Photo: RNZ / Samuel Rillstone
The impact of hospitals being forced to give back millions of dollars for a vital upgrade of data and digital services has been laid bare in newly released documents.
The upgrade was scuppered with under a third of the work done.
The documents showed that out of 15 services meant to be introduced or improved under the so-called Hira upgrade programe, only one of the 15 was completed.
Seven were partly done and another seven were deferred entirely.
At its worst, the impact was that "a sizeable proportion of the population" had seen zero improvement in access to their health information, including about a quarter of a million people not enrolled with a GP, the Health New Zealand documents said.
The agency had to give back millions that had been intended for the second phase or "tranche" of Hira, as well as keep services set up under its first tranche running.
Instead, a chunk of it, $25m, was urgently reprioritised to prop up hospitals' acutely troubled payroll systems.
Health Minister Shane Reti was warned what the impacts would be, in the days before before Budget 2024, an email to Reti first released to Pulse.IT showed.
Hira had been the centrepiece for upgrading old, fragmented and insecure data systems across public hospitals.
A summary released by HNZ showed one of the easier projects got done - scoring a green box - to continue on changing health terminology and codes that more than 40 companies used.
By contrast, the highest priority project scored a red box.
This service was the NZ Patient Summary, meant to give clinicians a up-to-date, comprehensive view even of patients they did not know.
Clinicians have told RNZ the NZ Patient Summary was what they had been waiting so long for. It was among the seven initiatives deferred indefinitely.
"Healthcare information will be unavailable for many people [and/or] providers" as a consequence, said the summary.
RNZ also has the email sent to Reti's private secretary on 28 May as the axe hovered over Hira.
Its central warning was that swathes of health IT were too old to get industry support anymore, and carrying on with them "carries serious risks for the organisation".
"These include ongoing security vulnerabilties and associated breaches, more frequent service outages, along with delayed response and recovery times," HNZ's director of data and digital strategy and investment, Darren Douglas, wrote.
The high stakes around a breach of health system data were vividly illustrated in 2021 by the Waikato DHB ransomware attack.
"In addition," Douglas continued, "tech debt will continue to act as a drag on workforce productivity while impeding management's ability to run services effectively."
The government had previously touted modern digital systems as a uniquely powerful way to boost healthcare.
A bunch of "specific impacts" were blanked out in the email, released under the Official Information Act, but it did list six ways in which a truncated Hira would be left hobbled, including that "services to enable the NZ Patient summary record to be integrated into vendor and sector products will be shut down".
Also, 2.7 million users' online health info accounts, such as My Health Record, would be much less useful. Instead of the accounts being enabled to be used on a wide range of services, such as the immunisation register, HPV screening and regulatory platforms such as assisted dying, it "would go into containment", with use constricted to just pandemic and disease uses.
Douglas's advice to Reti did not move the dial on Hira keeping its funding assigned under the previous government.
The newly released summary, in its header, said, "All B[udget]22 funding intended for Hira Tranche 2 was returned, along with the B21 funding intended to maintain the services stood up in Tranche 1.".
The upshot of the three-tranche Hira being abruptly stopped in June was, essentially, that far fewer patients - or doctors needing information about patients - would benefit than anticipated, the documents showed.
Even for consumers who got some benefit from the parts of the seven services that did get stood up, these were limited: The impact overall was of "limited choice and control", and "no ability to share access [to personal health info]" to whānau or the like.
Douglas's email to Reti in May also noted a primary health vendor was moving to stop its data going into the old systems by June 2024.
The reason? "There is an operational risk of the failure of existing shared electronic health record services in three regions."
Douglas told RNZ that they had worked with this vendor.
"As this access is continuing, there are no impacts," he said.
"We have been collaborating with relevant vendors and with the PHOs who manage shared records to mitigate any risk."
RNZ has asked for details of those three regions and the risk of failure.
Reti has said that HNZ Te Whatu Ora's organisation-wide reset includes reconsidering its data and digital upgrades.
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