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Connected HealthA Quantitative Study

[April 2009]

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Technical Appendix


Table of contents

1. Introduction..........................................................................................................................................3

1.1 Background methodology and survey population ................................................. 3 2. Methodology ........................................................................................................................................4

2.1 Sample structure and quotas: non-DHB Clinicians and ICT Decision-makers ............. 4 Table 1: Market segmentation mapped to ANZSIC classifications ..............................6

2.2 Sample structure and quotas - DHB Clinicians .................................................. 12 2.3 Questionnaire design - Cognitive testing.......................................................... 12 2.4 Response rates ......................................................................................... 13

Table 2: Sample, quotas and response - ICT Decision-makers.................................14 Table 3: Sample, quotas and response - non-DHB Clinicians ...................................15

2.5 Weighting................................................................................................. 16 Table 4: ICT Decision-makers......................................................................................16 Table 5: Non-DHB Clinicians .......................................................................................17 2.6 Informed consent.....................................................................................................................17 2.7 Data processing ......................................................................................................................18 Table 6: Key survey statistics.......................................................................................18 2.8 Data analysis for key segments..............................................................................................19 Table 7: Key segments - number of questionnaires received ....................................19 3. Glossary of key terms ......................................................................................................................21 Table 8: Abbreviations used in the report....................................................................21 Table 9: Glossary..........................................................................................................22


1. Introduction This Technical Appendix provides a more detailed outline of the methodology adopted for the Connected Health quantitative research. 1.1 Background methodology and survey population The quantitative Connected Health research involved three separate surveys, targeting three unique survey populations. These survey populations were defined as: Information and Communications Technology (ICT) Decision-makers for organisations within the

Health and Disability Sector (Health Sector) which were not District Health Boards (DHBs) (referred to as ICT Decision-makers).

Clinicians who worked for or in health care organisations which were not DHBs (referred to as non-

DHB Clinicians). Clinicians who were employed by DHBs (referred to as DHB Clinicians). The fieldwork for the three separate surveys was conducted between 10 November 2008 - 16 January 2009. The surveys used two different approaches. ICT Decision-makers and non-DHB Clinicians: the Ministry of Health (the Ministry) and Accident

Compensation Corporation (ACC) developed a database which was representative of enterprises in the non-DHB Health Sector. The database covered over 30% of organisations in the non-DHB Health Sector. Questionnaires were mailed out to everyone on the final database, with an introductory letter from the Ministry of Health inviting them to participate in the research.

DHB Clinicians: the Ministry invited DHBs to participate in the research. Two thirds (16 of 21) of

DHBs participated, covering a range of large, medium and small DHBs. Surveys were distributed to each DHB proportionate to the number of Clinicians employed by each.

All respondents had the option of completing the survey online or as a hard copy which they then mailed back to a UMR FreePost address. Those who completed it online used a login and password supplied to them in the invitation letter, to ensure that they could be matched to the overall quotas. Most completed the survey by mail.


2. Methodology 2.1 Sample structure and quotas: non-DHB Clinicians and ICT Decision-makers The sample for the non-DHB surveys was drawn from a database of 2,352 ICT Decision-makers and 4,903 Clinicians. The database reflected a sample frame that aimed to cover as wide a cross-section of the Health Sector as possible in a representative way and allow for robust analysis of key segments of interest. The Ministry of Health had developed a market segmentation of the Health Sector, and this forms the basis for the sample frame for the non-DHB surveys. The Ministry’s market segmentation identified 237 segments covering the entire Health Sector. In order to ensure that the sample frame accurately covered the Health Sector as a whole, it was necessary to find reliable statistical information. There were not, however, reliable figures available for the number of health professionals in the Health Sector who fall into each of these segments. For this reason, the sample frame for the two non-DHB Connected Health surveys was developed using Statistics New Zealand’s 1996 Australia New Zealand Standard Industry Classifications (ANZSIC) for the Health and Disability Sector. The quotas for the sample frame were developed using statistics from Statistics New Zealand’s March 2007 Annual Business Survey, which enabled the identification of the number of enterprises which fell into each of the selected ANZSIC classifications. Although these classifications and the statistics gathered were not perfect in terms of defining health practitioners or ICT Decision-makers in the Health Sector, they were the best information available for estimating the total population in the Health Sector. The 237 segments identified in the Ministry’s segmentation were combined into twelve categories based on the ANZSIC classifications. These are outlined below: - Private/Community hospitals - Ambulance - General Practitioners - Pathology - Specialists - Dental - Aged care/Residential care - Optometry and optical dispensing - Physiotherapists/Chiropractors/Osteopaths - Government - Pharmacy - Health Services (Not Elsewhere Classified) ANZSIC classifications are not directly tailored to the Health Sector and do not provide as much detail as would really be needed for a survey such as this (see the discussion in Section 2.4 for more information on this). ANZSIC classifications were used for this survey because: The sample frame needed to be based on robust statistics collected in a manner independent of the

survey, and no such statistics exist for the Health Sector as a whole. Individual organisations such as industry organisations do collect statistics (e.g. the Royal College of GPs) but the research needed consistently collected statistics for the Health Sector as a whole.


