Posted - 18 April 2019, Dr Alistair Hann, Chief Technology Officer
I don’t seem to last long before hearing about how some company or organisation is building a ‘platform’, but what do they mean by that term? From the analogy, we might guess that a ‘platform’ is something you can put other things on top of, so that they are elevated to a better place. In the case of the National Digital Platform for Health and Social Care, it is something to support building new applications and doing research.
That is still rather abstract, so let’s be explicit about what our platform needs to do: supporting applications that create and retrieve records of what happens in clinical practice and social care. Whether that application is recording treatment following a trauma, allowing citizens to manage their own chronic conditions, or a carer recording giving medication to someone in their home.
Those records are built up from facts - here are some examples:
In each of those examples it comes down to a record of: who did what relating to whom, and where.
To build a system that does that, we need components to do each of these jobs:
- Who - identifying the person adding to the record – i.e. a member of staff or a citizen.
- What – an action - e.g. a clinical measurement, care task
- Whom – the person the action relates to, i.e. the patient or care recipient
- Where– the location of the event, e.g. pharmacy, dentists’ practice, at home
To provide the ‘who,’ we need to be have an electronic identity for all staff across health and social care, and to be able to authenticate against that (is the person who they say they are). The use of Office 365 across NHS Scotland provides us with an opportunity to do that, as it will be sitting on top of a single staff directory. In Local Government, there is also ongoing work to align how staff identity works, and we will integrate with that. Separately, there is ongoing work in Scottish Government to produce new online identity assurance and we can use this to enable citizens to securely access their care record online and contribute to it.
The ‘what’ is complex – health is a huge domain, there are over 30,000 different clinical data points. We only want to define those data points once, and we need a place to record these facts. That is the job of a ‘clinical data repository’ (CDR) and we are using one that implements the openEHR standard. The advantage of the standard is that all clinical knowledge is modelled once, globally, by clinicians and it can then be used to capture data in a consistent way, regardless of the application it comes from – the alternative is that clinical knowledge is defined repeatedly, differently, in every system. It also captures data in a way that it can be re-used, avoiding asking people the same questions repeatedly.
The ‘whom’ is about a patient identifier – Scotland already has one of these, the ‘CHI number’. The system that stores and assigns those identifiers is called an ‘Enterprise Master Patient Index’ or EMPI, and that system is currently being upgraded.
The ‘where’ is captured in a number of systems in Scotland already, for example NHS 24 provide a directory of care locations and the Information Services Division also publishes National Reference Files of locations.
With these four components, we can start building applications and support other projects. The first application we have built helps people express their wishes for what happens to them if they are unable to express those wishes at the time. To find out more about that, take a look at our previous blog outlining our first product.