Digital and data across Scotland
In this special report HTN examines the landscape of digital healthcare in Scotland now at present and for the future, as well as speaking to representatives from the Scottish Government, NHS National Services Scotland and Scotland’s Digital Health & Care Innovation Centre, to hear their views on projects and priorities.
Strategic direction
In terms of health tech and data in Scotland; we started off the year with some insights from NHS Scotland’s chief data officer Albert King, whom we have chatted to in more detail further on in this feature. Albert discussed Scotland’s approach to data and AI in healthcare and the way that data and analytics are utilised to consolidate a variety of datasets, enabling users to unlock “critical and actionable insights that can support operational improvements and patient outcomes”.
We recently highlighted the new digital and data capability framework, designed to support digital skills and competencies across the entire health and social care workforce in Scotland; and in September we looked into the strategic plan for 2024-2027 for the Scottish Cyber Coordination Centre, outlining the vision for a “digitally resilient nation”.
This year Scotland’s Genomic Medicine Strategy 2024-2029 was published, which shares plans to develop a genomic medicine service “based on the principles of person-centred care” and better enabling the use of genomic information to support disease prevention and early detection, along with the need for national digital infrastructure.
We looked into the Scottish Government’s dementia strategy for 2024-2026, with digital highlighted as one of the key thematic priorities and explored the strategic framework for 2024-2026 from NHS National Services Scotland, which sets out the organisation’s vision, values and priorities – to enable transformation by supporting the implementation of new solutions, to continually improve services, and to active seek opportunities for collaboration.
The latest updates to Scotland’s Care in the Digital Age strategy, covered delivery plans for 2024 to 2025 across digital access, digital services, digital foundations, digital skills, and data.
HTN published a key story from Scotland in May, detailing progress made towards commitments set out in the 2021 digital strategy. Insights include the investment of £430,000 from the government since the strategy’s publication to help public sector organisations in upskilling employees in cyber security qualifications; the Scottish Digital Academy delivering learning to more than 14,000 people; and the development of three common digital platforms including a cloud operations service for the public sector.
Contents
- Key focuses for Scotland: Jonathan Cameron, deputy director for digital health and care at The Scottish Government
- Insight from InterSystems: Colin Henderson, country manager for UK and Ireland at InterSystems
- How Scotland is using data for healthcare: Albert King, chief data officer at NHS National Services Scotland
- NHS Scotland digital transformation – right data, right people, right place: Identity and access management
- The innovation landscape in Scotland: Grant Reilly, Head of Communications & Marketing at Scotland’s Digital Health & Care Innovation Centre
Key focuses for Scotland
We spoke with Jonathan Cameron, deputy director for digital health and care at The Scottish Government, to find out more about his experiences and insights.
“Scotland is going into a lot of the major transformation programme with digital at the forefront of our minds,” Jonathan reflected, with focus placed on areas such as automation of administration, workforce support, better patient outcomes and better integration of services. “It’s at the heart of what we are trying to do in Scotland, in social care as well as health care. It’s important to bear that in mind; social care and social work are major considerations for us, and we need to be mindful, based on the fact that this is a joint approach with local government, that we look for integration points where we can bring services, staff and users together. We need to remove the artificial barriers between services and look at how we structure things.”
A key focus lies in bringing the workforce along for the digital journey, Jonathan shared, in terms of confidence as well as practical skills. “That applies to all levels – we’ve done a lot of work at board level around engagement and understanding, as well as working with the frontline who use these tools in their day-to-day roles.”
In terms of recent projects and programmes, Jonathan highlighted how a theatre scheduling tool has recently been launched aiming to optimise theatres and help tackle waiting lists. “We are trying to taking every opportunity to reduce the lists,” he said. “We’re seeing huge changes in this space – the two boards that we have piloted the tool in have indicated that they feel much more confident about their ability to maximise theatre time. On a financial level, it has saved millions of pounds already.”