The two most important limitations of using ANZSIC classifications and Statistics New Zealand’s data based on these are that: They record the number of enterprises not the number of people. There are no firm statistics for the

number of people employed meaning the sample frame for this research therefore had to be based on the number of enterprises.

They do not provide as fine detail about the Health Sector as the Ministry’s identified 237 segments. They were however the best information available for this survey in the absence of robust statistics collected from within the Health Sector itself. There were a number of variations on the ANZSIC classifications to ensure that the survey covered a comprehensive and representative cross-section of the Health Sector. These included: The Health Services (Not Elsewhere Classified) category was extended to include organisations

defined by the Ministry or ACC as providing health care services but not included in the ANZSIC classification. In addition, specific quotas were provided for key groups within Health Services (NEC) to ensure that they were appropriately represented in the survey.

Changing the Pathology and Ambulance quotas to represent the number of offices rather than the

number of enterprises. While there are only a few enterprises in these two segments, they operate out of a large number of locations. Such offices may be in diverse locations and have widely differing requirements. In these cases, the sample included one ICT Decision-maker per organisation and one Clinician per office. The universe for the Clinicians sample in these categories was therefore the total number of offices.

The ‘Government’ ANZSIC classification provides no information on whether or not the organisation is

involved in the Health Sector. Because the research needed to target government organisations who were involved in the Health Sector rather than those who did not, the number of organisations in the Government quota category was determined not by ANZSIC classifications, but by the Ministry’s estimate of the number of government organisations working in the Health Sector. The Ministry, ACC and DHBs were excluded from this. A large proportion of the Government sample was made up of military and prison health care providers.


The table below outlines the Ministry’s market segmentation of the Health Sector and shows how this was grouped to fit in with the twelve categories based on ANZSIC classifications which formed the basis for the survey sample frame. While the table encompasses all segments identified in the Health Sector, inclusion in the research depended on the survey population definition (i.e. D1 - Tertiary DHB was not included in the non-DHB Clinician and ICT Decision-maker surveys). The numbers in the Population column are taken from Statistics New Zealand’s March 2007 Annual Business Survey.

Table 1: Market segmentation mapped to ANZSIC classifications

MARKET SEGMENTATION MAPPED TO ANZSIC CLASSIFICATIONS

ANZSIC classification

Business/Employer

Population (Enterprises)

Market Segment Code Ministry of Health Segment name

D1 Tertiary DHB - Clinical D2 Tertiary DHB - Management D3 Teaching DHB - Clinical D4 Teaching DHB - Management D5 Secondary DHB - Clinical D6 Secondary DHB - Management D7 DHB with SSA - Clinical D8 DHB with SSA - Management D9 DHB Emergency Dept - Clinical

D15 Rural hospital - Clinical D16 Rural Hospital - Management D21 DHB Mobile Worker D22 Mobile Community Nurse D23 Community nurse D24 Rural Nurse D25 DHB Emergency Dept with SSA D28 Registered Mental Health Providers D30 Mobile Community Nurse with SSA D31 Community Nurse with SSA D32 Rural Nurse with SSA D38 DHB NZ Group P1 Private Hospitals - Clinical P2 Private Hospitals - A&E P3 Private Hospitals - Management

N14 Charity Hospital Clinical N15 Charity Hospital - Management CH1 Current Health Network Uses DHB - Clinical

DMD1 Tertiary DHB CEO DMD2 Teaching DHB CEO DMD3 Secondary DHB CEO DMD4 DHB CEO with SSA DMD5 DHB NZ DMP1 Private Hospital Organisation Board and CEO DMN7 Charity Hospital Board and CEO

DMCH1 Current Health Network Uses DHB Organisation Board and CEO D27 Psychiatric Hospitals - Clinical P35 Private Hospitals - Psychiatric - Clinical P36 Private Hospitals - Psychiatric-Management

O861100/O61200 Hospitals 118

DMP15 Private Psychiatric Hospital Organisation Board and CEO


MARKET SEGMENTATION MAPPED TO ANZSIC CLASSIFICATIONS (Cont.)


