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The 2023 New Zealand Digital Health Year in Review

11 December 2023
By Kate McDonald
Patient portal ambassador Dr Andrew Miller. Photo courtesy Te Whatu Ora Te Tai Tokerau

Some of the major foundations upon which Te Whatu Ora Health New Zealand’s future health system will run began to come to fruition this year, headlined by the awarding of a contract to build the National Data Platform to Accenture. The NDP is described as a federated data platform that will bring together a number of national datasets held by more than 28 entities under the previous health system.

It came as Te Whatu Ora fleshed out plans to consolidate its health technology assets on fewer, better cloud-delivered platforms and for a refresh of the national interoperability roadmap, and as the health system continued to grapple with the massive restructure it has undergone.

Quiet progress was made with the Hira platform, which still seems to be undergoing somewhat of an identity crisis, although it did add some new capabilities this year such as the NZ Health Terminology Service, which uses CSIRO’s Ontoserver software. Plans to operationalise AI and machine learning within the newly united healthcare system were also fleshed out through a national strategy aimed at providing a protected environment in which to explore the potential of AI and its use in the real world.

NZ swore in two health ministers with medical degrees this year: in February it was infectious diseases specialist Ayesha Verrall, and in November is was GP Shane Reti following the National/ACT/NZ First election win. Dr Reti has said little about plans for digital health but he does have an interest. As always, though, paying for it all will be the stumbling block.

The year in digital health for New Zealand also saw patients getting access to their hospital records through a popular patient portal, the new Dunedin Hospital losing and then gaining again funding for digital, aged care facilities get access to the South Island’s HealthOne/Health Connect South system, and big new products from Dedalus and Orion Health launched on the local market.

Developments kicked off early in January with the partnership between the New Zealand Telehealth Services Whakarongorau Aotearoa and Christchurch-based start-up oVRcome, which is developing virtual reality exposure therapy delivered on smartphones to help people overcome phobias. oVRcome is also active in social anxiety, using smartphone VR and a psychologist as an audio guide, but this partnership will see Whakarongorau Aotearoa, formerly known as Homecare Medical and a joint agreement between Pegasus and ProCare PHOs, invest financially in the start-up.

Long-term national telehealth service head Andrew Slater was keen on the investment, but it wasn’t long before he had been poached by the newly formed Te Whatu Ora Health New Zealand as its new chief people officer.

In a year in which AI would dominate the headlines, New Zealand melanoma diagnostic service MoleMap announced it plans to use its AI algorithm to help screen patients in the early stages of melanoma, rolling the technology out to its 50 clinics in NZ and potentially its Australian sites. MoleMap has developed the AI in partnership with cancer researchers from Melbourne’s Monash University, with a local trial showing the system was capable of identifying melanoma in more than nine out of 10 cases.

The effects of the COVID-19 pandemic still lingered in 2023, but studies were showing that the level of use of certain technologies that took off during the pandemic, especially telehealth, were beginning to fade. A New Zealand study of general practices showed that in post-COVID pandemic conditions, GP practices were starting to retreat from some elements of digitalisation.

In March, national health information platform Hira added new apps to its marketplace, which is a single point of entry that houses APIs for vendors and healthcare providers to connect to health information from national data repositories. One is the New Zealand Health Terminology Service (NZHTS), which provides read-only access to terminology and code systems including the SNOMED CT New Zealand edition. Another is the National Health Index (NHI) core API, which was added later in the year and will enable consumers to update information such as their email, address and preferred name using their My Health Account login. Access to the APIs will be accessed through a connector plane, which will approve or deny access to Hira’s data repositories.

Te Whatu Ora then went to market for a business partner to help deliver an event notification service solution for Hira that will let healthcare providers know that details about a patient have changed. The program is ultimately aiming to have a New Zealand patient summary, using the standards-based International Patient Summary, available to consumers and healthcare providers by mid-2024. Money for the program was provided in the 2021 budget as part of a $400 million, four-year investment in data and digital. Hira ultimately aims to enable access to a virtual electronic health record by drawing together a person’s latest health data from trusted sources.

