Emotions were running high at the Digital Health Association’s (DHA) AGM in Auckland this week, held on the day that the new government rammed through legislation disestablishing the Māori Health Authority Te Aka Whai Ora, to obvious dismay at the meeting.

Some long-standing tensions over the direction of digital health within Health New Zealand – Te Whatu Ora were also on display, as chief data and digital officer Leigh Donoghue fronted up to give what sounded like an honest appraisal of the state of IT infrastructure across the system, memorably describing it as “an ugly baby” that had resulted from years of underinvestment.

Mr Donoghue, a well-known figure in Australasian digital health from his 13 years heading up Accenture ANZ’s health sector practice and as a board member of the Australasian Institute of Digital Health, did not mince his words in the speech, the thrust of which has been repeated by some of his colleagues over the last year or so.

He described a complex landscape with technology black spots, equipment and devices in a fragile state, mission-critical hospital systems with no back-up, an inventory of more than 6000 applications, and some people having to hop onto eBay to buy parts for ancient hardware to keep critical clinical systems going.

The remedy for Te Whatu Ora, as director of strategy and investment for data and digital Darren Douglass outlined last year, is to consolidate to fewer, better cloud delivered platforms, to simplify and standardise, and as Mr Donoghue said, to identify no more than two solutions in any domain, consolidate investments and deploy them widely.

He made no bones about the fact there would be resistance in the industry, mentioning a few mentions in the media that seemed to target his team as stymying innovation. Te Whatu Ora and its staff, he said, had been described as “woeful and wasteful, speaking technical gobbledygook” and a group of bureaucrats whose role in centralised control of health IT innovation was like “putting King Herod in charge of babysitting services”.

That zinger didn’t go down too well to a father of six who has read the Gospel of Matthew, but they came straight from the pen of health IT legend and frequent bomb-thrower Ian McCrae, founder and former CEO of Orion Health and contributor to the debate through a widely read couple of articles in the New Zealand Herald in the last year. Mr Donoghue took issue with some of Mr McCrae’s more incendiary comments, but likewise Mr McCrae took issue right back.

In a rather testy Q&A session, Mr McCrae returned to a frequent refrain about Te Whatu Ora leadership dodging proper procurement of health IT services during Covid – a reference in part to the expensive Salesforce platform purchased and deployed during Covid to handle the vaccination program, which just happened to replace a long-standing Orion Health system – and the vast sums of money going into the Hira program, which Mr McCrae thought better spent on more useful technology, such as expanding the South Island’s Health Connect South/HealthOne shared clinical information system (which Orion Health just happened to help build and provides the technology for) to the whole country.

One of Mr McCrae’s big bugbears has been that with consolidation under Te Whatu Ora, there is now only one purchaser for the entire public health system, and that purchaser has displayed a tendency in the past to choose large multinational vendors rather than home-grown innovations that are a hell of a lot cheaper. And where Mr Donoghue praised the Hira program, another figure in NZ digital health, Medtech CEO Geoff Sayer, asked what point his customers, NZ’s long-suffering GPs, could see in any of it.

There didn’t seem to be any resolution as the meeting moved on to other topics, and we wonder if Health Minister Shane Reti is going to have time to pay it much attention. In addition to contentiously shutting down Te Aka Whai Ora and calling a halt to the roll-out of “localities”, the replacement for the DHBs, Dr Reti has had to give over much of his time to the sillier demands National agreed to in negotiations with the smaller and kookier parties before the election, including deciding to gut tough new restrictions on cigarette sales and restoring pseudoephedrine-based cold and flu tablets back to their rightful place on the pharmacy shelves.

It all seems to be happening in NZ digital health, so to give it the coverage it deserves, Pulse+IT is putting on a New Zealand journalist to report on all the developments from the coalface. We’ll introduce him to you in the next couple of weeks.

Meanwhile, back in Australia and to its digital health plans, there has been a notably muted response to the National Digital Health Strategy released last week. A bit of strategy overload perhaps, what with the interoperability plan released last year and the Department of Health and Aged Care’s roadmap just before Christmas? There’s still the aged care data and digital strategy to come, so hold your horses.

We asked in our poll question last week if readers agreed with the aims of the National Digital Health Strategy. Overwhelmingly, people said yes: 82 per cent were in favour, just 18 per cent were against.

We also asked: if yes, what is your assessment of the strategy overall? If no, what do you think it lacks or gets wrong? Here’s what you said.

And in this week’s poll question, we ask: Is Te Whatu Ora’s remedy for digital health on the money? If yes, what should it prioritise? If no, how else can it be fixed?

Vote here and leave your comments here.