Transforming health and social care through digital technology

In 2018, the Scottish Government’s ‘Digital Health and Care Strategy’ outlined how technology will be used to reshape and strengthen services,  support person-centred care, and improve outcomes. As Scotland moves towards a digital built environment, information management specialist Stefan Mordue explains how Health Facilities Scotland (HFS) and NHSScotland (NHSS) are driving the adoption of Building Information Modelling (BIM) to help tackle challenges and deliver the Scottish Government’s strategy.

In April 2017, the Scottish BIM policy note set out how this collaborative tool that digitally captures all information related to a building should be adopted in public sector procurement. Since then, the implementation of BIM has become a key priority for HFS and NHSS. HFS has led on the introduction of BIM across NHSS through several pieces of work and the introduction of an NHSS BIM Development Group, now known as the Digital Estate Group. The group, in conjunction with HFS and consultancy support led by AECOM, have developed a BIM strategy.

This supports documents, templates and includes a training programme for NHS Boards to ensure the creation of a digitised information management process for those working on NHSS programmes. This enables consistency and facilitates collaborative working, which will in turn reduce waste and non-conformances. HFS and NHSS are prioritising the implementation of BIM across Scotland’s Health Boards.

With BIM fully embedded, NHSS is now creating a digital estates strategy. One of the key components of this is the digital twin — a shift from a deterministic to a more probabilistic, dynamic model.

Digital twinning

Via digital twinning, NHSS aims to link its physical assets (buildings and potentially end-users) to a digital representation, using data from sensors and analysing variables such as condition, efficiency and real-time status. This connectivity coupled with data analytics will reform facilities’ levels of operational effectiveness, generate extra insights from the digital twin to help reshape and improve services, support person-centred care, and improve outcomes in line with the ‘Digital Health and Care Strategy’.

The BIM process benefits individual NHS Boards by improving information management at a project level. It also has a significant impact at an organisational level overall. This longer-term vision supports the concept of a digital estate alongside the physical — a portfolio-wide collection of structured, indexed and searchable digital asset information, making it easy for a board to search, retrieve and make sense of its existing information. Over time this will help NHSS with future investment and better decision-making.

Seeing the bigger picture

Alongside recognising BIM as a tool to help deliver better hospitals and built assets, it’s important for users to understand how it can help improve service quality and efficiency, and the patient experience. For example, our strategic approach couples concepts, bringing processes such as BIM and Soft Landings together with technology to align building users’ objectives and operational functions, and support NHSS’s compliance agenda. Using BIM, digital simulations and analytics, we can then test the theoretical against the brief.

Four critical cornerstones

As part of our work advising HFS on its national approach and training material for Scotland’s Health Boards, we identified four cornerstone actions to help fully reap the rewards of a BIM approach:

1/Embed the UK BIM framework

It is important that all participants work from the same consistent set of standards and processes. To enable that, we recommend embedding and using the UK BIM framework, which comprises core standards backed with common processes and a suite of
enabling tools that, in combination, bring BIM deliverables to life. These focus on:

• Defined information requirements
• Collaborative working practice
• Data exchange and validation
• Security-minded digital working
• Better outcomes and end-user value (digital reality checking and a Soft Landings framework approach).

2/Ensure collaborative working – use of Common Data Environments (CDE) and workflows

The NHSS estate contains a colossal amount of information, which can be challenging. To tackle this, it’s essential to establish an Information Management and Common Data Environment (CDE) strategy that follows an agreed information hierarchy, covering how directories and folders should be structured along with agreed workflows and naming conventions.

3/Take a security-minded approach

As the use of digital data increases, so do the security risks associated with physical controls, staff behaviour, unauthorised access, and manipulation and sharing of data, information and systems. In a healthcare setting, you must consider the security of staff and patients, built assets, and the services delivered from those built assets, as well as the data and information that staff hold or can access. As a priority, you need to develop, implement and enforce a strict policy covering access to, and permissions for, sensitive information and project data.

The UK BIM Framework document, PAS 1192:5 ‘Specification for security-minded building information modelling, digital built environments and smart asset management’ details appropriate and proportionate measures you should take to manage security risks for a built asset, in whole or in part, asset data and information.

4/Use Soft Landings to maintain value throughout the lifecycle

Soft Landings (SL) is an essential element of the design and construction process. It maintains the golden thread of a building’s purpose through to delivery and operation, via early engagement with end users, the inclusion of a SL champion on the project team and, importantly, a clear commitment to aftercare post-construction. The SL approach aims to improve building performance by “aligning the interests of those who design and construct an asset with those who subsequently use it”.

It works to smooth the transition from design and construction into the operation and use of an asset, to make sure that operational performance is optimised. To enable that, these transitions must be considered from the earliest stages of a project right through to completion, rather than just at the handover stage. We combine BIM and SL to enable aspects such as reality checking and capturing digital information throughout the entire lifecycle. This information can then be used, for example, to test maintainability and support better stakeholder engagement through data-rich virtual environments.

What BIM success delivers

Successful and consistent BIM implementation across all Boards will facilitate and strengthen knowledge sharing across NHSS, support better decision-making and deliver greater efficiencies through the design, construction and operational stages of a project. Equally important, it will help the Scottish Government deliver the objectives of its ‘Digital Health and Care Strategy’, improving patient care.