As a GP, I am aware of what I can observe in my own clinic. I can track my patients’ blood pressure and diabetes control. I can see who misses appointments. The clinic’s screening tools show trends for individual patients, but not how my practice compares with others.
Existing tools cannot tell me whether my patients experience better continuity of care than average, or how my chronic disease management compares with that of my peers. While some feedback on the prescription of medication is available, there is no easy way for prescribers to compare and learn from their peers.
The system-level blindness is worse. Policymakers cannot determine whether reforms are reaching those most in need, or if inequities are worsening. How does improved funding in primary care improve avoidable emergency department (ED) visits and hospital admissions?
Are high-need populations getting more continuous care or just a greater number of fragmented visits? Which models of general practice deliver better outcomes for patients with multiple conditions?
We spend hundreds of millions of dollars on reforms without being able to accurately measure their effectiveness.
The gap is especially frustrating because a solution is almost within reach. New Zealand’s Integrated Data Infrastructure (IDI) already links de-identified data from health, education, housing, income and justice sectors. Researchers can examine how childhood housing instability affects adult health, or whether school attendance predicts later mental health service use.
The IDI can answer complex questions about how life circumstances interact with health across decades. Yet, for all its sophistication, it cannot show what happens in general practice, the most frequent source of healthcare in New Zealand.
Canada shows what would be possible if we could see more clearly what is happening in general practice. Its Primary Care Sentinel Surveillance Network (CPCSSN) has collected data from more than 1500 clinicians and over two million patients since 2008.
The key to its success was de-identifying data at source and mapping it to common standards. Researchers analyse anonymised records to answer specific questions in a secure environment.
Usage of the data must be vetted and approved by the clinical governance group. Researchers are only granted access to the parts of the database necessary to answer their specific questions.
The network gave clinicians instant, practical tools. Dashboards show prescribing patterns and highlight outliers. When you give doctors tools that support them in their work, they become more engaged. When they engage, data quality improves.
That virtuous cycle has made national studies of multimorbidity possible. It has enabled the tracking of chronic diseases and allowed researchers to evaluate the effectiveness of interventions.
New Zealand has some structural advantages Canada lacks. We already have the IDI infrastructure and protocols to run it securely. We have had national health identifiers for more than 30 years. We have a general practice enrolment system that links patients to providers.
The missing piece is general practice clinical data, extracted under proper governance and included in the IDI.
Privacy concerns are legitimate, but solvable. Data could be de-identified at source using encrypted NHI numbers. Transfers could be secure. Existing IDI protocols require analysis to happen only in secure settings, with access limited to approved users. Every use must be approved and logged.
Patients could choose to opt out of having their data included, as occurs in Canada. The CPCSSN network won an international privacy award for its design.
A national primary care data network would transform our capabilities. Doctors would get valuable feedback to help them prescribe safely and improve their management of chronic disease.
Policymakers could evaluate whether primary care spending reduces hospital costs. Researchers could examine how housing, education and income interact with access to GP care. Every measure could be broken down by ethnicity, deprivation and geography to show whether gaps are closing.
Canada’s experience offers a clear lesson. Peer-comparison reports helped reduce unnecessary antibiotic prescribing by primary care clinicians, not through coercion but through clear information about their own patterns.
New Zealand’s GPs want to deliver better care. They need information that helps them improve, not inspirational statements about transformed health systems.
The cheapest reform is the one that makes the rest smarter. With better data, New Zealand’s GPs could do what they entered medicine for: provide the best possible care.
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