Business/Employer



D11 DHB GP Services D12 DHB GP Practice Nurses D39 Mobile Surgery G1 Urban GP Practice with IPA - Clinical G2 Urban GP Practice Sole Trader with IPA - Clinical G3 Urban GP Practice with IPA - Management G4 Urban GP Practice Nurse with IPA - Clinical G5 Urban After-hours Medical Centre with IPA - Clinical G6 Urban GP Practice - Clinical G7 Urban GP practice - Management G8 Urban GP Practice Nurse - Clinical G9 Urban GP Practice Sole Trader - Clinical G10 Urban GP Practice Sole Trader - Management G11 Urban After - hours Medical Centre - Clinical G12 Rural GP Practice with IPA - Clinical G13 Rural GP Practice with IPA - Management G14 Rural GP Practice Nurse with IPA - Clinical G15 Rural After-hours Medical Centre with IPA - Clinical G16 Rural After-hours Medical Centre with IPA - Management G17 Rural GP Practice - Clinical G18 Rural GP Practice - Management G19 Rural GP Practice Nurse - Clinical G20 Rural GP Practice Sole Trader - Clinical G21 Rural GP Practice Sole Trader - Management G22 Rural GP Practice Nurse - Clinical G23 Rural After-hours Medical Centre - Clinical G24 Rural After-hours Medical Centre - Management G25 Mobile GP Practice - Clinical G26 Mobile GP Practice - Management G27 PHO GP Clinic - Clinical G28 PHO GP Clinic - Management G29 GP Franchise G30 GP owned by MSO G31 Private Medical Centres - Clinical G32 Private Medical Centres - Management G33 Registered Practitioners at Urban GP Clinics - Clinical G34 Registered Practitioners at Rural GP Clinics - Clinical G35 GP Not for Profit - Clinical G36 Urban After-hours Medical Centre with IPA - Management

O862100

General Practice Medical Services

3269

G37 Urban After-hours Medical Centre - Management




Business/Employer



P33 Private Accident & Medical - Clinical P34 Private Accident & Medical - Management N20 Māori Iwi Trust Run GP Clinics - Management N21 Pacific Island Trust Run GP Clinics - Management CH2 Current Health Network Uses GP - Clinical O1 PHO - Clinical O2 IPA - Clinical O3 MSO - Clinical

DMG1 Urban GP SME Practice Board/Owners with IPA DMG2 Urban GP Sole Trader Practice with IPA DMG3 Urban GP SME Practice Board/Owners DMG4 Urban GP Sole Trader DMG5 Rural GP SME Practice Board/Owners DMG6 Rural GP SME Practice Board/Owners with IPA DMG7 Rural GP Sole Trader DMG8 GP Franchise DMG9 GP Not for Profit DMP14 Private Accident and Medical Organisation Board and CEO DMCH2 Current Health Network Uses GP Organisation Board and CEO DMO1 PHO Organisation Board and CEO DMO2 IPA Organisation Board and CEO

O862100 General Practice Medical Services

3269

DMO3 MSO Organisation Board and CEO P19 Psychotherapists - Clinical P20 Private Specialists Sole Trader - Management P21 Private Specialists - Management P39 Private Specialist - Clinical

DMP6 Private Specialist - Sole Trader

O862200 Specialist Medical Services

1734

DMP7 Private Specialist SME Organisation Board and CEO D14 DHB Pathology Labs P6 Pathology/Lab Services - Clinical P7 Radiologist - Clinical

O863100 Pathology Services 31

DMP3 Pathology & Lab Services Organisation Board and CEO D10 DHB Ambulance Services N1 Ambulance - Clinical N2 Ambulance - Management N3 Air Ambulance - Clinical

O863300 Ambulance Services 28

DMN1 Ambulance Organisation Board and CEO D35 Community Dental Therapists P8 Dentist - Clinical O862300 Dental

Services 1511 DMP4 Dentist - Practice Board/Owner P12 Physiotherapist - Clinical P13 Chiropractors Clinical Requirements O863500 /

O863600

Physiotherapy Services /

Chiropractic Services

1180 P18 Osteopaths - Clinical




Business/Employer



D17 Reg. Māori Health Care Providers D18 Un. Reg. Māori Health Care Providers D19 Reg. Pacific Island Health Care Providers D20 Un-reg. Pacific Island Health Care Providers D33 Termination of Pregnancy D34 Sexual Health Clinic D36 Drug & Alcohol Services - Residential D37 Drug & Alcohol Services - Community Based P9 Rural Midwives - Clinical

P10 Urban Midwives - Clinical P11 High Tech Midwives - Clinical P14 Dieticians - Clinical P16 Podiatrists - Clinical P17 Psychologists - Clinical P22 Mobile Independent Providers - Management P23 Independent Providers - Management P24 Third Party Administrators P25 Mobile One Person Business P26 Insurance Companies P27 Practitioner in Travel Insurance Companies P28 Practitioner in Organisations P30 Health Phone Services - Clinical P32 Large Multi-Disciplinary Health Care Provider P37 Allied Care (Mental Health & Accident Related) - Clinical P38 Allied Care (Mental Health & Accident Related) - Management P40 Occupational Therapist - Clinical N4 Plunket - Clinical Needs of Nurses N5 Plunket Phoneline - Clinical N6 Plunket - Management N9 NFP Community Providers

N12 Family Planning - Clinical N13 Family Planning - Management N16 Drug & Alcohol Services Residential - Clinical N17 Drug & Alcohol Services Residential - Management N18 Drug & Alcohol Services Community-Based - Clinical N19 Drug & Alcohol Services Community-Based - Management N22 Youth Clinics - Clinical N23 Youth Clinics - Management N24 Mental Health Counsellor - Un-Registered N25 Allied Care (Mental Health & Accident Related) - Clinical N26 Allied Care (Mental Health & Accident Related) - Management CH3 Current Health Network Uses Others - Clinical

O863900

Health Services nec.

