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NHS and Vista Integration

NHS and Vista Integration. CAMTA Annual Meeting – London 14 Nov 2013 Ewan Davis Woodcote-Consulting and HANDI Health. My Credentials. Founding Director of HANDI Health CIC – A not-for-profit company supporting the Architects of the Digital Health Revolution www.handihealth.org

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NHS and Vista Integration

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  1. NHS and Vista Integration CAMTA Annual Meeting – London 14 Nov 2013 Ewan Davis Woodcote-Consulting and HANDI Health

  2. My Credentials Founding Director of HANDI Health CIC – A not-for-profit company supporting the Architects of the Digital Health Revolution www.handihealth.org Director of Woodcote Consulting Ltd www.woodcote-consulting.com Past Chair of TechUK Healthcare Group and current member of Healthcare Council (was Intellect) http://www.techuk.org Past Chair of BCS Primary Health Care Group Clients include NHS England – But not speaking for them or sharing anything not in the public domain

  3. VistA VistA is the EHR (mega suite) developed using MUMPS by the US Veterans Administration who deliver healthcare to 8 million US Veterans Core VistA code is public domain as a result of US Freedom of Information laws VA uses Cache (but have been careful to limit the use proprietary extensions) while some other implementations use GT.M VistA has been implemented in the VA with strong end-user engagement using agile methodologies and is credited with playing a central role in the remarkable transformation of VA care from “Basket Case” to “Best Care Anywhere” There are a number of VistA implementations outside of the VA in the USA and outside the US (e.g. Jordan) There are a number of VistA versions supported by both commercial and non-commercial entities and a number of organisations (large and small) able to offer services around VistA

  4. My Journey Initially suspicious of open source but now convinced that open source has an important role to play and creates commercial opportunities. A view that VistA had missed it moment in the NHS A view that VistA was “A better way to do the wrong thing” A concern that the success of the VA transformation had been conflated with the success of VistA A change of heart as I learnt more about the technology, commitment and ambitions of the VistA community

  5. NHS VistA Longstanding support from the UK MUMPS community for a NHS version of VistA No real expectation that the NHS would consider either open source and/or VistA NHS Campaign for VistAhttp://nhsvista.net/ Open source gains momentum in NHS NHS England announces plan for NHS VistA NHS England changes its’ mind about VistA

  6. Where are we Today? NHS England will facilitate NHS Trust to procure an open source EHR system Hope and expectation that someone will bid VistA Plans for centrally funded VistA localisation dropped Any one bidding VistA will either have fund localisation at risk or include localisation cost in bid

  7. NHS Open Source • Open source now central in NHS thinking driven by a desire to: • Comply with Government policy • Drive value by avoiding vendor lock-in • Facilitate end user engagement using open source approaches based on user-centred, agile methods very much hoping to mirror the successful approach used by the VA with VistA • Disrupt market and encourage proprietary vendors to “play nicely” • About much more than Just VistA • About open standards and open systems as well as open source • OpenEHR (CEN 13606) • OpenClinical • HL7

  8. NHS Open Source • Long history but until recently no material use of open source software in NHS • Last 5+ years have seen a number of projects reach a material level of use but still insignificant compared to proprietary solutions. • OpenEyes – Moorfields Hospital www.openeyes.org.uk • Leeds Portal – Leeds Teaching Hospital • http://forge.tactix4.net/gf/project/ocp_client/ • WardWare – Kings College Hospital http://www.wardware.co.uk/ • King’s ESB using Apache Service Mix http://www.ibm.com/developerworks/java/library/j-hsb2/ • Recently – Two major NHS national systems being redeveloped as open source. • NHS Spine http://www.woodcote-consulting.com/spine-2-and-the-second-coming-of-the-great-prophet-zarquon/ • eRefferals – (replaces Choose and Book) http://www.ehi.co.uk/news/ehi/8862/bjss-wins-e-referrals-contract • £260 million NHS Tech fund actively soliciting bids based on open source approaches http://www.england.nhs.uk/ourwork/tsd/sst/tech-fund/ • Suggestion that a number of established made be made available as open source to NHS.

  9. Future Vision • That actors in the health care system will have a set of tools that support their role. • Accessing knowledge and information • Store and manage information they create • Provide decision support • Digitally manage healthcare transactions • Help create data resources (“Big Data) • That these tools will be • Functional and desirable • Work seamlessly together – Interoperable, orchestrated, consistent • Be device and form factor agile • Create a Ecosystem to • Help actors to find safe appropriate tools to use or recommend • Provide the technical infrastructure to support the vision • Support sustainable business models • Create a community to drive the vision

  10. Digital Health Ecosystem User interface components (Apps) Web Services – SMART Wrapper – ITK - API Business Services Link to Other ESBs Link to Other ESBs Enterprise Service Bus (ESB) Ecosystem Services - Data Persistence, Knowledge, App Stores Other Services PDS, EHR, EPR, Decision Support, Identity Management, Consent Management Choose & Book, EPS, Security Broker – Some/all could be duplicated

  11. Where does VistA fit? • VistA community appear to share the vision • How can we evolve VistA towards the vision? • MWDS • Open MWDS • SMART • Browser technologies • Should the NHS participate in VistA evolution? • Why would NHS start from here? • How do we integrate with other NHS open source initatives

  12. VistA Strengths VistA is the most functionally rich of any of the open source EHR VistA has been widely implemented and demonstrated how it can support user engagement – But not in NHS Established mainly open source stack available Large global community VistA has a number of knowledgeable UK based advocates The MUMPS database remains a good choice for EHRpersistance VistA evolution is already underway with significant investment from VA and others.

  13. VistA Weaknesses MUMPS code base is unattractive to developers, complex and difficult to maintain. CRRS Is dated and relies on proprietary tools Limited implementation, so far, of browser based UI Workflows and clinical content entangled in code No UK implementation and localisation effort will be seriously non-trivial

  14. Alternatives • Stick with proprietary systems but demand open interfaces • Other open source EHRs • GNU Health – Seems like only serious contender and seems to be the platform of choice for a number of existing NHS Projects • Consider proprietary products that might be made available as open source • IMS Maxims • UHBPICS

  15. Questions and Discussion • More information see my blog www.woodcote-consulting.com/blog • If you are interested in health and care apps and lightweight digital tools (open or closed source) join HANDI www.handihealth.org • Email me • ewan@woodcote-consulting.com

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