We caught up with Stephen Baguley, chief clinical digital officer at NHS Grampian, who shared with us their current digital plans and priorities. “We’ve been concentrating on national priorities like the MyCare.Scot portal that went live in April, which is, I think, a route to a much better way for people to access their data and interact with the NHS,” he said. “There’s also the National Child Health System, that offers a way to collect data about children’s vaccinations, development assessments, and so on, giving us access to that data and offering the potential to do more things with it in terms of connecting the clinical systems that health visitors and school nurses use to the national system, rather than having to update information manually.”

In terms of local priorities, Stephen shared: “A lot of what we’ll be working on this year and early next year is not particularly transformational; over the next 12 months we’re planning to replace legacy systems like our PACS, RIS, and LIMS systems, but to our patients and citizens, it likely won’t seem any different.” Setting these foundations is paving the way for doing things like automating the analysis of lab results in the future, Stephen considered, “and we also went live with Infix theatre scheduling in a few of our specialties with plans to extend that further”.

Ambient voice technology has been tested in nursing documentation at Inverurie Hospital to summarise daily check-ins with patients, Stephen told us, saving around ten minutes per nurse-patient interaction. “We’re hoping to get funding to extend that to other settings, and to trial it to speed up the creation of discharge summaries,” he added.

As well as introducing new systems and products, a focus for NHS Grampian is on getting more value out of existing investments, according to Stephen, including the MS365 suite and productivity tools such as Power Automate, Copilot, and so on. “We are constrained by funding for that,” he explained, “as we’re funded for the licenses, but not to do anything particularly transformative – we have to reallocate money to be able to access those benefits.” Another priority is upgrading servers, he continued, “and these things might not seem exciting, but if they don’t happen, then things that are exciting for the wrong reasons happen”.

Looking ahead to the next 12 months, there aren’t any ambitions to do anything major around EPR or extending functionality in any big way, Stephen considered, but the impact of the new sub-national planning arrangements is hard to predict. There are likely to be efforts to improve the productivity of staff through the use of add-on tools like ambient voice, getting more capacity for automations and Power Automate, and encouraging the use of Copilot.

Stephen said: “We’re also looking at using AI to support coding, as we’ve seen evidence it can speed up the process. In general, though, I’m keen to focus on improving clinical safety around health IT, both making sure we digitalise where it can improve care quality, and that we manage any new risks that emerge.” A clinical safety officer is to be appointed, along with a lead NMAHP for digital to support with that, he noted.

Jonathan Cameron, deputy director for digital health and care at the Scottish Government, highlighted his involvement in many digital roll outs across Scotland over the last 20 years, particularly the delivery of the Emergency Care Summary, prior to moving into his current role overseeing strategy and commissioning of major programmes such as the MyCare app. “As part of the new Government, there’s now a public sector reform cabinet secretary,” he told us, “which underlines the importance that’s been placed on that, and health and care is seen as a key area.” The newly created Public Services Delivery Scotland will be taking ownership of a lot of digital work from a national perspective, he added. 

Having recently come out of the election period, there is still a sense of ironing out what priorities might be for the coming five years, Jonathan shared. “The core aims of our Digital Health and Care Strategy remain, but there’s a real drive toward opening up information services to citizens for health and care, with a real emphasis on the care part of that, and the MyCare app will be the first big step toward that.” Other focus areas include the digital health and care record, thinking about what that might look like, he went on, “and we’re stressing very much that we want to go beyond health – integration is really important because it’s to try and reduce the number of boundaries that we have”. 

Jonathan also talked about work underway in the innovation and research space, engaging with industry, and opening up data to researchers through Research Data Scotland, a fully digitised researcher access service. He highlighted AI, acknowledging the speed with which the technology is moving has meant having to adjust and move forward “quite quickly” on things like data strategy. “I’ve been part of the MHRA AI Commission recently, considering how you put the guardrails in place and make sure things are safely done, not just for today, but for three, six, twelve months down the line,” he said. “The opportunities are there to really support the workforce and help speed up diagnoses, and so on, but we’re looking at it from a position of augmentation, support, and what we can accelerate safely.” 

Admitting that cyber is one of the areas that keeps him awake at night, Jonathan spoke of working closely with colleagues in UK Government on the new Cyber Resilience Bill, considering the impact AI might have and the technology needing to be invested in to make things as safe and secure as possible. “There are lots of other things, and we’re coming across new innovations every day. We’re certainly very keen to encourage start-ups and other companies to come and look at Scotland, because we think we can move quite quickly, and there’s lots of good data available to support that.” An AI Policy Framework has been held up by the election but is due to be published shortly, according to Jonathan. 

In terms of an area where digital has made an impact over the last 12 months, Jonathan pointed to digital dermatology and its role in reducing unnecessary referrals or speeding up responses back to patients. “A lot of what we’ve achieved isn’t visible yet,” he noted, “but we’ve done a lot of work on the plumbing – the infrastructure, the platforms, and getting the foundations in place. For example, we’ve started some really good work on CHI or NHS numbers, using those in social care to make it easier to identify patients, so when you come to the Digital Health and Care Record, you know you’re talking about the same person.” 