Note: Becomes a segment for

any group that is not

classified in other health

ANZSIC classifications.

2804

O4 Health care Education Institutions




Business/Employer



O6 Student Health Services - Clinical O7 Student Health Services - Management O12 Children's Health Camps - Clinical Only O13 Task Groups O14 Public Health Programmes O15 Regional Programmes C1 Complementary Medicines - ACC Funded C2 Complementary Medicines, Sole Trader - ACC Funded

DMP5 Midwives DMP8 Mobile Independent Providers - Practice Board/Owner DMP9 SME Independent Providers - Practice Board/Owner DMP10 Mobile Sole Trader DMP11 Corporate Organisation Board and CEO DMP12 Health Phone Services Organisation Board and CEO

DMN2 Plunket - Clinical Needs of Nurses Organisation & Health Phone Services Board and CEO

DMN4 NFP Community Providers Organisation Board and CEO DMN6 Family Planning Board

DMN8 Drug and Alcohol Services - Residential Board and CEO

DMN9 Drug and Alcohol Services - Community Board and CEO

DMN10 Youth Clinics - Management - Board DMCH3 Current Health Network Uses Others Organisation Board and CEO DMO4 Health care Education Institutions Organisation Board and CEO DMO6 Student Health Services - University CEO etc DMO9 Children's Health Camps CEO & Board

DMO10 Task Groups Organisation Board and CEO DMO11 Public Health Programmes Organisation Board and CEO DMO12 Regional Programmes Organisation Board and CEO

O863900

Health Services nec.

Note: Becomes a segment for

any group that is not

classified in other health

ANZSIC classifications.

2804

DMC1 Complementary Medicines ACC Funded Board and CEO D13 DHB Pharmacies in Hospital D26 DHB Pharmacies in Hospital with SSA P4 Pharmacies in Private Hospital P5 Pharmacies - Clinical

P29 Pharmaceutical Companies

G525100 Pharmacy

(dispensing only)

900

DMP2 Pharmacies Organisation Board

O872100 Accommo-

dation for the Aged

606 P31 Private Long Term/Residential Care - Clinical




Business/Employer



N7 Long Term/Residential Care - Clinical N8 Long Term/Residential Care - Management

N10 Hospice - Clinical N11 Hospice - Management N27 Palliative Care Outreach

DMP13 Private Long Term/Residential Care Organisation Board and CEO DMN3 Long Term/Residential Care - Organisation Board and CEO DMN5 Hospice Organisation Board and CEO

O861300 Nursing Homes 42

P42 Private Long Term/Residential Care - Management P15 Optometrists - Clinical

O863200 Optometry and Optical Dispensing

343 P41 Optometrist Franchise

O5 Central Health Organisations O10 Prison Health Services - Clinical Only O11 Military Hospitals, Dental and GP services - Clinical Only O16 Ministry of Health O17 HealthPac O18 ACC O19 MSD

DMO5 Central Health Organisations Organisation Board and CEO DMO7 Prison Health Care - Dept. Corrections Board and CEO DMO8 Military Hospitals Board and CEO

DMO13 Ministry of Health Board and CEO DMO14 HealthPac Organisation Board and CEO DMO15 ACC Organisation Board and CEO

No relevant ANZSIC classification Government

Statistics not available from 2007 Annual

Business Survey

DMO16 MSD Organisation Board and CEO

The following factors should be noted: In some cases the ANZSIC classifications did not exactly match the target populations for the survey.

The ANZSIC classification Hospitals Q840100 for example covers both public and private hospitals but this part of the research did not cover public hospitals (these being covered through the DHB Clinicians survey).

It would have been useful if the ANZSIC classifications had been able to provide individual counts for

the number of enterprises in areas such as midwifery, audiology, psychotherapy and rehabilitation assessors. Instead, 1996 ANZSIC classifications combined such diverse organisations into the Health Services Not Elsewhere Classified (NEC) category.

The number of enterprises in each ANZSIC classification sometimes contradicted information provided

by other sources. According to Statistics New Zealand, there are, for example, over 3,000 GP enterprises in New Zealand, while according to the Royal NZ College of General Practitioners there are around 1,100.

The segments reflect the enterprise the respondent works for rather than their own occupation. An

example of this is a GP working in an aged care facility is included in the ‘Aged Care’ segment. This is because the weights are based on the number of enterprises not the number of Clinicians.


2.2 Sample structure and quotas - DHB Clinicians The sample frame for the DHB survey was developed using population data per DHB across New Zealand. Quotas were set based on the population proportion. If a DHB did not agree to participate in the survey, the quotas were redistributed, ensuring enough questionnaires were sent to large, medium and small DHBs. The Ministry sent each DHB Chief Executive Officer a letter outlining the research and requesting their participation in the research. Sixteen (16) of the 21 DHBs agreed to participate. Participating DHBs were then asked to distribute a set number of questionnaires to a cross-section of their Clinicians. Subsequently, there was less control over ‘who’ was asked to participate in the research than was the case in the two non-DHB surveys. 2.3 Questionnaire design - Cognitive testing The questionnaire development process included a cognitive testing phase. This consisted of 17 interviews with Clinicians and Decision-makers. These began by replicating as closely as possible a realistic questionnaire completion scenario, where respondents worked through the draft questionnaire specific to them (i.e. Decision-maker or Clinician). The specific process was as follows: Questionnaire placed inside an envelope with the covering letter and FAQ’s.