Scotland has also passed the milestone of remotely monitoring 100,000 patients for their blood pressure. “There’s been a lot of progress with remote healthcare, which is a big consideration for Scotland because of our rural landscape. In terms of outcomes, we are seeing reductions in hospital appointments and reductions in miles to attend appointments too – we estimate that about 60 million miles have been saved in total. We very much see digital as having a role to play in helping us tackle Scotland’s carbon footprint and responding to the climate emergency.”
There is a lot of work ongoing around Scotland’s core infrastructure, Jonathan continued. “There are opportunities with new technologies with AI, but first you need to upgrade your network lengths, you need to have good broadband, you need to have the right servers and cloud providers. Some of that gets very complicated, so we have been putting a lot of thought and investment into making sure the infrastructure is in the right place, to allow us to make use of the right tools at the right time.”
On what the appetite is like for digital healthcare in Scotland, Jonathan referenced the sea change that has been witnessed since the COVID pandemic. “It was a real tipping point for acceptance of digital, for patients but also for staff; it made people realise that yes, it’s safe to use and yes, it can bring benefits. Prior to that, we did see pockets of resistance; we were already starting to overcome it when the pandemic hit, but it has really accelerated since then.”
Citizens “want digital now”, Jonathan added. “The vast majority expect it, I think, and even need it to fit in with their lives. However, we are very mindful of digital exclusion. Coming back to our remote consultation work, we have taken steps such as making digital tools or services accessible in places like libraries or town halls to help people with access. We’re conscious that not everybody can afford certain technologies or broadband, so we are trying out different methods to overcome that.”
From a workforce perspective when it comes to attitudes around digital, Jonathan reflected that the focus lies in building confidence that it is the “right” thing to do. “There’s a massive programme of work around workforce development, capabilities and digital maturity so that we understand what we are good at, what we are less good at, and what needs attention so that we can improve.”
Bringing it back to working with senior teams, Jonathan said: “We’ve invested a lot of time in getting leadership teams on board, embedding the importance of digital and also the art of the possible. We need to support chairs and non-executives to ask the right questions about digital and make sure that their organisations are moving in the right way. We have done a digital mindset course for senior execs that has been really well received.”
Strategically, The Scottish Government has set out three clear priorities when it comes to digital healthcare, with an underpinning programme. “We need to accelerate our work on citizen access to services and information – that’s our digital front door programme,” Jonathan explained. “We are deliberately going into that with the mindset that it a digital front door and health and care, because we don’t want to get siloed. Similarly, we don’t want that door to just take the form of an app; we want different channels to suit people’s needs.”
The second priority is integrating health and care records, bringing the workforce together and enabling the sharing of information. “This builds upon work we completed many years ago around our emergency care summary,” he added.
Finally, Scotland is prioritising digital prescribing, with Jonathan noting that Scotland has “recognised that it needs to be easier to access medication in a safe manner, and that there is more we can be doing digitally in this space.”
Underpinning everything, and Jonathan’s main priority at present, is that of cyber security. “It’s front of centre of everything, and trying to keep up with the vast and ever-changing threat landscape is a major challenge,” he said. “We need to make sure we are doing everything we can, as much as we can, to secure our systems and enable access safely.
What excites Jonathan in this space, on a personal level? “I’ve been in and around digital healthcare for around 20 years, and I still get amazed by the opportunities that digital and data can bring,” he said. “I’m excited to see the difference that it makes as we move in the right direction with citizen access and empower people to do more for their own health. The prevention agenda is going to be really important, and we need to support that shift is thinking. Can we use digital and data tools in a different way to encourage people to lead healthier lives? It’s about being part of the wider ecosystem that makes change for people’s lives, and that is always what has driven me.”
Insight from InterSystems
HTN also sat down for a chat with Colin Henderson, country manager for UK and Ireland at InterSystems, to discuss their projects and the outcomes they have seen in Scotland.
Colin explained how InterSystems’ work in Scotland ties into the country’s three key aims when it comes to healthcare – to give citizens more control and participation in their care, to provide the right tools and technology to record and share information in a standardised way, and to make the most of collected data for planning, research, population health management and more.
