Posted - 20 May 2019,
My name is Dr Sam Patel and I am a consultant physician in respiratory and general medicine working in NHS Lanarkshire. I recently joined NDS as one of the team’s Clinical Leads – this blog highlights my reasons for joining the team, as well as my hopes for the National Digital Platform.
Dr Steve Baguley’s blog described the concept of a ‘single source of truth’ for information, a call echoed by clinicians and clinical informaticians as something that needs planning and effort. Currently, clinical information is tied up in various systems with poor information interoperability. And Dr Paul Miller’s blog argues the need for interoperable standards, e.g. a blood pressure recorded in one system is relatable to blood pressure measured in another.
I believe we need complete interoperability to connect our health and social care to get the full picture of our health as citizens. At eHealth events in the past, I have highlighted the benefits of connecting portals across health boards and exchanging information between GPs and hospitals as a major advance in health care delivery, but this is only achieved through the connection of silos of information from one system to another which raises its own set of problems. How would a clinician or social care practitioner know that there was information in another system to search for? What would happen if they act without the ‘undiscovered’ information? If there is contradiction, which source is right? In the past I have used the term forensic to describe how clinicians need to assemble information from a variety of electronic sources, but why describe accessing medical information for patient care in terms of detective work? Diagnosis and treatment is hard enough without adding barriers.
So how did I end up working in digital health? My interest in technology reaches back to early childhood, being taught to code on my Sinclair ZX81 by my uncle whilst he was studying computer engineering, and though my productive coding days have passed, I always maintained my technical skills and understanding. This brought me into the world of clinical informatics 7 years ago, driven by the need to address real problems for frontline doctors. During that time, I led a Scottish Government commission into how we can improve electronic communication of medical information between GPs and Hospital, as well as continuing my work across various national and local digital projects whilst completing my MSc in Global eHealth at Edinburgh University. Last year, I also completed my contribution to the Digital Health and Care Strategy as part of the advisory panel. All of this whilst being a full time clinician in a busy district general hospital.
What have I learned? Technology has undeniably revolutionised a lot of frontline care - from radiology to laboratory tests and the presentation of information from diverse sources through tools, such as clinical portals. However, this progress is far from consistent and does not meet our ambition to integrate health and social care information in Scotland.
We know that technology in healthcare is difficult and is rarely done well - anywhere in the world. Interoperability is crucial, but clinical processes need to change in synergy with new technology. Trying to do the latter without clinician involvement and leadership usually fails. These themes were reflected by the expert advisory panel for the Digital Health and Care Strategy for Scotland published last year. A major shift was to put the citizen at the centre and this is important. We need to be able to delivery care efficiently and effectively, for that we need usable IT systems, but we need to do this in partnership with our citizens.
We need to empower citizens, by providing individualised relevant and appropriate information on how to be healthier and how small changes can avoid ill health later in life. Our citizens are already searching for this information themselves, why not provide a reliable accurate source? These are not new concepts and are encapsulated in detail in the Health Literacy Action plan, part of Chief Medical Officers Realistic Medicine program.
Why has my focus expanded beyond the pressures of frontline clinical care? The future of medicine will not be solely driven by the results of huge clinical studies applied to individual patients. It will be precise and individually decided based on genetic, environmental and personal data. If we are unable to collect, store and link these disparate sources of data in a meaningful way then we will never be able to deliver these benefits. The design of the National Digital Platform aims to achieve these goals and will enable the sharing and re-use of data across health and care settings for the delivery of efficient and usable systems in the near future. It will also enable the long-term goals of learning health systems and precision medicine for the treatment and prevention of disease.
These are the reasons that clinicians like me take time from treating patients to work in the field of clinical informatics. It is the reason that I joined the team at NDS and I am grateful that I am not alone since the task to deliver this future will not be easy.
Dr Sam Patel