Integrated health and social care systems need accessible mobile technology - but is it moving fast enough?

Digital technology is a key ingredient in the future of health and social care, according to a number of government strategies and action plans, as Scotland’s population grows older and services are faced with more people with complex and multiple medical conditions.

Published last month, the National Clinical Strategy for Scotland is the latest of these and provided a backdrop for Holyrood Connect’s eHealth Scotland: Transforming Scotland conference.

Feedback from the extensive national conversation consultation showed people wanted access to technological health solutions, though not as a replacement for face-to-face contact.

Eddie Turnbull, who heads up the eHealth directorate at the Scottish Government, said technology is already transforming healthcare in Scotland. “If you go to any GP surgery or walk around any hospital you’ll see everywhere IT supporting health and care professionals in their everyday duties,” he said. “It's transforming the way health and care professionals access information.”

Looking to the future, those professionals will increasingly be expected to carry out their work in communities and in patients’ homes as the integration of health and social care is realised. For this, they need instant access to, and the ability to update, a wide range of data.

The patient portal, expected to be unveiled in the summer, is hoped to meet some of this demand. The information must also be secure, warned Turnbull. “As we open up our systems to give controlled access over the internet to other agencies and individuals and their carers, we need to implement an even higher level of protection against cyber attack,” he said.

An information security framework is planned. “We need to pick up the pace,” he conceded. Questions remain as to why access to digital solutions remains intermittent.

“We know what the technologies are, we’ve seen the equipment used in practice and we’ve seen them piloted,” said Dr Karam Sarsam, a practising high dependency clinician. “What we really need to do is to find ways to incorporate these into what we’re doing.” Sarsan is also a clinical adviser to IT security company Imprivata.

“I find myself fighting the clutter on a daily basis” dealing with paperwork, he said. Written notes are liable to be damaged, stolen or even rendered indecipherable with poor handwriting.

Integration, Sarsan suggested, is provided by uniformity of function not identity, and this should be reflected in governance arrangements. The fact practitioners don’t have equal access to technology is wasteful, suggested event chair Pennie Taylor.

Turnbull said solutions are not simple, but the pace has been picked up already. “It’s no use giving everyone an iPad if in fact the systems that support them are not capable of providing the right information to that individual,” he said.

Examples on show at the conference suggested otherwise. An app by Belfast-based Totalmobile apparently needs no restructuring of back-end systems. It is designed to give nurse practitioners a route through their working day with full access to the necessary patient files even when offline.

Business Development Manager Fiona Conti said: “We don’t mess with back-end systems, we don’t try and create bigger silos, we pull the relevant information out and present it to the practitioner, regardless of whether it’s a housing system, GP system, or any acute or primary care system, it doesn’t matter. If we have the APIs [application programming interface] we can do it.”

A similar solution is being introduced in the Western Isles. Morse, by Cambric Systems Ltd, has been developed with the health board after the successful implementation of digital pen technology and digital wards saw face-to-face patient time increase. The board has gone from having the worst handovers in Scotland to the best in terms of patient safety, according to Dominic Tooley, clinical adviser for Western Isles health board.

“We see [Morse] as a tool which will be a virtual ward and virtual office for our community teams and we’re extremely excited about that,” said Christine Chlad, eHealth Project Manager.

Although different health board systems are increasingly interoperable, there are still differences. When social care systems are added to the mix, there are even more variables. “We don’t need another system,” said Chlad. “We’ve got systems that do what we need them to do. What we needed was something to pull it all together and allow clinicians to take it out with them.” 

Which begs the question: why aren’t all health boards doing the same thing? Health Secretary Shona Robison told the conference the “not invented here” syndrome needed to become a thing of the past. “I have made it very clear to boards in the here and now, lines on maps should not dictate their decision-making,” she said. A glimpse into the future, perhaps?