IT systems have changed the world. They have also changed the way that governments approach prevention.
In 2008, the National Partnership Agreement for Preventive Health provided NSW Health with more than $40 million to implement healthy weight programs for children. NSW Health knew this was a unique opportunity to build much needed infrastructure to support the prevention workforce. That’s why they decided to invest in a purpose-built IT system to help scale up prevention activities, and created the Population Health Information Management System, nicknamed PHIMS.
Instead of building a simple system to solely track the implementation of a single program, NSW Health invested in creating the underlying IT infrastructure that would track multiple prevention activities and combine the information in one place. PHIMS is used to track programs and policies related to childhood obesity, but the vision is that one day it will support a broad range of prevention programs addressing many issues, from physical activity and nutrition to tobacco and infectious disease.
So what can PHIMs do? It can update the Health Minister on the number of NSW schools that have adopted active travel policies, or the proportion of government-owned food venues that meet dietary recommendations. It also means local health promotion teams can use the same system to plan and track their daily progress towards achieving state-wide program targets. This kind of information has the potential to enhance the status of prevention as a field, and to raise the legitimacy of prevention work to equal that of clinical work.
However, IT projects in clinical practice have been plagued by poor success rates and high price tags. For example, billions of dollars have been invested in electronic patient record systems, but adoption and use has been slow and problematic.
So why has PHIMS remained strong for more than five years while others have failed? That’s what a research partnership of Prevention Centre researchers, NSW Health policy makers and Local Health Districts is setting out to learn. Together, we have designed a study that uses observations and interviews to collect data, and a process of co-analysis and reflection involving both policy partners and Local Health District staff. The aim is to better understand how PHIMS has impacted the delivery of prevention across NSW and the daily practice of the people who use it.
Of course, like any innovation, PHIMS means different things to different people, so the research is striving to get different stories from different contexts. Each of the team’s partners brings their own experience and views to the table, but together we are on the lookout for how PHIMS can change and adapt to work better for everybody. A key dynamic to understand is how innovation in practice is not stifled by reporting requirements.
By digging deeper, we are learning that success involves more than just a good IT design – it involves aligning technology with prevention activities and management structures. IT simply provides a tool to support prevention delivery. Technology cannot be a substitute for continuous quality improvement activities, like examining what is getting delivered, reflecting on reasons for success and for failure, and using these learnings to inform future work. Successful projects operate using quality improvement processes, but there are other elements too – elements like leadership and the culture of the organisation. That’s what we’re capturing with this research.
Systems like PHIMS bring prevention work to light and this can help to make the ongoing funding of prevention activities a regular part of the health system. However, they can also change the way health promotion practitioners work by focusing on some activities only, such as counting the number of water fountains in city parks but ignoring others, like the time and effort it takes to build strong community-level partnerships to address violence or mental health.
Keeping these considerations in balance is why it’s helpful to work in partnership. Together, we are learning how IT monitoring systems can help make prevention activities a core component of the NSW health system, while supporting quality practice and innovation.
Check out these examples of PHIMs data in action during the World Congress on Public Health, showcasing NSW’s progress in delivering childhood obesity programs.
Dr Katie Conte is a Research Fellow at The Australian Prevention Partnership Centre, based at the Menzies Centre for Health Policy, University of Sydney.
Lina Persson is Director, Population Health Intelligence Systems Centre for Epidemiology and Evidence, NSW Ministry of Health.
Deni Fukunishi is Principal Analyst, Population Health Systems Administration, Centre for Epidemiology and Evidence, NSW Ministry of Health.