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Scotland's health and care sector set for digital technology revolution

Scotland's new digital health and care strategy contains a blueprint for the adoption of digital technologies to transform the way health and care services are delivered and improve outcomes for patients.19 Jul 2018

Central to the wide-ranging strategy, which has been developed jointly by the Scottish government, NHS Scotland and local government body COSLA, are plans to giving patients more control over how their data is used.

To support those plans, a new national digital platform is envisaged through which patient information will be accessed and managed, while the strategy also addresses issues of governance and collaboration, skills and information assurance which will all be required to support the ambitious project.

New national digital platform

A range of IT systems and solutions are in place across Scotland's health and care sector. It means patient data is often held in silos, presenting an out-of-date, inaccurate or incomplete picture of an individual patient's health status and care needs to those responsible for the provision of relevant treatment and associated services.

The problem is acknowledged in the new Strategy, which provides for the creation of a new national digital platform, as follows:

"We will begin work now to deliver a Scottish health and care ‘national digital platform’ through which relevant real-time data and information from health and care records, and the tools and services they use, is available to those who need it, when they need, wherever they are, in a secure and safe way,"

"We will develop at a national level a digital platform that enables the appropriate creation and use of information at source and facilitates the interoperability of existing and new health and care technologies. This will be delivered through the development of a new architecture, the use of secure cloud-based services and the use of common shared international standards," it said.

The new platform is to be a secure portal through which health and care workers will be able to input, access and share information about patients, regardless of the location of the health and care professionals who are responsible for the provision of any relevant services.  It therefore has the potential to support both home care services and the provision of remote health care.

Infrastructure and supporting processes will be put in place within the platform to provide for "appropriate use of information" for purposes beyond direct care "to ensure that health and care systems in Scotland are continuously learning".

In addition, patients will be given access to the information stored about them via the platform, being able to update information about their health and wellbeing, including their records and from personal monitoring, and to interact directly with services and service providers.

The new platform will also be designed to ensure that the potential of data is used to "better understand the drivers of inequalities and poor public health outcomes".  The insights gleaned will assist the development of what is referred to as "new digitally based services and interventions that can make a difference".

Access to clinical, biomedical, social care and other patient-specific data will also be facilitated through the platform, to be used for certain types of approved research carried out in the public interest. The aim being to create opportunities for public sector researchers, academics, and businesses engaged in life sciences, for example, to utilise the data in controlled conditions, including in research partnerships.

The platform will also be where new products and services with potential to improve health and care services will be accessible to professionals working in the sector.  The strategy envisages the use of open application programming interfaces (APIs) and standards to support interoperability between the innovations and existing systems. In this respect, the digital health market in Scotland is expected to evolve in a way that is similar to the anticipated expansion of open banking services used within the banking and payments markets.

Information assurance

The move to give citizens in Scotland more control over how their health and care data is used is to be supported by the development of new information assurance standards.

The standards, which are to be shaped by the public and professionals, will be compliant with the General Data Protection Regulation and will clarify what is described as "the required information assurances needed for different uses of health and care information, and appropriate choices for citizens about how their information will be used".

The move recognises the need to maintain public trust over the use of their information and promises greater transparency and education around the importance of data in areas of wider public or societal benefit, such as research into new treatments or the development of learning and knowledge to improve public health.

A new simplified and consistent national approach for information assurance is to be outlined by 2020 and will take into account the different needs of users and citizens, providing clarity in relation to information sharing across the health and care sector.

Leadership and collaboration

Digital transformation projects can often come into difficulty due to a lack of leadership and governance. In this respect, it is positive that implementation of the digital health and care strategy will be led by a new national decision making board. Executives from the Scottish government, local government and the NHS will make up the new board, with further support and advice to be provided by representatives of industry, academia and the third sector.

The decision making board will have a number of dedicated tasks, including adopting standards required to deliver interoperability and information sharing across Scotland's health and care sector, and agreeing on the financial framework through which reforms will be delivered.  It is acknowledged that the strategy can only be implemented if there is collaboration across multiple stakeholders.

The strategy recognises the benefits of a structured, focused approach to delivery and introduces what is described as a new, collaborative approach through which the eight national health boards in Scotland will create and benefit from improvement and transformational change, working with the Scottish government, COSLA, the Local Government Digital Office, the Scottish Social Services Council and the Care Inspectorate.

"Collectively we will design a consistent approach to supporting transformational change which brings together expertise and knowledge, incorporates technology as integral to all change programmes, and embraces and delivers significantly greater opportunities for self-management".

Digital skills

The strategy also recognises that digital health and care is only possible if people employed in the sector have the requisite skills to exploit the technologies available.

As a key milestone, by September 2018, a clear approach to developing the modern workforce and the necessary leadership to drive change is to be outlined by NHS Education for Scotland, the Local Government Digital Office and the Scottish Social Services Council.

The importance of leaders with the skills and experience to drive the agenda for digital health and care in Scotland is also set out, along with plans to enable health and social care professionals to build their digital and data skills, capabilities, competencies and career paths via frameworks and learning pathways.

Under the strategy, universities will also have a role to play in ensuring students have the digital skills that organisations need now and will require in future. It is hope that in common with similar public sector strategies, this driver will help trigger a much needed expansion in the number of computer science and related technology courses on offer within Scotland's further education sector.

A word of caution

There are challenges to implementing any digital transformation successfully and relevant stakeholders will be looking to learn lessons from mistakes made in the health and care sector in the past.

In particular, it will be important to learn from key initiatives that were designed in the past to breakdown barriers and de-silo health information.  The withdrawal of the care.data initiative in 2016, due in large part to pressure brought by privacy campaigners, was a high profile setback in attempts to improve health services and inform medical research through the centralised availability and use of aggregated data.  Trust over the use of data, particularly sensitive health information, is imperative if the potential of digital health and care solutions is to be realised.

The Scottish government should similarly make the most of existing data standards that have been developed more generally in the UK (such as the data security standards developed by the national data guardian in England, Dame Fiona Caldicott, and the plans for a new healthy child record standard in England).  Scotland continues to be in the fortunate position of being able to take advantage of delivery mechanisms and standards that have been proven to work elsewhere in the wider NHS and that opportunity must not be wasted.

Conclusion

The publication of Scotland's new Strategy is a welcome development and will provide a much needed focus and additional momentum across the health and social care sector in Scotland.  As ever, funding will be required, both centrally and at a Health Board and Local Authority level in order to ensure that the Strategy creates the right environment to "change the face of health and social care delivery" in Scotland.   

Matthew Godfrey-Faussett is an expert in digital health at Pinsent Masons, the law firm behind Out-Law.com. This article was first published by Digital Health Legal.