The DNA of the Health Digital Investment Plan

---

No strategy, no matter how well conceived, ever springs full grown from nothing. Every strategy has its roots in other thinking and planning. The word strategy itself derives from the Greek word strategia, meaning to lead an army. All strategy originally evolved from the thinking of generals in military campaigns, where it descended through mind numbing iterations of peer reviewed business publications and large consulting firms into its current managerial interpretation.

The Health Digital Investment Plan (HDIP) is clearly a strategic plan, even though it tries to avoid that word. Its use of three levels is a classic McKinsey model for structuring strategy.

Darren Douglas, in his presentation launching the HDIP at the HINZ conference in late 2025, referenced the previous strategies and articulated that the HDIP is descended in part from those previous strategies.

Looking back over the 34 years since the first Health Information Strategy was published in 1991, two things become clear. The first is that there has been a continuous, iterative effort to unify and modernise a historically fragmented healthcare system. The second is that the interval between major strategic iterations is remarkably consistent at around 4-5 years.

Listed in chronological order, the major strategic plans are as follows:

1991: Health Information Strategy

Developed by the Department of Health, this foundational blueprint sought to address a historic lack of relevant, timely, and accurate health data by establishing a national framework for information management.

1996: Health Information Strategy for the Year 2000

Designed as an update to the 1991 strategy, this framework aimed to coordinate national, regional, and local health information initiatives to better support the continuity of care across the sector.

2001: The WAVE Project (Working to Add Value through E-information)

Commissioned in response to the exponential growth of the World Wide Web and networked communications, this plan emphasised the development of systems to support patient-centric, integrated care. It identified critical deficiencies in data architecture and recommended establishing an independent organisation to lead sector-wide IT capability.

2005: Health Information Strategy for New Zealand (HIS-NZ)

Building directly upon the WAVE report, HIS-NZ proposed an evolutionary approach to developing a distributed electronic health record (EHR) and enhancing connectivity across primary and secondary care. During this period, domain-specific strategies were also published, such as the National Mental Health Information Strategy 2005–2010.

2010: National Health IT Plan

This plan established an explicit target: by 2014, a core set of personal health information would be electronically available to consumers and treatment providers, regardless of the clinical setting. It marked a formal shift away from fragmented, organisation-centric IT in favour of regional "common platforms" and shared care records.

2013/2014: National Health IT Plan Update

A mid-cycle update that consolidated strategic achievements, such as the scale-up of eReferrals, eDischarges, and the modernisation of the National Health Index (NHI) platform.

2015: Independent Review of New Zealand's Electronic Health Records Strategy

An independent review in 2015 critiqued the sector's "virtual EHR" approach, noting that progress was uneven and constrained by federated governance and underinvestment. In response, the Ministry of Health launched the Digital Health 2020 programme, broadening the policy focus from "IT" to "digital health" and setting a path toward a uniform information platform and a single EHR objective.

2020: Interoperability Roadmap (HISO 10083:2020) & Vision for Health Technology

These frameworks codified the sector's shift toward a fully interoperable digital health ecosystem. The Roadmap emphasised API-driven connectivity (utilising the HL7 FHIR standard), cloud-first policies, and standardised clinical terminology to ensure seamless data exchange.

2025: Health Digital Investment Plan (HDIP)

The current 10-year investment roadmap outlines a transition from aging, high-risk systems toward a modern, unified digital health infrastructure. It prioritises stabilising core infrastructure, levelling the digital baseline across regions, and enabling advanced capabilities such as predictive analytics and artificial intelligence.

The predictable cadence of issuing new plans is indicative of several systemic and structural realities within the New Zealand health sector.

Restructuring

Information systems are deeply intertwined with the physical and administrative structures of the health system. Over the past three decades, New Zealand has undergone frequent, policy-driven structural reforms: transitioning from 14 Area Health Boards to Regional Health Authorities and Crown Health Enterprises in 1993, to a single Health Funding Authority in 1997, to 21 District Health Boards in 2000, and ultimately to the centralised Health New Zealand (Te Whatu Ora) model. Each four-five-year strategic cycle closely mirrors the desire to redesign digital architectures to support these evolving administrative boundaries and new models of care delivery.

Technological advancement

A half-decade represents a significant generational leap in information technology, necessitating frequent strategic realignment. For instance, the 2001 WAVE project was deemed necessary because technology had "leapt ahead" with the widespread adoption of the Internet since the 1996 plan. Similarly, the transition from the 2020 frameworks to the 2025 HDIP reflects an urgent imperative to leverage modern capabilities, such as public cloud infrastructure, zero-trust security architecture, and artificial intelligence, which were largely embryonic during earlier planning cycles.

Chronic underinvestment

The regular interval between plans also reflects a persistent gap between visionary policy and operational execution. Review documents routinely note that the ambitious goals of previous strategies were only partially realised within their intended lifespans. The 2010 Plan acknowledged that, a decade after the WAVE report, key recommendations had still not been fully implemented.

This implementation lag is primarily attributed to systemic underinvestment; independent assessments have noted that 40–70% of District Health Board IT expenditure was historically consumed by basic maintenance and infrastructure, structurally starving the sector of the capital required for transformative innovation. Consequently, the four-to-five-year cadence often represents a cycle of strategic optimism followed by a pragmatic need to reset objectives due to the limitations of decentralised governance and constrained funding.

What happens now?

The HDIP and the Centre for Digital Modernisation are in start-up mode. It is too early to say how things will go, but there are many encouraging signs.

One of them is that there has been at least a tacit acknowledgement of the tupuna (ancestors) of the HDIP.

In future posts we’ll break down what the HDIP means for smaller organisations in health, and keep you updated on progress.

---

CIO Studio provides independent digital strategy and leadership for New Zealand's health, NGO, and community organisations. If you want to talk to an expert about your digital and AI strategy, get in touch for a no obligation conversation.