eHealth Aim and Associated Requirements
1. To enhance the availability of appropriate information for healthcare workers and the tools to use and communicate that information effectively to improve quality.
The vision for 2020 is that NHS Boards will build on the existing infrastructure of electronic clinical systems, integration hubs, and the adoption of portal technologies so that:
- the staff who currently record patient information on paper will have access to an effective and resilient electronic clinical system designed to specifically support them in their daily role and work caring for patients;
- the current situation where staff typically only see information recorded in their own sector (primary, community, secondary or social) which gives rise to risk for the patient and issues with continuity of care, will be addressed. Staff will have access to an appropriate view of each patient's comprehensive Electronic Patient Record, including information recorded by the patient;
- patient care processes will be supported as these systems will enable staff to refer to colleagues, triage referrals, request investigations and receive results, generate clinical correspondence, and track care and receive prompts and alerts;
- information can follow patients irrespective of departmental and organisational boundaries.
- By 2017 NHS Boards will complete making the nationally agreed 14 priority clinical information items available electronically. Additionally, over the period to 2020 NHS Boards will provide staff across health and social care with appropriate electronic access to an increasingly broad view of patient information as it is digitised to create a comprehensive Electronic Patient Record. This is expected to be through NHS Boards' clinical portal infrastructure and will include a focus on ensuring a simple, intuitive and fast interface for the use of clinicians that facilitates their work and supports safe care.
- NHS Boards will continue the process of acquiring, improving and widening the scope of their major clinical information systems comprising of their Patient Management System, Community System and Mental Health System.
- By 2017 the process to put in place a contractual environment to support the provision of GP systems, and associated integration with community systems will be completed addressing important new needs and integration requirements.
- By 2016 eHealth Division, working with key partners such as Healthcare Improvement Scotland, will sponsor development of a clear strategy and organisational arrangements for the future creation, adoption and management of clinical decision support information and tools, and the intelligent use of patient electronic information to enhance safety, care quality, and clinical knowledge and learning, ensuring a feasible, effective and affordable approach.
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.
The vision for 2020 is that:
- citizens will be able to use a patient portal to access their own Personal Health Record, and make their own contributions to the record, promoting patient ownership of their information;
- patients will also be able to access structured information about managing their health, prevention and self-management of conditions;
- patients will use secure two way electronic communication with their health and social care providers to book and manage appointments and order repeat prescriptions, resulting in convenience for patients and reduced transaction and administration costs for NHSScotland;
- patients will also be able to download their data for their own personal use in applications and devices. Again this will be intended to support health maintenance, prevention and self-management.
- *NHSScotland will continue to adopt the products and infrastructure available as part of the public sector Digital Services Strategy. Specifically, the Citizen Account system (myaccount) will be the service through which patients will authenticate their identity and register for online transactional services. The service will be developed to allow registered users to link to their CHI number which will be the key to retrieving their personal information and data;
- By 2015 eHealth Division will sponsor the definition of a national approach to a patient portal that will provide a single point of access for patients and the public to their information and digital services. A development and implementation approach and an associated business case will also be required.
- The patient portal business case and consequent development will be undertaken over the period 2016 - 2020. This will provide citizens with access to a Personal Health Record and the ability to contribute information, make use of secure messaging, and download data for their own use.
- All GP practices will be encouraged to provide online repeat prescribing and online appointment booking as online services with a view to at least 90% of practices offering this service by 2017.
- By 2017 NHS Boards will have implemented electronic communications by which correspondence with patients can, optionally, be done online thereby providing an improved service and reducing transaction and administration costs.
3. To contribute to care integration and to support people with long term conditions.
The vision for 2020 is that integrated health and social care teams that support people with long term conditions and multi-morbidities will use systems to:
- easily and effectively share information and communicate electronically to co-ordinate their activities to ensure seamless, more effective and higher quality care for patients;
- support current and emerging forms of care delivery, including single point of care community hubs, hospital at home, and community wards, that are all aiming to provide supported discharge and alternatives to acute care and admission.
Additionally, standardised models of technology enabled care, such as home health monitoring, will become available enabling patients to remain at home or in the community. eHealth services will be developed to ensure that they accommodate these developments in patient care.
- NHS Boards will continue to work with the Health and Social Care Partnerships to fully define their information management requirements and develop appropriate solutions, building on the work of the Health and Social Care Information Sharing Strategic Framework.
- The current deployment of capability to enable sharing of information between health and social care will continue.
- By 2015 Boards will have better capability to stratify their patients to identify those with multiple morbidities and long term conditions.
- Over the period to 2017 and beyond NHS Boards will develop their information systems to ensure that they support individual patient's conditions and circumstances. eHealth will have a role to ensure that the emerging technology enabled care solutions that are expected to play an increasing role in patient pathways are supported within these information systems.
4. To improve the safety of people taking medicines and their effective use.
In the period to 2017 and on to 2020:
- significant progress will be made in enabling hospitals to adopt electronic prescribing and medicines administration (HEPMA) systems. These systems will allow electronic prescribing and medicines administration processes such that the drug record is available within the Electronic Patient Record. This will allow system intelligence to be applied to prescribing decisions and monitoring of administration with risk reduction and quality of care benefits for patients;
- in addition, as an associated development, NHSScotland will develop electronic capability to support the reconciliation of patient medications across all transitions of care, in particular between primary and secondary care at admission and discharge ('Closing the Loop'). This will address a key area of risk in patient care.
- By 2015 eHealth Division will sponsor work to be undertaken collaboratively to confirm and agree a way forward for NHSScotland. This will address the medications information management vision, including both a HEPMA solution and a 'Closing the Loop' roadmap. It will also include implementation approaches, phasing and funding arrangements.
