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Co-designing and developing the National Notification and Digital Tracing Service to support test results delivery for people in Scotland. The Challenge On 11 March 2020, the World Health Organization declared the outbreak of a global pandemic and in the same week the Digital Health & Care Innovation Centre was commissioned by the Scottish Government to support Scotland’s digital response. We collaborated with Public Health Scotland, NHS National Services Scotland, NHS Greater Glasgow & Clyde, NHS Lothian, Storm ID and Sitekit to co-design and develop the National Notification and Digital Tracing Service to support test results delivery for people in Scotland who had been tested for Covid-19. The Objectives Partnership and Collaboration - Developing the National Notification and Digital Tracing Service would require several partners to work collaboratively and at pace. Collaboration was key to ensure that, within a matter of weeks, people would be able to receive test result notifications via digital channels. Secure Integrations - With pace being a priority, the National Notification and Digital Tracing Service needed to leverage existing technologies, services, and capabilities to securely provide COVID-19 test result notifications to people who had been tested. It was agreed to focus on using the NHS National Services Scotland Integration Hub, the GOV.UK Notify service and the National Contact Tracing Management System. Channel Shift - From the outset, the National Notification and Digital Tracing Service needed to be architected for scale and flexibility so that it could respond to evolving public health requirements and meet the diverse needs of the public and the range of NHS Boards. A key part of this was to expand on DHI’s co-design findings to date – focusing on how the people of Scotland could help to co-manage their own contact tracing digitally, improving the efficacy and sustainability of the contact tracing effort. The Insight The National Notification and Digital Tracing Service was developed at pace and was well received by tracing and clinical staff in 12 NHS Boards. Results were routed to dashboards developed for each NHS Board, allowing test result delivery teams to search and filter over test results. Feeds were set up by individual NHS Boards to allow them to control which people received notifications, excluding inpatients and those in care homes for example. Rules were established to automate results delivery to help speed up contact tracing efforts with a manual option to address any exceptions. More than 2 million test results from UK Lighthouse Labs and Scottish Labs have been ingested by the service, resulting in more than 2 million page views of the citizen-facing web application. Responding to demand, the service was updated to give people the ability to share details of contacts they had come in to contact with, to help accelerate vitally important contact tracing work to slow and break transmission of the virus. Interim findings show that for people who were notified of a positive test result, 45% went on to use the digital service to provide details of those they had been in contact with and of those, 75% self-reported their contacts and settings within 60 minutes of receiving their positive test result notification. The service is currently undergoing a full evaluation by the University of Glasgow. The Technology The National Notification and Digital Tracing Service leveraged the Lenus Health Platform that supports secure health data exchange and was developed using Microsoft Azure PaaS to allow for rapid delivery, agile infrastructure deployment and to support scale-out during peak demand for resources. Secure integrations with the NSS Integration Hub, GOV.UK Notify service and the National Contact Tracing Management System were vital. With these technologies and integrations in place, the National Notification and Digital Tracing Service acted as a vital bridge between NHS systems, data and an individual, providing information in a timely and secure way. This allowed each person to act rapidly on the result of a test in support of government and clinical guidelines to help control the spread of the virus during the pandemic. The Methods DHI has been developing the DHI Exchange - a new demonstration and simulation environment to support the de-risking of new digital services while leveraging common, person-centred data-sharing infrastructure. The methods involve rapid co-design, prototyping and system integration activities to help get from an idea to an integrated proof of concept quickly. These methods were put to the test for this Covid-19 response with the National Notification Service moving from idea through procurement, scoping, funding approvals, co-design, service mapping, prototyping, integration, full production development, full governance (clinical safety, information governance, data protection, equalities impact, security) and into production for every NHS Board in Scotland in 51 days end to end. This has provided DHI and its partners with the confidence that we can digitally transform a national service swiftly when the environment is conducive. DHI now looks to build on this to support health and care service remobilisation into 2021 and beyond.

