There are daily reports on the pressure the coronavirus is putting on the health services of the UK’s devolved nations.
While it may be hard to fathom that IT service management has a role to play in managing a pandemic, for Deryck Mitchelson, director of digital and chief information security officer at NHS National Services Scotland, Covid-19 was a catalyst for change.
The organisation Mitchelson has worked for over the last two and a half years provides central services for NHS Scotland, including the National Blood Transfusion Service, shared IT services, human resources (HR), finance and procurement.
From an IT perspective, before the pandemic, NHS National Services Scotland had embarked on rolling out Microsoft Office 365, says Mitchelson. The IT services it provides across NHS Scotland include wide-area network (WAN) as a service and security as a service. It also runs mainframes and hosts a number of critical websites for NHS Scotland. One of these is the community health index (CHI), a unique identifier, which Mitchelson says links every piece of health data that is recorded across NHS Scotland.
NHS Scotland began using ServiceNow three years ago to provide IT service management (ITSM), he says. “We matured our ITSM and looked at building workflows such as for HR and business logic. Covid-19 is where we saw how we could scale out ITSM.”
At the start of the pandemic, the first opportunity to do this was in managing the supply of personal protective equipment (PPE) to front-line staff at NHS Scotland. “We had to ensure there was enough PPE at the right place at the right time,” says Mitchelson.
Demand was greater than the ability to supply PPE, which meant equipment needed to be procured from abroad, with orders sometimes being fulfilled by suppliers that NHS Scotland had not previously worked with.
“Covid-19 is where we saw how we could scale out ITSM”
Deryck Mitchelson, NHS Scotland
“We created a custom app to manage supply and demand in ServiceNow, to understand the data and provide a dashboard, which was the best way to show to management that we were sourcing the right stuff and getting it to the front line,” he says.
The shortage of PPE meant that NHS Scotland needed new suppliers, some of which were outside the EU and the UK. And management needed to know that the PPE had actually turned up, says Mitchelson. “We had people waiting at Preston airport, checking if big pallets of PPE would be there.”
Although there are many approaches the team could have taken to building an app to track the procurement and deployment of PPE, Mitchelson believes ITSM offered the best approach because it can be applied to asset management. “ITSM is about managing data and intelligent workflows,” he says.
For example, he points out that ITSM deals with objects such as HR or computer resources, and a common case is the joiners and leavers process in HR. “You need to manage data and trigger actions,” he adds.
Applying ITSM to test and trace
Like PPE procurement, NHS Scotland needed an effective way to manage test and trace. Mitchelson says it wanted to be able to manage Covid-19 test data in a way that would enable it to understand clusters of positive tests.
The data was pooled into a data platform and linked to the CHI. This, he says, provided raw data and enabled the public health team and the Scottish government to know that the datasets they were using were based on the same infection data.
The data platform has a virtualisation layer and provides published schemas. Access is also available using tools such as PowerBI and Tableau. NHS Scotland rolled out national testing and local testing at the health board level. Over a six-week period, Mitchelson says the team developed a ServiceNow CSM (case management)-based contact-tracing app for test and trace.
NHS Scotland used a cloud-based telephony contact centre with local contact tracer teams provided with laptops running the ServiceNow client. Managed by a local team leader, the system provides a workflow for the contact tracers, running via ServiceNow.
In September 2020, NHS Scotland kicked off the digital part of the mass vaccination programme, to develop a management tool at the point of vaccination, says Mitchelson. “The tool needed to be linked to the CHI number and had to manage the schedule for mass vaccination centres,” he adds. This is the third application built on the ServiceNow platform.
Launched nationwide on 20 January, the vaccine management system developed on the Now Platform integrates and digitises the vaccine administration process, and scheduled 220,000 vaccination appointments in the first 12 hours.
Mitchelson says it made sense to extend this tool to enable GP clinics to set up vaccination slots and scheduling and be able to send out appointment letters via Royal Mail. As it continues the mass vaccination programme, NHS Scotland has now extended the platform to enable the general public to book vaccination appointments via a public portal.
“The public portal is a big opportunity for us – but it is also a big cyber risk,” says Mitchelson. He adds that although it was good enough to go live with 80% functionality, for the internally focused vaccination scheduling system for healthcare users, the public portal needed more care and had to be secure.
What began as an IT service management project has turned into something that is integral to the mass roll-out of coronavirus vaccination across Scotland. Mitchelson says the team is now dealing with a backlog of requests for enhancements to the ServiceNow platform. “We will be looking at the supply chain and stock of vaccination,” he says. “Is supply going to the right places? It is always good to have a dashboard.”