UK Healthcare Interoperability

[Julian Coombes]

Hi, this is a long post (blame Carl). Its about me and the work I've been doing. If you're interested in open source healthcare in the UK, then you're probably interested in the following :-

I've been working with open source/low cost health care on and off for the past couple of years. My background is in distributed banking systems, systems integration, interoperability, security, Java and open source software - up until October 2011 I was lead technical architect for a global internet banking system at a large uk bank. Since then I've been working on building interoperable healthcare infrastructures using open source technologies.

Specifically I've been working on interoperability with a leading UK GP clinical system and developing solutions which benefit from that interoperability. I've developed the capability to deliver patient records to a secure web portal, and the ability to deliver PDF document summaries of patient data by email - basically you email the system with the nhs id of the person you're interested in, and back comes their medical record as a PDF document.

The solutions use open source throughout, so no software license costs and because cloud technology is used for message routing, they're massively scalable. With the current solution, its perfectly reasonable to run all 8000+ UK GP practices through it.

Additionally the core of the interoperability is based around Mule open source enterprise service bus. Once your patient data is in mule, its pretty straightforward to interoperate with anything.

In order to try and realise the potential of this architecture, I've been talking to local GPs looking for a specific application to develop and identified a portal for secure web access to patient records for out of hours GP support in the local area. The benefits here are fairly clear and would result in less hospital admissions. I'm told they've wanted a system like this for the past 10 years.

So I put together a business case to cover the roll out of the system for 23 GP practices using a mixture of leading GP clinical systems. My system would take 2 months to deliver, including some additional development. At the end of the two months, all patient data in the local area would be accessible by out our hours GP staff through a secure web portal.

I had a meeting with the local IT staff, including the Head of IT, last week. They were happy the system met security standards, and generally impressed with what was proposed, to the point where they were willing to give the project their backing.

We'd managed to identify an appropriate pot of cash to support the work, the final funding discussion was supposed to take place Tuesday Feb 7th.

However, following a meeting on Monday Feb 6th with North West NHS to discuss patient access to medical records, the local Head of IT withdrew her support for the project. The reasoning was that she had effectively been instructed to work with existing system suppliers to deliver patient data. As my system competed with the existing system suppliers, she felt that she could no longer support it.

Given the challenges facing NHS IT, and the desire to move towards open, innovative, agile and low cost systems, its difficult to imagine how this can happen when systems that provide these qualities get rejected in favour of the existing system suppliers.

I can deliver a live system in two months that improves outcomes and will likely save lives, this is effectively being ignored by NHS IT who would rather spend literally millions on systems that take years to develop and will only deliver the same information.

Regards,

Julian.

[Julian Coombes]

Forgot to mention that I've been having conversations with a company who are putting in a hospital system and want to hook their hospital system to my infrastructure. That way when people get admitted to hospital their up to date GP records are immediately available to the people treating them ...

[d...@fishms.org]

Julian,

I sounds like a good project. A few things -

1) Patients have the right to opt out of such systems as yours - how is
this being handled?
2) Whilst the head of IT is the right first route to follow, many of these
organisations will cease to exist if the new NHS Bill comes into force.
You seems to have engaged the local GP's - may I suggest you approach the
local CCGs (Clinical Commisioning Groups) to progress this project.

Regards
Dan Fish

> *Hi, this is a long post (blame Carl). Its about me and the work I've been

> Julian.*
>

[Taavi Tillmann]

Julian,

It sounds like you have come up with a fantastic solutions and I would fully support its implementation. It also sounds to me like you have come against a specific conflict of interest issue. This person who gave the order to pursue private systems as opposed to open-source ones may have suspect links that border on corruption. The NHS is, after all, a public organization and should choose the most efficient solution to serve the public good. Whoever is biased toward private systems a priori, could theoretically be investigated on grounds of corruption, and asked to justify why it is that they prefer private systems. While it is difficult to predict how to now proceed, I would suggest that you get some solid support from senior clinicians, either at the GP, hospital or CCG level. With their backing, you may be in a stronger position to investigate and challenge whatever conflicts of interest this bottleneck-person is creating for you. 

