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The positive stance of the Cabinet Office towards Open Source software is widely communicated. However the Department of Health's current IT consultation paper 'An Information Revolution' does not mention open source software at all. This stark omission in a paper which depends on 'a presumption of openness' across the NHS supply chain begs for comment from the open source community.
According to the Department of Health, patients will be given the information to consent to treatment, given control over their data in new forms of online experience and given the decision to release this data for management and research purposes, which will in turn improve care. This new world is to be underpinned by "a presumption of openness" between systems, governed by open standards of information exchange.
Great vision, but how do we get there? Data openness is not a natural characteristic of proprietary software, which by law can only be modified by the owners, instantly limiting development capacity and extending the timescale for delivery. By contrast, open source software can by law be modified by all. So why hasn't the consultation paper recognised open source as significant accelerator of change? In these times of austerity, with close to zero extra cash coming from the Department of Health, there are big questions to be answered about where the new systems to deliver this information revolution are going to come from.
The widespread and consistent application of open, international healthcare standards is severely lacking. It is not the availability of standards that is the problem, but their support within proprietary systems, professional bodies and care organisations. Implementation requires significant programmes of change combined with supplier accreditation schemes. Standards on their own are no guarantee of delivery.
Open source software can provide an accelerator 'platform', through which open standards can be directly implemented and introduced into service by anyone with the appropriate skills. One of the best examples of this approach is the US Connect project (link) which implements a full IHE cross-community document sharing solution for national health information exchange, an approach with has similarities with other European projects (such as OHT, OW3, OeHF, O3 and Sintero).
Open source not only lowers total cost of software ownership, but also delivers benefits faster and more frequently than the traditional software procurement method. As the Connect project demonstrates, the speed of delivery in open source acts as a stimulus to proprietary systems vendors to invest more rapidly in incorporating open standards into their own systems.
Awareness and skills to use open source social networking (such as Elgg), business intelligence (Pentaho) , integration (OpenESB) and enterprise resource planning systems (OpenERP and DentalOpenERP) to cover the whole enterprise is rising, but nobody should be under the illusion that this software is commonplace in UK healthcare. There are different management issues to address with open source software. We have to build different models of procurement – a fact recognised recently by the European Commission.
The Department of Health has yet to recognise the hugely positive management leverage that open source can bring to bear in a change programme as large as its information revolution. Open standards in proprietary systems have not and cannot deliver 'openness' on their own and 'presumption' is no substitute for strategy.
If open source continues to be regarded as a mere technical feature of a proposed solution, which people reading the consultation paper can be forgiven for assuming, then the chance to kick start the new liberated NHS into life are going to be missed for another decade.
Eckhard Schwarzat, director of ValueDecision, and Malcolm Newbury, a director of Guildfoss, have senior experience with international management consultancies and software companies, and have been active participants in healthcare open source and open standards communities for many years. A long version of this article, as well as the chance for readers to comment, is available here.
Smart Healthcare Live 2011 will feature IHE Open Healthcare, organised with the support of Integrating the Healthcare Enterprise, the international open standards accreditation body. Click here for more information.
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