KEY POINTS:
Tom doesn't do anything in half measures. He and his wife have five children aged from 17 years to five-year-old twins. His other 'baby' is HealthLink, a long-standing public-private partnership with the New Zealand Ministry of Health. Not surprisingly, this doesn't leave much time for anything else. After setting up his own business at the age of 21, Tom has been a committed entrepreneur ever since, stopping only to do an MBA which helped him become even more fascinated with the transition from paper-based processes to electronic ones.
Tom Bowden is the founder and CEO of HealthLink which has been the electronic heart of the New Zealand health system since 1993. Facilitating the transfer of one million pieces of patient information per week between general practitioners and other health service providers (including laboratories, hospitals and specialists), the company operates throughout New Zealand and in much of Australia.
Healthcare is a very contentious area. From the outside it looks like an environment with kind people in white coats looking after others. In reality it is just a massive scramble for resources. It is, as someone said recently, a series of warring tribes, each with their own religious beliefs.
Right now the health sector is fairly combative. There are all kinds of agendas, and the challenge for government is to align those agendas as much as possible, to minimize conflict and get everyone heading down the same road.
When you have 50 staff to look after it is hugely important to know where you stand with government. We have a million items of medical information a week, and we answer 150 fault calls a day, so it's an important piece of the health sector. That's a lot of paper removed and it is an awful lot of complicated systems.
The good news is that GPs are strong and are generally in good heart. Ninety-five percent of New Zealanders are enrolled with a GP, and GPs are doing better financially, are happier and have a major influence over the direction of the health system.
If we see a change in government in November, GPs will probably get more autonomy. That will be good, because the health bureaucracy has blown out due to a desire at all levels to micromanage. GPs are highly qualified professionals and you have to be able to trust them to get on with the job, so you should set the broad parameters and let them go for it.
HealthLink is to a large extent the electronic glue of the health system. It allows GPs to exchange all sorts of information with other parts of the health sector and it provides the security needed to secure medical information. Every piece of information we send is encrypted (or scrambled) and electronically signed. We don't really support the formation of central repositories of information - there are potentially major privacy issues with those. That's why it's important, in my view, to make the GP responsible for 'stewardship' of his or her patients' information.
Ideally what we want to achieve is an increase in the efficiency and effectiveness of patient care. One day we want you to be able to move right through the health system and allow anybody that is helping you to find all the relevant information about you that they need, without compromising your privacy by inadvertently accessing information that you wish to remain private.
I set up a business early, at 21 - I suppose I like being in charge of whatever I am doing. My first venture was a design and print company. After seven years I undertook an MBA part-time and I became fascinated with the transition from paper-based processes to electronic ones. This was 1984 to 1987, pre-deregulation and Telecom.
I had been in printing when it was becoming more and more IT-based. I observed the changes keenly. From 1978 to 1987, when I was doing it, there was huge technology development, with creations like the Apple Macintosh which revolutionised the printing industry, almost overnight.
Aware of impending changes I decided that telecommunications was the place to be, so I became an employee again in a specialist subsidiary of Telecom. Among the areas that clearly could benefit from electronic communications was healthcare, so we talked to the Ministry of Health which, in the early 1990s, wanted to have partners because it didn't want to get into running computer networks.
As long we were good boys and girls and played by the rules and did good things for the sector, the Ministry was quite happy with whatever we did.
The Ministry was very encouraging, but not very keen on giving us funding to do anything. We had to go and turn it into a business, which is when we founded HealthLink. I persuaded my Telecom bosses to invest in a joint venture, and a year later we set the company up as a stand-alone specialist business and bought services from Telecom.
One catalyst for us was the 1992 health reforms. Simon Upton totally changed the whole New Zealand health system, and fortuitously, what we provide supported the newly reformed health sector very well. If you devolve responsibility for day-to-day healthcare delivery to GPs that is good, but if you still have a largely paper-based system all you do is create an administrative nightmare.
On day one, 15 years ago we had no clients, and the health sector didn't exchange information electronically at all. Now we exchange a million items of information a week.
