Scotland’s e-health strategy for 2011-17, released on Monday, describes itself as “ambitious” and to have “the citizen at its centre.”
It commits to joining up health and social care IT, increasing patient access to services, and improving support for people with long term conditions.
But a key concern of those making early responses to the strategy is how another commitment - to give clinicians more access to adequate information, when they need it - is going to be managed.
The strategy – the second published for NHS Scotland since health became the responsibility of the devolved administration – says it wants all health boards to be using clinical portals by 2014.
This idea is not new. The Scottish Government’s first eHealth strategy, issued in 2008, presented the procurement of a standardised national portal as one of three significant procurements to be completed by 2011.
The portal was to be a “single online entry point through which various elements of information related to a single patient can be accessed by authorised users” and was to be developed incrementally over the five year lifetime of the strategy.
However, the project was dogged by medical concerns about content and confidentiality, and was singled out for criticism by the Scottish Parliament’s Health and Sport Committee last March.
In a report on portals and telehealth, the committee said it was concerned about the slow pace of progress, and the risk of health boards deciding to develop or adopt multiple systems.
It urged the executive to make the project a core part of its new IT strategy, then in development, and to find the funding for it.
And about to roll out
In the event, three consortia were set up to explore ways forward. A consortium of four health boards in the South and East of Scotland developed a prototype with Northgate Managed Services, using Carefx’s Fusionfx platform last year.
They then developed a business case for the system, placed a £6m contract for it in February, and are about to see it go-live in Lothian. NHS Lothian director of eHealth Matin Egan told eHealth Insider that a wider roll out following on from the go-live should be “relatively straight-forward”.
Meanwhile, the Western region has been rolling out NHS Greater Glasgow and Clyde’s portal. And the Northern region is looking into a portal developed by NHS Tayside, while dealing with issues around information governance.
The latest strategy wants the portals in place in all boards within three years in order to save money and increase efficiency, but also to increase support for collaboration between boards, reduce unnecessary duplication of tests and to increase the accuracy of records.
The British Medical Association in Scotland has approved of the Scottish Government’s emphasis on using technology in a modern way.
But its lead on NHS IT, Alan McDevitt, has sounded caution about the challenges of coming up with new ways of protecting information as technology, such as portals, is rolled out.
“With the growing use of electronic patient records, it is essential that we know who has looked at which records and when, so we can ensure only appropriate access,” he said.
“A proper identity and access management system must be in place for staff to give proper electronic identities and access. Health staff should only have access to records of patients they are actually looking after and they should be able to see only information they require to carry out their duties for patients in their care.”
The strategy says the use of single sign-on and audit tools will be two key elements of an Information Assurance Strategy to safeguard access and privacy that will be fully in place by 2017.
In August, the NHS in Scotland announced that Imprivata’s OneSign single sign-on would be used by health boards across Scotland, having already announced a contract for them to use the Fairwarning privacy surveillance system. Both will be delivered by Northgate Managed Services.
As well as enhancing security, head of IM&T at NHS Borders, Jackie Stephen, said the expectation that all health boards will implement single sign-on should increase productivity.
Stephen told the Health Informatics Conference held in Edinburgh this week that about 20% of calls to her board’s help desk were to do with forgotten passwords.
“I’m really looking forward to having single sign-on in my board; it’s going to release some time within the help desk to allow them to focus on other things and support other parts of the agenda.”
Finding the money
The new e-health strategy focuses on five strategic aims, rather than on the delivery of specific systems. But it sets out nine deliverables for the period covered by the 2011 spending review. These will be reassessed in 2014 in line with the next spending review.
The Scottish Royal College of Nursing has expressed concern that this will leave the strategy under-funded, and lead to further “patchy” IT development. But Stephen argued it would give health boards more flexibility to achieve the key deliverables within the six year time frame.
“Clearly for each board it’s going to be very different... it does offer us an opportunity to work within our boards about what our priorities are. It allows us to look at how we use our resources to use them in a more effective way.”
The strategy has also created a new framework for financing e-health within Scotland, which Stephen says will encourage more collaboration and responsibility.
Instead of allocating funding on a project-by-project basis, investment will be allocated to boards with the expectation they will deliver on the five key strategic aims. Stephen says this will encourage boards to work together on processes such as procurements where they may be able to save money.
Boards will also be expected to incorporate plans for e-health in their local delivery plans with the Scottish Government and their annual reviews.
More projects to build on
But ongoing investment will need to be found for other early procurements of national systems. Launching the latest strategy, Derek Feeley, the acting director general of health and chief executive of NHS Scotland, hailed previous projects to procure a national patient management system and standardise GP IT systems as successes that will need to be supported.
A national framework contract worth up to £120m was signed with InterSystems’ for its TrakCare patient administration system in 2010. NHS Borders became the first trust to implement the system in January this year, and others have followed, with NHS Ayrshire and Arran going live in April.
Going forward, the government has also committed to continue investment in telehealth projects, with investment of £1m per year promised to the Scottish Centre for Telehealth and Telecare, run by NHS 24.
Indeed, by 2014 the Scottish Government has promised to produce an IT strategy specifically for health and social care as a way of supporting the country’s rapidly ageing population, with is living with a particularly high level of chronic disease.
The national Emergency Care Summary, which has been accessed more than 6.6m times since its launch in 2006, is also being extended to include information from the ePharmacy Programme, which was set up to test the benefits of sharing information about what has been dispensed for a patient against what was prescribed.
The government wants to take the programme further by creating an up-to-date medication summary available to healthcare workers. These plans have spurred positive responses from both the BMA and the RCN.
McDevitt said: “I am sure many patients, especially those with long term conditions such as kidney failure, will find this helpful. So long as the patient’s information is available to themselves and the clinicians treating them and kept secure from others.”
Meanwhile, the RCN says the strategy’s focus on giving patients more access was a good move, as was the emphasis on widespread portal implementation.
“Now is the time to make sure that all patients from across Scotland benefit from new technology and, in particular, that clinical staff have a readily accessible ‘dash board’ system to monitor clinical data so that patients benefit from the best possible care.”
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