One of the longstanding problems in Aotearoa New Zealand’s health system is the ‘postcode lottery’ – specialists, hospitals, screening facilities and community supports are distributed unevenly around the country, meaning not everyone has the same access to quality care.

The reach that technology enables can help overcome the postcode lottery, which is one of the reasons why making more and better use of digital technologies is one of the five ‘system shifts’ the New Zealand government is emphasising as it reorganises and consolidates the healthcare system.

However, digital technologies can do more than bridge distances. They can help people live healthier lives, overcome cultural and linguistic barriers, cut down on administration, aid diagnosis, improve workforce development and advance medical research.

“Other industries have been digitally disrupted for 20 years or more,” says Vanessa Ding, general manager of the National Institute for Health Innovation (NIHI), run by UniServices and based on Waipapa Taumata Rau, University of Auckland, research. “Health was a latecomer – but Covid-19 has forced health services and consumers to adopt digital technologies. That’s been a positive shift because people are ready for it now, which brings exciting possibilities for health promotion and disease prevention.”

One reason for health reform is the need to keep costs under control. With the smart use of digital technologies, low cost doesn’t have to mean low quality.

“Empowering people to make choices and take actions that promote better wellbeing means fewer people will need healthcare in the first place,” says Ding. “However, the consistency and frequency of support needed is far greater than what is available via traditional channels.”

The NIHI-run SMS4BG trial is an example of how technology can help people take control of their health. Trial participants received individually tailored text messages with reminders to eat well, exercise, manage stress and monitor blood glucose levels. Compared to a control group, those who received the texts had a greater improvement in their blood glucose levels.

Another example delivered by NIHI is SPARX, the world’s first gamified cognitive behavioural therapeutic intervention for youth with mild to moderate depression. With multiple academic publications and a huge evidence base behind its outcomes, the project is now working to scale its impact through a process of human-centred design, product roadmapping and development.

“We’ve taken insights from youth, parents, counsellors and psychiatrists to continue developing the product so more young people end up accessing clinically validated cognitive behavioural therapy via an engaging, user-friendly digital interface,” says Ding. “With the huge needs in youth mental health, this is one proven way to provide support to all our rangatahi with no waitlists or geographical boundaries.” 

Of course, different communities have different needs. Co-design – a NIHI strength – ensures digital tools meet the needs of the communities they’re meant to serve, with a priority focus on Māori and Pacific peoples and other communities experiencing health inequities.

“By operating a human-centred design process and co-designing with Māori through partnerships and engagement, we’re ensuring Māori have a greater role in designing health services that meet their needs,” says Ding, adding that similar principles apply to engagement and co-design with other communities.

For example, a NIHI-led team developed the OL@-OR@ health and wellbeing app starting with extensive co-design wānanga with Pacific and Māori communities. Based on community priorities, the app was developed with a holistic view of health, including culturally tailored information not only on diet and exercise but also on spirituality and cultural connection. 

Similarly, the txtpēpi and TextMATCH maternal and baby health programmes were developed by NIHI-affiliated researchers in consultation with Māori, Pacific, East Asian and South Asian community organisations as well as with end users and other stakeholders. With txtpēpi available in Te Reo Māori and English and TextMATCH in a range of languages, the evidence-based text message content was tailored both linguistically and culturally.

To support medical reserach, NIHI co-manages two registries of clinical data. These large, consolidated digital registries give health researchers access to the quantity and quality of data they need.

ANZACS-QI securely gathers quality-audited clinical data on every suspected case of acute coronary syndrome in New Zealand.

The Bariatric Surgery Registry gathers data and reports on outcomes from weight loss surgery in Australia and New Zealand. 

Digital tools can also improve workforce training and development. Online courses and workshops such as those offered by Whāraurau and the Immunisation Advisory Centre are increasingly common. More unusually, NIHI is developing a virtual reality tool to help professionals better understand the daily challenges of people with Fetal Alcohol Spectrum Disorder.

Despite all the digital innovation already taking place, Ding says more can be done to turn research-based knowledge into impactful solutions. That process is what NIHI specialises in.

“We fuse the power of research findings with our expertise in human-centred design, novel technologies and product lifecycle management to create clinically rigorous health interventions that are a pleasure to use,” says Ding. “When academic, clinical and digital expertise come together, that magical blend can shape the future of health.”