We have raised the level of information movement around the health sector to a very high level, by international standards. Two years ago a Commonwealth Fund (www.commonwealthfund.org) report on IT put New Zealand at the top of the 10 OECD countries it had measured. It happened to measure all the things we do at HealthLink.
We can only improve health information at the rate at which people trust the integrity of the health system. If people start to lose trust, as they have in the UK, the whole health system is affected. If they do not trust the confidentiality of the health system, people won't be frank with their doctor.
The main thing driving me is a desire to improve the health system. Having got into the system more by chance than design, I now know how important information is. We have a very clear policy and strategy - to enable primary care to communicate easily, dependably, and safely. That is our entire focus.
What seems to work best around the world is a primary care-led health system, which is what New Zealand has. That means, effectively, that your GP organizes how your personal healthcare is delivered. This approach has been almost conclusively shown to be better value for the taxpayer and better-quality care for patients.
We are also in Australia. There we spent a long time trying to change the health system before we realized that it was like trying to turn around an oil tanker. We're now biding our time, doing what we can while we wait for the system to realize it needs to change. The recent change in government seems to signal a commitment to fundamental healthcare reform and a desire to implement a primary care-led strategy.
There is no question that the health systems of all western economies must change. Our population as a whole is ageing and the baby-boom generation is going to put a big burden on the health system. As a consequence there is a real skills shortage and an international market for skilled professionals. This is not working in our favour at present.
We are targeting British-style health systems, because of the way in which they are organized. A health system like India's, which is not organized and has little automation, is impossible for us to work with. The fact that the New Zealand system is automated makes a huge difference to patients. Here, people go to hospital, get treated effectively and then go home. In Australia, without a good communications system, their health sector is somewhat less efficient.
We have identified Australia and Canada as being the first markets we will pursue. Once they are under our belt we will look at others. In Canada we are looking at forming a joint venture, while in Australasia we are operating on our own.
My purpose is to lead a worthwhile and fulfilling life - to have enough money to feed and clothe the family, and to do useful and interesting things.
I have five children, aged from 17 to five-year-old twins. It's all on at home! I am usually up at about 5.30am, and fairly early to bed. I don't watch any TV apart from the news.
Getting good people around you who can complement your skills is very important. It's also a matter of ploughing into it but knowing when you need to notch back a bit - not going so hard at it that you end up hitting the wall. I have learned to pull back. I have a very busy, demanding life, so some weekends I will work 20 hours and on other weekends I will do absolutely nothing work-related.
I have some good people in Australia, but there was a time when I was there every two or three weeks, and that is hard with a lot of kids. It is very hard on my wife to leave her behind coping with the rabble. Fortunately she is highly organized.
I think if you are doing something you believe is good for the country and society it encourages you, because you can look around and see the real benefits of your work. Seeing the healthcare service visibly improve through your own efforts is incredibly rewarding.
Every year in early January, my wife and I write a personal plan of what we hope to achieve. We then measure ourselves against those goals and make sure we are both committed to the same objectives - one of the biggest failings in marriage is when two partners are after different things.
Tom Bowden At A Glance
* Chief Executive of HealthLink Ltd
* Involved in electronic communications for 20 years
* Built HealthLink from scratch, starting in 1993
* HealthLink now has offices in Auckland, Sydney, Brisbane, Melbourne and Perth
* Responsible for the exchange of one million pieces of patient information per week
* Has five children and lives in a 150-year-old historic home in Parnell, Auckland
* Propagates native plants and grows old roses as a hobby
Goalgetting Tips for Today
* Never, ever give up on something that makes sense, however hard it is to achieve
* Understand and try to influence the main drivers that are affecting your environment - eg Government
* Understand your business in great detail and respect those who can do likewise
* Be very clear about your five most important strategies and pursue them relentlessly
* Be a force for good in your community and in your work environment
Dwayne Alexander, our goal guru is founder of LiveMyGoals, the social network for goalgetters.