Patient access to their own information was also high on the agenda in 2023, with Te Whatu Ora Te Tai Tokerau Northland doing some important work with patient portal vendor Manage My Health to open up hospital documents to patients, starting with outpatients letters and discharge summaries. Manage My Health is best known as a general practice patient portal and is integrated with New Zealand’s leading PMS Medtech. With 68,000 Northlanders already having a Manage My Health account, anyone who has been a patient at Whangārei, Dargaville, Bay of Islands or Kaitai hospitals can now see some of their hospital information. It is an optional system, but in a trial of 15,000 patients, no one opted out. Manage My Health also signed up to the government’s My Health Account digital health identity service this year.

In April, New Zealand’s health services directory Healthpoint went live with a national immunisations services directory in advance of the flu season. The directory was made available to third party applications through Healthpoint API, which is built on the Amazon API Gateway using the HL7 FHIR standard. Later in the year, Healthpoint partnered with Auckland-based digital health company Vensa Health to integrate the API into Vensa’s repeat prescription application to enable patient choice of pharmacy selection. Patients can order repeat script requests for themselves and their whānau and search for the nearest pharmacy based on their geo-location on their mobile. It also enables medical centres using vensa.com to search and nominate a default pharmacy for medication collection when a patient orders a repeat script online.

In May, then Health Minister Ayesha Verrall reversed promised cuts to the budget for the new Dunedin Hospital and announced additional funding of $97 million for data and digital infrastructure to get the hospital operational. The $1.68 billion, 421-bed hospital is the largest health project ever undertaken in New Zealand and the aim is to make it a fully digital hospital at HIMSS Level 6. IT specialist Inde Technology is in charge of designing inpatient and outpatient flow, IT network design, cloud infrastructure, telephony, audio-visual design and modern features like real-time digital location and wayfinding technologies. The Health Connect South clinical portal will be used at the new hospital, along with systems such as the South Island Patient Information Care System (SI PICS).

More than 90 per cent of aged care facilities in the South Island are now using the Health Connect South/HealthOne systems to access patients’ electronic health care records and shared care plans. The systems began rolling out to aged care facilities in 2022 after the solution had been upgraded to improve usability for aged care nurses. Nurses access the systems through a web browser and are able to see the resident’s shared primary care summary record held by their general practice and community pharmacy, while the HCS electronic medical record for South Island hospitals provides clinicians with an up-to-date, unified view of their hospital record. H1/HCS includes four types of shared care plans: acute, personalised care, advance care and ARC shared goals of care.

Once the darling of the New Zealand stock exchange, Orion Health has seen its fair share of troubles over the last half a decade but in 2023, it began targeting growth again. It rebranded its health data intelligence services as the Orchestral health intelligence platform and is touting it as “the biggest step forward in health data since the advent of integration engines some 20 years ago”. Features include built-in machine learning, natural language processing, data de-identification, a terminology service, patient indexing, data integration, and data analytics capabilities. Orion was also heavily touting is Virtuoso digital front door capabilities that it has rolled out for Health811 Ontario in Canada. It is also live in New Zealand, where Southern Cross Healthcare has piloted an eAdmissions solution. Orion also has large markets in digital care records and health information exchanges in the US and Europe.

New Zealand is also a target market for global health IT firm Dedalus with its ORBIS cloud-enabled electronic medical record. Dedalus has most of the PAS market in New Zealand with iPM and webPAS, and its MedChart medications management system and ePharmacy are also long-term stayers, but a new EMR offering is something relatively new. Dedalus also offers its new DC4H interoperability platform, powered by FHIR, to the New Zealand market. Dedalus has worked with Te Whatu Ora Whanganui to create an interface to Microsoft Teams using DC4H and Te Whatu Ora Waikato to ingest data held in its integrated care record.

In June, Te Whatu Ora announced it was looking to set up a national rural clinical telehealth service to improve access to after hours care in rural areas across the country, working with Te Aka Whai Ora Māori Health Authority to deliver it nationwide. The service is envisioned as providing an after hours telehealth nurse triage, booking, and handover service; GP overflow and after hours telehealth consultations; an integrated booking system support service; and program coordination of rural practices. A precondition is that the service have approved access to GP PMSs and available shared electronic health records for informational continuity of care. The tender was awarded to the Ka Ora consortium in November, comprising of telehealth provider Reach Aotearoa, GP telehealth service Practice Plus and virtual urgent care clinic Emergency Consult.

