A more integrated and interoperable health system offers clear and profound benefits. All with many advantages, there are also many risks which will need addressing. Chief among these is security.

The HI Scotland 2017 was a huge event. There were nearly 40 talks, each tackling health related topics. The sessions were delivered by speakers including: Shona Robison, MSP, Cabinet Secretary for Health, Wellbeing and Sport, Dr. Margaret Whoriskey, Head of Technology Enabled Care and Digital Health Care Innovation at the Scottish Government, George Crooks, CEO of the Digital Health and Care Institute, and many others from across industry and academia.

Across the body of talks, there were several recurring themes. Firstly, how data - in the form of interoperable shared records - can benefit patients. George Crooks, OBE CEO Digital Health and Care Institute Scotland, talked about an aging population.. Far from labelling an older population as a crisis, Crooks said: ‘The problem is we don’t capitalise... We don’t have the ability to capitalise on all the available experience We need to change that.’

He addressed rising demand on health services and how we need to embrace technology to preserve the NHS. Banks have changed how they use technology and how they interact with their customers, he said, but health delivery remains somewhat mired in the past.

Over a period of five years, he explained, GPs will see over three million patients simply to take their blood pressure. Home monitoring is more cost effective and also often accurate too. Patients’ blood pressure often rises in the surgery due to the worry of being subjected to a test, for example.

He said: ‘It’s not about replacing doctors or nurses with tech and robots. It’s about using all digital channels to protect face-to-face services. That’s the most precious resource.’ And to do this, he said, we should look to deliver care in the home via the devices people have and that they understand: smartphones, tablets, PCs and smartTVs.

Power to the people

Other speakers outlined their project work on citizen portals. There were two types. One where patients could use a web interface to manage their health appointments, see results and receive information. Others, John Costello, Project Manager, NHS Greater Glasgow and Clyde, showed something more adventurous: ‘All the portals we’ve seen, thus far, solve one problem and serve one (health) board. And they can’t scale. We’re looking at how we can build something that is truly national. Something that scales and that can be added to. We’re hoping to build a platform that encourages developers to join rather to than build their own portal.’

Other projects took the portals concept and asked how they can be used as a means of promoting wellness and not just help people to manage their illness at home. The goal was to enable citizens to upload personal data gathered from home devices like activity trackers, home blood pressure monitors and a host of IoT devices. This data could be pulled in by clinicians and used to spot problems before they develop.

Portals of this collaborative nature are indicative of a sea change in how health care is be thought about and delivered. Traditionally health care is managed from the top down. From a health system to the patient. The new model shows how citizens can work with health care to manage their own wellbeing. In many ways the model works from the bottom up - from patient to care service.

Risks and rewards

This data rich world isn’t without its risks. Outside health, in the everyday world, we’re happy to exchange our data for access to social media services like Facebook and Twitter. And we’re used to these services - indeed many of the digital products we use daily - evolving and innovating at a breakneck rate.

Claudia Pagliari, Director of Global eHealth, Usher Institute of Population Health Sciences, University of Edinburgh, explored what social media might mean for the future of health. ‘Innovation works slowly in heath,’ she said. ‘And that’s because of a need for safety. We are working in an optimised but in a slow way. Outside of health people are failing fast.’

Social media, she explained, is changing how people think about health information. People share information about their health worries on social platforms and seem willing to discuss almost anything. Previously people trusted just their doctor, now they trust people on Facebook as a source of expert health insight.

This isn’t however an entirely positive situation. In the political sphere, fake news is causing lurches in public opinion and polluting public debate. In a health setting, fake news can be palpably dangerous.

How health institutions use social media is very much ‘a mixed bag’, she explained. Some use social channels to simply push out information in much the same way as they do leaflets. Others monitor social media for reasons of damage limitation. If they spot a complaint, they can act and deal with the problem away for public gaze.

The good, the bad and the clickable

As a tool to inform the public about health risks and to influence changes in lifestyle, social media is then a potent force for good.

There are, however, examples of how health professionals are using social media in innovative, if unintended ways. Doctors are, the BBC reported, using WhatsApp widely. On one hand the service is an excellent way of moving information about quickly and efficiently. When it comes to patient data, from a compliance and confidentiality perspective, WhatsApp is the stuff of CIO’s nightmares.

Another example of how WhatsApp is being used innovatively and as a means of achieving clinical objectives can be seen in Zimbabwe. There it’s illegal to advertise drugs. To sidestep the rules, pharmacists are using the encrypted system to share news about drug availability and supply.

Elsewhere socially enabled applications are being used to help people spot fake drugs. The systems let clinicians share barcodes and so spot problematic drug batches.

On a grander and global scale, big pharmaceutical companies are also very alert to using social media as a strategic intelligence tool. While people, Pagliari explained, may be unable or unwilling to discuss symptoms with their GPs they’re more than happy to chat on social media. And big-pharma is listening. If, for example, a new drug has known side effects and there’s a spike in mentions of those symptoms online, firms know there could be a problem. They may recall a drug or begin a communication campaign.

Social listening, she explained, isn’t new. Google Flu Trends - though no longer active - used search trends to model flu infection rates. The search giant used similar techniques to analyse the spread of Dengue.

Finally, Pagliari pointed to Kate Granger’s life and work as an example of how social media can provide insights into health and also into death. Granger was a geriatrician who began fundraising after being diagnosed with cancer. She also blogged and tweeted about her journey through care and, ultimately, to death. For academics and clinicians, this body or data is proving an invaluable source of insight and illumination into understanding care pathways.

A final note

Prof. Bill Buchanan OBE, The Cyber Academy, Edinburgh Napier University, looked at digital health and care though another prism - he explored the necessity for cyber security. There are, he said, examples of countries that are doing incredibly well when it comes to building and using shared record systems and citizen portals. These include Finland and Estonia.

As other countries aim to emulate their success, they need to be careful. If we get security wrong, Buchanan said, we’re in trouble. We’ll kill patient trust and risk huge fines under the GDPR.

There is an answer though, he said: ‘Believe the hype: blockchain is the solution.’ It can provide a means of ensuring patient data is kept secure, anonymised and banishing the need for passwords.