NHS and Vista Integration

CAMTA Annual Meeting London 14 Nov 2013 Ewan Davis Woodcote-Consulting and HANDI Health
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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

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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
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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
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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 VistA http://nhsvista.net/

Open source gains momentum in NHS NHS England announces plan for NHS VistA

NHS England changes its mind about VistA

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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

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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

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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/ Kings 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-greatprophet-zarquon/ eRefferals (replaces Choose and Book) http://www.ehi.co.uk/news/ehi/8862/bjss-wins-e-referralscontract

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.

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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

Create a Ecosystem to

Functional and desirable Work seamlessly together Interoperable, orchestrated, consistent Be device and form factor agile 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

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Digital Health Ecosystem

User interface components (Apps)

Web Services SMART Wrapper ITK - API Business Services

Link to Other ESBs Enterprise Service Bus (ESB) Link to Other ESBs

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

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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

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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 EHR persistance VistA evolution is already underway with significant investment from VA and others.
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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

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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 UHB PICS

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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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