Hansard

I welcome this debate on the important role of information technology in improving the safety, effectiveness and efficiency of care. I hope that I will be able to address many of Christine Grahame’s points and questions. She described the report as worthy, but she also said that it is important. The Scottish Government is clear about the value of investing in e-health measures and set out its agenda in 2008 with the launch of the e-health strategy. That agenda is developing to support the implementation of the quality strategy.

Our approach has been to build on previous successes in NHS Scotland, of which there have been many. For instance, a European Union review of the emergency care summary concluded last year that NHS Scotland’s approach provides a lesson for all health services.

Our strategy is to make incremental change to support the progressive convergence of systems, while avoiding overcentralised approaches. Many members will have seen in reviews of health IT programmes in England the criticism that those programmes are highly centralised. I am pleased that the Health and Sport Committee broadly supported NHS Scotland’s approach: the Scottish Government recognised the risks in the centralised approach.

The Health and Sport Committee took evidence on developments in the clinical portal and telehealth and published its welcome report in May. The report contained several recommendations and I will let members know what has been done to address them.

Christine Grahame offered a good definition of a clinical portal. I would describe it as a window on a clinician’s computer that allows them to view defined information about their patients in a virtual electronic patient record that is drawn from information that is held in different clinical IT systems. I do not know whether that definition is better, but it is different. Perhaps the definitions taken together provide clarity on what we are talking about.

Our strategy seeks to avoid setting up a large national database of clinical information. Instead, the portal, or window, assembles relevant information for the clinician from different sources at the point when the information is needed. I have seen the British Medical Association’s briefing for the debate: I am glad that we agree that that model is right. I am also glad that we agree that better access to such information will support improved care delivery and decision making, and that patients can be reassured that clinical staff have the information that they need to provide safe, effective and efficient care.

NHS boards fully support the development of the clinical portal. The fact that they are in different positions technically argues for a flexible and incremental approach to delivery. Boards have organised themselves into three regional groupings, two of which—the north and the west—include boards that already have portal investments. The south and east of Scotland boards commenced work on shared arrangements first and have developed a working portal prototype that was well received by clinicians. They are now developing the business case for procurement and an implementation plan. The west and north of Scotland boards have assessed the existing portal technologies in their areas and are working up proposals for sharing.

The committee’s view was that there should not be a lot of different clinical portals. The Scottish Government and senior leaders in NHS Scotland share that view. We will look for the optimum path that produces results quickly, most cost effectively and with the maximum local support for implementation. We expect that to lead to a maximum of four technical solutions, including the two existing developments in NHS Greater Glasgow and Clyde and NHS Tayside, to which Christine Grahame referred.

The clinical change leadership group is considering standardising the presentation of information to clinicians. Increasingly, NHS Scotland solutions will use the powerful new integration tool Ensemble. That will provide the nationally agreed engine that will support sharing across NHS Scotland and initiatives such as the portal. I say “engine” because it is very much under the bonnet: the clinician will not see it but it will help to enable what they see.

The focus on the underlying integration of NHS Scotland IT systems will be a building block of future IT developments. It is important that if we need a reminder of how useful clinical portals are, we need only look at the growth in their usage. One example is the NHS Greater Glasgow and Clyde portal. Last summer, the portal was used to look up about 1,500 test results a week. In the first week of September this year, 180,000 documents were accessed and the portal had around 6,800 active users. That tells us that clinicians like it and, more important, that they are using it.

The portal is not intended as an access point for all the information about a patient that the NHS holds. A survey of clinicians was undertaken in which they were asked to rank the pieces of information that are of most use to them when seeing a patient. The clinicians identified consistently 14 types of key clinical information. Those first types of available information in the clinical portal include such things as current medication, test results and clinical letters. Information items from the top 14 that are harder to get or are not held electronically at the moment will be introduced incrementally so as not to hold up clinician access to information that can be made available quickly. That way of working is entirely consistent with the e-health strategy.

Working incrementally, we are seeking to build on what is already available and take it forward in a pragmatic way that delivers value for money and is developed as close as possible to the front line. In recent years, all our major IT systems have been developed along those lines. For instance, the new patient management system is the product of NHS boards working closely together. That has produced strong board commitment to delivering the benefits of the investment. By working together, the solution was delivered more cost effectively than was predicted for a centrally led alternative approach.

A key issue for the committee was the strength of safeguards in the system to protect patient confidentiality and ensure that information can be accessed only appropriately. On many occasions, I have said that the Scottish Government regards safeguarding patient records and confidentiality as being of great importance. That is true regardless of whether information is held on paper or computer. Confidentiality is important not only because of legal and professional duties, but because it sits at the heart of the relationship of trust with patients that is vital for effective care.

The Scottish Government is developing an information assurance strategy in which we are building on successful existing work to improve information governance. It will bring together important issues about the availability of information and business continuity, and how we deal with confidentiality. It will retain a strong focus on awareness and staff behaviour: it is as much about pieces of paper and staff conversations as it is about accessing IT systems.

We have also revised guidance on records management: “Records Management Code of Practice” was issued to NHS boards in August 2010, and we are consulting on final revisions to the code of confidentiality, which I anticipate being made available to boards at the end of the year.

Of course, the e-health programme is also focused on improving IT systems. Plans to improve board capacity to audit and control access to IT systems on the basis of staff roles are well advanced. I referred earlier to the British Medical Association briefing. I believe that the BMA will be reassured that our actions in this area are exactly what it and other clinicians are calling for.

We are also addressing guidance information for patients. Health rights information Scotland has been commissioned to produce a leaflet and video clip for patients on e-health and its implications for the service that patients receive from the NHS, and on how their information is stored and shared safely. Related, extensive stakeholder consultation and user testing are under way.

I turn to the other theme of the Health and Sport Committee report: telehealth. Good progress is being made on telehealth-related activity. The committee is well aware of the work that the Scottish centre for telehealth undertakes. The centre was established in 2006 to provide advice to NHS boards as they sought to realise the potential of telehealth products. It has carried out a number of pilots. That said, the inquiry heard of frustration at the lack of conversion of pilots into mainstream services.

The Scottish Government shared those concerns and initiated a review, which was commissioned in January 2009 and reported in August 2009. A key recommendation of the review was to bring the Scottish centre for telehealth into NHS 24. That transition took place on 31 March this year. NHS 24, as Scotland’s key telehealth provider, will use its expertise to provide a national focus for telehealth-related activity.