What if the healthcare system isn’t missing information, but missing integration?
Aotearoa New Zealand’s healthcare system collects vast amounts of patient data every day – from GP visits and prescriptions to hospital stays and lab tests. But much of it sits untapped in digital silos, scattered across providers, regions, and outdated systems.
That’s the heart of our healthcare data crisis. And, as we’re reforming the system, we have a timely opportunity to reset — with strategy, integration, and care at the centre.
Rebuilding with purpose: The digital upgrade ahead
Nowhere has the crisis been more visible than in the recent ‘Excel scandal’. A Deloitte report revealed that Health NZ | Te Whatu Ora had been managing its entire $28 billion budget using a single Excel spreadsheet. This led to hard-coded errors, no audit trail, duplicate entries – and a $1.013 billion budget blowout in 2022/2023. Excel is a useful tool. But it was never designed to underpin the finances of a national health system.
Meanwhile, Health NZ | Te Whatu Ora is still juggling more than 6000 apps and 100 digital networks – a fraught landscape that underscores the urgent need for coordinated, modernised digital infrastructure.
Laying the foundations for a unified system
The 2022 consolidation of all DHBs into Health NZ | Te Whatu Ora aimed to fix these very problems. On paper, a single national body could standardise data systems, integrate records and streamline care.
The transition, however, is still in its infancy. Legacy systems remain across many regions, and without sustained leadership and investment, the vision of integrated, patient-centred data remains out of reach.
Cybersecurity in focus: Defending our health data
In 2021, Waikato DHB suffered a devastating ransomware attack that exposed patient data and froze clinical systems. It was a wake-up call – and one we have yet to fully respond to. Healthcare data remains a prime target for cybercriminals, and experts warn that Aotearoa New Zealand’s digital health infrastructure still lacks the resilience, staffing and investment needed to keep pace with growing threats.
Global lessons: What data-driven care looks like
- Denmark has one of the most digitally integrated health systems globally. Its national platform gives patients and providers shared access to records, prescriptions and appointments. A central medication database helps reduce errors and support coordinated care, especially for long-term and chronic conditions.
- Estonia gives every citizen real-time access to their digital health records via a secure online portal allowing users to access electronic prescriptions, book appointments, and receive test results. Digital prescriptions give patients easy renewal and remote fulfilment. They are also adopting artificial intelligence to support medical diagnoses and enhance healthcare efficiency.
- Finland, with a similarly dispersed population to Aotearoa New Zealand, links health data across registries, hospitals and population studies, supporting some of the world’s most comprehensive medical research. Its centralised infrastructure enables large-scale, longitudinal studies that improve understanding of diseases and inform policy. Finland is also working toward more inclusive data strategies, with Sámi communities among those advocating for stronger Indigenous representation in healthcare data echoing global sentiment reflected in coalitions such as the Global Indigenous Data Alliance (GIDA), which includes Aotearoa New Zealand, Canada, the United States, Australia, and the Sámi, and seeks to embed cultural values into digital governance.
Māori data sovereignty: An important foundation
Amid digital reforms, one key consideration in Aotearoa New Zealand is ensuring Māori data sovereignty is not an afterthought, but a guiding element of system design. This is especially important given the cultural and spiritual significance Māori place on different parts of the body. For example, studies involving brain tissue may raise profound ethical concerns – particularly around the upoko (head), which is considered tapu (sacred) in te ao Māori (the Māori worldview). These perspectives challenge us to build systems that are not only technically robust, but culturally respectful and co-governed. In a move towards change, Health NZ | Te Whatu Ora is working with Manatū Hauora to put into practice a Māori data sovereignty framework.
According to the work of Dr Karaitiana Taiuru and Te Mana Raraunga (the Māori Data Sovereignty Network), Māori have inherent rights over data relating to their whakapapa (genealogy and history), communities and collective wellbeing. These rights are rooted in tikanga (custom) and require not just access, but also authority and guardianship over data governance.
As Peter-Lucas Jones, Chief Executive Officer of Te Hiku Media stated in an interview with Time Magazine, “In the digital world, data is like land. If we do not have control, governance, and ongoing guardianship of our data as Indigenous people, we will be landless in the digital world, too.”
What needs to change
Aotearoa New Zealand, must treat healthcare data as a taonga – as a treasure and a central tenet of our health system – one that requires protection, partnership and purpose. That means:
- replacing outdated tools like Excel with secure, interoperable digital systems
- investing in cybersecurity and digital skills across all regions
- establishing national standards for data sharing, consent and privacy
- embedding Māori-led governance and cultural co-design into all health data systems
- learning from global leaders while honouring local values and Indigenous rights.
This is not just a digital problem, it is a governance challenge. We need to shift from patchwork fixes to future-focused, culturally grounded infrastructure to transform Aotearoa New Zealand’s healthcare data crisis towards a patient-centred digital health future based on equity, transparency, and in consideration of mana motuhake (self-determination).
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