Hansard

The subject matter of this debate is the use of technology, but the committee’s report is really in two distinct parts. The first part considers a single patient record portal and the second part considers e-health. It could be argued that the first issue is very much part of the second issue, but they were separated because of the way in which we took evidence. I suppose that the first part is to do with an administrative system and the second part deals with direct patient care. As technology grows, we will need to look at all the various aspects of e-technology and perhaps break them down further into groups such as paediatrics and elder care.

I will talk about the portal first. I was struck by several issues, including the fact that there is a myriad of IT systems in the health service. There are different systems in use not just between health boards, but between departments in the same hospital. That means that information cannot be shared among local units, far less among health board areas. Important information being unavailable caused slow diagnoses and repeat tests. Sharing information among health board areas is desirable, given that people are more mobile and that such information could be life saving. We also need to look at the huge waste of resources that occurs when tests and results are duplicated because they are not accessible to different departments in the same hospital.

The evidence that we took shows that GPs appear to have the most comprehensive patient records, but even they do not form complete records and they are often held in paper form. Common sense says that there should be one system for the same health board and the whole health service in the country. England and Wales have taken that route, but we discovered that they had hit complications. The Scottish health service therefore went in a different direction.

A number of Scottish health boards have been developing versions of a portal that can interrogate different systems and pull forward certain essential information, but there are patient confidentiality concerns that relate to that model. Members have talked about shared log-in details and passwords. They are essential in our health service because of the time delays that there are in issuing new passwords and log-in details, given the use of locum and bank staff. We need to consider ways of eliminating those delays from the system.

The best audit process that I can see, having followed the evidence, is to give patients access to their records and to have those records include an audit trail of who has accessed them. Before we do that, we must be sure that the log-ins and passwords are not shared, that patient access is secure and that people can access only their own record. However, those problems should not be insurmountable. The situation would certainly not be tolerated in any other business, because of the inherent inefficiency of people searching for information and running duplicate tests.

That ties in with an issue that I have raised with NHS Highland regarding the transmission of laboratory results. Ideally, they should be transferred electronically in a format that can be incorporated into GPs’ computer records automatically. However, currently, the results are transferred in paper form. They are printed out in the lab and posted to GPs, who then have staff inputting the results at the other end. I intervened and asked for the process be changed. I have been told that lab results will be scanned at the lab and sent electronically to GPs. That will speed up the transmission of the information, but it will not create greater efficiency for staff, because someone in the lab wiII have to scan the information and someone in the GPs’ office will have to put it on to the computer system in a way that can be interrogated to show patterns.

I move on to e-health more generally. It is timely that Liam McArthur will speak next, because I was up in Orkney recently and was shown round the Balfour hospital in his constituency. I was impressed by the videoconference facilities in its accident and emergency department. Local staff can pull in expert opinion that allows them to make decisions about a patient’s further treatment. Remote areas are much keener to incorporate e-health, but they need buy-in from the specialists. That is happening, but it must become the norm.

Like Mary Scanlon, I am concerned that the Balfour hospital is the only rural general hospital in Scotland that does not have a CT scanner. As she said, such a scanner is essential for stroke care, but it can be used for many other problems. A scan can inform whether someone can be treated locally or should be referred for more specialist treatment at another unit. That can be done by sending scans electronically. When I was in the Balfour hospital, I was told that another benefit of a scanner is that it can inform staff if a patient is untreatable. In a remote community, that information can save patients who are in their last hours from being moved from hospital to hospital without their family around them and without the support that their friends can give them at that terrible time. It means that precious remaining hours can be spent with loved ones, rather than chasing round the country.

We need to use technology to reduce hospital stays. Pre-operation checks should be done as close to home as possible. DanMedical has pioneered equipment that can be used to carry out those checks at home. Doing so can shorten hospital stays and reduce the number of last-minute cancellations. Currently, in remote communities, pre-op checks might mean an additional day in hospital if someone needs to be checked the day before their operation and cannot return home. That leads to cancelled operations when there are complications. The use of technology could build efficiency into the system.

There are many more issues that I could talk about, such as care in the community. Mary Scanlon talked about Argyll and Bute. There are issues about treating people with Alzheimer’s in the community and ensuring that people are safe at home. Helen Eadie talked about the eye screening pilot in Fife. I am glad that, after I raised that issue with NHS Highland, it agreed to consider whether it can implement such a programme.

We have some way to go with e-health. We began the journey many years ago, but we have not travelled far. The current IT systems are not fit for purpose, so making them appropriate for modern use must be a priority.

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