Jim Brown is asking some quick-fire questions: “What’s the role of the state as a health and wellness provider or facilitator? How do we want to construct our societies? What’s our social licence?” He pauses, then adds: “We’re in a really cool time. It’s all about ‘hey, let’s get on and do some things’.”
At the forefront of the Data and Digital division of New Zealand’s new centralised health organisation – named Health New Zealand Te Whatu Ora (meaning ‘the Weaving of Wellness’) – Jim is actively engaged in figuring out how those questions can be answered and how health services should look as a result. Many technology roadblocks to service delivery are eased or gone, he says, so there is an opportunity to “reimagine” things in relation to public health.
Jim gives the background. Since 2022, New Zealand’s health service has been operating under the Pae Ora (Healthy Futures) Act, which puts a focus on wellbeing. “It’s about families and communities being enabled, through healthcare provision, to seek wellness and good health,” he explains. ”Our healthcare, in large degree, has been highly medically focused. We have high hospital and specialist centricity in how we look at health. But if we look at it from a wellbeing perspective, there are a whole lot of things that are interrelated about your opportunities for good health, like housing and literacy.”
Under Pae Ora, New Zealand’s network of 20 District Health Boards (DHBs) and eight shared service agencies has been replaced with the centralised structure, which aims to bring more consistency to service provision nationwide. “With the DHBs, we had distributed governance, distributed service design and delivery, and that led to variability,” says Jim.
The New Zealand health service is a big beast, with a budget of NZ$26.5 billion in 2023/24 and about 250,000 direct and indirect employees. As with health services across the globe, there is never enough money to fulfil everything the government would wish, so deciding where to direct the “constrained dollars” is critical. One of five system shifts the health service is undertaking is that ‘digital technology will be used in more and better ways’.
“We’re seeking to enable people to have the resources to do things for themselves as much as they can,” says Jim. “Then, when they need to get involved [with the health service] a bit more, to ensure we’ve got really good access, either physical access to a service or information access.”
A big picture thinker, Jim’s approach to his role is informed by his varied career. He started out as a social worker but readily admits he wasn’t suited to it. “I’m more of a get-out-and-get-things-done kind of guy, ideally at scale,” he says. “I had quite a significant career change, into the wool industry of all things.”
During his time in wool, there was a move towards an international way of standardised trading including an international coding structure. “The result was everybody around the world who traded in wool knew what the blends and products were,” he says. “In a funny old way, that wool industry involvement is quite instructive to what we’re doing now.”
He worked in other industries in manufacturing and supply chain systems, including as IT manager – “what we would now call a chief digital officer” – for a confectionery business. “In manufacturing, you have a lot of opportunity to do stuff with equipment and information,” he says. “Your insights into your customer keep you alive: What’s selling? What are people buying or wanting to buy? When and where?”
The confectionery company would regularly experiment with new products and had a big financial hit with bubblegum cards of animated characters – a product that it didn’t even manufacture itself. “We were entrepreneurial,” Jim says. “You’d give stuff a go; if it was a goer, you’d amp up and go hell for leather.”
However, when the company introduced 1990 Gulf War bubblegum cards, which had been a big seller in the US, the stock didn’t shift. “We had containers full of the things, which ended up going through a distressed goods seller,” he says. “It was an embarrassment.”
The lesson about knowing your customer stuck with Jim. “What works well in one place doesn’t always transport universally, it’s all about local conditions,” he says. “In health, how we’re organised around the country is really a matter of the local conditions of the people who live there. They’re the ones who know what’s going on.”
Jim also worked in telecoms at a time when the New Zealand state telecoms company was sold to private investors. They had to get under the hood to figure out what was working and what wasn’t; merely maintaining the status quo wasn’t an option. Again, the parallels with the health service shake-up are apparent, says Jim. “We went through a big transformation. It was really about delivery of product that was of value to customers. To be able to survive, you’ve got to be able to provide things that people want.”
Layering all those lessons together, Jim sees huge potential for technology to assist in delivering quality health services to the New Zealand population where and how they want it. The reimagined system is organised around Localities, taking a holistic approach to community wellbeing while recognising demographic differences. The north of the North Island has a large rural Māori population, for example, whose needs differ from city-dwellers. New Zealand also has significant immigration from Asia.
The big things for us in public health are being able to surveil what’s going on, identify the things we need to be aware of long-run, then enable prevention,” says Jim, who notes he is old enough to remember when polio was relatively common in local families. “If we can enable prevention and enable people to have good wellbeing, then most people get on and do pretty well themselves.”
In his sphere of Data and Digital at Health New Zealand, that means managing tech systems across a highly distributed ecosystem that includes GP, specialists, radiologists, hospitals, pharmacists and many others. That includes working on connectivity projects with messaging giant HealthLink, part of Clanwilliam, which operates the secure messaging network that connects professionals across the health system, exchanging over 100 million clinical messages annually.
The healthcare overhaul, initiated by the Labour Party government of former Prime Minister Jacinda Ardern, was underway when the Covid-19 pandemic hit in 2020. “We got a really big wake-up call when Covid came, that our public health services were poor cousins,” says Jim. “We had to stand up a whole lot of capability real fast. It actually enabled us to look at things in a different way.
“Through Covid vaccinations, we learned a lot about how we could do vaccinations to get better spread and more vaccinator capabilities around the country. It’s all about distribution, about access to things that are of value when you need them. That became a fundamental design factor for us as we worked through our Covid response.”
Health New Zealand worked with HealthLink to implement a new National Immunisation Register (NIR), a complex piece of technical work. It involved heavy lifting around the interoperability of modern API-based systems with the national register in a way that complements existing international standards and messaging formats known as Health Level Seven (HL7).
“Historically, vaccinations – particularly for childhood vaccines – were pretty much all done in general practice,” Jim explains. “We didn’t have other means of doing that, in pharmacies or other settings. With Clanwilliam and HealthLink, we’ve built a really cool bit of engineering that enables both data approaches, APIs and HL7, to work together and coexist.”
“That’s a game breaker for us because it enables us to look at completely new ways of doing vaccinations. We’ve now got this big drive into vaccinations in pharmacies and other settings. For example, many Maori health providers are social care providers with a bit of health provision; with modern engineering, we can add vaccinations in that setting.”
Jims says Health New Zealand has a wider programme of work based around interoperability. “We’re in a different engineering world now,” he says. “We have a whole bunch of interesting new things to enable health and wellness delivery. Because our engineering is modern, we can stand those up pretty quickly.”
He expects he will be busy for the foreseeable future. “We were doing the health reforms and then Covid turns up. Bang. Then, as Covid is starting to wane, we’re into implementing the Pae Ora Act and significant change processes,” he says. “It’s been a bit of a madhouse but we’re running in a new mode now.”
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