Artificial Intelligence (AI) could contribute to a healthier future if we engage skilled care practitioners in its design and development. The majority of Scottish health and care workers remain passionately committed to providing the ‘right care to the right person at the right time’, however truly personalised care remains elusive within a system facing unsustainable pressure, too many people still experience ‘conveyor-belt’ type services as demand increases. Artificial Intelligence (AI) could contribute to a healthier future if we engage skilled care practitioners in its design and development. AI: Creates potential for new person-centred health and care models embedded in communities Puts more decision-making power in the hands of citizens, making them the primary source of data and insights about their health and wellbeing Supports personalised public health, drawing upon data from health and wider sources to enable people to maintain health, wellbeing and prevent illness Has the capability to generate insights across real-world data from health, social care, education, and citizen-generated data to create new opportunities for integrated health and care Lots of data and information exist within health and care but there is an ongoing need to convert this into insight, knowledge, and action. AI enables us to enrich traditional approaches by combining data gathered for research purposes with real-world data, generated from services and citizens. However, we need to ensure sourced data is fit for purpose. AI and enhanced computing capabilities could support decision-making and early intervention by recognising patterns and interpreting insights from complex information. However, for results to make sense and enable us to act, additional data sources are required, and we need to combine the different strengths of AI and humans. AI is not a panacea to resolve all our data challenges and we need to understand its’ strengths but also its weaknesses to ensure it can add real value. Ethical and regulatory guidance on use of AI in healthcare practice is still emergent, presenting us with the challenge and opportunity of leading the way in using AI for good in improving people’s health and wellbeing. Scotland already has exciting AI-enabled collaborations involving industry, academia, and care practitioners. These projects enable us to better understand the relationship between treatment and social determinants of health and include the further development of machine learning from images captured by the colon capsule pill (SCOTCAP) to aid diagnosis and support the national redesign of outpatient gastroenterology services; the UKRI funded iCAIRD project which is initially exploring clinical decision marking in breast cancer screening; the Right Decision Platform which is using information and AI to support decision making by frontline health and care staff, and enable self-management. The development of AI enabled services shines an uncomfortable spotlight on areas of bias, stereotyping and prejudices that continue to be a negative aspect of human behaviour. To avoid bias being exponentially magnified by AI, trusted, safe and ethical solutions need developed and approaches to generating and collating real-world data need to be reviewed. This requires co-design and collaborative methodologies involving care practitioners and citizens with lived experience to harness the power of AI for social good. This blog piece was first published in the Powering Good - Insights from Nesta’s AI for Good programme report on 03 December 2020

Daring to consider “The art of the possible” a Holyrood Magazine interview with Professor George Crooks OBE, Chief Executive Officer, Digital Health & Care Innovation Centre “It’s really all about helping Scotland’s people live longer, healthier lives and helping our economy to grow,” Professor George Crooks OBE says by way of summing up the work of the Digital Health & Care Innovation Centre (DHI). As Scotland’s national innovation centre for digital health and care, DHI has years of experience in working with partners to address the key societal challenges in the field of health and care – transforming great ideas into real solutions. Well known across Scotland under its previous title, the Digital Health & Care Institute, DHI (a collaboration between the Glasgow School of Art and the University of Strathclyde) has worked for six years to provide engagement, facilitation, project management as well as service, business, technical innovation to increase individual and organisational readiness to harness digital innovation for impactful results. Unveiling its new title, DHI is highlighting that track record of credibility in providing innovation in digital health and care. That expertise proved essential when DHI stepped up to help Scotland’s rapid response to the public health crisis caused by the Covid-19 pandemic. And for Crooks, as the Chief Executive Officer, drawing on those years’ experience was crucial in mobilising DHI’s substantial contribution to the public health crisis of the present. “The challenges facing Scotland are the same as those facing most societies across the world,” Crooks tells Holyrood in