IT systems are a bit like a new car. Both can take you from A to B, hence the frequent analogy of the information super highway to describe the internet, while in neither case does their successful use depend on a deep understanding of the technology.
The simile can be extended further. While in England, the NHS National Programme for IT (NPfIT) resembled a nifty sports car, launched quickly but ultimately disappointing due to the scale of its ambition; the Scottish equivalent is like a trusty old family saloon, developing incredibly slowly but inevitably reliable.
Scotland uses 'eHealth' as an umbrella title for a myriad of IT systems. These take three forms. GPASS, the old GP IT system, was deemed unfit for purpose and is to be replaced with commercial clinical systems.
In secondary care, the Scottish Government is in the process of tendering for a patient management system. The third, the Emergency Care Summary (ECS) for communicating between GP practices, out-of-hours providers and A&E services, has already been implemented.
All but the last of the three, however, are not exactly breaking the speed limit. "Progress on the eHealth agenda in Scotland is slow, but that is not necessarily a bad thing," says Martin Woodrow, national secretary of the British Medical Association in Scotland. "The Scottish Government is moving forward cautiously with its IT strategy having learned lessons from the IT failures in England."
Progress "is slow" on replacing GPASS, adds Woodrow, and "even slower" on finding a suitable patient management system.
The ECS, meanwhile, is motoring along well and covers the whole of Scotland, unlike England's Summary Care Records. Its summaries include basic patient information such as allergies and current medication, and patients must give explicit consent for its use, a move which has been welcomed by BMA Scotland.
The ultimate destination, however, is a "single electronic health record", although the route being taken is different to that of the English sports car.
Rejecting the big bang
"We are not going for a big bang new computer programme to deliver a single record," health secretary Nicola Sturgeon told the Scottish Parliament's Health Committee in October last year. "We have instead decided to take an incremental and progressive approach." That means "joining up bits of the system that exist already, modernising areas that need to be modernised and filling in gaps in the system".
"The end point will be a system that consists of different components, all of which can talk to one another," Sturgeon added. "The single sign-on portal will perform the function of a single electronic patient record. It is hoped that we will get there in a more sensible way than has been tried elsewhere."
The health secretary's allusion to "elsewhere", or in other words England, was deliberate and not without a political subtext. This does not mean, however, that the Scottish saloon car is not without its problems. The Scottish Government has not even piloted anything like the centralised architecture which has caused problems in England, while GP surgeries in Scotland are not anywhere close to sharing information with secondary care providers.
The health secretary constantly emphasised the "enormous potential" of IT systems to improve delivery of care while saving money. NHS Scotland's budget for projects including eHealth will, nevertheless, rise by 31% over the next two years as a result of the Scottish Government's most recent budget package.
The Scottish Parliament's Health Committee, which scrutinises the budget process, took particular interest in this emphasis on cost savings, although it also heard evidence to the effect that "constraints in what the market can supply" were slowing down progress in identifying precisely what clinical system replaces GPASS.
Even so, said Christine Grahame, the Committee's Scottish National Party convenor, "the Committee welcomed the creation of a single electronic record and sees potential value-for-money benefits in the approach outlined by the cabinet secretary".
Above all, the Health Committee has urged the health secretary not to lose sight of ensuring compatibility of new systems with the existing IT set up. The Scottish Government says future efforts "will be nationally coordinated, but with a collaborative approach that allows for local flexibility and innovation". The priority is the development of that single clinical portal, enabling sign-on to different sources of patient information for authorised clinicians.
To revisit the car simile once more, attempting to reach that priority destination too quickly, as in England, could result in either car veering off the information superhighway. North of the border the Scottish Government is determined, however slowly, to prevent that from happening.
