‘LAND was the raw material of the agricultural age, iron the raw material of the industrial age. Data is the raw material of the information age.”

The former innovation adviser to Hilary Clinton, Alec Ross is right to a point, though it might be worth re-wording the quote.

“People who toiled the land were the raw material of the agricultural age, people who hammered and worked iron were the raw material of the industrial age. People as producers of data used and accessed without their consent are the raw material of the information age.”

We are the constant source of value on the digital journey, just as our parents and grandparents were through ages past. Yet only now are we are possibly on the cusp of something extraordinary, that our toil, hammering and work that generates data may start to be individually and collectively in our ownership.

Over the last few weeks we have considered Estonia as it emerged from the domination of the Soviet Union, its journey to full and equal membership of the largest democratic trading bloc that has ever existed, the EU. We’ve also considered Scotland’s journey since the re-convening of Holyrood and the critical Christie Report.

When we last ventured out, we walked the Estonian X-Road and sought to understand the value of our individual and collective data as a nation and soon independent nation state. So, let’s continue our digital journey across Estonia which is breenging ahead nearer than any other democratic state to that very goal, by looking at some of their practical digitisation applications and the possibilities for the radical digitisation for Scotland. How about starting with health?

NHS Scotland has a long history and since the advent of the information age many digital projects have come and gone with varying degrees of impact.

While the Estonian and Scottish models of delivery differ they both face similar challenges, which if properly utilised digitisation can help with – let’s look at the Estonian e-health record.

With a population of 1.5 million it has more than 20 million health records of various sorts, produced by dentists, hygienists, nurse practitioners, general practitioners and surgeons. Dental records, hospital appointments, vaccination records, x-rays, case notes and much more are collected in Estonia and at least 95% of that material is digitised and fully accessible to the patient.

While much of the information is held in differing data bases, the Estonian e-health portal allows you and your health practitioner instant access to all your collective health data. Reducing a profound bureaucratic mountain of paper and time, as well as cost and importantly ensuring quick access to data to importantly inform decision making.

One practical outcome has been on the prescribing of medication. When prescribing via the e-health portal all other medication you may have been prescribed by another practitioner is cross referenced automatically, highlighting any conflicts in the medical prescription. It is estimated that the system has seen practitioners change between 15 to 17% of all original prescription due to the auto warning.

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The e-Prescription service itself is so effective that more than 95% of all prescriptions are accessed via the electronic prescription service, all paperless.

Estonia left the old system behind over a decade ago and as has been argued in pervious articles this contrast shows how bureaucracy and an unwillingness to change is our problem, not the technology. While Estonians access their system using their ID card, we in Scotland could easily use our very own CHI number, otherwise known as our Community Health Index number. Aye, that’s right, we all have an NHS ID number, 10 characters long and its used as the unique patient identifier, giving access to everyone in NHS Scotland (bar us) to many parts of our health records.

There are currently eight CHI geographical databases, which ensures a good decentralised security protocol. Though given their geographic nature, if you move house you may find yourself with a different CHI number given to you by the local health board, which sadly undermines the effectiveness of the system, with unnecessary bureaucracy, ensuring a system which is created to be inflexible by design. This outlook and approach limits opportunities for health and social care practitioners to use our data to improve health and wellbeing.

So, one step forward with the decentralised CHI number and 10 back for the intentional limitations placed upon it by bureaucracy. Yet, Scotland does have a system that with a few tweaks and barriers removed could enable the delivery of a e-health system built to our needs.

In addition, the CHI is in reality an ID number. ID without a card, an ID that excludes us from the system and creates hurdles for us to jump over to access our records. Plus when you do eventually get access to them, you need to pay for it (in most cases) and when given access are escorted to view them and not left alone. Oh, and it can take up to 40 days to access them and then it’s a separate paper form for access your dental records.

There is far more to Estonian e-health than prescription and access to records and it is a journey Scotland is well able to emulate.

So, here after some reflection is radical digital proposal: the full digitisation of all health records, which citizens can access using their existing CHI number. Giving us ownership of the CHI number as well as full access to the system. It’s time to remove the burden of paperwork and bureaucracy from our health and social care practitioners and enable a system to work to our and the nation’s benefit. We have nothing to lose and lots to gain.

This is part four in a series that examines the way ahead for tech-savvy Scotland