We must accelarate the move towards eHealth solutions

If there is a single message to be taken from Holyrood’s recent eHealth Scotland conference, it is that while good stuff is happening in terms of digital responses to some healthcare challenges, we must accelerate the rate of change.

Speaking at the conference held at the Glasgow Hilton Hotel on 25 and 26 February, Professor Andrew Morris, Scotland’s Chief Scientist and Director of the Institute for Population Health Sciences and Informatics at the University of Edinburgh, said: “There is a window of opportunity for Scotland to be world-class at this. But I do worry about pace.”

He is not alone. Almost every speaker to step up to the conference podium referred to the necessity for action.

Cabinet Secretary for Health and Wellbeing, Shona Robison MSP, summed up why it matters: “Health and care services worldwide are facing demand, capacity and resource challenges. Technology-enabled service redesign must be at the heart of delivering the 2020 Vision which is that everyone is able to live longer, healthier lives at home, or in a homely setting.”

The Cabinet Secretary outlined her belief that digital technologies provide real opportunities to deliver safer, more person-centred and more effective care.

“The Scottish Government has made a commitment that by 2020 there will be a personalised digital health and wellbeing record available so that everyone is enabled and confident to digitally access and jointly manage the health and care information that is important to them and their wellbeing,” she said. “I have asked for an increase in pace in our ongoing work in giving patients digital access to the more common services such as booking appointments, ordering repeat prescriptions and receiving correspondence electronically.”

In the Scottish context, eHealth is defined as the use of information, computers and telecommunications (ICT) to meet the needs of individuals and improve the health of citizens. It is also the overarching term that encompasses telehealth and telecare, telemedicine, digital health, mobile health and health informatics. 

Eddie Turnbull, Head of eHealth at the Scottish Government, reflected on the progress made to deliver the national eHealth strategy 2011-17.

“Technology-enabled service redesign must be at the heart of delivering the 2020 Vision which is that everyone is able to live longer, healthier lives”

“We are in a good place as regards eHealth in Scotland, but there is still much to be done,” he said. “Taken in combination, NHSScotland represents one of the largest ICT systems in Europe, if not the world. Yet there are very few examples of citizen online access to healthcare services.” 

That is why, mid-way through its span, there is to be a refreshed strategy. This recognises the pivotal role that eHealth has at the centre of service transformation as a catalyst for service change.

It is widely acknowledged that services have to change because of intensifying financial pressure, an ageing population and to address health inequalities. Integration between health and social care also requires dedicated ICT support to facilitate effective partnership working at local, regional and national levels. The implementation of the Scottish Wide Area Network (SWAN) will allow information to be shared between public bodies for the first time and in order to maximise its potential, the use of eHealth has to escalate.

That is why a new strategic aim has been added to the original six aims of the eHealth strategy, ‘To contribute to innovation occurring through the Health Innovation Partnerships, the research community and suppliers, including the small and medium enterprise (SME) sector’.

There is top-level recognition that NHS Scotland cannot hope to realise the benefits of eHealth by working in isolation. The expertise of the industry is vital to support innovation, developed in partnership with frontline clinicians.

The conference’s breakout sessions offered delegates the opportunity to explore ICT solutions being developed as pilots in various settings. Barriers to wider roll-out include what one presenter described as ‘technological bigotry’, meaning that wheels are sometimes reinvented simply because of rivalry between health board areas. 

Confusion about data governance and information-sharing protocols is also identified as a block to wider implementation, and definition of governance arrangements from the top was urged, to facilitate cascade and prevent consequent hold-ups. One speaker referred to data protection ‘duck-outs’, often used as an excuse for delay.

Speaker after speaker highlighted exciting innovations on the horizon that hold transformational promise, such as contact lenses that can monitor blood glucose levels.

Justene Ewing, Chief Executive of the Edinburgh-based Digital Health Institute, urged delegates working across academia, industry and frontline care to collaborate closely to innovate, improve the experience of patients and boost the Scottish economy at the same time. £150m has already been invested in innovation centres to support this.

“People understand the necessity, they like innovation and technical solutions”

The conference’s second day started with a focus on patient information. Maureen Falconer, Senior Policy Officer with the Information Commissioner’s Office in Scotland, described the priority being placed on data protection internationally. She urged organisations involved in health and care integration to seek advice about how to safely share data for wider benefit.

Dr Scott Cunningham of the University of Dundee demonstrated the award-winning ‘My Diabetes My Way’ website that allows patients to access their information online, and promotes self-management. The shared electronic record principles that underpin that website are replicable to other chronic conditions.

Dr Claudia Pagliari, Senior Lecturer in Primary Care at the University of Edinburgh, is an expert in analysis of eHealth risks and benefits.

She acknowledged that while the data ecosystem is growing, some clinicians are cautious about widespread adoption of the personal health record (PHR). “The evidence base for the PHR in terms of prevalence and impacts is weak,” she said. “There is some work taking place in Europe, but none in Scotland.” 

Innovation in eHealth breakout sessions included discussion about electronic medicines communication that is bridging the gulf between hospital and community, and an explanation of Scotland’s Infection Intelligence Programme that is proving its worth by preventing illness and saving lives; while speakers from NHS Ayrshire and Arran profiled the ‘Ayrshare’ system that is designed to promote inter-agency information exchange for child protection.

The conference’s final session featured a presentation by Raul Mill, a member of the management board of Estonia’s eHealth Institute, who shared his country’s personal held record.

Every Estonian has online access to their own PHR, and it is the individual citizen who decides to whom they grant viewing permission: the vast majority give access to all involved in their care. 

Patients can easily see who has looked at their records, and monitor activity relating to all their health and care, no matter where they are in the world. Culturally, in Estonia, there appears to be less concern about the security of eHealth data than is typical in Scotland.  

The conference closed by hearing the perspective of eHealth clinical leads: Eunice Muir, representing Nurses, Midwives and Allied Health Professionals and Dr Paul Campbell, Consultant Anaesthetist and retrieval medicine specialist, who is the newly-appointed Chair of the Clinical Change Leadership Group, the national eHealth committee of all Scotland’s clinical eHealth leads. 

They described eHealth successes, the work that is taking place to develop it in frontline settings, and the clinical enthusiasm for it that is growing here. 

“People understand the necessity, they like innovation and technical solutions,” said Dr Campbell. “Many also appreciate that eHealth systems are much more secure than paper documents in hospitals.”

And that is a message that needs to be shared more widely. 

For more information on Holyrood's upcoming Telehealth and Telecare conference, click here.