A GP's response to Scotland's health and care data strategy by Rob Walter

dghealth

Nov 4

This blog was first published on FutureScot on 11th August and can be seen at https://futurescot.com/getting-the-best-out-of-patient-data-is-key-to-unlocking-future-health-benefits-in-scotland/

It is important that clinicians' voices are heard in the consultation around Scotland's new health and care data strategy, which closed recently (12th August).

Busy GPs like myself are the trusted gatekeepers at the coalface of healthcare.

We have first-hand knowledge of just how important it is that the right information is available to the right clinician at the right time, wherever the patient interacts with health and social care services.

What then can the new data strategy do for me that might improve patient centred care?

A legacy of trust

An early step in healthcare data access was the successful introduction of the national Emergency Care Summary by NHS Scotland in 2006. This allowed patients to consent to access to their health data at the point of care delivery, rather than consenting in advance for data upload.

It was widely accepted and trusted by the profession and patients alike, with high uptake compared to other nations' summary care records and provided out of hours and emergency care access to prescribing and allergy records.

We need to build on that and the trust the public have given us with their information.

We've come a long way since 2006. Electronic patient records have become richer and technology has developed to allow multiple users involved in a patient's care to share it and input data. Patients themselves can also choose to share data captured by personal devices such as smartwatches.

This huge growth in information brings many more opportunities to improve both individual and population health. But we also risk losing important details amongst a tsunami of information

Risk of information overload

It is essential the systems we use are both intuitive and help guide the user with structured data capture.

We need to be able to handle the volume and present it in a concise and meaningful way, surfacing the current abnormal above the background noise and giving clinicians evidence-based resources and treatment pathways.

The end goal must be that data can be amalgamated and analysed in its entirety so that clinical decision support works across the whole patient record and not just in 'my view' of it.

Technically, there are many ways to achieve this but for me the key components are:

interoperability (systems talking to other, using standard FHIR (Fast Health Interoperability Resources) messaging);
retaining a diversity of systems to meet the different requirements of different areas of medicine and social care;
Maintaining confidentiality and integrity through strong role-based access that ensures universal understanding of what is and isn't allowed to be viewed by specific users in role, whilst ensuring clinical safety in the background. This is imperative if we are to retain patients' trust.

The importance of clinical coding

To mobilise this data requires standardised coding. Historically, primary care has relied on the READ V2 coding system which has served its purpose and has now been retired. The future is SNOMED CT – an international coding language that has a UK specific version.

It is a much richer code set that is well structured and uses 'semantic tags' to help categorise types of codes. For the end user, choosing coded information is simply a case of searching for terms, or with good clinical systems, automatic presentation of the best terms to use in a structured manner.

Once we achieve all of this, we will be delivering a high-quality data set which we can then interrogate and learn from.

High-quality data will drive better care

A rich, comprehensive, and accurate data repository that can be analysed in near real time offers so much for the health service in Scotland.

For example, machine learning algorithms can identify patient cohorts who would most benefit from intervention – allowing us to target our limited health resources to those most in clinical need.

High-quality data can also drive valuable research into new treatments and medicines, and this is recognised as a key part of the vision for Scotland's new data strategy.

The consultation paper rightly highlights that we must tread very carefully – using health and social care data 'for the public good' and adopting a transparent approach to reassure the public that their data is being used appropriately.

Dr Walter is a GP at the Gillbrae Medical Practice in Dumfries, and clinical intelligence director at EMIS, which provides clinical systems to more than half of GP practices in Scotland.

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