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Abstract
Objective To deploy a digital application of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) across health boards (HBs).
Methods Clinicians, patients and other regional stakeholders collaborated with the Scottish National Technology Service (NTS) defining requirements. Development was agile with user feedback.
Results The ReSPECT web application developed on Scotland’s National Digital Platform used an openEHR Clinical Data Repository. Plans can be viewed and edited across settings. Deployed in 2020, by July 2025, 8 of 14 HBs were onboarded and >5500 patients had digital ReSPECT plans.
Discussion openEHR structures clinical data in a modular way, enabling other applications to use the same data layer. Close collaboration between technicians and users fulfilled the application’s requirements and solved problems together.
Conclusions Collaboration on the digital ReSPECT accelerated deployment, enabling more people’s wishes and clinical recommendations to be captured and shared across care settings and transitions. openEHR technology enables new data uses.
Ethics
No ethics approval was required. A Scotland-wide Data Privacy Impact Assessment was shared with health boards’ (HBs) governance teams during onboarding. Patients agreed to the secure digital storage and processing of their data in line with UK data protection law.
Results
By July 2025, >5500 digital ReSPECT plans had been completed. In FV and Tayside HBs, any setting with access to the clinical portal can view ReSPECT plans. Direct access to the application is available for authenticated users. Following the ReSPECT plan publication, an automated integration with the document management system (DMS) provides a copy to general practices (GP). GP unscheduled care can view ReSPECT via the emergency care summary7 (ECS), where the individual’s practice has copied this. Advisors in SAS can view ReSPECT via integration with the web service for ECS.7 The ReSPECT web application can save a versioned plan as a PDF, enabling printing and wider sharing. Tayside, the Western Isles and Dumfries and Galloway HBs were onboarded in Winter 2022. Four further HBs had access to the ReSPECT application by September 2024 (figure 1). Digital access to ReSPECT plans means that more complete, easily structured, patient-centred information is available all in one place to SAS and GP unscheduled care, when patients face a health crisis.
Increasing digital ReSPECT plans. ReSPECT, Recommended Summary Plan for Emergency Care and Treatment.
Conclusions
This innovative collaboration between NTS and regional HBs to develop the ReSPECT application has expanded digital capability for emergency care situations. Close clinical involvement from the beginning has ensured it meets users’ requirements and keeps patients’ needs at the centre. The openEHR specifications for Scotland’s National Digital Platform CDR potentially allow data reuse by other clinical and/or patient-facing future care planning applications.
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