A robust, integrated digital system would enable faster treatment, better information for clinicians and help close equity gaps, writes Cecilia Robinson.
A robust, integrated digital system would enable faster treatment, better information for clinicians and help close equity gaps, writes Cecilia Robinson.
THE FACTS
The Government has invested in digital healthcare, including a 24/7 service.
The service has delivered over 21,700 consultations, with 83.5% treated without in-person follow-ups.
The Shared Digital Health Record aims to unify records nationwide, enhancing continuity and emergency care.
As the co-CEO of one of New Zealand’s largest primary healthcare providers, with both in-person clinics and digital services, I’ve experienced our health system both as a patient and as a professional. Like so many New Zealanders, I know what it feels like to be let down whencare wasn’t there in the moments it was most needed. That lived experience of system failure motivated us to build Tend, driven by the belief that bold innovation is the only way to create a health system that truly serves all New Zealanders.
Some have argued that the Government’s investment in digital health does little to ease pressure on the frontline but the data tells a different story. The Government’s investment in the 24/7 digital health service marks a crucial milestone. In the testing phase, we have been one of eight providers delivering it, but regardless of our role, what matters most is that the service is here because it is the right move for the future of healthcare in Aotearoa.
Contrary to the claims, the service is already showing promising signs of impact. In just a few months, it has delivered more than 21,700 consultations to over 19,000 people nationwide. Most turned to it after being unable to secure a timely GP appointment. Encouragingly, in more than four out of five cases (83.5%), patients were treated without the need for an in-person follow-up. This meant thousands received immediate care while unnecessary demand on the wider system was lifted.
The service is being used in every part of New Zealand, from our busiest cities to our smallest rural towns. Every ethnicity is represented in the data, showing that digital health, when designed well, expands access across the country. These results matter because they dismantle the argument put forward that claims digital health does little to ease pressure on the frontline. Our local evidence says otherwise.
As Dr Mataroria Lyndon, senior lecturer in medical education and leader in Māori health equity, highlights: “The Health Quality and Safety Commission ‘A Window on Quality 2024’ report showed Māori, Pacific, women and those with disabilities were more likely to report that their most recent primary care appointment was via telehealth compared with other populations. This further shows uptake of telehealth among underserved communities.”
Lyndon continues: “Nearly half a million New Zealanders aren’t enrolled with a primary care provider and telehealth and online care can help address the barriers to accessing healthcare.”
We see the same story within our own network, where quality data and integrated systems show how equity can shift when services are designed the right way and how an integrated model can drive more equitable access.
In one of our largest regions, Māori made up 12% of enrolled patients before integration; 12 months later that figure is over 20%. At one of our medical centres, Pacific enrolments rose sevenfold and those from higher-deprivation populations fivefold after moving to an integrated digital model. By combining in-person and digital care, underpinned by data that highlights gaps, we’ve been able to expand access while delivering safer and more effective care.
As Lyndon notes: “These numbers represent thousands more whānau with better access to care, showing what can be achieved when equity, care integration, digital solutions and data sit at the heart of system design.”
The broader evidence reinforces the value of telehealth in Aotearoa. Dr Ruth Large, Chief Clinical Officer at Whakarongorau, who deliver Healthline, has noted that nurse and paramedic-led telehealth triage is already diverting tens of thousands of people from emergency departments each year. Research shows that a simple call to Healthline prevents nearly 23,000 unnecessary ED visits annually, underscoring its critical role in the health system.
While it took time for Healthline to build its reach and recognition, understandable given telehealth was a new concept at its inception, the impact has been substantial.
By contrast, the 24/7 service is still in its infancy and has already delivered close to 22,000 consultations in the first few months. Remarkably, this has happened with very little promotion, most New Zealanders don’t yet know the service even exists. Just as importantly, it is beginning to close the equity gap, reaching Māori, Pacific and high-needs populations.
Why reform was essential
The progress we are now seeing has been made possible in large part because of the changes initiated by the previous Government. In 2022, then Health Minister Andrew Little made the bold and controversial decision to disestablish New Zealand’s 20 District Health Boards and create Te Whatu Ora Health New Zealand. It was a courageous move, one that history will likely judge as strategically right, even if the timing and the process was less than ideal.
For a nation of just five million, running 20 separate bureaucracies was indefensible. Each board had its own governance, executive management, HR systems, commissioning structures and IT platforms, entrenching duplication, waste and inequity. Some did benefit from the old patchwork; providers such as software vendors could sell the same service multiple times across different DHBs. But patients, clinicians and taxpayers paid the price. They were trapped in a system that was fragmented, inefficient and unfair.
If you were designing a world-class health system from scratch, you would never replicate 20 bureaucracies. In a population of just 5 million, you would build one unified structure. That is what the reforms set out to achieve. The benefits have been slow to surface, but with time and the right leadership, they can deliver stability and finally end the postcode lottery that has long defined access to care in New Zealand.
