At a time when the NHS is facing radical change and is seeking opinions on how to push back on the centralised approach to IT that has been adopted since 2003, this Challenge Paper is designed as a proposal for a fresh approach to NHS IT. We welcome responses, or indeed counter-challenges, to its content.
The NHS is just emerging from a decade of wasted opportunity in the development of clinical information systems, particularly Electronic Health Records.
The National Programme for IT was a centralised approach to information sharing that has failed on a number of levels. This has delayed the introduction of new systems, weakened the commercial supplier base and disheartened many IT professionals in the service. The NHS needs a fresh approach to clinical IT.
Some have called for the use of more open source software, and it is true that open source and open standards can go some way towards providing long term solutions for the NHS.
Putting good quality toolkits into the hands of developers at the grass roots of informatics in the NHS could help to harness the enthusiasm of local clinicians and developers, channelling their solutions towards interoperable, extensible systems built using open standards and open source.
But just introducing open source software risks repeating many of the mistakes that have dogged the National Programme – lack of involvement of practitioners, protection of the vested interests of product vendors, reliance on large-scale service providers and over-complicated solutions to immediate and very practical problems.
Open Health Informatics introduces two new dimensions to the open standards / open source landscape. Firstly, the use of open interfaces so that every component of a solution can be plugged in and out at will, enabling a ‘best of breed’ approach to open source and eliminating, once and for all, the product-centric culture that has held back the NHS.
Secondly, the use of open development processes – agile development that involves users and other stakeholders at every step of the way. Agile, open processes also eliminate the pretence that users know exactly what they want at the start of development, or that the solution provider knows exactly how to deliver it.
Using open source and open standards can solve some of the problems in the delivery of information systems for the NHS; also using open interfaces and open development processes can ensure that the next generation of systems delivers the effective solutions that service users will demand.