Dr Cath Calderwood: June 24, 2019
A few years ago, I read an interesting and thought-provoking editorial in a medical journal with the engaging title of ‘You, Me and the Computer Makes Three: Navigating the Doctor-Patient Relationship in the Age of Electronic Health Records’. The author reflects on the increasing influence of technology across all aspects of health and care and raises concerns about its potentially detrimental impact on the doctor-patient relationship, a dynamic viewed by many as close to sacrosanct.
With this in mind, some of you may now be wondering why I have chosen to write a blog about digital health.
After all, in my four years as Chief Medical Officer for Scotland, I have championed approaches that seek to strengthen the relationship between patients and health and care professionals. Why support something that might endanger this?
Furthermore, if you’ve had the chance to read my most recent Annual Report, Personalising Realistic Medicine, published in April 2019, you’ll be aware that my focus is on people, not technology. The report even goes as far as to highlight these words by Victor Montori, Professor of Medicine at Mayo Clinic in the United States:
‘Healthcare is a caring and learning system. It is not driven by data, industrial processes or technology. It is driven by people.’
So, why am I writing this blog?
The simple answer is that I don’t view digital technology as a threat to the care we want to provide. Quite the opposite in fact.
Over the last four years, I have been outlining a new vision for health and care in Scotland: Realistic Medicine. This aims to improve patient care by creating a personalised approach, where the person receiving care is at the centre of decision-making. It seeks to reduce harm, waste and unwarranted variation, whilst acknowledging and managing the inherent risks associated with delivering care, as well as championing innovation and improvement. Digital technology, and in particular the new National Digital Platform, will be essential in enabling us to deliver Realistic Medicine.
The National Digital Platform has, at its core, a patient-centred record, a ‘single source of truth’ containing all the information professionals and citizens need at the point of care. This is Realistic Medicine. It is innovative and transformational. It will ensure that patient data, including key information about what matters most to the individual, is accessible across the health and care system at all times. It lays stronger foundations for shared decision-making because, in providing citizens with their own data, people will be empowered to review it and ask more questions. It reduces waste – when data becomes portable between systems, it can be entered once but be used many times, sparing professionals having to duplicate information across applications. It minimises clinical risk – the record represents one version of truth which, providing it is checked and updated periodically, offers professionals the reassuring promise of reliability and diminishes the likelihood of errors and misunderstandings in shared care or on transfer of care. And, finally, it tackles unwarranted variation – for patients, there should be greater consistency in how care is delivered; for our population, there will be a wealth of analytical data at scale for us to compare and address variation in data recording and health outcomes.
The value of the National Digital Platform in helping Scotland to realise Realistic Medicine extends beyond the patient record. In time, the platform will incorporate decision support tools, a key resource for assisting citizens in shared decision-making. It will also be used to facilitate components of technology enabled-care, a separate arm of digital health but one with strong affinity to Realistic Medicine. Already, for example, Home and Mobile Health Monitoring is empowering more people across Scotland to self-manage their health, while video clinic technology such as Attend Anywhere is enabling NHS services to provide more appointments where patients want them, particularly in more remote and rural areas.
Most importantly though, we know that our citizens want a National Digital Platform. Last year, we held Scotland’s first ever citizens’ jury on a health topic. A citizens’ jury is a deliberative method of public engagement and is recognised as being an effective way of elucidating public values when the topic being considered is complex or poorly understood. In this process, a stratified sample of the Scottish population convened to consider the question ‘what should shared decision-making look like and what needs to be done for this to happen?’ Commentators, ranging from healthcare professionals to those who had experienced care, were selected to bring a variety of perspectives to the jury. All jury members participated in a discussion on shared decision-making and developed thirteen recommendations for consideration by Scottish Government. Among them, were the following two (as written in the jury members’ own words):
- There should be a database online for all healthcare and social care professionals to access information about a patient's history;
- All patients and service users need to be able to access their records (e.g. medical records) and test results so that they are more aware of what they want to discuss and what questions they want to ask.
The Scottish Government has committed to taking both of these recommendations forward and the National Digital Platform is the mechanism for delivering the meaningful change that our citizens seek.
Earlier in this blog, I shared a quote from my latest Annual Report, in which Victor Montori suggests that health and care systems should place an emphasis on people rather than technology. I still believe this to be true but I am also convinced that people and technology should not be in opposition with each other. Indeed, as Victor goes on to say, ‘people are first’ but ‘the systems, technology and information are back-up to support people’. This is why the new National Digital Platform is so important. It is the ideal support for our people – not only for our professionals across health and care who want to provide Realistic Medicine, but also for our citizens who deserve to receive it.
Dr Catherine Calderwood is Scotland’s Chief Medical Officer. She is grateful to her clinical fellow, Dr Stephen Fenning, for his contribution to this blog.Dr