In July, Te Whatu Ora announced that Accenture had won the contract to build the National Data Platform (NDP), which aims to unify information previously held by numerous organisations such as district health board. Accenture will work with Auckland data and analytics solution specialist Acumen BI on the project, which will build a common national platform for data management and sharing for reporting and analytics. Te Whatu Ora interim head of integration Stuart Bloomfield said the NDP was foundational project for the reformed health system. The NDP will provide researchers and planners with access to a wide range of analytics-ready information they can’t currently view in one location, because the previous health entities held data in different ways, he said.

In August, Te Whatu Ora’s director of strategy and investment for data and digital, Darren Douglass, told the MedInfo conference that the organisation plans to consolidate its health technology assets on fewer, better cloud-delivered platforms, look to scale existing technologies on a national rather than district level and even slow down or cease planned procurements as part of its data and digital strategy. He announced that the 2020 national interoperability framework was being refreshed, and that Te Whatu Ora was developing a strategy around platform and agile, targeting the numerous cloud platforms that are in use. Conformance to a minimum set of data and digital requirements and standards is a key initiative for Te Whatu Ora, supported by a move towards certification of applications and solutions.

As the year began to wind down, Te Whatu Ora’s general manager for emerging health technology and innovation Jon Herries provided an update on the organisation’s four-point plan for AI, including a governance framework and a large language model policy, a trusted research environment and a separate production system called the algorithm hub to help operationalise AI and machine learning within New Zealand’s newly united healthcare system. The strategy is aimed at providing a protected environment in which to explore the potential of AI and its use in the real world, while also protecting patient information and research data and evaluating whether new AI tools are any better than existing technologies. Generative AI for clinical notes and clinical coding is being looked at, as is Nabla Copilot for automated structured notes for in-person and video consultations.

What the newly elected government plans for digital health in New Zealand is still a bit unknown. New Health Minister Shane Reti says he will not make major structural changes to the health system apart from the promise to disestablish Te Aka Whai Ora, and while he is also not offering any new money, he is planning to implement recommendations from the Sapere report into primary care funding that uses age, sex, ethnicity, deprivation and morbidity factors to calculate capitation payments. He has promised to restore services that were promised for the new Dunedin Hospital but were later cut, and has also said he hopes to speed up infrastructure projects. A return to setting national health targets is also on the cards.

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

The Silhouette digital wound imaging platform, which is being used to improve the treatment of diabetic foot ulcers in health facilities across Australia, NZ and the world. The electronic wound assessment system monitors and manages wound healing, aiming to reduce diabetes-related foot complications and ultimately reduce amputations.

Mobile hospital wait time app Emergency Q is helping to ease pressure in the emergency department at Southland Hospital and is also helping to encourage patients not enrolled with a general practice to do so.

Medi-Map added single sign-on (SSO) for its shared medication chart to users to access the platform using their organisation login credentials. Medi-Map is designed to give GPs, pharmacists and aged care facilities access to a shared interface for residents’ medications charts, which can be updated in real time and are accessible from any device.

Wellington-based workforce management and rostering solution vendor Core Schedule entered the NZ aged care sector with its scheduling platform, with the help of AWS’s cloud computing capabilities. In use at Middlemore Hospital and the former Canterbury and Hutt Valley DHBs, Core Schedule is able to search through organisational staff to find everyone who is available to work or who has specific skills or qualifications and allow them to pick up shifts from their phone.

Te Whatu Ora South Canterbury went live with Sysmex New Zealand’s Eclair eOrdering solution for radiology (eRad) and its result sign-off module. South Canterbury joins the West Coast and Nelson Marlborough in recently adopting the capability. It went live in Nelson Marlborough in 2019 but was first used in Canterbury in 2012. Eclair forms the basis for the TestSafe South clinical data repository (CDR).

Secure messaging platform Celo Health had a big year, deploying its clinical messaging app for humanitarian group Médecins Sans Frontières’ (MSF) healthcare operations globally. The app provides secure messaging capabilities on Android and iOS devices and desktops, with chat, consent and clinical image capabilities. It also won a similar contract with NZ Air Ambulance.

Primary care provider Tend Health continued to make headlines this year, including for its online “walk-in” primary care service, which offers 10-minute GP telehealth consults for immediate, non-emergency needs through its mobile app. Tend also provides in-person GP consults at its bricks-and-mortar clinics in Auckland, the Bay of Plenty and the South Island.

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