How you can do that will depend largely on the local arrangements of power. For example, our hospital is also having difficulties with our clinical systems not being interoperable. Our senior clinicians support the idea of bringing in an integrated system, but IT tells us that private systems are too expensive to implement. Thus in our case, we would prefer an open-source approach as opposed to a private approach, were this offered. However, each place is different so you'll have to figure out how to work with each organization individually, depending on local bases of power.

The GP-Hospital information exchange you mention is very important. Far too often, patients come to our hospital out-of-hours with vague drug or past medical histories, and we cannot find out what has been happening to them in the community until the next day (in which case this can still take many hours). This delayed access to information causes suboptimal treatment. Implementation of your system would clearly improve patient care in this aspect.

Best,

Taavi Tillmann, 

FY1, North Middlesex University Hospital

[Joseph Dal Molin]

As shocking as this may seem it is not unusual nor, depending on the
circumstances, illegal. Procurement practices and policies have
co-evolved with proprietary software business models for over 30 years
now. This has led to often convoluted tendering processes and
establishment of "purchasing" bureaucracies that are intended to prevent
corrupt business practices. The upshot of this is that governments have
found their own processes so onerous that they often enter into "blanket
procurement" agreements via a competitive tender in which one or more
companies bid to offer a range of services. The gov't body then issues
task orders or specific requests for proposal to the company that won
the blanket tender. This form of procurement is common practice here in
Canada and the US and the Connecting for Health project was essentially
modeled after this approach. It discriminates against small companies
that do not have the resources or can meet the mandatory criteria to bid
on these blanket agreements. The small companies have to resort to
sub-contracting to larger firms who often do not have the subject matter
expertise to actually perform the work.... the net effect is that the
cost of a solution goes up 50 to 100% to cover the additional overhead.
Not to mention the added complexity of potential finger pointing between
subs and primes. Procurement methods are long overdue for a serious
evaluation as to their efficacy... especially given the dramatic
failures and lack of effective innovation we have experienced for many
years now.

BTW Julian, are you releasing your solution as open source?

Cheers,

Joseph

Joseph Dal Molin
President, E-cology Corp.
Tel: +1.416.232.1206
Skype: dalmolin

On 12-02-08 04:04 AM, Julian Coombes wrote:
> *Hi, this is a long post (blame Carl). Its about me and the work I've

> Julian.*

[Joseph Dal Molin]

This should read....

"The gov't body then issues

task orders or specific requests for quotation to the company that won
the blanket tender which effectively locks out any other option."

Joseph

[Rob Tweed]

..which is exactly how the NHS NPfIT ended up

Rob

---

Rob Tweed
Company: M/Gateway Developments Ltd
Registered in England: No 3220901
Registered Office: 58 Francis Road,Ashford, Kent TN23 7UR

Web-site: http://www.mgateway.com
Twitter: @rtweed

[Julian Coombes]

>> BTW Julian, are you releasing your solution as open source?

There are key parts which would benefit from being open source in order to aid interoperability so eventually I'd consider making them open source. There are parts to do with providing a secure conduit which again ought to eventually be opened as I don't believe in security through obscurity. Then there are parts which can't be open sourced ... if you think hard enough you'll figure out which bits they are. So in short, I'd like to open most of it, but more importantly my main concern is trying to ensure it serves its main beneficiary which is the NHS ...

[Carl Reynolds]

I've emailed a few DH/policy contacts about this.

It might be worth dropping Richard Bacon a line.

http://blogs.computerworlduk.com/the-tony-collins-blog/2011/01/mps-letter-to-christine-connelly-in-full/index.htm

[Julian Coombes]

Currently this situation is being looked at by the UK Government Cabinet Office through the extended supplier feedback service.
My understanding is that in order to look at it, they'll be calling on the Department of Heath to investigate ...

https://update.cabinetoffice.gov.uk/sites/default/files/resources/extended-supplier-feedback-service.pdf

The case has also been across the desk to the Crown representative for SMEs ...

http://realbusiness.co.uk/news/selling-to-government-stephen-allotts-whitehall-battle

J.

[Carl Reynolds]

Excellent news! 

Really hope this is sorted :-)

Best, Carl