Respondent asked to open the envelope and proceed as they would in a ‘normal’ situation.

Researcher observed - without question or comment - and timed how long it took the participant to

complete the questionnaire.

When the questionnaire was completed, the researcher spent around 20-30 minutes with each participant discussing any experiences or problems they had in completing the questionnaire and any feedback or comments they had.

The number of changes made to the questionnaires as a result of the cognitive testing was fairly small. Final questionnaires were then developed and provided to the Ministry and ACC for approval.


2.4 Response rates For the non-DHB Clinicians and ICT Decision-makers surveys: Multiple call-backs were made to potential respondents to ensure that the response rate was as high

as possible and that as many as possible of the quotas were met. If a questionnaire was returned ‘gone no address’, efforts were made to find a replacement person or

an updated address. Potential respondents were reminded about the survey up to three times, and where surveys were

returned, ‘not known at this address’ attempts were made to find correct addresses. Notices were placed in two ACCNews newsletters to inform potential respondents of the upcoming

research and encourage them to participate. The Ministry also contacted all the Responsible Authorities and Professional Organisations to inform

them that the research was taking place and encouraged them to let their members know. Some Responsible Authorities and Professional Organisations also agreed to place information supplied by the Ministry about the survey on their website or in newsletters and emails to their members.

As a result of these measures, response rates for each of the main quotas were fairly consistent. Quotas that were not completely filled were generally those where the number of surveys required was a very high proportion of the total number of enterprises in the segment. For the DHB Clinicians survey, the Ministry of Health reminded DHBs directly, asking them to remind their Clinicians in turn. The survey period was extended by several weeks in order to allow time for these responses to come in, as responses could well have been slowed by the busy period prior to Christmas. The overall response rates for the surveys as outlined in the Key Survey Statistics table in Section 2.3.1 represent healthy response rates for mail surveys of this length, particularly given that: The survey was amongst the Health Sector where potential respondents would be expected to be very

busy and therefore potentially reluctant to complete surveys. Participants were not offered an incentive to take part. For the DHB Clinicians survey, the fieldwork period included Christmas and New Year. The following tables outline the distribution of the total sample within each of the sample frame ANZSIC classifications, the target quotas that were set for each survey, the actual number of responses and the corresponding response rates. The ‘total sample’ comprises those for whom there were valid contact details. The response rates are calculated as the total number of responses received divided by the total sample. The main report shows the overall response rates for DHB Clinicians, non-DHB Clinicians and ICT Decision-makers. The tables following show the response rates by quota for the non-DHB Clinician and ICT Decision-maker surveys.


Table 2: ICT Decision-makers Sample, Quotas and Response

CONNECTED HEALTH SAMPLE, QUOTAS AND RESPONSE - ICT DECISION-MAKERS

Population

(Number of Enterprises)

Total Sample

Quotas Numbers of Questionnaires

Received

Response Rates

Private/Community based Hospitals (incl psychiatric hospitals) 60 25 5 10 40% General Practice Medical Services 3269* 501 130 176 35% Private Specialist 1734 299 60 78 26% Pathology 199# 48 10 20 42% Ambulance 194# 46 10 11 24% Health services not elsewhere classified 2804 465 107 146 31% Dental 1511 250 50 80 32% Physiotherapist/Chiropractor/Osteopath 1180 239 47 94 39% Pharmacy (with Dispensary, not DHB) 900 214 36 69 32% Aged care/residential care 648 165 26 67 41% Optometry and Optical Dispensing 343 80 14 28 35% Government 40 20 5 5 25% Total 12882 2352 500 784 34% * This is the total number of enterprises in the Statistics NZ ANZSIC category for GPs. See Section 2.1 of this Technical Appendix for a discussion on the accuracy of this figure # As mentioned in Section 2.1 of this Technical Appendix, for the Pathology and Ambulance quotas the number of offices have been used rather than the number of enterprises


Table 3: Non-DHB Clinicians - Sample, Quotas and Response

CONNECTED HEALTH SAMPLE, QUOTAS AND RESPONSE - NON-DHB CLINICIANS

Population


Total Sample

Quotas Numbers of Questionnaires

Received

Response Rates

Private/Community based Hospitals (incl psychiatric hospitals) 60 55 20 13 24% General Practice Medical Services 3269* 1312 250 408 31% Private Specialist 1734 464 130 157 34% Pathology 199# 86 50 25 29% Ambulance 194# 130 50 38 29% Health services not elsewhere classified 2804 1388 300 434 31% Dental 1511 244 50 73 30% Physiotherapist/Chiropractor/Osteopath 1180 461 50 150 33% Pharmacy (with Dispensary, not DHB) 900 219 50 60 27% Aged care/residential care 648 270 50 71 26% Optometry and Optical Dispensing 343 234 50 75 32% Government 40 40 30 12 30% Total 12882 4903 1080 1516 31% * This is the total number of enterprises in the Statistics NZ ANZSIC category for GPs. See Section 2.1 of this Technical Appendix for a discussion on the accuracy of this figure # As mentioned in Section 2.1 of this Technical Appendix, for the Pathology and Ambulance quotas the number of offices have been used rather than the number of enterprises


