Dr Dianne Davis gets things straight from the start. “Call me Di,” she says. “The only time I ever got called Dianne was when my mother was cross. It was ‘DIANNE!’ So it was Di when I was in the good books and Dianne when it was bad.”
Just back from a week-long biking tour with her husband and speaking from the building site of her new home overlooking the ocean on New Zealand’s North Island, Di’s sunny demeanour reflects the southern hemisphere’s late summer. She seems to be a good example of the old maxim, sometimes attributed to Benjamin Franklin: ‘If you want something done, ask a busy person.’
A qualified GP turned GP Liaison, Di is Clinical Leader on the eReferral and HealthPathways initiatives at Health New Zealand | Te Whatu Ora Te Tai Tokerau and is also running a digital health initiative to give the Northland public online access to their health information. The Northland health service has been hugely improved by eReferrals, she says, while HealthPathways is a big job-of-work to standardise the way things are done across primary and secondary care settings.
“The other part of my role is probably the most important work of my career,” Di says. “We are developing a patient portal allowing everyone to access their health records. It is all about empowering patients with their own health information.”
Di was born and raised in Gisborne, a small city on the east coast of the North Island. Brought up on a vineyard, all her summer jobs were based on the land and people who work with their hands. She credits her father as having “a huge influence” on her life. “He left school when he was about 12 but he taught himself to do all sorts of things and innovate,” she says.
“I love creating things. I love gardening, I love upcycling furniture. I love to take a bit of furniture apart and create a new way of using it. And I like doing that in my work – just breaking a system down to parts and putting them back together in a better way.”
She was the first person in her family to go to university, studying medicine at the University of Otago. Di had early roles back home in Gisborne and in Hawke’s Bay, and specialised in obstetrics. After meeting her husband, who is also a specialist, she went into general practice but got increasingly frustrated in 15 years as a GP.
“The system just seemed so broken,” she says. “There was a very out-of-date-model that hadn’t evolved in a hundred years. My time wasn’t used properly; my books would be full and I would be running late, dealing with really complex problems that I often didn’t need to see.”
Reading a book called In Praise of Slow, by Canadian journalist Carl Honoré, clarified for her that she needed to slow down. “It’s a really cool book, a dangerous book,” she laughs. “It just made me think, ‘I can’t do this’. I just didn’t have enough energy to give to my patients and my family.”
Di was taking three months out from GP work and had resolved to give it up when an opening arose for a GP Liaison role at Whangārei Hospital in Northland, acting as a link between referring GPs and the specialists to which their patients are being sent. It was a good fit, as issues with getting patients referred into hospital services was a long-standing bugbear for Di.
During her time as a GP, she recalls, GPs were presented with a new paper form to fill out for patients being referred for colonoscopy. “There was absolutely no input from GPs,” she says. “They were asking for information they didn’t need and the boxes [on the form] were too small to write what we did need. There was no collaboration and it just made me so angry.”
In her role as GP Liaison, she availed of Ministry of Health grants that were available to improve systems. They secured funding to develop three electronic referral forms – one for colorectal referrals, one for breast conditions and, importantly, a generic referral form.
The eReferrals system eliminated GP concerns about where patient referral had gone in the “black hole” of a hospital system, says Di. “Everything was paper-based prior to that so GPs really welcomed it. They wanted to know that their referral had got there and their work was done.”
The eReferral system uses technology from HealthLink, part of global healthtech company Clanwilliam, that enables connections for professionals throughout the New Zealand health system. Across Australasia, HealthLink connects more than 15,000 medical organisations, exchanging over 100 million clinical messages each year.
“We dealt with the problem that GPs wanted us to solve, which was secure transmission,” Di explains. “We’ve made life a whole lot better for the GPs and specialists but one of the things I’m most proud of is that we’ve really significantly improved the life of our most overworked and under-heralded staff, the booking clerks who make all the appointments.”
Seventeen years on from that first innovation, the eReferral system is still growing and Di still manages it. “Once we had the basic platform in with HealthLink, we just iteratively grew it and grew it and grew it,” she says. “We’ve almost got rid of paper in our [healthcare] community. We’re also the first in New Zealand to have educational professionals able to feed directly into the medical services, where their kids have needs. It’s really cool.”
All her work now is focused on reducing waste and improving communication, invariably through the use of IT. She is trained in Lean methodologies and systems improvements to the extent that she says: “I think I would regard myself as a system engineer these days.”
Di adds: “Right throughout my career, I always wanted to see systems get better. I have an aversion to anyone’s time being wasted, whether that’s someone in the health sector or the patient. I hate waste. In that regard, the work I’ve done with HealthLink has given me an incredibly satisfying career.”
Delivering and improving health services isn’t always easy in Northland, a peninsula stretching about 330km from Auckland to Cape Rēinga. The peninsula, known for its natural beauty, is just 7.5km across at its narrowest point and has 1,700km of coastline. Three hospitals serve the Northland population of about 180,000 people, just over one-third of which is Māori.
“We’ve got a lot of rurality, a lot of poverty. It’s a geographically difficult area to deliver healthcare,” says Di. She is passionate about the patient portal, which will give people direct access to their health information. Her work involves getting GP practices on board and educating citizens through a range of methods that include an information roadshow.
Di tells the story of one patient who asked: ‘Am I really allowed to see this information?’ “That’s outrageous in this day and age,” she says, animated. “It’s her information. I want to change that to being an expectation, not a privilege. That’s my mission.”
HealthLink is involved in the digital health programme, which has started with patients being able to access hospital discharge summaries electronically rather than having to wait for a discharging doctor to do their rounds. Patients will receive a notification when an eReferral is sent or progressed on their behalf, rather than being in the dark about its progress.
“It’s not an easy project because we’re trying to undo hundreds of years of subservience. But I haven’t come across anyone – not a single person in the years working on this – who doesn’t think it’s a good idea,” Di says about the initiative, which is co-designed with the local consumer council.
Di would love to have more resources for the digital health initiative, not least because she is also responsible for running HealthPathways for Northland. She does have some fears that local innovation such as her eReferral work would not be possible under current health reforms, which have replaced the legacy District Health Boards with a centralised body called Health New Zealand Te Whatu Ora.
“Yes, some things should be centralised but we’re going to lose some of this local innovation. I’m just hoping that I leave enough of a legacy behind that it can’t all be turned off,” she says, smiling.
While she admits to missing the direct patient contact she had as a GP, she has no bigger regrets about the path her career took away from primary care. “With these things, there’s often a lot of chance, like the GP Liaison job coming up just when I decided I needed to break from general practice. Things happen when you create space in your life.”
If her first eReferral project arose from frustration with how things were done, what makes her cross these days? “Just not being able to move fast enough,” she says, firmly. “The technology will always change but what we hopefully leave behind is culture change.”
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