“From an InterSystems perspective, because of our installed base in Scotland, we see ourselves as a strategic partner in terms of trying to help Scotland deliver on some of the objectives in these strategic aims,” he said. “Those aims overlay with our own vision and offering as a company.”
As an example, regarding citizen access, Colin highlighted how InterSystems has been delivering its unified care record in Scotland, mainly to the east of the country. “This sews the health and care system together from a data perspective. There are lots of silos of information out there, and we bring that information together and make it visible to users during episodes of care, so that the health and care professionals can have a comprehensive overview of information to support decision making. It’s worth noting that providing the unified care record is not only about care teams viewing information, it’s also about bringing the patient into those activities as well. On the east coast, in Lothian, for example, we have enabled citizens to book their own appointments – this can seem like a simple thing to do, but it isn’t available everywhere, and just giving people the choice of where and when they might be able to get their appointment can have a positive impact for the patient.”
Another early-stage project is the MyPath cancer care project led by Edinburgh University in collaboration with Lothian Health board, which looks at the digital support of patients who have got a complex condition such as breast cancer. “Care needs can change a lot with conditions like this, and patients need a mechanism to be part of that wider multi-disciplinary team, to allow them to play an active role in decision-making around their care,” Colin noted. “We are looking at how we can use technology to support engagement and communication across the care teams, with the patient at the centre of these communications.”
Regarding the provision of tools and technology to record and share information in a standardised way, Colin highlighted how electronic patient record TrakCare is now implemented in 12 of the 14 health boards in Scotland. “It’s almost unanimous and there are a lot of benefits to that, because it means that there is a consistent product that the users are handling every day, reducing the training burden of learning to operate multiple different systems. In addition there are clear operational cost benefits of consolidating around fewer digital systems.”
InterSystems is currently working on rolling out a new user interface. “We’re very conscious of the fact that the workforce is very busy, and of challenges such as staff burnout,” Colin reflected. “We want to make the experience as seamless as possible for the user to ensure easy navigation of menus and swift access to the information needed to support staff in their roles, and accessible across a range of devices that suits the user preferences.”
Another project in this space involves supporting with waiting list management in Scotland; Colin explained how InterSystems is working with the health boards to improve board-to-board referrals across regional boundaries, enabled by the fact that TrakCare is utilised by so many health boards in the country.
“TrakCare has also extended into community settings,” Colin added. “This is advantageous as it is one care journey, really, from the patient perspective, irrespective of care setting. If we can deliver information across all care settings, it creates a more holistic view of care arrangements. In Glasgow, for example, we have extended into hospices for palliative care so that care teams within the hospital and outside it can see where the individual is at in terms of their needs and circumstances.”
When it comes to making the most of data, InterSystems is exploring how the wealth of data flowing through its systems can be utilised with from disease-specific view. “It means that care teams looking after people with a specific condition can get a view of the information they need to deliver personalised care, but it also means we can start to bring together disease-specific datasets to help with research,” he said. “We can build a data pipeline that stores that information in a way that is useful to researchers for benchmarking, and to bring in other datasets to support pharmacogenomic studies, correlating effectiveness of a therapy against different genetic profiles.”
Referencing the role of AI, Colin said: “We are working on some initial pilots – they tend to be more administrative, currently, looking at areas such as length of stay prediction, or risk of re-admittance. The wider potential is in transcribing a conversation and converting it into a structured clinical note with the right diagnostic codes, or for AI to help surface key information intelligently to support clinical workflow and processes. This will transform the end user experience, and ultimately, drive value for patients.”
How Scotland is using data for healthcare
To find out more about how Scotland is using data for healthcare, we spoke with Albert King, chief data officer at NHS National Services Scotland.