2.5 Weighting The DHB Clinicians survey results were weighted according to the total number of Clinicians employed by the participating DHBs. The overall figures for each survey can therefore be said to be representative of all Clinicians within the participating DHBs. For the non-DHB Clinicians’ and ICT Decision-makers’ surveys the overall data was weighted by the number of enterprises within each of the main quotas. The number of enterprises was taken from Statistics New Zealand’s March 2007 Annual Business Survey using their ANSZIC classifications. The “overall figures” for each survey (e.g. All ICT Decision-makers) can be said to be representative of all enterprises in the target ANZSIC classifications. Quotas for the survey broadly reflected the total number of enterprises within each of the quota categories. Some quotas were increased to encourage a larger number of responses from that category, either because the category was very small or because the Ministry regarded them as particularly important. Quota groups that were deliberately over-sampled have been weighted down to reflect correct proportions in the overall figures. Table 4: ICT Decision-makers

WEIGHTED NUMBERS OF RESPONSES - ICT DECISION-MAKERS

Population


Number of Questionnaires

Received

Weighted number of Questionnaires

Received Private/Community based Hospitals (incl psychiatric hospitals) 60 10 4

General Practice Medical Services 3269* 176 202 Specialist 1734 78 107 Pathology 199# 20 12 Ambulance 194# 11 12 Health services not elsewhere classified 2804 146 161

Dental 1511 80 93 Physiotherapists/Chiropractors/ Osteopaths 1180 94 73

Pharmacy (with Dispensary, not DHB) 900 69 56

Aged care/residential care 648 67 40 Optometry and Optical Dispensing 343 28 21 Government 40 5 2 Total 12882 784 784 * This is the total number of enterprises in the Statistics NZ ANZSIC category for GPs. See Section 2.1 of this

Technical Appendix for a discussion on the accuracy of this figure # Pathology and Ambulance uses the number of offices rather than the number of enterprises


Table 5: Non-DHB Clinicians

WEIGHTED NUMBERS OF RESPONSES - NON-DHB CLINICIANS

Population


Number of Questionnaires

Received

Weighted number of Questionnaires

Received Private/Community based Hospitals (incl psychiatric hospitals) 60 13 7

General Practice Medical Services 3269* 408 388 Specialist 1734 157 206 Pathology 199# 25 24 Ambulance 194# 38 23 Health services not elsewhere classified 2804 434 325

Dental 1511 73 179 Physiotherapists/Chiropractors/ Osteopaths 1180 150 139

Pharmacy (with Dispensary, not DHB) 900 60 107 Aged care/residential care 648 71 77 Optometry and Optical Dispensing 343 75 41 Government 40 12 5 Total 12882 1516 1516 * This is the total number of enterprises in the Statistics NZ ANZSIC category for GPs. See Section 2.1 of this

Technical Appendix for a discussion on the accuracy of this figure # Pathology and Ambulance uses the number of offices rather than the number of enterprises

2.6 Informed consent Respondents can be deemed to have given informed consent to take part in the survey because they participated voluntarily and were provided with information outlining the purpose of the research and how it would be used in the accompanying letter inviting them to take part in the research.


2.7 Data processing Data purity The nature of a mail survey is that the people who return the survey are not necessarily those who were sent it. This often occurs because there is no way to prevent potential respondents passing the survey on to a colleague who they believe would be more likely to provide valuable information or would be more interested in filling it out. All questionnaires were checked to ensure respondents met the requirements of the survey population (i.e. whether they were a non-DHB Clinician providing services to people, a DHB Clinician providing services to people or an ICT decision-maker). The data from all questionnaires was entered twice in order to ensure that the data had been entered correctly. Where the two rounds of data entry differed, the original surveys were checked to verify which data was correct. Margins of error The margins of error for the surveys in the table below are quoted for ‘50% figures at the 95% confidence level’. Table 6: Key survey statistics

KEY SURVEY STATISTICS

Survey Number of Responses

Margin of Error**

Non-DHB Clinicians 1516 ±2.3% ICT Decision-makers 784 ±3.4% DHB Clinicians 155 ±7.9%

Margins of error are almost always presented in this way. ‘50% figure’ refers to the survey percentage (i.e. if 50% of respondents said that they used a particular

technology, this would be a ‘50% figure’), and is the maximum margin of error. This is because the margin of error gets smaller as the survey percentage approaches 0% or 100% (i.e. if 90% of respondents said that they used a particular technology, the margin of error would be smaller than if 50% said that they used it).

