Digital health and care strategy

Digital Foundations

Priority three: The infrastructure, systems, regulation, standards and governance are in place to ensure robust and secure delivery.

Alongside our people and our services, digital technology provides the foundation on which our health and care system is built upon. Some of what we have needs modernising or improving. It might still be effective at doing what it was designed for but is not capable of supporting the way we want our modern integrated health and care system to function.

For people interacting with services, and for the staff who work in them, there still exists a fragmentation of experience across the system. We need aligned infrastructure, systems, regulation, standards, procurement and governance to be in place across all services to ensure their effective delivery. This extends to the standards that are used within those systems, and the cyber resilience of what is in place.

Addressing these issues means investing in the development of modern cloud-based infrastructure that adheres to today's standards, and is as secure and resilient as possible. We also need to make sure our systems comply with legislative standards. This includes the need to comply with regulatory requirements where some health and care software and digital products can be classed as medical devices. This approach will help ensure the best features of design, deployment, maintenance, monitoring, as well as the clinical/care safety, are present for our IT systems across health and care. Adhering to recognised global standards will also enable easier data sharing and privacy controls.

National Digital Platform

A core commitment in the last strategy was to develop a 'National Digital Platform' (NDP). This is not a single product but a collaborative and integrated approach to delivering cloud-based digital components and capabilities that will play a significant role in our health and care digital ecosystem, underpinning our commitment to improve the availability and accessibility of health and care information and services. Whereas the 2018 Strategy had one section focusing on the NDP, in this version it is integrated throughout and is seen in the focus on new architecture, the development of a cloud strategy and the increased focus on shared standards.

And as we open up access to data and services, we we will ensure we are only providing access to those who are able to prove they have the right to do so. This requires both our staff and our citizens to be able to authenticate/verify their identify. The roll out of Office 365 across much of the public sector – and all of the NHS – means staff now possess this capability. However, this is not the case for everybody in Scotland and for many of our partners in the third and independent sectors. This must be addressed if we are to achieve a fully integrated health and care approach for citizens.

A digital approach is about more than just the technology and systems, it is about a cultural shift toward thinking and planning as digital organisations. The Digital Maturity Assessments committed to in this strategy will provide the foundation for how we learn, share and prioritise improvements. An assessment of digital maturity undertaken in 2019 was a key early deliverable from the 2018 Strategy and the findings from the previous assessment have informed the content of this strategy.

By ensuing the correct digital foundations are in place in line with the commitments set out in this strategy, we can improve the overall experience for everyone who uses health and care services.

SNOMED: digital working behind the scenes for staff and patients

SNOMED is a clinical coding system for use in electronic health records. SNOMED gives clinical and care IT systems a single shared language. It contains all the terms needed, from procedures and symptoms through to clinical diagnoses and medications. This enables data to be recorded consistently and accurately which, in turn, makes exchanging information between systems easier, safer and more accurate. We will roll out the use of SNOMED across Scotland. We will explore opportunities for its use in the care sector. There will be a strong focus on training and support for users to learn and use the new codes for patient care.

Our Commitments:

• Work with the digital identity programme to adopt a common approach to online identity where personal data is controlled by the individual.
• Develop and provide support for organisations to have access to the basic resources required to develop as digital organisations.
• Review the current digital funding delivery model in Scotland to support all of our organisations, regardless of size, to reach their digital potential.
• Put in place a regular assurance process for reporting and regular discussions to support our organisations with planning, strategy development and other key decision making as appropriate.
• Further embed Office 365 across the health and care system, to support staff working across organisational boundaries so that they can better work in multi-disciplinary teams.
• Publish a cloud-first strategy that details our approach across health and care to national infrastructure, data hosting and architecture, including how the development of a digital platform will contribute to the twin aims of citizen and staff access to relevant real-time information.
• Develop and embed a standards based approach to clinical and care safety cases for all major systems.
• Publish, and review on a regular basis, details of our approach to ensuring compliance with a range of technical, data and design standards.
• Develop a commercial and procurement strategy that covers all national, regional and local approaches to developing and buying digital products, including requiring all suppliers to demonstrate their commitment to citizen/user needs/design.
• Modernise our core business systems to support our workforce and ensure safe staffing.
• Conduct digital maturity exercises across our health and care delivery landscape every two years, with funding to support identified areas of improvement, both nationally and locally.
• Develop a model for 'what good looks like' for Scotland, building on other maturity models globally, that showcases the incremental steps required for digital progression.
• Only fund initiatives that are secure by design: we will improve the security capabilities and resilience of our services by protecting the digital systems that support Scotland's health and care infrastructure and essential services and ensuring a secure-by-design approach is adopted across the supply chain.
• Streamline the information governance landscape setting out the roles of key organisations, and building on our learning from the response to Covid-19.