Poor access to patient notes makes outsourcing risky, say doctors

• Doctors say patient records hard to access for public and private clinicians
• Potential safety risk for patients with more operations being "outsourced" to private - union
• Health NZ says new system coming, but meanwhile patient information always available to treating clinicians
• Private providers say longer-term contracts allowing more "consistent" approach.

"Ad hoc" sharing of patient information between public and private hospitals is putting patients at risk, warn doctors, with the government push to outsource thousands more operations.

Health NZ says it is working on a new national electronic patient data service - but insists critical records are already available to clinicians when they need it.

College of Surgeons spokesperson and Christchurch urologist Sharon English said staff spent "a lot of time" tracking down patient records from other hospitals or districts.

Private surgeons who also worked in the public system could at least log in and see patient notes held there, she said.

"It would be different for a surgeon who works only in private, who would have to be either given access or ensure that a full copy of the notes is there.

"And that's actually very hard, to get every single file."

It was even more difficult extracting notes from private hospitals on patients sent back to public for post-op care, she said.

Even within the public system, it was not seamless.

"Just having all the public hospital systems talking to each other for a start would be fantastic."

Rather than expensive outsourcing, the public system should be resourced properly to look after public patients, she said.

"We see this as a work-around rather than a permanent solution."

'Scale' of outsourcing ramps up the risk

Health Minister Simeon Brown wants 215,000 elective procedures done in the 2025/26 year - an extra 21,000 more than initially planned.

Most will be done in Health NZ facilities, but agreements have been signed with 60 private providers.

Of the more than 12,764 extra procedures done this year under the Government's "elective boost", most have been done in private hospitals.

The Association of Salaried Medical Specialists - which represents senior hospital doctors and dentists - said "the scale" of outsourcing made the lack of consistent record sharing an urgent problem.

Director of policy and research Harriet Wild said canny patients often showed up for specialist appointments with their own ring-binders of notes and test results.

"It's really ad hoc across the board: the data sharing between primary care and secondary care, public hospitals and private hospitals, it's higgledy-piggledy and all over the place."

In some cases, missing patient information could be life-threatening: "If you're talking allergies, or medications that do not mix".

Outdated legacy IT systems were also a curb on efficiency in many public hospitals, she said.

"Any doctor will tell you the shambles of their current hospital IT system and whether their computer can be safely updated because all their software is hopelessly out of date.

"We're really operating many years in the past and it's very unsafe."

Society of Anaesthetists president Morgan Edwards said access to patient records was a basic requirement.

"In order to provide adequate care we need to be able to see patient notes, but what we receive from the private hospitals is a very rudimentary patient questionnaire most of the time, it's filled in by the patients.

"They may say they 'get out of breath sometimes', but that could be from running a marathon or getting out of bed. So, it's really vague."

Public hospitals within Auckland could at least see each others' records, although they were all in slightly different formats, she said.

"Once you start to get patients from outside the bounds of Tāmaki Makaurau we can't see really anything. Often bloods will be visible, but not clinic letters. And the real question is, has this patient been adequately pre-op assessed? Because that information doesn't necessarily follow the patient.

"For example, at Waitematā we've got a huge amount of capacity, so we're getting patients from further and further afield all the time, like from Northland, but we can't see their notes very well."

Patients who had not been assessed properly and were too sick to be treated in the private system sometimes had their surgery cancelled, which allowed "inefficiency to creep in".

"While the outsourcing has got some potential huge benefits, it's also just so expensive, that in many ways it does feel like a short-sighted solution.

"It's difficult to jump on board with a concept that is not the most cost-effective use of health money, if we're looking at a 20-year plan."

She said anaesthetists raised the patient record problem with the Minister at a recent meeting.

"He was also surprised at this information, it was new information to him. We're now trying very hard to meet with Health NZ to ensure there is consistency of process across the country."

Shared digital health record coming - Health NZ

Health NZ spokesperson Cath Cronin said outsourcing planned surgical care to private hospitals to reduce wait times was "not new".

"Patient safety and the protection of patient information is taken very seriously for anyone treated in public or private facilities. There are multiple checks and balances built into the referral and surgical treatment process."

All decisions regarding which patients were appropriate to receive care in private hospitals were made by the relevant specialist multi-disciplinary clinical team.

"Critical patient information will always be available to the treating clinicians. A surgical operation will not proceed without the surgeon and anaesthetist first reviewing the patient's clinical record. If the surgeon and anaesthetist are not comfortable with the information they have, the patient will not be accepted for surgery."

Health NZ was working on a new electronic patient data service called the Shared Digital Health Record to "help" secure sharing of health information nationwide, and was looking to centralise radiology and diagnostic results data, she said.

Longer contracts allow more consistent approach - private hospitals

Private Surgical Hospitals Association chief executive Chris Roberts said outsourcing had been going on for decades and there were "long-established processes in place to protect patient safety and privacy".

Private hospitals already carried out 70 percent of elective operations, and more than 90 percent of ACC-funded operations.

Outsourcing had been "ad hoc and varied" until now, he said.

"What is now being proposed by the Minister and Health NZ is a more consistent approach."

Regarding information sharing, there could be "some legacy issues from the district health board model", which allowed for different approaches in different regions".

"But Health NZ is now providing national guidelines. It is for Health NZ to comment on their processes and requirements."

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