HIT Lessons Learned from Scotland

My trip to Scotland provided a remarkable opportunity to exchange ideas and experiences.

Scotland has nearly 100% adoption of electronic health records among general practioners and is making good progress in hospitals with innovative built/bought inpatient systems.   As in most countries, health information exchange is still evolving, but novel databases supporting disease management at the community level and an emergency care summary exchange are already live.

Here's what I learned while in Scotland

1.  Scotland has 5 million people - about the same size as Massachusetts.    There's a real "can do" attitude that makes significant change at the national and regional level possible.

2.  General Practictioners are passionate about IT.   There are 2 major electronic health records (Vision and EMIS) used in ambulatory settings in Scotland.  I was able to test them with demonstration patients and they seem to be a bit more focused on creating a journal of patient health events as compared to EHRs in the US which follow the Meaningful Use paradigm of structured problem lists,  e-prescribed medications, allergies, notes/reports, and coded diagnostic results.

3.  Healthcare information exchange between EHRs and hospitals is document centric.   My limited experience suggests that clinical encounter summaries in Scotland are shared via episode of care documents rather than structured data element exchange.

4.  There is a national healthcare identifier which enables records to be coordinated and aggregated in a national emergency care database, registries, and for continuity among caregivers.

5.  The National Health Service provides comprehensive care across all settings and therefore can drive innovation and adoption across the country.

Scotland has many of the same healthcare challenges as the US - increasing obesity, earlier onset and increased numbers of diabetics, and the worldwide issues of tobacco and alcohol use.  

Through the use of careplans/guidelines, registries, electronic health records, and care coordination across the community, Scotland is hard at work improving public health and population health.   I think of Scotland as an extraordinary testbed for healthcare IT implementation.  With its high adoption of EHRs among community clinicians, its bottom up approach to creating automation to meet the need of hospital stakeholders at a local level, and its population size that makes implementation doable, I highly recommend that vendors partner with Scottish healthcare provider organizations to test innovative solutions which can then be spread throughout the world after successful pilots.

Thanks for Andrew Morris and the University of Dundee for hosting me.  I look forward to our further work together.