a Zoom interview from his Bonnybridge home. “The issues of an ageing population, the increase in long-term conditions and also the lived experience of people in disadvantaged parts of the country, and the health inequalities associated with that. And all the while health and care delivery continues to be stretched, resource-intensive and challenging to deliver face to face. “Those challenges have not gone away during Covid-19. “In fact, in some cases, it has exaggerated them,” he adds. “So, the challenge is: what do we do about it? “That is where digital tools and services are creating real opportunities.” DHI has helped develop innovative technological and service-based solutions for the health and care sector, improving experiences for citizens health and care professionals, as well as creating opportunities to capitalise on its expertise and innovations internationally. Key to DHI’s process is their ‘methodology for success’ - a whole system, creative approach to health and care transformation At its core, Crooks says, is a simple lesson that he learned over his 23 years as a GP: listening. “What we’re all about is how can we create sustainable health and care services?” he says. “And the most important thing I think we can do is this: listen to people. “Listen to citizens, patients, their families and carers, to find out what their real challenges are. “Equally, listen to those who are delivering services and ask them - what is it that would make their lives easier? What are the challenges they are facing? What would a positive and brighter future look like?” And the responses to those key questions are often strikingly simple. “The people of Scotland aren’t asking for the moon,” Crooks says. “They just want to access health and care on their own terms, when and where they need it.” This is a guiding principle and aspiration for everything DHI does, Crooks says. “If we personalise health and care services and make it easier for people to access them on their own terms, and enable people to make better-informed health and well-being choices through the way that information is shared and presented, then we can actually improve health and care in ways that five or 10 years ago we couldn't imagine,” he says. What DHI has learned over its years of innovating, Crooks says, is that success comes when partners go on this journey together. “We have a team of 34 people of which 12 are designers,” Crooks explains. “We work with citizens, health and care professionals, managers and policymakers to get a deep understanding of the current state of service delivery. “And only when we understand what the real underlying challenges are, will we consider what a future service that would be better for everyone would look like. “Only then do we co-design and develop it, and only then do we identify technology to deal with it,” he says. “If you can understand what people’s challenges and fears are and address them within a new digitally-enabled service model, then you’ve got a great chance of success,” he adds. “That’s what we’ve done in DHI since we started six years ago: we have developed an innovation model that takes organisations and individuals on that journey.” This well-established method, and the connections forged across industries, sectors and borders, is what made DHI a natural partner in the rapid Covid-19 response, helping to develop some of the key innovations used by the NHS and our public health teams during the pandemic response. It’s widely acknowledged that until such a time as an effective vaccine is available, that the key to suppressing the virus and saving lives is the Scottish Government’s Test and Protect contact tracing system.” DHI played a leading role in developing crucial parts of that system, including the National Notification Service (NSS) - the text alert system that updates people on their Covid-19 test results - and also a simple contact tracing tool (STT) used by public health teams to assign and record information about cases during the early stages of the pandemic. Working through from the initial research stage right through to the implementation stage under a pressured and expedited schedule, Crooks says that their contribution to the Covid-19 response was proof of the level of professionalism and credibility DHI had already established before the crisis struck. “We were able to do that using our existing infrastructure, our connections with industry and our strong relationships with National Services Scotland and other health boards, to design, develop and expand on that service in a matter of weeks,” Crooks says. Over a period of forty-eight days DHI worked with the Lothian and Greater Glasgow and Clyde health boards, Public Health Scotland, NHS National Service Scotland as well as SMEs Storm ID and Sitekit to power through the development of these digital tools which have become important components of the contact tracing network. Crooks said of the project. “It’s all about partnership, that’s been the key to success. Everything that we’ve done, we haven’t done alone. We’ve done it in collaboration with health boards and with Scottish business.” Speaking of the partnership experience with DHI, Martin Egan, the