5 Key strategic principles
Six principles will underpin the programme of work which leads towards this vision:
1. Confidentiality safeguards are an obligation
The NHS cannot deliver effective care without information. In the patient's interests, there needs to be a balance between the security of information systems and health records and their availability.
Paper-based records and communication are not particularly secure, and while every effort is made to protect them they can potentially be seen by inappropriate people, and can be misplaced or lost. Electronic records and communication can address some of these issues, for example through access control measures. Electronic records nevertheless introduce new challenges relating to safeguarding large volumes of information, and such measures allow access to be restricted to authorised individuals with professional codes and contracts which prohibit inappropriate use of information.
NHS Scotland already has in place comprehensive arrangements to address these issues and support the duty of safeguarding patient confidentiality 3. We are not complacent, at a time when as we are designing new systems to improve patient care and patient safety there have been high profile breaches of information security elsewhere which serve to undermine public confidence. In this context, we regard the following as important in designing and implementing improvements:
- access to information must be based on legitimate reason and the interests of the patient
- key stakeholders are the public, patients and healthcare professionals
- eHealth currently has the support of key stakeholders, and we need to retain that support through consultation.
2. Continuing an eHealth journey, exploiting what exists and filling gaps
Our approach to introducing eHealth improvements will not be via a 'large complex national IT project'. The last decade has seen good progress by putting in place relatively simple 'bridges' between existing IT systems, and replacing many instances of paper-based arrangements with computers and telecommunications. This incremental approach will continue. We will assist in the filling of both gaps which currently exist and new gaps caused by older systems no longer supporting NHS Scotland requirements. Delivering on this eHealth strategy requires greater integration and this will be a key priority for the NHS in Scotland.
3. Focus on benefits, supported by technology and change
eHealth is not about technology, but about improving the outcomes of care, the safety of care and the efficiency with which care is provided. IT systems will not deliver these benefits of themselves. Clinicians and other staff will deliver these benefits in hospitals, in surgeries and in patients' homes.
We want IT investment and implementation to be led by this focus on benefits to NHS Scotland's patient care. Over the next three years we will increase our investment in helping NHS Boards to plan changes to patient pathways and to support change and benefits management.
We will also ensure that we improve our focus on gaining benefit from the investment we have already made as well as planning new investment.
4. Virtual, not a large single database, electronic patient records ( EPRs) in direct care
Clinicians require as complete an information picture as possible, yet relevant information relating to an individual patient is held in a variety of EPRs. In theory this could be addressed by replacing all these EPRs with a single national database that can be used by all clinicians thereby enabling them all to work off the same patient record. However, this is not the preferred strategic direction.
We envisage a clinical portal presenting information to clinicians from a variety of information systems. Once the necessary tools are procured, this should be relatively quick to set up. It will allow progressive improvement in authorised sharing of information, in line with our incremental approach. It also allows us to build experience about what information clinicians find most useful in the patient care setting.
5. Technology development, standardisation and convergence
The themes underpinning developing the technology and standards which support eHealth will be:
- focus on ease of use;
- convergence on fewer and more re-usable, cost-effective IT systems;
- integration between systems, internal to the NHS and with partner agencies where appropriate;
- common data standards and terminology across information systems;
- value for money;
- whether a national service or local choice will be considered on a case by case basis.
There will be a need for improving resilience of our IT infrastructure and ease of integration between systems, and replacement of some key national and local systems that are reaching the end of their useful life.
6. Collaborative approach to delivery, drawing on best expertise
As Better Health Better Care explains, mutual services are designed to serve their members around a common sense of purpose. This will be the hallmark of how NHS Scotland approaches improvements in eHealth, with national and local organisations working for the common good. This means that no single delivery model will suit each and every initiative. We will seek to ensure that we can draw on the range of skills and expertise from across Scotland. This will require a different way of looking at traditional roles and organisational allegiances, and the need to ensure that roles and responsibilities will be spelt out and governance taken seriously.