We often focus on New Zealand’s crumbling hospitals, ageing buildings and facilities that can no longer meet demand. Yet our technology is in an even worse state. Unlike bricks and mortar, digital foundations touch every aspect of patient care.
Starship Children’s Hospital in Auckland. Photo / File
Since the creation of Te Whatu Ora Health New Zealand, the urgency of reform has been most visible in our digital infrastructure. Bringing together the systems of 20 former District Health Boards has left the organisation responsible for more than 4000 separate clinical and business applications, many outdated, incompatible and unable to communicate with each other.
New Zealand’s fragmented system is inefficient, unsafe, costly and inequitable, the result of decades of ad hoc investment without a national plan. A robust, integrated digital system would enable faster treatment, better information for clinicians and help close equity gaps. Yet many of our largest hospitals still rely on handwritten notes and paper charts, slowing care and increasing risk. While leading health systems use real-time records, digital prescriptions and AI, our most advanced facilities remain stuck with tools from the last century.
Overseas clinicians who come to New Zealand often remark that our system lags their home countries by up to 20 years. What they see here are structures and processes already reformed elsewhere. It’s a sobering perspective but also a reminder that we can learn from others’ journeys and leapfrog, rather than repeat their mistakes.
Our data offers a glimpse of what digital integrated care can deliver. In one part of the network, emergency department presentations among enrolled patients dropped by up to 26% compared with the same month the previous year. That shift represents thousands of New Zealanders receiving care at the right time, in the right place and it suggests what could be possible more broadly as services continue to integrate.
We also see the benefits in prevention, not just acute care, when digital interventions are used well. In Auckland and the Bay of Plenty, the number of flu vaccines delivered in April 2025 was 42% higher than the same month a year earlier. The difference was the platform: in 2025 we introduced a banner promoting flu vaccinations and integrated it with our systems for patients to find convenient times to book. This growth shows how an integrated model, combining in-person services with digital tools, removes barriers and makes it easier for people to access protection.
Supporting the workforce
Some critics suggest that digital health removes GPs from the frontline. In certain situations that may be a risk, but our experience shows the opposite can also be true. At Tend, many of the clinicians providing online consultations are New Zealand trained and registered, living or holidaying overseas. Without digital services, their expertise would be lost. With them, they can continue contributing to care in Aotearoa from abroad, in particular overnight.
We also know that many GPs in New Zealand are reluctant to take on more in-person hours due to burnout, family commitments or the demands of running a practice. Yet those same doctors are often willing to pick up extra online sessions. Digital platforms give them flexibility to contribute, adding to capacity rather than draining it. Critics need to be mindful not to tip into scaremongering, because when used well, digital health can expand capacity and support the frontline rather than undermining it.
Global lessons in digital leadership
These workforce benefits are not unique to New Zealand. Denmark shows what’s possible with a well-designed system, having built one of the world’s most advanced digital health infrastructures. Every citizen has a single electronic record that follows them across hospitals, GPs and pharmacies. Clinicians share real-time information, patients can access their results and the system supports research and innovation. The result is greater efficiency, better outcomes and confidence in seamless care.
Estonia, with 1.3 million people, proves small nations can punch above their weight. It has built a digital-first system where every citizen has secure online access to their health records. Data is interoperable across hospitals, primary care and pharmacies.
We can also learn from outside the traditional wealthy nations. Many African countries leapfrogged legacy systems in mobile health and telemedicine, precisely because they weren’t held back by outdated infrastructure. New Zealand now has the same chance to skip decades of patching and build modern, integrated systems from the ground up.
The shared digital health record
That is why the Government’s announcement of a Shared Digital Health Record (SDHR) is so important. The SDHR aims to unify records nationwide, improve continuity of care and support services like 24/7 telehealth. If successful, it will mean GPs, hospitals, emergency responders and digital providers can access the same patient history in real time. This reduces duplication, accelerates emergency care and spares patients the exhausting experience of retelling their story over and over.
This initiative is still in its early stages, and it will require sustained investment and commitment to succeed. But it is precisely the kind of forward-looking leadership that our system has lacked and deprioritised for too long. Together, a unified health record and digital-first services create the foundation for a truly integrated, resilient and patient-centred health system.
Conclusion
There is no quick fix. Transforming a system this large and complex takes time. Legacy systems must be unwound, clinicians supported and patients encouraged to adapt. Progress will bring setbacks, but success depends on persistence, not perfection. Other nations achieved seamless, digital-first healthcare through decades of sustained commitment, not by changing course with every election.
Reform is disruptive, but clinging to a fragmented system is no longer an option. The same. Health and Disability System Review, led by Heather Simpson, identified weak leadership as a defining problem. While successive governments have shown moments of boldness, too often progress has been slowed by patch protection and political short-termism. What we need now is courageous, bipartisan decision-making that endures beyond election cycles.
The Government’s investment in digital healthcare, including 24/7 access and the Shared Digital Health Record, shows the kind of leadership required. The benefits are already visible: faster access and more equitable care. The future of healthcare must be integrated, digital, equitable and resilient.
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