Dr Paul Miller: March 10, 2021
Something remarkable happened in the middle of February this year. For the first time, data held on the NES Digital Service (NDS) National Clinical Data Store (NCDS) was used in NHS Highland’s Orion Portal to display COVID-19 immunisation records.
That might not seem to many readers as immediately remarkable, after all it is what you would expect – citizens’ immunisation records viewable by health care staff – but this represents a significant change in how NHS Scotland has approached this type of problem and demonstrates that we can build capability and national infrastructure to support people’s health and care.
I want to tell you a bit more about the vaccinations NCDS. Some of you may have heard of it, and others maybe only in passing and, of course, many not at all!
The NCDS is an NDS built and managed database used to store records of immunisations for Scottish citizens. Currently this is just for COVID-19 immunisations. This provides a ‘source of truth’ for the immunisation status for all people in Scotland.
It does not provide any user facing applications or interfaces - it is the ‘data store’ and was developed in collaboration with the other digital directorate in NES, NES Digital. The application that NES Digital developed is the Vaccine Management Tool (VMT), and this runs on top of the NES TURAS platform. The application was built with direction and help from clinicians in Greater Glasgow and Clyde Health Board. The VMT is the user facing software that is used in many clinics and vaccine centres across Scotland to enable recording of vaccination data at the point of care. If you have been administering vaccines, you may have used it yourself.
Under the bonnet, the VMT sends copies of the records of immunisations to the NCDS. For those that may be interested, this is achieved using a “FHIR API” based on the UK FHIR Core Immunisation Profile. A FHIR API is essentially an industry standard way of sharing digital health data. The NCDS can then securely share citizens’ immunisation history records to other services, again using a FHIR API.
When someone attends a vaccine clinic, the vaccinators can view the person’s previous vaccination history in the VMT screens. That information comes from the NCDS - the VMT requests this data from the NCDS as needed and then shows it in the interface.
The same FHIR API is being used by the Highland Orion Portal to retrieve and display immunisation records in portal views, for clinicians to be able to view a patient’s immunisation history.
The National Clinical Data Store also has two-way communication with general practice IT systems for exchanging immunisation records. This exchange is assisted by our partners Albasoft, an Inverness company that has worked with NHS Scotland for many years. This allows us both to send immunisation records held on the NCDS to general practice systems, and to receive and store records from general practice systems into NCDS.
In this way, the NCDS has become the synchronised, central store for all immunisation records for COVID-19.
This has not been without its challenges. Variability in the way vaccines are recorded in different systems and by practices has required methods of data tidying and matching, as well as processes to remove duplicate records. The COVID-19 vaccination programme is moving at such a rapid pace the most important thing is that people can have their vaccines and that staff are not obstructed in that aim by their computer systems.
Our vaccines team has worked across the NHS, with partners in Public Health Scotland, NHS NSS, territorial Health Boards, NES Digital and Scottish Government to overcome these problems, often with a degree of urgency to meet immediate clinical need. Internally we have managed the clinical safety of the design of the NCDS in line with the DCB0129 Clinical Safety standard, and my colleague Brendan O’Brien and his informatics team at NSS are assuring the safety of the IT more widely with an ‘end to end’ approach.
Our compliance team have ensured that this storing, sharing and processing of data meets the highest standards of data governance and privacy, in keeping with data protection law.
The National Clinical Data Store data is copied to a ‘read only’ database to allow NHS National Services Scotland to report on the data for Public Health Scotland’s use.
All this represents a new way of doing things. In the past, each system in Scotland would try and maintain its own records of health care events, each then unsure of data held elsewhere. The aim of the National Digital Platform is to provide the central record of health and care data for Scottish citizens, both for direct care and to help improve our health system. The NCDS is the first demonstration of this working at scale.
The core infrastructure of the Store has been designed and built by the NDS team, all of whom are employed by NHS Scotland. By building this ourselves we create a pool of knowledge, resources and talent that can be utilised to further develop the National Digital Platform in the future, helping us deliver on the strategic vision of a “single platform, or spine, for data that other systems connect into.”
Next steps for the vaccinations NCDS are being discussed. I would like to see the scope extend to include all NHS vaccinations over time, so that we can provide citizens with views of their lifelong immunisation record and let them access their data so they can use their records for their own purposes. I hope all this comes to fruition, but of course right now our priority is supporting the population wide COVID-19 immunisation programme to help us all be able to see friends and family again, and to go outside without worrying.
I hope you agree then that this is indeed a remarkable moment. There has not been any fanfare (now is not the time for parties!), but the vision of the National Digital Platform has now become a reality, and this provides us a firm foundation on which to build capacity for the future.
Dr Paul Miller
Clinical Lead, NDS