Open Source in Good Health and Vice Versa

Last week I wrote about the UK government's “new” IT strategy, which is designed in part to avoid some of the costly mistakes of the past. And as far as the latter go, there aren't many bigger or costlier than the NHS National Programme for Information Technology (NpfIT).

On Open Enterprise blog.

Why the UK's “Smarter Government” Plan is Not So Clever

There's no doubt that the area outside computing where the ideas underlying open source are being applied most rapidly and most successfully is that of open government. Alongside the US, which is has made great strides in this area, Australia, too, has caught the transparency bug. So what about Blighty?

On Open Enterprise blog.

Tories Back Open Source Software...They Say

Evidence that open source and the more general concept of openness is becoming trendy: the politicians are bandying them around again. There was a flurry of this stuff last year, and here is the latest effort from the Tories....

On Open Enterprise blog.

A Different VistA for the NHS?

I've written quite a lot about Microsoft's ill-fated Vista in Open Enterprise, but nothing so far about another VistA:

Electronic Health Record systems (EHR) are essential to improving health quality and managing health care delivery, whether in a large health system, hospital, or primary care clinic. The U.S. Department of Veterans Affairs (VA) has developed and continues to maintain a robust EHR known as VistA - the Veterans Health Information Systems and Technology Architecture. This system was designed and developed to support a high-quality medical care environment for the military veterans in the United States. The VistA system is in production today at hundreds of VA medical centers and outpatient clinics across the country....

On Open Enterprise blog.

Making the Connection

When the following press release arrived, my heart beat a little faster....

On Open Enterprise blog.

Que la Bête Meure

The National Health Service's £12.7 billion computer system is in doubt after its managers acknowledged that there will be further delays.

Connecting for Health, the NHS agency responsible for the world's biggest civil IT project, said it didn't have a clue when hospitals in England will start using the software that is required to keep track of patients' medical files.

Come on, put the beast out of its misery.

Federate!

You know it makes sense:

A £13bn overhaul of the NHS records system has suffered so many problems that hospitals have struggled to keep track of people requiring operations, patients with suspected MRSA and potential cancer sufferers needing urgent consultations.

W(h)ither the UK Database Nation?

Interesting:

The court’s view was that health care staff who are not involved in the care of a patient must be unable to access that patient’s electronic medical record: “What is required in this connection is practical and effective protection to exclude any possibility of unauthorised access occurring in the first place.” (Press coverage here.)

A “practical and effective” protection test in European law will bind engineering, law and policy much more tightly together. And it will have wide consequences. Privacy compaigners, for example, can now argue strongly that the NHS Care Records service is illegal.

To say nothing of the central ID card database that permits all kinds of decentralised access....

Is This the Season of Porcine Aerobatics?

On Open Enterprise blog.

A Privacy Disaster Waiting to Happen

I was already teetering on the brink of opting out of the NHS patient database; this just pushed me over:

A new national database of confidential patient records is being opened to access by NHS staff who need no professional qualifications - despite official assurances that records will only be accessed by specialists who are providing care or treatment.

A document obtained by Computer Weekly under the Freedom of Information Act also provides evidence that NHS Connecting for Health - which runs part of the £12.4bn National Programme for IT [NPfIT] - has quietly decided to weaken assurances given to patients about the confidentiality of records.

Doctors are angry because they say that patients were given an assurance that non-clinical staff would be unable to access the national summary care record database which is being trialled at NHS trusts in various parts of England.

Requiem for a Failed Methodology

News that Granger is abandoning the sinking ship that is NHS Connecting for Health is hardly a surprise. The £12 billion project was doomed before it started, because it tried to apply an unworkable, 20th-century, closed-source software methodology - one that not only does not scale, but that actually gets worse the bigger the project (hello, Fred Brooks).

The only way to address these kind of mammoth undertakings is by using a lightly-coupled, decentralised approach. And that means open standards at a minimum, and ideally full-bore open source. The equation is simple: the more openness, the greater the scope for componentisation, the greater the flexibility - and the greater the chance the damn thing will actually work.

Sadly, NHS Connecting for Health will go down in history as the perfect demonstration of this fact. - Sadly, because I shall be paying for some of it.

IT's Got to be Local and Open

Nice story in the Guardian today about a local UK health system that works - unlike the massive, doomed, centralised NHS system currently being half-built at vast cost. It makes some important points:

Next week the annual Healthcare Computing conference in Harrogate will buzz with accusations that the national programme has held back progress. There are two reasons behind this charge. First, under the £1bn contracts signed early in the programme, hospitals have to replace their administrative systems which record patients' details with systems from centrally chosen suppliers. As this involves considerable local effort for little benefit, progress is painfully slow. The second problem is the potential threat to confidentiality arising from making records available on a national scale.

Quite: if there is no local benefit, there will be no buy-in, and little progress. Think local, act local, and you get local achievement. The other side is that if you impose a central system, security is correspondingly weaker. Hello, ID card....

Of course, there are many areas where you want to be able to bring together information from local stores for particular purposes. That's still possible - provided you adopt open standards everywhere. Hello, ODF....

Reasons Not to Use Closed Source: No. 470

Yesterday I passed on a story about a closed source company unilaterally upping its support prices, and simply locking people out of their files if they refused to pay. Now, here's another good reason not to use proprietary systems.

The UK's shiny new IT system for the National Health Service (NHS) is fast becoming the biggest disaster in the history of computing. The latest area to suffer is that of childhood vaccinations:

Child vaccination rates may be falling to risky levels after a new IT system was installed, a health watchdog says.

Ten out of London's 31 primary care trusts have installed new software to manage the vaccine programme as part of a £6.8bn overhaul of NHS computers

...

Richard Bacon, a Tory MP and member of the Commons' Public Accounts Committee, said: "The national vaccination programme has been one of the NHS's greatest successes."

But he added the IT upgrade appeared to be "destroying it at a touch of a button".

And why is this all happening?

A spokesman for NHS Connecting for Health said the new system was implemented at short notice because the previous supplier "withdrew support for its ageing system from the market".

Had this "ageing system" been open source, the NHS could simply have called in another third-party contractor and given them the code. Since it was closed source, it was doomed when the supplier abandoned it, leaving the health system up to its neck in the proverbial.

Nor is this a matter of simple inconvenience: children are likely to die, if herd immunity is gradually lost as a result of these IT failings.