Reflecting on some of the data projects and programmes he has been involved in over the past 12 months, Albert shared that he has been working with Tom Wilkinson, chief data officer for the Scottish Government, on a horizon-scoping project. “We put out an open call inviting people to help us co-create a long-term vision for public sector data in Scotland, looking at where we want to go in the next 20 years. The creation of that vision has involved not just the public sector but the private sector, third sector, civil society; a range of organisations. We’ve had three workshops so far and heard some really good insights, and we’ve agreed on a number of principles to help shape our thinking.”
Albert said that this work is “really exciting to see” in terms of what it means for the future, and noted that “a lot of long-term investments have been building up digital infrastructure in Scotland”, such as the Researcher Access Service from Research Data Scotland in April and the launch of Seer2.
“We’re also seeing investments delivering real impact; for example the near-time data service delivered on the Seer2 platform in response to the winter plan. Part of the vision for Seer2 was that it would enable us to be more responsive and collaborate across organisational boundaries, and this service absolutely does that.”
The Seer2 platform, Albert noted, has played a role in helping work emerge practically from academia, such as the deployment of a risk prediction model developed through research. “Often, there is a lot of great research that happens in an academic context, but it doesn’t really see the light of day,” he said. “But through Seer2, we have been able to take that risk prediction work, productionise them, and deploy them. It’s about taking a spark of innovation and turning into something that will have national impact and help people.”
Albert shared that he recently attended The Alan Turing Institute’s AI conference, where he heard the estimation that “around one percent of models developed in academic context end up in something that resembles production. And I don’t really think that’s okay,” he reflected, “when you think about the investment in academia and also the data that we are working with it. It’s people’s data, it belongs to the nation. I believe we need to do better in this space; I see it as an obligation, but it’s also an opportunity, because there is huge untapped potential there.”
Albert is currently collaborating with two partners in the academic space, with a view to narrowing the gap between academia and practice. “I think we can reimagine how we approach a lot of research and innovation if we work together,” he said. “We can bring people closer to the data and shorten those timelines, and we can narrow the gap between the services that will consume those products and innovations, and the people who are making them.”
Regarding Scotland’s priorities for data going ahead, Albert commented on the need to “ensure sure that we have got the enabling underlying conditions right. From my perspective, artificial intelligence is very interesting because there is massive potential there; for my team it’s a question of how we can enable people to safely utilise the insights from AI. But it needs to be harnessed productively, and a key part of that is making sure we have the data infrastructure right. It’s a tricky balance, because I think we will only get the license to focus on the infrastructure if we continue to deliver some really impressive results in the ‘hot’ topics like AI. So finding the way to balance those two areas is something we need to work out.”
Another project currently underway focuses on ensuring that data is discoverable across the data sector, with Albert emphasising the importance of acknowledging social care as well as healthcare. “Our data strategy spans both, so we need to be able to look across both as well as wider public services and use all this data to generate insights. Also, it’s about data trust; people need to trust that the data is there to support them in their roles, and that it is high quality.”
On the topic of data trust, Albert raised the issue of bias within data and how this can be tackled. “We need to understand the data we have and the features in it, and that comes back to having the right infrastructure in place; making sure data is discoverable; and making sure that it is well-described. We need to manage tools through their life cycles, because it’s not just a case of deploying them. We need to make sure that tools continue to produce relevant results over time, as populations change.”
The final priority Albert mentioned was that of workforce identity, which he called “an enabling condition that we need to get right. We need to make sure that the right people have access to the right data – but only them.”
As for what excites Albert in this space, he said: “I’ve always been really excited in the potential of AI – my degree was on AI back in the nineties. My dissertation was on using AI for image processing. I’m particularly interested in the potential for AI to process large volumes of image data, reduce the time to diagnosis and make better use of a really skilled workforce. Studies indicate that we could release time for nearly 50 percent of the workforce and get people better results as a consequence. That’s a better outcome for the workforce because they are doing more interesting work and it’s better for patients because their care improves as a result. That’s what I find exciting in this space.”
NHS Scotland Digital transformation – right data, right people, right place - a focus on Imprivata
Identity and access management is a key element in bringing NHS and social care workforces together, and enabling the secure sharing of information for better patient outcomes. Such technology underpins the digital journey, and can enable fast access to patient information that supports clinicians while also safeguarding data.
