1 Executive Summary
The 2011-2017 eHealth Strategy included a commitment to undertake a review and refresh of that document in 2014. During the period since 2011 there have been significant developments. The Scottish Government's 2020 Vision now provides the key context for health services and for implementation of the Healthcare Quality Strategy. Together they set the strategic narrative for NHSScotland and for eHealth. In addition, the publication of Scotland's Digital Future: Delivery of Public Services has set out a collaborative public sector approach to ICT and a focus on the needs of citizens. More recent developments have increased the emphasis placed on health and social care integration.
This document is the refreshed 2014-2017 eHealth Strategy. It reflects developments since 2011 and includes a perspective out to 2020. Not unexpectedly, it retains a significant focus on healthcare and the needs of NHSScotland. However, it is important to note that the strategic direction in Scotland is towards the provision of integrated health and social care, and this will be reflected in the future development of eHealth. Associated with this will be a further shift in focus from the internal needs of NHSScotland towards joint requirements with local government and third sector partners, and, in particular, the expectations and requirements of citizens and patients for electronic information and digital services.
NHSScotland has made significant progress on developing an interoperable and clinically rich eHealth ecosystem, covering local and national needs, by taking an incremental and pragmatic approach which makes best use of historic investments, while focusing on developments that directly support safe, person-centred and effective health and care. The current position compares well with similar health systems and has been delivered at reasonable cost. Whilst these achievements are substantial, there remain significant challenges and opportunities for eHealth over the coming period. These challenges include:
- reducing variation in infrastructure and applications, and maintaining the resilience of systems that now need to be available 24/7/365;
- ensuring the availability of funding for replacement and modernisation of existing systems;
- filling gaps in electronic information coverage and systems integration (the most significant being community systems and HEPMA);
- providing citizens with the means to access their health and care information, and utilise secure interfaces between consumer health and care products / tools and core health and care information systems;
- building greater capability for clinical and business intelligence;
- further developing information governance so as to balance the need to protect the confidentiality of patient information with the need to share information in order to provide integrated care.
These challenges and opportunities make on-going investment and support for eHealth essential, although, it has to be recognised that NHSScotland remains subject to significant financial pressures and other demands for its resources.
This eHealth Strategy is supported by a separate eHealth Finance Strategy and an eHealth Technical Strategy, and the various delivery programmes are set out in an eHealth Business Plan. These will form the basis for national and local work with the NHS Boards to ensure affordable eHealth plans that focus on the strategic priorities and are cognisant of the need to deliver operational efficiencies that can help to alleviate the pressures on service delivery.
The eHealth Vision
The revised vision for eHealth in Scotland is shown below.
The eHealth Vision
By 2020 eHealth in Scotland will:
- Enable information sharing and communications that facilitate integrated health and social care across all settings from the patient's home to the hospital.
- Provide information processing, analysis and intelligence that supports and complements the work of health and social care professionals and improves the safety and quality of care.
- Support people to manage their own health and wellbeing and live longer, healthier lives at home or in a community setting.
- Contribute to a partnership between the Scottish Government, NHSScotland, the research sector and industry to enable Scotland to be a long term leader in digitally enabled care.
The eHealth Aims
A set of six eHealth Aims were developed as part of the 2011 eHealth Strategy. These remain appropriate for the next period of eHealth development and, together with a seventh aim specifically in relation to innovation, are consistent with the 2020 Vision. These aims, which reflect the business and clinical needs of NHSScotland, are shown overleaf.
The eHealth Aims
1. To enhance the availability of appropriate information for healthcare workers and the tools to use and communicate that information effectively to improve quality.
2. To support people to communicate with NHSScotland, manage their own health and wellbeing, and to become more active participants in the care and services they receive.
3. To contribute to care integration and to support people with long term conditions.
4. To improve the safety of people taking medicines and their effective use.
5. To provide clinical and other managers across the health and social care spectrum with the timely management information they need to inform their decisions on service quality, performance and delivery.
6. To maximise efficient working practices, minimise wasteful variation, bring about measurable savings and ensure value for money.
7. To contribute to innovation occurring through the Health Innovation Partnerships, the research community and suppliers, including the small and medium enterprise (SME) sector.
Achievement of the 2020 Vision for eHealth is expected to result in substantial benefits for citizens, patients and health and social care staff as follows.
Citizens and Patients, in addition to their face-to-face care, will be able to:
- use a patient portal to access their own Personal Health Record and make their own contributions to the record;
- have structured access to information about prevention, managing their health and the availability of relevant health services, and a route to access peer and community support, for example as currently being trialled through the Living it Up programme;
- order repeat prescriptions and book appointments online and use secure two way electronic communication with their health and social care providers to receive information, make enquiries and track their care arrangements;
- access a portfolio of proven technology enabled solutions, such as home health monitoring, tailored to match individual patient's condition(s) and circumstances. This will enable them to undertake a much larger role in managing their own health care.
Clinicians, Social Care Staff and other third sector partners will be able to:
- quickly access at the point of care an Electronic Patient Record that provides the information that they need to make their contribution to the patient's care within the context of the wider health and social care team;
- electronically record their findings, and share these with the rest of the care team, and quickly and easily initiate care processes, such as investigations, referrals, and treatments, and generate clinical correspondence. Workflow will co-ordinate the inputs of other staff and monitor the patient's progress;
- have quick and easy access to increasing amounts of clinical guidance and decision support that is relevant to the specific patient context, including highlighting any substantial variation from expectations, and generating appropriate prompts and alerts.
Managers, Planners and Researchers will have:
- better access to appropriately anonymised and summarised data, arising from the myriad of patient contacts taking place across NHSScotland, that will enable individual and teams of clinicians to analyse, better understand and improve their clinical practice;
- support from immediate information that enables them to take operational decisions on an hour-to-hour and day-to-day basis that can improve patient flow and the management of outpatient, inpatient and community services;
- a greater capacity to analyse and understand specific patient populations, whether by geography, age group or condition(s), and undertake risk stratification and predictive analytics that can inform prevention measures and early intervention with a view to improving health and reducing unplanned admissions.
As a result of the above, eHealth will contribute towards a continuing shift of the location of care along the spectrum from acute hospitals towards the patient's own home, with eHealth support for community health and social care teams and capabilities to support self-management such as remote monitoring and teleconferencing. eHealth will enable care and treatment to be more personalised and continuous. People will be healthier for longer and when they have health problems these will be predicted and managed more effectively and more efficiently, benefitting not only the patient but also the overall sustainability and total capacity of the health system.
Email: Alan Milbourne