‘95% confidence level’ indicates that according to sampling theory, the actual percentage for the

population as a whole will lie between the survey percentage less the margin of error and the survey percentage plus the margin of error on 95% of occasions (i.e. if 50% of respondents said that they used a particular technology and the margin of error is ±2.3%, then we can be 95% sure (in statistical terms) that the actual percentage for the population as a whole lies between 47.7% and 52.3% (50% ± 2.3%).


2.8 Data analysis for key segments Analysis of key segments for DHB Clinicians The total sample for DHB Clinicians (n=155) was smaller than for the other two surveys, meaning that there was less room for breaking this down into sub-samples. The report therefore focuses on responses from all DHB Clinicians rather than breaking these down to smaller sub-samples. While there would almost certainly be significant differences between different types of DHB Clinicians, the sample size for this survey would not allow analysis of such segments to be robust. Significance tests were conducted comparing Clinicians from small, medium and large DHBs. These yielded few significant differences and have therefore not been mentioned in the main report. Analysis of key segments for Non-DHB Clinicians and ICT Decision-makers The Ministry of Health identified twenty key segments for analysing the results to gain a better picture of the Health and Disability Sector which were used for the ICT Decision-Maker and non-DHB Clinician surveys. These segments were selected based on the Ministry’s understanding of the Health and Disability Sector and were informed by the results of the Connected Health qualitative research. Table 7: Connected Health key segments - number of questionnaires received

CONNECTED HEALTH KEY SEGMENTS - NUMBER OF QUESTIONNAIRES RECEIVED

ICT Decision-

makers Non-DHB Clinicians

CORE SEGMENTS - SUFFICIENT RESPONSES FOR ANALYSIS GPs 176 408 Private Specialists 78 157 Independent Practitioners 169 110 Pathology 20 25 Ambulance 11 38 PHO 30 N/A IPA/MSO 6 N/A Not-for-Profit organisations 95 99 Aged Care 67 71 Mental Health 21 170 Pharmacy 69 60

CORE SEGMENTS - INSUFFICIENT RESPONSES FOR ANALYSIS Private/Community based hospitals 10 15 Large multidisciplinary health care providers 4 6 Public health/Regional prog./Task groups 7 4 Student and youth/Family planning/Sexual health/School nurses 2 17 Government 5 12

ADDITIONAL SEGMENTS - SUFFICIENT RESPONSES FOR ANALYSIS Sole Traders 34 223 All Rural 161 218 Rural GPs 81 89 Non-Rural GPs 95 319


Statistical significance tests were conducted for all segments where there were more than 30 respondents (i.e. they were not conducted for the five segments where there were not enough responses for any analysis, nor for Pathology Decision-makers, Pathology Clinicians, Ambulance Decision-makers, IPA/MSO Decision-makers or Mental Health Decision-makers). The following points should be noted: The sample sizes for several of these segments were too small for robust analysis. This generally reflects

there being few organisations in the Health and Disability Sector as a whole that fall into those particular segments.

While the following ICT Decision-maker Segments are small, they are considered large enough for robust

analysis because of the total number of organisations in that segment (i.e. the universe) is small.

- Pathology (20 out of 31 organisations in New Zealand participated). - PHOs (30 out of 81 organisations).

For the following ICT Decision-maker segments, results should be treated as indicative only:

- Ambulance (11 out of 28 organisations in New Zealand participated). - IPA/MSO (6 out of 36 organisations).

Not everyone in the survey fell into one of these segments, with the exceptions generally coming from the

‘Health Services Not Elsewhere Classified’ ANZSIC classification (e.g. midwives). Most of the segments are mutually exclusive. In other words, being in one segment generally precludes a

respondent from being in another segment. These are termed the ‘vertical’ segments, and relate to the part of the Health and Disability Sector the organisation works in. These segments are:

- Aged Care - Pathology - Ambulance - Pharmacy - General Practitioners - Primary Health Organisations - Independent Practitioner Associations/

Management Services Organisations - Student and youth/Family planning/

Sexual health/School nurses - Large multidisciplinary health care providers - Mental Health

- Public health/Regional programme/ Task groups

- Private Specialists - Private/Community based hospitals The ‘horizontal’ segments are not mutually exclusive. In other words, most respondents in one of these

categories will also be in one of the ‘vertical’ segments. The ‘horizontal’ segments are: - Not-for-Profit organisations; - Independent practitioners; - Sole traders; - Rural; - Rural GPs and non-rural GPs (only contain respondents from the GP segment). The PHO and IPA/MSO segments were included for ICT Decision-makers only. This is because the PHO, IPA and MSO organisations included in this segment did not themselves provide clinical services, with services instead being provided by the general practices that are members of these organisations.


