Boundaries should not be barriers

April 9, 2018 Colin Gray

Scotland is a country of contrasts, a highly populated central belt where the majority of the population live, but also with vastly dispersed rural localities. One of the biggest drivers for digital health in Scotland has been cross-boundary care across this diverse geography. It seems to be an obvious problem with a seemingly simple solution – share health information electronically.

In the central belt, often a patient living near the boundary of a health board may actually be geographically closer to the regional hospital than their own. Conversely, patients living in remote rural or island communities may have to travel significant distances to access specialist healthcare facilities. Boundaries should not be barriers for patients visiting, say, Golden Jubilee National Hospital for a hip replacement, or the Beatson Oncology Centre for specialist cancer treatment. Regional, and indeed national, sharing of information is therefore essential if connected care is to become a reality around the world.  

In 2011, the Scottish Government implemented an eHealth strategy to enable better communication and information sharing for both patients and clinicians across the country. Their vision for 2020 is to incorporate health and social care providers into digital health initiatives, giving clinicians a more holistic and detailed picture of a patient no matter where they are in Scotland.

Through Orion Health technology, five boards in the West of Scotland have been able to join up their clinical portals to enable access to patient information across a region serving 2.2m patients. NHS Dumfries and Galloway joined NHS Greater Glasgow and Clyde, NHS Lanarkshire, Golden Jubilee National Hospital and NHS Ayrshire and Arran as the final board in July 2017. This has contributed to better delivery of care across the West of Scotland and the success has sparked a similar initiative in the North of Scotland.

Alison, a 59-year-old patient who lives just across the border under the remit of NHS Greater Glasgow and Clyde, came into Hairmyres Hospital in Lanarkshire, as an emergency patient complaining of chest pain. Since Alison’s GP records and previous investigations were all in the Glasgow system the onsite doctor, Dr Patel, would have had to correspond with her GP in Glasgow and ask for access to the her medical history.

As in this example, before portal-to-portal sharing, accessing health information was often a lengthy, manual and inefficient process. Research done in the West of Scotland found that doctors were spending 70 minutes a day searching for patient information and that the value of that time was almost £20,000 a year per clinician. Portal-to-portal sharing improves health outcomes by reducing the time spent chasing information and enabling clinicians to make the well-informed decisions, more quickly.

Now, in the West of Scotland, clinicians can access the patient record in real time regardless of which of the five health boards the patient resides under. In Alison’s case, Dr Patel is able to evaluate her previous tests, diagnoses and correspondence between other specialists recorded in the NHS Greater Glasgow & Clyde Clinical Portal, allowing for more accurate and personalised care.

Most recently, four health boards in the North of Scotland have also turned their focus to regional working, commissioning a project to create a single clinical portal for the region, provided by Orion Health. By late summer 2018, NHS Highland, NHS Grampian, NHS Orkney and NHS Shetland will have shared health and care portal for their citizens, using data from existing patient management systems, picture archiving and communications systems (PACS), the Scottish Care Information stores, and emergency care summary data. The second phase of the project will incorporate information from the North of Scotland partnering GP practices and social care systems. This means care providers in these boards will be able to view joined up health and social care information held on a patient including any current care plans, effectively allowing better management of hospital discharges, potentially freeing up secondary care capacity. 

The advancements in regional information sharing in both the West and North of Scotland, home to around three-quarters of Scotland’s population, are transforming health and care and improving patient outcomes. It’s exciting to see the success of digital health in real world situations helping to deliver more accurate, personalised care to patients. Significant steps in the continuous drive towards making the ‘one patient, one record’ ideal a reality.

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