The poor state of the IT systems in the New Zealand health system is not a new subject. The words, ‘Ugly Baby’ come to mind.
Less front of mind is the state of systems in community care. While the Venn diagram of systems used will intersect with some of the 6,000 systems referred to above, community care is broader than this. Many of the services are not funded by contracts from Health New Zealand | Te Whatu Ora, but by a plethora of other government agencies, such as MSD, OT, and Corrections.
The result is that community health and social care providers can have many teams, delivering on a wide range of services, for a large number of commissioning agencies.
Often, the needs of different services are met with a range of different systems, which can include:
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- Systems imposed on them by commissioning agencies, such as FSNet for the Family Start programme
- Systems designed for other use cases, such as using medical PMS for social service delivery
- And of course paper and Excel.
As a sign of my naïveté, it came as something of a shock to me, to discover that government agencies are often no better. Excel is still King!
The result of this is that a provider's operations and data are often broken up into silos.
Breaking providers into silos leads to:
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- Inefficiencies
- Poor coordination between teams
- Compromised security. Emailing Excel spreadsheets full of sensitive PII comes to mind
- Poor data capture and quality
- A lack of information about the impact of services
- And ultimately negatively affected outcomes for whānau.
As I have spoken of in previous presentations, part of the problem is the funding model, which funds individual services, rather than providers as a whole. There is also a lack of explicit funding for systems, with funding often only for the costs of staffing, leaving little for providers to invest in systems.
Which doesn’t mean that government doesn’t want the data! The current coalition government has repeatedly referred to a need to fund organisations according to their impact.
On the face of it, this makes a lot of sense, but it only makes sense if services and government agencies have the ability to capture and analyse required data.
I’m proposing that we need a way to remove the silos. We need end-to-end data capture and analytics that allows providers to work from a unified system while programatically delivering required data to commissioning agencies, without creating silos.
In the diagram above, each provider has many teams working from one system, with full access to their information, and data from specific contracts is programatically delivered from many providers to a single commissioning team.
An example of where this would be applicable would be the Healthy Homes Initiative contract, whereby 19 providers deliver the service in the community with data delivered to the team at Health NZ in Auckland.
In this scenario, the data from all the teams could also be appropriately aggregated within the commissioning agency, and even nationally.
Since 2017, Noted has been working with community-based health and social service providers, working steadily towards delivering on the solution described.
Our current customer base of over 152 customers includes community teams at Health New Zealand | Te Whatu Ora, Pegasus Health, 22 Māori health providers, mental health and social services providers, over 26% of NZ secondary schools, and various small private practices.
Constantly iterating over, and extending the platform, we have identified a number of key components that we believe are absolute requirements for a solution of this nature to work. They include:
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- Standardised data concepts, including for wellbeing measurement
- Transparent data capture by frontline staff
- Teams
- Highly flexible access controls
- Interoperability with other systems providers and staff rely on
- And seamless synchronisation with sophisticated Data Discovery tools, available to both providers and commissioning agencies.
Data domains
To create a platform that would work across the ecosystem we needed to create a library of data domains that would enable us to create standardised tools that work for all customers and provide for the aggregation of data from across the ecosystem.
PC, our data architect, led the project; collaborating with our own staff and customers to create a taxonomy of 300 data domains designed for community care in Aotearoa.
This included grappling with the concepts of whānau and whakapapa.
Importantly, the concepts can be labelled as the customer wishes. In some organisations, a ‘client’ could be ‘tangata whaiora’, in another it could ‘patient’.