3. Glossary of key terms Table 8 outlines abbreviations and shorthand terms commonly used in the report and which also appear in the main report. Table 8: Abbreviations used in the report

ABBREVIATIONS USED IN THE REPORT

Abbreviation/

Shorthand term Full term

ACC Accident Compensation Corporation Connected Health Connected Health Programme ICT Decision-makers ICT Decision-makers for Health Sector organisations which are

not DHBs DHB District Health Board DHB Clinicians Clinicians who are employed by District Health Boards GP General Practitioner ICT Information and Communication Technology IP Independent Practitioner IPA Independent Practitioner Association ISDN Integrated Services Digital Network (a means of connecting to

the internet) ISP Internet Service Provider MSO Management Services Organisation Non-DHB Clinicians Clinicians who are by employed by organisations other than

directly by District Health Boards PHO Primary Health Organisation PMS Patient Management System SME Small to Medium Enterprise The Ministry Ministry of Health VoIP Voice over Internet Protocol (internet telephone)


Table 9 is the glossary of terms provided to respondents alongside the questionnaires. Table 9: Glossary

GLOSSARY

Term Definition

Application Licence Fees A fee that allows users the right to access a software application but not own it.

Broadband

Broadband is a high speed Internet. Broadband is ‘always on’ - there is no waiting to connect to the internet as there is no dialling up. Your telephone can be used at the same time. Common forms of broadband include DSL (Digital Subscriber Line), cable modem, WiFi (wireless access), and Metro Ethernet (Ethernet access over optical fibre).

DSL

Digital Subscriber Line is the technology that allows the transfer of computer data down the telephone line at frequencies above those used for voice traffic. This allows both internet usage and voice calls to be made on the one telephone line.

Fixed location Operating from a single site.

Hardware

Hardware is a comprehensive term for all of the physical parts of a computer, as distinguished from the data it contains or operates on. In contrast, software provides instructions for the hardware to accomplish tasks.

HealthLink

HealthLink is an example of an organisation that provides an electronic communications and integration service used in the Health Sector to exchange electronic patient information via their computer systems.

Health Network

The Health Network is a secure communications network that enables the Ministry of Health and other health care professionals to communicate securely with one another over a closed, electronic network. Only approved organisations are able to access the network and the resources available on it. The Health Network forms part of the national framework for the secure and private collection and sharing of electronic health information within the Health & Disability Sector.

Health Network Provider

Health Network providers are the first point of contact for health care professionals for any queries regarding access or operation of the Health Network. The three Health Network providers are Telecom, TelstraClear and HealthLink.

ICT

Information and Communication Technology is an umbrella term that encompasses all computer-based technologies used for recording and communicating information. This includes methods for broadcasting information such as radio, television, cellular phones, computer and network hardware and software, the internet, satellite systems, as well as the various services and applications associated with them, such as videoconferencing and distance learning.

IPA

Independent Practitioners’ Association. Associations of general practitioners set up in response to the Health and Disability Services Act 1993, as an infrastructure for the provider side of primary health care funding arrangements. These associations are generally established as limited liability companies or trusts, and most are owned by the general practitioner members.


GLOSSARY (Cont.)

Term Definition

ISP

Internet Service Provider. An organisation that provides access to the Internet. Connection to the user is provided via dial-up, ISDN, cable, DSL and T1/T3 lines.

ISDN

Integrated Services Digital Network. ISDN is a set of standards for digital transmission over ordinary telephone copper wire as well as over other media.

MSO

Management Services Organisations are organisations designed to improve the efficiency and profitability of physician practice groups (IPAs) while enhancing the ability of physicians and physician assistants to render quality medical care to patients. They do not deliver medical treatment but rather provide all necessary management, administrative and business services and operation of non-medical aspects for the delivery of medical care.

Outreach Clinic

Where a health professional works out of one or a number of community premises that do not belong to the parent organisation.

Primary Health Organisations (PHOs)

PHOs are the local structures for delivering and co-ordinating primary health care services. PHOs bring together doctors, nurses and other health providers in the community to serve the needs of their enrolled populations. PHOs vary widely in size and structure and are not-for-profit. PHOs get a set amount of funding from the District Health Boards to subsidise a range of health services.

Registered Health Practitioner

A registered health practitioner is defined by the Health Practitioners Competency Assurance Act 2003 (the Act). The Act defines professions and authorities that register members of those professions. A registered health practitioner must hold a practising certificate issued by the relevant authority.

Remote working

Work is conducted from various locations that are situated some distance away from the base so travel is inevitable. There may be numerous and varied work sites.

Software

Software is a general term for the various computer based business systems available. It is often divided into application software (programmes that do work users are directly interested in e.g. PMS, MS Word, MYOB) and system software (which includes operating systems and any programme that supports application software e.g. Windows XP, Linux, Video or other hardware drivers).

Teleconferencing

Simultaneous conference between three or more sites via phone or other audio.

Videoconferencing

The linking together of individuals and groups by means of telecommunications networks and video technology, so that people in remote locations can participate in “meetings” where one or several of the participants is “present” in the form of a live video link displayed on video monitors.

VPN

A virtual private network (VPN) is a network that uses a public telecommunication infrastructure, such as the Internet, to provide remote offices or individual users with secure access to their organisation’s network. The goal of a VPN is to provide the organisation with the same capabilities, but at a much lower cost by using the shared public infrastructure rather than a private one.

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