NHS Scotland, founded in 1948, forms thecornerstone of the publicly funded healthcaresystem in Scotland. NHS Scotland is a hugehealthcare provider - there are more than 4,000GPs and over 80% of the population are registeredwith NHS dentists. The figures highlight the scaleand scope of its undertakings. For example, in 2009,NHS Scotland estimates that more than 23 millionpatients had face-to-face contact with its GPs andpractice-based nurses, and consultant clinics treatedmore than 4 million outpatient visitors, an increaseof 2.8% from the previous year's figures. This is atypical slice of NHS Scotland activities in 2009(http://www.isdscotland.org/isd/810.html): The number of staf employed was 168,976 A total of 974,000 inpatient and day case procedures were carried out Operating costs were 9.3bn for the financial yearending March 2009 It pays over 4bn a year in staf wages 1.3bn was spent by NHS boards on prescriptiondrugs It is a major administrator of immunizationprogrammes in Scotland. For example, the overalluptake of human papillomavirus immunizationamong girls in the second, fifth and sixth years ofsecondary school in Scotland in 2008/09 was 93.5%for the first dose, 92.4% for the second dose and87.7% for the third dose It performed over 450,500 cervical smears in the yearending March 2009.Since its inception, NHS Scotland has been a pioneerin the use of technology to enhance the delivery of itsservices. For example, the world's first kidney transplantwas done in Edinburgh in 1960, while the CaithnessGeneral Hospital in Wick became the world's firstwhisky-powered hospital (via a biomass, wood-burningpower source at the malt whisky distillery). Advanceshave also been made in the adoption of IT and nowNHS Scotland is considered a leader in developingpatient-centred care services. The role of informationsystems in NHS activities became more prominent in1998, when the Department of Health commissioneda report to study the use of information systems inenhancing the delivery of patient care and services. Thereport Information for Health (DH, 1998) outlined theneed for providing lifelong electronic health recordsfor clinical use and making available the informationregarding best clinical practices for treatment andcare. The aim was to provide on-demand access toelectronic patient records and ofer a platform wherebybest clinical practices are shared by all in the NHS. Theculmination of this study and further ratifications laidthe foundations for the formation of NHS Connectingfor Health, a directorate within the Department ofHealth in 2005. The primary role of this directorate isin supplying information and IT systems needed in thedelivery of patient-centred care services in England.In Scotland, the information and IT systems deliveryis provided by National Information Systems Group(NISG), an arm of National Services Scotland (NSS), anon-departmental public body that provides supportservices to NHS Scotland. NISG supports the deliveryof information management and technology productsand specialist services that enable clinical processesand improve efciency across NHS Scotland. NISG hasbeen involved in many of NHS Scotland's IT initiatives,and an examination of two examples highlights thetransformation and benefits brought about by theadoption and implementation of information andrelated communication technologies in healthcare.Scottish Care InformationScottish Care Information (SCI) is an initiative toconnect the primary healthcare services with secondarycare systems using the internet. Primary care systemsare the first points of contact in patient care; theyinclude services like GP practices, opticians, dentists,pharmacists, walk-in centres and NHS Direct. Theseservices are connected to secondary care systems, likeNHS trust hospitals, ambulance trust, emergency careand so on, by the internet. SCI provides the gatewaywhereby patient information is seamlessly transferredfrom primary to secondary care systems and vice versa.For example, the SCI gateway connects approximately80% of GPs in Scotland. The GPs are connectedthrough the 'general practice administration system' forScotland and the network allows the sharing of patientrecords and essential information between diferentboards and care systems. Further, every registeredpatient in Scotland receives a unique communityindex number, which enables NHS clinicians to accesspatient records across Scotland and, in the case ofemergencies, allows quick intervention and deliveryof safe and efective treatment. It is estimated that, inany given month, over 15,000 clinical personal andadministrators use the system to share patient-relatedinformation, ranging from test results to referrals todischarge information.CLEARCLEAR stands for 'clinical enquiry and response'service and provides NHS Scotland professionals witha knowledge base of patient care. It is a repositoryproviding evidence-based information on diagnosis andtreatment options for a variety of illnesses. NHS clinicalprofessionals can ask questions relating to prognosis website and can get evidence-based answers froma variety of sources including NHS 24, the medicinesinformation service and health management library. In short, it is an online medical database, which canprovide specific responses to queries relating to clinicaldiagnosis and treatment. The responses are publishedonline and are categorized into domains for clarity andeasy reference. The growing database is expected toincrease knowledge sharing within the NHS Scotlandcommunity and contribute to the overall improvementin delivery of care services.There are numerous other NHS Scotland IT initiatives,and all have been implemented with a view toincreasing efficiency and providing a world-classhealth service to the people of Scotland. Furtherinitiatives are planned, using the latest technologiesto make available superior patient-centred services.NHS Scotland is ushering in a groundbreaking eraand its initiatives have laid the foundations for a trulyadvanced e-health society.

Case study questions

1 From an organizational perspective, what are theadvantages of developing IT-led services?

2 There has been a lot of criticism in the popularpress of NHS IT investments. What are the pros andcons of large-scale IT investments?

3 What are the legal and ethical issues in sharingpatient information?

4 NHS Scotland is moving towards an e-healthplatform, where information will be held from'cradle to grave'. What are the implications of suchinitiatives? Do you think it is 'big brother' in action?

Edgar, David. Business Strategy (p. 115). Macmillan Education UK. Kindle Edition.