Posted - 28 March 2019, Steve Baguley, Clinical Lead - NES Digital Service
Dr Steve Baguley is a consultant Sexual Health & HIV Physician and Clinical Director of eHealth for NHS Grampian. He recently became one of the Clinical Leads for NES Digital Service (NDS). In our latest blog, he writes about his motivation for taking on the role.
Inverurie station can be a cold place at 6am. The waiting shelter provides little protection from storm Charlemagne and my platform companions and I eagerly await the arrival of the train south. Getting up at the back of 5am isn’t the reason why I wanted to work for NES Digital Service.
Since qualifying as a doctor in 2004 and working in Scotland, England and Australia, I have often reflected on the systemic duplication of information in the multiple records kept about a patient. The partial medication lists, vaccination history, diagnoses and problem lists; the sketchy information on a patient’s social context and what their priorities are; and the repeated interrogations and investigations that patients experience while we clinicians attempt to plug our information gaps. The patient often has the best record of this information of course, but they’re usually unable to access our records to keep us right.
From the perspective of 2019, it’s obvious how this fractured information landscape holds back health systems that are attempting to achieve the Quadruple Aim - the aim of achieving better outcomes at lower cost while providing a good experience for citizens and employees. This is hard to deliver when information management is so inefficient.
Simplistically, there are three approaches to this problem. One is to create an access point to view the information held in multiple locations. The information – such as the problem lists, stays in those locations but is at least now visible to someone who needs to see it. This is the classic ‘portal’ approach. The second approach is to shuffle data about between systems. If I record that a person has had their appendix removed in the records software that I use, it will then be pushed to appear in the record of that person’s GP. This is known as interoperability and relies on commercial software providers happily agreeing to store information in similar ways and for that information to be pushed and pulled around the place in a standard way.
My vision, and that of many clinicians, is of a third way – a future where we have one version of the truth: one medication list, one record of diagnoses and procedures, one place for documents and one place for observations and investigation results. In this future the health or social care practitioner, whether they’re a community podiatrist, a homecare provider or an ENT surgeon will be able to see most of the baseline information they need before they see the patient. All observations – Blood Pressure, weight etc, will appear in a timeline regardless of who took them – citizen included. And the citizen will have full access to all this information.
The data will be standardised and interoperable of course – for example, when a patient moves overseas, but within the nation there will be no need for portals or interoperability wizardry. The data will be at the centre and applications of various sorts will be used to view and contribute to the record as needed.
A health or social care consultation can then be focused on the problem that the patient has come in with. Role-based background information, relevant for the reason for attendance, will be available to the practitioner, rather than them needing to spend time gathering this. By having access to, and the ability to contribute to, their/our healthcare information, citizens will develop a greater sense of agency; a sense that our health is our problem to own and that we’re in the driving seat. This can have a positive psychological effect.
Of course, this is a complex area. Not every health and care provider needs to see everything. The significance of a Blood Pressure reading taken during a hospital admission is different from one taken by a patient in their home. There will still need to be periodic sense checks of the information in a record – is this person really allergic to penicillin? One risk of a single record of truth is that when it contains fake data there’s with nothing to compare it against. All these are important considerations, partly to be addressed by training, professionalism and legislation and partly by having a data model that’s designed with these complexities in mind.
And this brings me to the reason why I wanted to join the NES Digital Service. NDS has been given the commission to build a National Digital Platform for Scotland; collaborating with a few key organisations, but with NDS acting as chief architect and steward. And it’s the National Digital Platform that has the best chance of delivering the vision that I, along with many other clinicians and patients, want to become reality. Some of the architecture and technology has been discussed in previous blogs and more detail will be shared as the collaboration continues; in particular the requirements for those wanting to connect novel services and products to the platform.
For now, my focus is on using my privileged position in NDS to guide the National Digital Platform, so that it can help Scotland achieve the Quadruple Aim. And that’s worth the occasional morning standing on a cold, dark and windy station platform.
Dr Steve Baguley