Patient First, the UK's largest patient safety event, will return to London's ExCeL on 21-22 November 2017
In comparison to worldwide proprietary software vendors such as Microsoft, Apple and IBM, open source software may not be a term that you recognise. However, the UK Government has been keeping abreast of its development and gradually engaging with OSS over the past decade. This year, strong guidance on how to procure open source software and assess its suitability, plus a catalogue of OSS applications is expected to be pushed through internal government, which confirms its position firmly in the mainstream arena.
What is Open source?
The first thing that needs to be explained is what open source actually is – in its simplest form it is software that has been developed in a public and collaborative manner. Unlike proprietary software, OSS has unrestrictive licenses and is generally free to use, giving consumers the freedom to choose solutions that can be built, tailored and adapted to their specific needs without the fear of prohibitive licenses and vendor lock-in.
Its key benefits include robustness, simple implementation and low maintenance. It does not directly attract renewal costs or fees and due to its flexible nature, OSS lends itself well to skunkworks projects.
These advantages are key when it comes to the public sector’s current standpoint – it is keen to find ways to reduce costs, whilst providing an increasingly efficient service, with changes in procurement now focussed on getting greater value from each purchase made.
These changes in procurement also include re-use costs, which have always been an issue with proprietary systems that lock users in, so it comes as no surprise that the Cabinet Office has halted all NHS purchases of Microsoft software whilst it negotiates a central deal. This decision has been made in an attempt to regain control and reduce the overall cost of software to the NHS, and in turn, opens up the playing field to open source suppliers, who are able to build flexible systems that can be adapted for re-use across multiple departments. A similar project is currently being undertaken within the country’s Police force.
Long-term supporters of open source within the government include Office of the Chief Information Officer, Robin Pape, minister for the Cabinet Office, Francis Maude and advisor to the Efficiency and Reform Group, Liam Maxwell and with his recent appointment to Government Chief Information Officer, the use of OSS throughout government is sure to gain momentum.
Mark O’Neill, leader of the Cabinet Office’s skunkworks team, is currently developing low cost IT applications and advising on the procurement of large projects. Although still early days, he stated in a recent interview: “We are looking at the community aspect as it is intended to provide faster, more agile ways of getting things done and the community aspect is key.”
Who is making the transition?
The Department of Health’s vision is to enable greater transparency of information, which includes the ability to access said information from the location it is needed, whilst restricting who can access it. In 2010, the DoH expressed an interest in a number of open source initiatives that were submitted during the Information Revolution consultation.
Many government departments are considering a move from proprietary software to an open source alternative; NHS Scotland is investigating the use of open desktops, which will encourage the use of OSS applications and other programmes that store data in a manner that can be used by other applications.
There are numerous open source and free applications that are being specifically developed for the healthcare market, such as DentalOpenERP, which enables dental suppliers throughout the UK and Europe to run more efficiently and covering all operational processes in one open source solution. DentalOpenERP has been designed so that in time, it can be successfully deployed within various other primary care settings.
In addition, this July, the government’s technical innovation hub, DotGovLabs, hosted a ‘Dragon’s Den’-style competition to decide on the winner of this year’s Healthcare Challenge prize. The winner was Rob Dyke of Taxtix4, who has assisted the University of York in conjunction with a Knowledge Transfer Partnership (KTP) to develop a healthcare-specific hub for open source software development, in conjunction with BCS, PHCSG and the ehealthopensource ecosystem programme.
Understanding the issues
Many of the systemisation challenges faced within the healthcare industry are shared with the majority of other industries – projects become too large, objectives are not clearly specified and the people creating the applications are removed from the people using it. Factors such as these can create a product that simply does not fit the use and in some cases, can reduce efficiency rather than enhance it.
The case for closed or proprietary software is that the supplier often gains domain experience is able to spread this learning over multiple sales of the same package. However, larger gains can be made if the lessons learned are shared freely within both the healthcare and technology industries, thereby soliciting greater review and collective benefit.
When designing the functional aspect of the system, the focus should be on the process needed, not what the current software does. E Healthcare was in practice long before IT was introduced; therefore, technology should be used to streamline these established processes with rapid information retrieval, security and efficiencies. Users and their environment need to be taken into account, with adaptations to suit where appropriate.
As with any application, professional skills are needed to enable it to be optimally used. Plus, finding the right sized building blocks to build the nation’s healthcare systems is essential – too small and the costs and time are great, too large and they will not allow for the flexibility and fine tuning needed to meet the unique demands of a modern healthcare industry.
Creating the solutions
As open source has contributors from across industry, it naturally attracts innovators to create solutions to problems as well as refiners who iron out the finer points and both have the freedom to build and perfect the systems.
The Open Health Tools Project supports the Integrating the Healthcare Enterprise (IHE) initiative, which intends to bring together a standard set of information that can be implemented across healthcare systems enabling new products and services to be introduced whilst maintaining compatible information. This project has a community of healthcare and technology industry professionals working together toward a common goal. This is in contrast to the closed approach, where a system is developed in isolation by a single organisation and sold into the market without the opportunity for the users to affect its design and usability.
By building one common system that can be adapted for use across multiple sites and departments, it results in less training and a deeper knowledge of the implemented technology across the organisation.
In addition, with an OSS system, there are no ongoing software costs and users have the ability to independently tailor the system to suit their unique requirements, both during the initial build and as business requirements change.
Finally, there are the exit and retirement strategies to consider. Proprietary systems ‘lock’ the user in; therefore, in order to retrieve essential data from their system, users may have to engage a consultant to reverse engineer the information schema. Plus, some license restrictions may prevent organisations from using external parties, creating a costly exit strategy and leaving them with no choice but to pay the vendor to export your key data.
With OSS, open standard and open data, users enjoy no such restrictions – they are able to view and introspect all components of their systems and the data contained. Therefore, it is a lot easier to access and export business logic, functions and data from an open system, thereby dramatically reducing the exit cost.
Looking to the future
Once marginalised in favour of proprietary software, open source is finally making waves in the corporate and political worlds. Its philosophy, methodology, flexibility in its usage and modification and obvious cost benefits simply cannot be ignored. No matter how you look at it, OSS has a significant part to play in the future of IT.
However, irrespective of the type of system an organisation chooses, technology should not be used to solve process problems and can never be expected to overhaul a organisation’s operations alone – it is only through understanding the issue and resolving it that IT can then be implemented to enhance and streamline the offering.
About the author
Stuart Mackintosh is the MD of OpusVL. He is a member of the government’s OSS implementation steering group, which governs and monitors the effective adoption and use of open source technologies through government departments.