New Zealand’s Implementation of Health IT Provides a Quality Model for U.S. Efforts

A 20-year effort has focused on delivery and IT innovations, lowering per capita costs

Published: Monday, October 24, 2011 - 09:28

(NZTE: Christchurch, New Zealand) -- A new report by New Zealand Trade and Enterprise suggests that New Zealand can provide a valuable model for health policy makers and IT professionals seeking to reduce costs and increase the quality of health care in the United States and other nations. By strategically viewing health care as a continuum, from the patient to the care provider and community, and employing a range of new approaches and electronic health technologies, New Zealand has overcome many of the barriers to developing a truly integrated care service.

"The United States can learn much from New Zealand's decades of experience in developing and implementing electronic medical records and health IT systems and technology, which has helped make New Zealand a leader in overall quality of care delivery among OECD [Organization for Economic Cooperation and Development] nations," says John D. Halamka, M.D., the chief information officer of Beth Israel Deaconess Medical Center, as well as the chief information officer at Harvard Medical School, and chairman of the New England Healthcare Exchange Network (NEHEN).

New Zealand is similar to the United States in terms of its population health dynamics, the population distribution between urban and rural areas, and its high use nationally of information and communication technology. At the same time, the per capita cost of health care in New Zealand is significantly less than in the United States, with New Zealand per capita health expenditures reported for 2008 equaling US$2,683 versus US$7,538 in the United States (OECD data).

The new report suggests that New Zealand's leadership in the development, implementation, and uptake of health IT may play an important factor in the country's strong health-care performance and ranking. The use of health IT in the New Zealand primary care sector is 1.6 to 5.1 times greater than that of the United States in all areas, ranging from electronic access to patients' test results to computerization of routine health care practices.

"Over the past 20 years, New Zealand has developed and implemented new approaches to health care delivery, enabled by innovative medical technologies and health IT systems, allowing the country to achieve high-quality health care at reasonable cost," says Duncan Catanach, director for West Americas, New Zealand Trade and Enterprise. He noted that New Zealand has been in the vanguard of many developments in health care delivery, including:
• The use of clinical systems in primary care
• Integration of care across primary, secondary, and community settings
• Shared care planning
• Patient-centric health, self-management, and co-production
• The use of national health indexes to ensure that records and orders are consistently associated with the right patient
• Accurate tracking and assessment of hospital utilization

New Zealand was the first country in the world to establish an electronic population health index—a system that contains a comprehensive database of nearly 20 years of health encounters—which is now supplemented with an equally comprehensive health practitioner index. As well as being used in formulating public policy, these indexes have been the foundation for developing rich clinical data sets, which in turn have greatly facilitated the growth of an internationally respected health research capability.

Overcoming barriers to an integrated health system

Although being a small country with a single tier of government has certainly facilitated the widespread adoption of electronic health systems and technologies, New Zealand nevertheless has faced many of the traditional barriers to developing an integrated health care system. Among the strategies taken to overcome these barriers have been the:
• Recognition that doing nothing is not an option
• Early involvement of clinical leadership in strategy development
• Developing a vision and strategy for socializing it throughout the health-care sector, getting community buy-in and support as far as possible
• Establishing key infrastructural elements—technologies, consent frameworks, architectures, integration approaches, process changes, etc.
• Creating partner-style engagements between the health-care sector and the supplier and research communities, focused on common goals
• Initiating and evaluating a series of trials, with the clear commitment to move from trial to large-scale deployment on success
• Aligning the reward frameworks with the new structures and processes (still very much a work in progress)

Free-market competition paired with cohesive leadership

Another strength of the approach that New Zealand has taken in its national health IT strategy is enabling the best outcomes of free-market competition while providing the leadership and incentives to ensure an orderly and cohesive update of technology investment. "Government allows individual health care organizations to make their own decisions about IT strategy and suppliers, but encourages them to do this within a national framework," says Catanach. "Among medical technology and health IT companies, competition is encouraged, but adherence to standards, along with other ways of facilitating interoperability, is also encouraged and increasingly mandated. The result has been cost-effective, technology-enabled change toward a more effective, affordable, and equitable national health care system."

About The Author

New Zealand Trade and Enterprise

New Zealand Trade and Enterprise (NZTE) is the New Zealand government’s national economic development agency that works to improve the international competitiveness and sustained profitability of New Zealand business by providing access to people, knowledge and opportunities. It stimulates New Zealand’s economic growth by helping to boost export earnings, strengthening regional economies, and delivering economic development assistance to industries and individual businesses. Through its knowledge of and contacts in overseas markets, it connects New Zealand businesses with trade and investment opportunities internationally.