- NHS Boards will implement the agreed way forward, collaborating on all aspects where there may be advantage to NHSScotland and patients, such as common datasets, design and infrastructure, and shared maintenance and support.
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.
The vision for 2020 is for significant further development of current capability to support:
- integrated and person-centred information and intelligence to support decision making, quality evaluation and improvement, which can be used to assess performance and improve patient care;
- analysis, interpretation and use of data, information and intelligence.
There will also need to be parallel and ongoing development of information governance arrangements and patient consent models to retain the public's confidence, and to ensure it keeps pace with developments. In addition to supporting NHS related research, this infrastructure will impact positively on the wider field of informatics for health and biomedical research as set out in the recent draft strategy for this area.
- By 2015 eHealth Division will review the process for development, maintenance and use of clinical content and messaging standards and datasets in Scotland, reflecting both UK and wider international developments. This will include resource requirements and a plan for the adoption and maintenance of standards, and arrangements for ongoing engagement with suppliers in relation to this key requirement.
- By 2015 NHS Boards will assess the requirements and approach to the future use of SNOMED CT within NHSScotland eHealth systems, including engagement with suppliers regarding requirements in this area.
- By 2016 eHealth Division will sponsor work to review with key parties, including the NHS Boards, the National Information Leads Group, NHS National Services Scotland and Health Analytical Services Division, as well as with other research and industry interests, the requirements to ensure alignment between information system developments at local level, business intelligence activities at NHS Board and national levels, and the generation and maintenance of local and national data sets, and the best approach to ensuring a co-ordinated and effective information architecture, infrastructure and governance. It is expected that this will take the form of an Information Strategy for NHSScotland.
6. To maximise efficient working practices, minimise wasteful variation, bring about measurable savings and ensure value for money.
eHealth developments under the other strategic aims should make a substantial contribution to improving efficiency through making staff more efficient, and enabling better informed and more timely decisions about patient care which will increase available capacity.
The focus on enabling self-management includes a clear objective to release NHSScotland capacity for redeployment, whilst clinical decision support should also enable staff to increase their knowledge and capability to care for patients.
The vision for 2020 is that this will be reflected in a largely paperless environment. Staff and physical assets will be utilised in the most effective and efficient way, including seven day services where appropriate, as a result of increased capacity to organise, manage and control the healthcare delivery environment.
- *NHS Boards will focus on taking advantage of the economies of scale available from eHealth convergence and common infrastructure, both hardware and software, and associated benefits of overall simplification and greater resilience of the eHealth systems architecture. NHS Boards will be expected to include within their local delivery plans, and report at their annual reviews, their assessment of opportunities and progress with convergence with NHS Partners and on a regional public sector basis.
- Advantage will be taken of the annual IM&T Survey to collect information on eHealth convergence that will allow NHS Boards to compare progress and share learning. This will also be linked into the reporting of performance based on common measures and a robust annual eHealth review process.
- Implementations will focus on identifying, defining and supporting real change to care models and processes. This is undoubtedly challenging and disruptive. However, for eHealth, and in particular technology solutions to enable self-management and to impact efficiency, significant effort will be required to ensure they complement or replace existing care activities and are not just an add-on to current practices.
7. To contribute to innovation occurring through the Health Innovation Partnerships, the research community and suppliers, including the small and medium enterprise (SME) sector.
The vision for 2017 is that NHSScotland will be working in an effective partnership with the Scottish Government, the academic sector and industry, including SMEs, to promote Scotland as an attractive location for organisations active in the area of eHealth research, development and innovation. This applies to NHSScotland's existing suppliers of eHealth systems and tools, from which continuous innovation is expected, as well as other potential suppliers.
NHSScotland will continue to expect any new eHealth products, developments or upgrades to be affordable, effective and resilient, and to offer significant benefits not currently available to NHSScotland and its staff and patients. The best way to achieve this will be to involve users in the researching, planning, development and trialling of new systems and tools from the outset. It is expected that key relationships will continue to be established at international, national and local levels, with the ultimate aim of seeking additional research and innovation investment opportunities, and the momentum that can arise from a concentration of expertise within a Scottish cluster. Such opportunities will include NHSScotland involvement in consortia bidding for European Union, Medical Research Council and Innovation UK Funding.
- NHSScotland will participate with academia, the Digital Health Institute, Scottish Government, the Enterprise Network and industry partners in the definition of a strategy for research and innovation in eHealth in Scotland, including identification of the key opportunities with potential for development at scale;
- NHSScotland will undertake to engage in a structured programme of periodic meetings with the industry and its representative bodies to share information on developments, key areas of interest and critical challenges. This will include participation in initiatives to promote Scottish eHealth science and technology internationally;
- NHS National Services Scotland will co-ordinate the activities of NHS Boards on leading growth in the publication of Open Data for external use and analysis to better facilitate research and innovation;
- NHSScotland will continue to pursue the widespread adoption of standard clinical datasets and messaging standards, and will encourage, including through possible contractual obligations, the opening up of APIs on eHealth systems to allow other suppliers to provide complementary innovations. This will include recognising that patients will, over time, expect to both download their own data for personal use in applications and devices and record data that they have generated through their own personal health monitoring and assessment activities;
- NHSScotland will continue to work through the DHI, the Health Innovation Partnerships and other consortia to collaborate with commercial organisations including SMEs, as well as continuing to work directly with local partners and networks;
- The DHI and NHS national procurement will continue to act as advisers in relation to appropriate procurement arrangements and options for IP and suitable contractual terms and conditions.