Digital Healthcare in Scotland – A Guddle of Clunky IT Systems

Healthandcare.scot writes that at the recent Health and Social Care Scotland conference in Glasgow, Health secretary Jeane Freeman admitted that IT for Healthcare in Scotland was in a bit of a guddle, lacking strategic direction.

This state of affairs was also repeated by the industry. As FutureScot reports a recent Scottish parliament committee hearing featured professionals from across Scotland’s Healthcare sector commenting on the progress of building an integrated system for Scotland.

Representatives from industry bodies including dentists, GPs, optometrists and pharmacists aired concerns about the effectiveness of data sharing between the NHS and community care providers, describing the situation as one of “clunky IT systems that don’t talk to each other”.

Auditor General

This state has been officially documented too, reflecting the analysis and conclusions of the report from Scotland’s Auditor General on this topic, describing a situation of disjointed IT as the root issue holding up Integrated Health and Social Care in Scotland.

Specifically in their progress report they identify:

“An inability or unwillingness to share information is slowing the pace of integration

Throughout our work we were told of examples where this was not happening in practice, because of local systems or behaviours. Examples include:

    • GP practices being unwilling to share information from new service pilots with other IAs;
    • IAs themselves being unwilling to share performance and good practice information with others; and difficulties in setting up data-sharing agreements between IAs and ISD.
    • Different interpretations of data protection legislation are not helping with the ease with which information is being shared.
    • As identifying gaps in data about community, primary care and social care services and establishing how this information will be collected. This is something we have highlighted in several of our previous reports.
    • NHS and social care services are made up of many different specialties and localities, often with different IT systems, for example, systems to record X-ray results or record GP data. Many of these systems have been built up over years and commissioned separately for different purposes. Some services still rely on paper records.

This is mirrored by conclusions identified in the Technical Architecture report from Digital Health and Care Scotland:

    • “Most of the organisations surveyed have integration capabilities and the social care products in use do support APIs. However, the use of these APIs was found to be fairly low and system integration was often achieved using bespoke development techniques.
    • Interoperability is a key challenge for all health boards and integration is in all cases achieved using InterSystems Ensemble. The survey discovered the lack of semantic interoperability standards (such as SNOMED CT) lead to potential patient safety and clinical workflow issues due to incompatible systems being integrated together.
    • Data sharing agreements are common place among the organisations surveyed with most having data sharing in place with NHS boards, other Local Authorities, government and/or police. While the agreements were in place, practically applying it had come with its challenges.
    • Establishing data sharing agreements were cited as a key challenge to sharing data with other organisations.”

Audit Scotland then describe the impacts of lacking these integrated capabilities:

“Sharing of information, including both health and performance information, is a vital part of providing effective care that is integrated from the point of view of the people who use services. It is also vital in helping to anticipate or prevent need.

This disjointedness has an impact on people who need care and on the ability of health and care professionals to provide the best support that they can. For example, people with multiple and complex health and care conditions can have to explain their circumstances to many different professionals within a short space of time. This can delay people getting the help they need, waste resources and gets in the way of care provision being more responsive to people’s needs.”

The Solution: Government as a Platform

Commenting on the way forward the hearing recognized the value of the National Digital Platform, but felt that the timescale for this is too long, with more immediate solutions needed in the short term.

Also it is not a new EHR system they need but a method of integrating existing systems. Dr Carey Lunan, Chair, the Royal College of General Practitioners, makes the point that there is a need for basic IT systems to work together better, over the high-tech telemedicine solutions that tend to receive most of the focus.

Mr McColl, a Govanhill dentist, postulates the need for “some form of Cloud-based platform that is ideally government-led”, describing the solution needed: Government as a Platform (GaaP). In short this builds on the initial early steps of the NDP but greatly expands the scope in a number of ways, both technologically and in terms of the organizational model.

Most notably it acts as a single integrating platform – A national gateway that interlinks all public sector IT systems via a common integration model.

Some local authorities, like Aberdeen, are pioneering local data sharing platforms, but McColl forecasts that this would lead to yet more disjointed systems, a point repeated by Audit Scotland making the case for a single, national GaaP approach:

“Time and money are being spent on fixing local IT problems when national solutions should be found. Local fixes are being put in place to help overcome data sharing barriers. This includes bringing teams of staff together under one roof, so they can discuss individual cases, rather than relying on electronic systems such as internal emails to communicate.

Local areas are spending time and money implementing solutions which may continue to be incompatible in the future. There is a need for a coordinated approach to the solution, which includes the need to consider a national, single solution for Scotland.”

Digital Healthcare 3.0

We have a new ebook report in the pipeline that will describe how to address all of these challenges, through:

  • A core GaaP Blueprint – A reference model for a Digital Ecosystem Platform for Health and Social Care in Scotland.
  • Lessons learned from successful national platforms notably E-Estonia, and how they’ve achieved an entirely integrated digital nation including Healthcare via their ‘X-Road’ system.
  • Harnessing the Personal Data Economy – Leveraging the Decentralized Web and Self-Sovereign Digital Identity for a new paradigm of secure personal data sharing.

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