Reflecting on the digital health picture overall, Jonathan said: “We’ve made a lot of progress on things like our national digital platform and getting ready to put in the services on top of all these great foundations, and I think you’ll start to see that shift coming from Scotland fairly soon.” 

When we spoke with Catherine Kelly, CCIO at NHS Borders, she reflected on her experience of digital transformation in both Scotland and England. She has worked on a part-time secondment with the Scottish Government Digital Health and Care Directorate on two occasions, and has held CCIO roles in England with UCLPartners AHSN, UCLH NHS Foundation Trust and North Central London ICS.

While working for NHS Borders, Catherine also undertook a three-year part-time secondment with NHS England as clinical lead for the Data for R&D and Frontline Digitisation programmes. “I have been privileged to be involved with some major digital transformation programmes over the years,” she said. “My experience across both England and Scotland has shown that digital transformation has progressed in different ways and at different pace across each system. Returning to Scotland has highlighted opportunities to build on existing progress and further strengthen digital maturity, particularly in smaller health boards such as NHS Borders.”

Over the last two years, NHS Borders has focused on strengthening digital infrastructure and improving compliance as core foundations for transformation. This has included implementation of a new LIMS, wider use of M365 apps, deployment of a child health system, and development of Power BI dashboards to support a more data-driven approach to operational planning and improvement.

“We have also just started migration of our first few GP practices to the new GP system and are preparing to go live with the new national PACS,” she said. Catherine added that significant work has taken place over the last year to develop a new clinical strategy, with input from multiple clinical stakeholders. “Our new digital enabling strategy underpins the transformation objectives in the clinical strategy,” she said. “The main challenge for us is having adequate digital capacity to meet local demand, alongside the requirement to participate in a large number of national digital programmes which require the same resource.”

“One of the main challenges for clinical teams is having to work across several systems, rather than being able to see key patient information in one place”. Catherine said. Although NHS Borders has an EPR system in place, it is currently used mainly for patient administration and order communications, rather than real-time clinical notes and charting. As a result, acute services remain dependent on paper case records, which the health board aims to reduce over the next 12 months.

Community and mental health services use EMIS Web, while GP practices are migrating to OneAdvanced Vision EPR. Catherine noted that Scotland’s national “best of breed” approach for other applications, including EPMA, maternity and theatre scheduling, adds further complexity.

“I recognise the value an enterprise EPR would offer from a clinical and operational perspective, having been involved in such programmes in NHS England,” she said. “I would like to see NHS Scotland move in a similar direction, ideally with convergence of separate health board EPRs and improved interoperability between core clinical systems.”

Most territorial health boards operate independent digital services for staff and patients within their local geographies. This has led to local configurations of the same EPRs and clinical systems, making seamless information sharing across care settings and health board boundaries more difficult than might be expected for a country the size of Scotland.

Catherine pointed to significant variation in digital maturity across Scotland’s 14 territorial boards. “In general, the smaller the boards are, the more likely they are to be at the lower end of digital maturity,” she observed, “because smaller boards often have less overall funding available, which can make it harder to prioritise large-scale digital investment alongside other operational demands”.

The introduction of two sub-national planning groups for the East and West of Scotland could be a significant enabler of regional transformation. NHS Borders is one of seven boards in the Subnational East planning group, which is focused on supporting regional collaboration to improve how services are planned, delivered and enabled across health board boundaries.

Catherine said there are “exciting discussions about potential digital enablers for these major transformation programmes that we will deliver collaboratively at scale.” She added: “It is satisfying to be able to highlight best practice from similar initiatives in England and consider how these could potentially be implemented in a Scottish context.”

The sub-national groups are also preparing to implement a single national business system ERP to replace existing finance, HR, payroll and procurement systems. In parallel, the MyCare.scot app will provide a national digital front door for patients and citizens to access their health and care record and interact with services.

Catherine said she found the transition back to NHS Scotland challenging because the CCIO role is not widely recognised. “I think I’m the only full-time CCIO in any of the territorial boards, even though NHS Borders is the smallest mainland board, which is testament to our Medical Director,” she said.

She described the key gap in Scotland as the absence of a strong, multidisciplinary clinical voice in digital transformation. Although this is improving, she noted that clinical digital leadership still does not have the same authority or influence seen in many NHS Trusts, or at regional and national levels in England.

She also highlighted the lack of national or regional CCIO and CNIO roles and observed that few territorial health boards have dedicated clinical safety officer posts to support digital transformation.

Catherine added that health board clinical digital lead roles have often depended on short-term transformation funding, making it difficult to sustain clinical input over time. “The value of the clinical voice in digital transformation remains underrepresented,” she said. Without stronger, more sustainable and valued clinical digital leadership, she argued, Scotland remains at a disadvantage.