At 11pm in an emergency department, a nurse moves quickly between patients. Each time she reaches a workstation, she types another username and password. New screen, same interruption. It is a small task on its own, but repeated dozens of times across a shift, it slowly erodes the time she has with the people who need her most.
As New Zealand marks Digital Health Week for 2025, much of the public conversation centres on artificial intelligence, virtual care and the promise of new clinical tools. But the foundations that determine whether any of these innovations succeed are far less visible. They sit behind the scenes, in the systems, infrastructure and design decisions that either remove friction from a clinician’s day or quietly add to it.
New Zealand’s national health system is in the midst of a major transition. More than twenty former district health boards - each with their own legacy technology, processes and procurement history - are being brought together under a national structure at a time when budgets are tight and demand for care continues to rise.
A briefing to the Minister of Health last year noted that around half of critical hospital IT hardware is already past its intended life. A recent stocktake described the public health IT environment as the largest and most complex in the country, with more than 6,000 applications running on about 1,000 physical servers.
New Zealand’s first health infrastructure review also identified a multibillion-dollar capital shortfall, with over 30 percent of hospital buildings in poor or very poor condition.
For clinical teams, these pressures manifest not as policy documents but as slow logins, frozen screens and systems that cannot easily connect. Digital health is not stalled by a lack of ambition; it is slowed by the need to keep complex environments running every hour of every day. No ward, operating theatre or radiology service can simply be paused while technology is rebuilt around it.
This complexity becomes clearer when looking at how past decisions shape the present. Regional health organisations adopted different identity systems, clinical applications and radiology platforms. Many of these tools are strong, but much of their capability is under-used because teams are focused on keeping essential services running, rather than on planning upgrades or exploring newer features.
That’s why building digital infrastructure into the design of new facilities matters. Inde’s involvement in the high-level design for the new Dunedin Hospital highlighted how early consideration of digital workflows, such as identity, access, clinical mobility and application delivery, helps prevent inefficiencies being baked into a building for decades.
Including IT architects at the earliest stages ensures new hospitals are designed not only for clinical excellence but for the operational reality of how nurses and doctors move, document, and transition between tasks. Good design anticipates the pace of a ward at 11pm as much as the needs of a meeting room at 11am.
Early decisions also determine how quickly proven solutions can be scaled. A small but powerful example is tap-on access with staff ID badges. Instead of repeatedly typing credentials, a clinician taps their card and is returned to their workspace almost instantly. It is not a new application, nor a major platform replacement. It simply removes a recurring point of friction. Across thousands of clinicians and thousands of shifts, those saved seconds translate into meaningful time with patients.
Similar approaches - such as facial recognition in theatres or streamlined access to clinical tools - reduce administrative strain without disrupting established workflows.
AI tools such as diagnostic support systems and digital scribes also hold potential to reduce documentation. But they depend on reliable networks, consistent identity and well-designed data flows. Without strong foundations, even the smartest technologies struggle to make a safe and timely impact.
While design from the start is important, all this work is happening against the backdrop of constrained budgets. Health New Zealand’s reporting shows that digital services account for just 2.2 percent of overall spend, with proposed restructures reducing digital roles to around 1.4 percent of total staff. A HiNZ survey of more than 350 digital health experts and frontline clinicians also found that 97.5 percent believed cuts to digital services would delay improvements in patient care.
The prevailing mindset across the system has become “keep the lights on” - address issues when they surface, extend support contracts where possible, and defer wider upgrades until absolutely necessary.
Yet this is also why specialist external support can make a meaningful difference. Health IT teams are highly capable and deeply committed, but they are often required to keep legacy systems running, deliver new projects, plan future architecture and stay across fast-moving technologies all at once.
External partners with deep technical expertise can complement that internal knowledge, helping organisations unlock more value from the technology already in place and ensuring that future upgrades - whether in identity, mobility or clinical application delivery - are approached safely and with confidence.
Strengthening New Zealand’s digital foundations, and making better use of the systems we already have, offers one of the most practical ways to return time to clinicians and improve care for patients across the country.