Health IT - Failure to Learn from Failure

I’m in Rotorua at Digital Health Week, the annual conference of Health Informatics NZ or HINZ. I’ve attended 3 or 4 times over the past 12 years while working in, among other things, digital health policy from a consumer perspective. My mission this time is to support Craig Young of TUANZ drumming up awareness of our new TUANZ Digital Health Consumer Advocacy Group, of which I am currently the convenor.

There are good, and less good features.

The opening keynotes were interesting. Rob Campbell as Chair of the new Te Whatu Ora was impressive – he doesn’t fit the mould of typical government agency chairs, but actually tells it like it is. Six months into the role he conceded that Te Whatu Ora has made nothing like the progress he had hoped, and that he found the role intensely active but intensely frustrating. “We are not here to be decorative,” he said. “We are here to insist on, and lead change. Our Board are activists, not monitors.”

Too many people, he said, are trying to replicate the old way of doing things. The old way had an abundance of poor work practices, low quality information, confused messages, and confused contractual relationships.

Hear, hear to that – spot on.

Various officials from Te Whatu Ora have followed. Their presentations have been professional and articulate - lots of buzz words and impressive diagrams.

But as the conference has progressed, and as I reflect on the 2010s, the sense I get is more of the same. Same people. Same agenda. Same wide range of innovative health IT applications but none of them at any meaningful scale. Same enthusiasts working effectively on innovative projects. Same unspoken resigned acceptance that however promising a project may be, the system is incapable of converting pilots into widespread Business As Usual.

Reflecting back to around 2011/12 I realise that when you strip away the rhetoric, the government presentations are hard to distinguish from those presented to the same conference in 2011/12 by the then National Health IT Board. Or in 2016/17 by the then Ministry of Health.

So what’s the missing link?

We’re missing feedback on past efforts, and honest recognition that so many aspirations fail to gain critical mass year after year. There are 1100 people at this conference who are passionate and highly skilled in health informatics. Where is the deep debate about what we are going to do differently this time round to avoid the same traps?

Governance of health has been transformed once again. But management, in IT at least, goes on as usual.

We keep doing the same thing and expecting a different outcome. Einstein had a word for that.

So its time for consumers to step up. I think I know what most informed consumers want from health IT – a joined-up system that delivers all details of a person’s health interactions to everyone who needs it including ourselves at the right time. The ability to routinely utilise our choice of all modern communication tools to interact with health practitioners. Support for self-management of our health, and data security at least as good as in banks.

We need to stop thinking of ourselves as a “patient” – in both meanings of the word. We are consumers, we pay the bills both directly and via our taxes, and we demand input.

That’s why TUANZ has stepped up with its TUANZ Digital Health Consumer Advocacy Group. You’ll hear a lot more from the Group as we find our feet.