With cost pressures increasing on all NHS Scotland healthcare services and the need to “deliver more for less”, digital is seen as a key tool to help drive efficiencies and greater productivity. Inefficient IT can become even more of a burden than no IT at all and lead to core activity taking longer, impacting those key areas that need to be addressed. However, when deployed well, the broader adoption of digital platforms drive efficiency and higher productivity. Removing barriers by streamlining the experience of the clinician at the point of care, reducing the time taken to access clinical applications and the data they contain can be a true enabler to better patient care. Indeed, NHS Scotland’s Care in the Digital Age: Delivery Plan emphasises the importance of digital transformation in healthcare.
As Jonathan Cameron mentions in the headline article, a key focus is bringing the workforce along for the digital journey. Accessing applications that clinicians need to do their job should be as transparent and easy as possible, for example, a simple badge-tap to open a patient record or a clinical application. A Once for Scotland policy in this area would ensure that every clinician, nurse, allied health professional and social care worker would access patient information in exactly the same way, from any location, delivering economies of scale as well as a better experience for healthcare workers.
Single digital identity – standardised approach for NHS Scotland
To make this approach a reality, each NHS employee would have a single digital identity, which they would prove (authenticate) with their NHS smartcard, a virtual smartcard, or a token or badge and PIN. Within this digital identity, employees are provided with role-based access, so depending which job they are performing, in which location, they have seamless access to the applications and records they need for that role at that point in time.
Using role-based permissions when onboarding new staff can reduce provisioning times from days to just minutes. As well as ensuring that clinicians, locums, or student doctors on rotation are able to hit the ground running as soon as they start work in a new location, it also saves considerable time for stretched IT staff who are freed up for more proactive work.
Role-based access supports staff mobility, enabling NHS staff to work across departments and even across different organisations, without the need to be reprovisioned each time, or to use a different form of authentication.
Time saved, user adoption of digital workflows boosted
This reduction in friction for end users when using technology not only saves huge amounts of time (numerous studies cite savings of 30 – 45 minutes per 12 hour shift), it also significantly reduces frustration, and consequently, clinician burnout.
Another significant benefit is increased user adoption for digital technologies. By making access fast and easy, saving users time, they are far more likely to adopt new workflows more enthusiastically. A prime example is the use of connected medical devices, such as those used to take vital signs for the calculation of early warning scores, and the new Hospital Electronic Prescribing and Medications Administration (HEPMA) which is being rolled out across Scotland. While improving hospital efficiency HEPMA also better safeguards both patients and clinicians, because there is a clear audit trail of who prescribed what for which patient and when.
Safeguarding systems and patient privacy
Safeguarding data and patient privacy are key tenets for digital transformation to be successful, and bring cyber security into sharp focus. Managing user access more closely, avoiding the use of general login accounts or sharing of credentials (sticky notes with passwords left in full view) and enabling fast user switching so that there is no need to share logins provides a full audit trail. It also reduces the likelihood that privileged accounts will be used for nefarious purposes, either deliberately, or because an account has been hacked.
Strong management of privileged accounts, including those of vendors and partners. is a key component for NIS2 compliance, ISO27001, CIS Controls and Cyber Essentials Plus. This helps to thwart cyber attacks because it limits the damage that a potential hacker could do should they successfully gain access to a system.
Imprivata technology is already in use in health boards across Scotland and the rest of the UK and Ireland. For more information and to calculate just how much time you could save with Identity and Access Management software please visit: https://www.imprivata.com/roi/imprivata-onesign#roi-calculator
The innovation landscape in Scotland
To find out more about digital healthcare in Scotland from an innovation perspective, we spoke with Grant Reilly, Head of Communications & Marketing at Scotland’s Digital Health & Care Innovation Centre (DHI).