Director of Digital, NHS Lothian said: “Working as part of the team to deliver the NNS and STT showed the power of a collective ‘can do’ attitude and what can be achieved when faced with a crisis.” “The DHI brought to the table a level of expertise and experience in delivering products and joint working with industry partners, and they provided a safe environment to develop the tools ... As a Department we look forward to working with the DHI on new projects in the future.” William Edwards, Director of eHealth at NHS Greater Glasgow and Clyde added: “The collaboration around the tracing and notification service built upon previous successful collaborations and existing infrastructure which DHI, National Services Scotland and other partner organisations have shaped to support Healthcare delivery in Scotland.” With the recent news that over one million Scots have downloaded the Protect Scotland proximity app onto their smart phones, could it be that the pandemic will come to be seen as a watershed moment in the story of Scotland’s digital ambitions? Crooks certainly thinks that the Covid-19 pandemic could be seen as the time in which “digital health and care has come of age”. But, he says, that process is often one of playing catch-up with where the public are at. “Citizens of Scotland have been using mobile technology and digital tools and services to run their day-to-day lives for many years,” Crooks says. “So, is it a surprise that when we deploy user-centred design to develop digital tools and services that are actually useful in the pandemic that people adopt them? Should we be surprised by that? “I don’t think we should,” he says. “That’s the great opportunity we now need to seize upon in Scotland.” “DHI has a remit to ask challenging questions. To bring in policymakers, to bring in thought leaders both in Scotland and internationally, to challenge thinking, to challenge the status quo and to ask the ‘what if’ questions. “And once we’ve asked the ‘what if’ questions, then build a way towards realising that. Not in a hugely expensive way, but by running our simulations - to show the art of the possible. “Sometimes we’ll get it right and sometimes we’ll get it wrong. But if all of that moves us to a better place for you, me, our children and grandchildren, then we’ll have done something meaningful.” This blog piece was first published in the Holyrood Magazine on Monday 05 October 2020.

The Digital Health & Care Institute (DHI), one of Scotland’s seven innovation centres, today announced a brand refresh and name change, to the Digital Health & Care Innovation Centre. From Monday the 5th of October, DHI will be known as the Digital Health & Care Innovation Centre . The name change, albeit minimal, maintains Digital Health & Care at the heart of what we do, while the addition of Innovation Centre better aligns with Scotland’s six other innovation centres and how impact is delivered. Professor George Crooks OBE, Chief Executive Officer at the Digital Health & Care Innovation Centre, said, “Over our first five years of business, the DHI established itself as an instantly recognisable brand within our sector. Through our expertise and experience in collaborating, co-designing and successfully delivering projects, we have proven ourselves to be a trusted and valued part of Scotland’s digital health and care community.” As we proceed with our Phase 2 business plan it is essential that our brand positions DHI as the organisation to go to with your digital health and care challenges, especially as we expand our international reach and engage further with health and care providers, industry, academia and other organisations from across the globe.” The brand refresh includes a name change, a redesign of our website and enhancements to our logo, font and colour palette. Grant Reilly, Communications & Marketing Manager, said, “We’ve worked closely with Maguires and Screenmedia, two local award-winning creative agencies, to audit, better understand and refine the way we present ourselves and our impact to our key stakeholders. We now have much more impact to share and it is essential that we do this in a professional manner as we continue to grow our networks and our project portfolio.” The Digital Health & Care Innovation Centre (DHI) is a national resource funded by the Scottish Government and the Scottish Funding Council.  It is a collaboration between the Glasgow School of Art and the University of Strathclyde (its host institution).  Our focus is innovation in digital health and care will help the people of Scotland live longer, healthier lives, while providing sustainable/ inclusive growth for our economy.  We collaborate, co-design and transform great ideas into real solutions by providing engagement; facilitation; project management; service, business, technical and innovation that assists in increasing individuals and organisations readiness to harness digital innovation for impactful results that have real benefits to the system and the citizen. Contact information Grant Reilly Communications & Marketing Manager Digital Health & Care Innovation Centre 1st Floor, Suite B, Inovo Building, 121 George Street, Glasgow, Scotland, G1 1RD