing will change , just the bureaucracy will be centralized .

One question
how can we have centralized management without a centralized Computer (software) system , ie the same system nationwide .
Thats going to be another huge and and wastefull money pit .

afe66

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#2696086 21-Apr-2021 13:50

The actual notes should stay local so can be sourced when system falls over.

If going to scan them electronically, it will be a huge jobs with probably 100s of tons..

I have little faith having worked in hospitals with electronic systems. There are never enough terminals to annotate the notes in real time. At nursing handover times the terminals are all in use. You end up writing things on paper then going back to enter data later.

Ward machines are invariably slow cheap units

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#2696092 21-Apr-2021 14:01

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...

some/most diseases probably fall under that category, but there are some that can be managed better...

it can be said that monitoring blood glucose and cholesterol, i.e., managing it before it goes out of hand, could save a fair few from diabetes and heart disease. if we can at least manage those 2, it'd be tangible improvement.

wellygary

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#2696100 21-Apr-2021 14:16

nitro:

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...

some/most diseases probably fall under that category, but there are some that can be managed better...

it can be said that monitoring blood glucose and cholesterol, i.e., managing it before it goes out of hand, could save a fair few from diabetes and heart disease. if we can at least manage those 2, it'd be tangible improvement.

The first and easiest solution to helping out hospitals is to pour gobs of money into GPs and after hours clinics,

The problem is that there is an historically adverse relationship between the Ministry of Health (Govt) and GPs ( Private businesses) which results in lots of bureaucracy and overheads as the MoH work to make sure that GPs aren't lining their pockets too much..

PolicyGuy

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#2696102 21-Apr-2021 14:19

Batman:

afe66: Health NZ otherwise known as Auckland and the others Health.

Expect local decision making to be devolved to auckland. Now faceless decision making will be made 100s if not 1000km away.

That sounds worse that what we already have ...

It would be :(

I expect there will be a devolved regional structure if only because having all the bureaucrats in one place in Wellington or Auckland would be far too expensive.
I'd look for maybe five "Regional Health Service Delivery Offices": 'Northern Region' for everything north of the Bombay Hills ; 'North Central Region' (or maybe 'Aotea', anything but 'Waikato') for Taupo to the Bombay Hills; 'Central Region' for Taupo to Levin, 'Remutaka Region' (not 'Wellington' or 'Capital') for Wellington, Wairarapa and Kapiti; and "Southern Region" for the whole South Island.

If they were smart, the Regional offices would not go where the existing DHB head offices are, both for optics and for regional development: maybe something like Northern in Albany, North Central in Rotorua or Cambridge, Central in Marton or Dannevirke, Remutaka in Porirua, Southern in Timaru or Blenheim.

Just my $0.02
:)

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#2696115 21-Apr-2021 14:42

Just want to express thanks for the insights shared by @frankv They are some very helpful and interesting views from someone who is clearly informed with inside knowledge of the sector. The example of the limitations with providing specialist services in every regional location highlights this nicely, and shows understanding of the bigger picture which is often lost amidst the myriad personal experiences (which is all that most people have to go on). It doesn't make those experiences any less frustrating, but hopefully it shows the difficult trade offs that are being made to provide a balance between cost and coverage.

tchart

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#2696120 21-Apr-2021 14:57

shrub: Hopefully this will cull a bunch of middle managers on fat salaries out of the system to free up funding for more preventive health care.

And hopefully hire some more nurses/doctors.

Example of DHB craziness today my son has flu like symptons, local GP says to get a COVID test but we dont have any test facilities in the Hutt Valley! Had to drive to Porirua (which is a different DHB).

COVID test nurse says "that looks like strep throat" so they swabbed for that too.

Call the local GP to talk to the nurse about getting antibiotics, but we have to talk to the GP.

Would be good to see some prescriptions able to be done by nurses to free up GP time.

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#2696121 21-Apr-2021 15:01

Bung:
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.

I turned up at Masterton hospital for surgery, scrubbed and ready. Only be told they weren’t operating that day due to staff shortages.

Geektastic

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#2696123 21-Apr-2021 15:05

1101:
shrub: Hopefully this will cull a bunch of middle managers on fat salaries out of the system to free up funding for more preventive health care.

It will save so little money it wont be at all noticeable .
A few salaries is a drop in the bucket .
"Vote Health for 2010/11 stands at just under $13.574 billion. "

NZ needs to get real over health costs & govt spending. Its a hole that will never be filled .
DHB's racked up huuge debt ( $885m ? ) because they couldnt run on the money given. So nothing will change , just the bureaucracy will be centralized .

One question
how can we have centralized management without a centralized Computer (software) system , ie the same system nationwide .
Thats going to be another huge and and wastefull money pit .

Unless politicians are prepared to close hospitals when money runs out and only reopen them in the next FY, budgets are tantamount to pointless really. Think of them as guidelines, Minister....

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