The decision by CSC to withdraw support for the iSoft primary care products is the most recent in a long line of commercial decisions that have not served the best interest of the NHS, GP practices and their patients.
Decisions like this are the inevitable consequence of a market in which companies and systems are bought and sold and in which decisions are taken in interests of shareholders and remote investors, not users, who as a result are left facing considerable cost and disruption.
There is another way – The Open Source way, which has increasingly demonstrated its ability to deliver software in ways which puts control in the hands of users without the risk of vendor lock-in, while simultaneously creating commercial opportunities and economic growth.
At a global level the rise of the Internet is the most powerful demonstration of the potential of this approach. In healthcare the success of products like VistA, OSCAR, OpenEHR and SMART Platform demonstrate the potential of the approach. In UK healthcare we have seen a rapid growth and engagement from the grass roots with initiatives including eHealthopensource, HANDI, NHS Hack Day, Digihealth, TheDigitalDoc and projects like OpenEyes, WardWare and the Leeds Open Portal.
Government too has embraced the open source approach in health with support for the initiatives above and with it own projects including the Open Data Platform and The NHS Code4Health initiative.
Integral to the Open Source approach is transparency and open governance driving up quality, ensuring clinical safety, security and sustainability with funders able to see where their money is being spent.
These developments make it the right time for a new initiative, which will ensure that never again are GPs and their patients held to ransom by supplier lock-in, or faced with an expensive and disruptive change. It also provides an opportunity to drive forward an open ecosystem facilitating not only the transformation of health and care but also growth opportunities for the UK life-sciences and IT sectors including those existing vendors with the vision to embrace this new way of working.
How will we do it?
We don’t simply want to replicate existing GP systems, but instead do something radically different: creating an IT ecosystem, initially for general practice, but easily expandable to other care settings. The key components of this will be:
- An open electronic record repository. This would separate the storage of the record from the applications that manage it and handle the associated work-flows allowing the creation of multiple ‘front ends’ to meet different users needs and facilitating access for secondary uses under patient control.
- A set of open-standard interfaces (APIs) to enable third parties interact with the repository and associated services to provide apps and tools to support the process of care.
- A set of open source components which would provide the core functionality needed to support a GP practice, which together provide a ‘front-end’ to support the delivery of health and care that puts patients and carers at the centre and all parties have the tools for effective and efficient care in partnership.
This open architecture will greatly reduce the investment required to build software creating an ecosystem of third-parties applications and services, adding value for patients, clinicians and carers in which users and enterprises of all sizes can participate creating a vibrant selection of free and commercial applications.
The overriding principle is that “no single component essential for the operation of the platform should depend on proprietary intellectual property capable of creating vendor lock-in”.
Initially, the focus will be on providing at least one open source implementation of all the key components, but it is expected that there could also be alternative implementations, under a variety of business models.
It is envisaged that core platform development will be carried out by a combination of professional developers working in small agile teams with domain experts and volunteers. This activity will need to be funded by those that otherwise will have to continue to fund the much more expensive and often ineffective proprietary NHS.
With the right support from key decision-makers, and leadership from the front-line of health and care, this approach will secure UK General Practice’s already enviable global leadership in the application of IT at the point of care, catalyse and facilitate the transformation of health care delivery, open-up health data under patient control for the benefit of the UK Life Sciences and create growth opportunities for UK industry.
could a supplier abandon a software platform, leaving its users high and dry and with a serious business continuity problem. With an open source system, we would still have the source code and a community capable of supporting it;
will NHS institutions be left with unmaintained and unmaintainable software, due to a supplier having ceased trading. With an open source system, we would still have the source code and a community capable of supporting it;
could a supplier unilaterally control the way a software platform develops in future. The user community will be able to control the direction(s) of travel;
will users have to make do with anything less than the version of the software that best meets their needs;
will users have to put up with ‘Well that’s just the way it works’ in response to functionality issues.
Ewan Davis, Rob Dyke, Marcus Baw 2013