A final review of the National Programme for IT by the Cabinet Office’s Major Projects Authority has finally put an end to centralised commissioning of electronic health records. Instead local NHS trusts will now be able to commission their own IT systems for this purpose. As we recommended in our report Fixing NHS IT: A Plan of Action for a New Government these local systems will need to integrate with the national infrastructure already in place and with each other.
We welcome this change, as it opens the doors for local choice and design and gives space for creativity and innovation in the design of IT systems. In many cases the best medical systems are those developed by, or working closely, with the people who will actually need to use them, namely clinicians.
One example of this is the the patient record system used by the Veteran Health Administration (VHA) in the US, known as VistA. This system, although originally developed on a very small scale by those working within the VHA, has grown and is now used in the care of over 4 million US veterans. One of the beauties of the VistA system is that the software is open source and thus can be used and developed outside of the VHA, both within the US and around the world.
Further developments of open source patient record software are occuring in this country. One example is that of OpenEyes, driven by Bill Aylward, at Moorfields eye hospital, a collaborative open source EPR for opthamology. This software provides the basic infrastructure and key functions that are needed, but will also accept apps to do specific tasks which can be added in by other software developers. Other trusts are welcome to use OpenEyes and it is already in use at St Thomas’ Hospital, Manchester Royal Eye Hospital, Maidstone, and Royal Victoria Eye and Ear Hospital.
Whilst elements of the NPfIT programme which are now established, including the Spine, the N3 Network, NHSmail, Choose and Book, SUS and PACS are welcome and provide a national infrastructure, the decentralisation of other parts of NHS IT will continue to allow both public and private innovation and the constant development which IT requires. Whilst a national IT system was a worthy aim, we feel that this new approach will lead to systems more closely tailored to meet local needs.
I think we have to be very careful when talking about the cost-savings that could be achieved by implementing Open Source software in to Hospitals. While the concept of Open Source software in the area of Electronic Patient Records is an admirable one, we need to avoid any misconceptions that it will provide a completely free alternative to Proprietary software.
While Open-Source solutions may be free at the point of procurement, the fundamental problem is that someone needs to support the software. I would suggest that many NHS Trust’s IT Departments may struggle to find the time and resources to do this. Thus, it is likely that the support function will have to be outsourced to a third-party organisation with the relevant skills to do this, which will place a costly on-going revenue burden upon Hospital’s finances at a time when NHS Managers are under pressure to reduce such overheads.
Furthermore, implementing electronic working in any area of clinical activity is a much more sophisticated process than just simply installing a program on to a PC. It requires changes to established working practices, and in the transitional stages clinical staff require training and support adjust to these changes and to fully realise the benefits of electronic working.
Let me be clear; I am not against the concept of Open Source software in healthcare. I am merely suggesting that there are wider considerations that must be made before it is pronounced as the de facto solution to delivering more efficient healthcare in the light of the Government’s recent decision to scrap the National Program for IT.
Clarification: OpenEyes is not /currently/ in /active/ use at those hospitals. We are working with those partners though.