The centre is a world-leading collaboration between the Glasgow School of Art and the University of Strathclyde, funded by the Scottish Funding Council and the Scottish Government. With a vision of using research and innovation in digital health and social care to create sustainable services, develop future skills and positively impact people’s lives and health outcomes, DHI works with industry, health and social care providers, academia, the public sector and citizens to create collaborations and co-design person-centred solutions. Additionally, the centre undertakes its own research, facilitates international knowledge exchange and publishes academic outputs to support healthcare wherever it can.
Grant shared some of the main programmes DHI has been involved with, including SCOTCAP – the use of video capsule technology, which patients can swallow to reduce the need for invasive colonoscopy procedures. “This particularly helps people in rural communities as they travel long distances to undergo an uncomfortable and stressful procedure. By identifying people who could benefit most from this non-invasive approach, delivered in the local community, we wanted to explore whether we could speed up diagnosis, reduce the need for further invasive investigations and of course remove the need for that travel,” Grant explained.
“In this case, the camera pill technology was already there; working with a German company trialling this technology for the investigation of large bowel disease in Denmark, we identified a research team based in Inverness that was keen to transform how patients could benefit from this innovative approach. This involved the need for careful research into clinical safety and effectiveness of the investigation, but equally importantly developing an efficient service delivery model for the delivery of a community-based service that was acceptable to patients and clinicians alike. There was also a need to develop a business model that demonstrated that this approach was affordable, but that it could actually reduce the cost of the investigation and reduce the negative impact on the environment from less use of chemicals, plastics and other items needed to deliver the more invasive hospital service. We did lots of trial work up in the Highlands with remote communities to prove that it worked, and it has now been adopted and scaled across Scotland.” Other reported benefits include enabling early and effective screening in the community; reducing the total cost of gastrointestinal diagnostics; and avoiding unnecessary referrals for outpatient appointments.
“We’re now looking at how we can use AI to improve the accuracy of diagnosis and speed up the delivery of results for the patients,” Grant shared.
DHI has a research team in place, carrying out international research on behalf of project partners; and facilitates Scotland’s innovation clusters, with a focus at present on healthy ageing and digital mental health. New clusters planned for the future include diabetes and women’s health.
When it comes to the impact of DHI’s work on staff, Grant said: “We’ve developed digital tools that have supported health and social care staff at all levels in decision-making by providing decision support services – for example, dose calculators for specialist medicines, as well as instant access to national clinical guidelines and triage and assessment tools.”
For patients, he reflected that the benefits are widespread; SCOTCAP, as an example, brings many direct benefits to patients from reduced travel to reduced stress and discomfort. “We’ve also provided products for the general public to support them in making better-informed choices with regards to their own health,” he added. “We’re very citizen-focused at DHI; everything comes back to the question of how we can support patient outcomes or experience.”
On data, Grant shared that DHI is currently working on a new approach that will aim to ensure people have access to their data and information, including “grey area data” such as insights from fitness, sleep or nutrition tracking apps that the citizen may be using themselves; but may not see themselves as in control of their data. “By blending health and care data with personal data provided by the person and their families, we can better personalise services to meet their individual needs,” Grant said. “There’s a lot of value in that data, and we want to empower patients by better utilising it. So that’s a focus for us going forward.”
On the topic of the future, Grant shared that DHI has recently been funded for a further 10 years and has developed a strategy with seven key strategic priority areas. These include supporting the transformation of health and social care; developing a digital infrastructure as national assets to de-risk innovation; enhancing Scotland’s connected ecosystem through cross-sectoral innovation clusters; developing a future skills pipeline to deliver workforce capabilities for Scotland’s future; extending commercial engagement to support economic growth; supporting health and care contribution towards net zero; and enhancing Scotland’s international reputation when it comes to research and innovation.
“Ultimately, we are bringing together the capabilities that new digital technologies can bring, with the real everyday challenges being experienced by the people of Scotland,” Grant concluded, “along with those tasked with managing and delivering services. We’re focused on designing, developing and deploying new products and services that can empower and activate people to make better-informed health and wellbeing choices, and we are focusing on prevention and keeping people healthy and happy at home and in their communities.”
