This thesis examines the reasons why a key policy goal of New Zealand's National Health IT Board - to provide electronic health records to all New Zealanders, with an essential prerequisite being greater connectivity between sector information systems - has not materialised and, indeed, seems to be such a distant prospect. The research focuses on the Auckland metropolitan region, and where information exchange intersects with the primary care sector.

The research was conducted by interviewing some of the key policy actors involved in this issue, all of whom could speak from different parts of the sector and held different perspectives and roles in the implementation of the policy. A theoretical framework based on the Policy Implementation literature was utilised, which identifies the extent to which there is both policy congruence and policy clarity amongst stakeholders.

The thesis first encompasses the complex and fragmented history of New Zealand's health system, and identifies relevant international literature which recommends avoiding either 'top down' or 'bottom up' implementations of IT systems in health. A strong theme was that the focus must begin with implementing standards, and incentivising sector stakeholders to work on that basis.

Participant interviews revealed a perception that the centre is relatively weak, and that there has been no clear articulation of a 'burning platform' for change and there has been no targeted incentivising, such as has been seen in the US since 2009. The structure of the health system itself - particularly the primary care funding model - was also repeatedly noted by participants as providing a disbenefit to support a goal such as interoperability. Another key issue was the dissatisfaction expressed by primary care informants about their PMS products and vendors. Those working in primary care appear to sharply feel a power imbalance, both in the relationship with DHBs and with their software vendors.

The interoperability policy goal is therefore considered to be a 'symbolic implementation' (Matland, 1995), featuring high levels of ambiguity and conflict. The route out of this situation is for the centre to clearly assess the relative coalitional strengths of different groups in the sector, and allocate resources and provide incentives in such a way as to shift power imbalances, so that the desired outcome can be achieved. This will require proactive and bold initiatives from the centre, which participants did not perceive had been forthcoming.