Ewan Davis - CAMTA 14 Nov 2013.pptx

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Woodcote Consulting

NHS and Vista Integration

CAMTA Annual Meeting – London14 Nov 2013

Ewan Davis Woodcote-Consultingand HANDI Health



Woodcote Consulting

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

http://www.handihealth.org/

http://www.woodcote-consulting.com/

http://www.techuk.org/

http://www.techuk.org/







Woodcote Consulting

VistA

• VistA is the EHR (mega suite) developed using MUMPS by the USVeterans Administration who deliver healthcare to 8 million US Veterans

• Core VistA code is public domain as a result of US Freedom ofInformation 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 acentral role in the remarkable transformation of VA care from “BasketCase” 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 andsmall) 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

http://nhsvista.net/

http://nhsvista.net/



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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 desireto:

– Comply with Government policy

– Drive value by avoiding vendor lock-in

– Facilitate end user engagement using open source approaches based onuser-centred, agile methods very much hoping to mirror the successfulapproach 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 butstill 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 opensource.

– 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 sourceapproaches http://www.england.nhs.uk/ourwork/tsd/sst/tech-fund/

• Suggestion that a number of established made be made available as opensource to NHS.

http://www.openeyes.org.uk/



http://forge.tactix4.net/gf/project/ocp_client/

http://www.wardware.co.uk/

http://www.ibm.com/developerworks/java/library/j-hsb2/

http://www.woodcote-consulting.com/spine-2-and-the-second-coming-of-the-great-prophet-zarquon/


http://www.ehi.co.uk/news/ehi/8862/bjss-wins-e-referrals-contract


http://www.england.nhs.uk/ourwork/tsd/sst/tech-fund/








































http://www.wardware.co.uk/

http://forge.tactix4.net/gf/project/ocp_client/






Woodcote Consulting

Future Vision

• That actors in the health care system will have a set of tools thatsupport 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



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Digital Health Ecosystem

Enterprise Service Bus (ESB)

User interface components (Apps)

Web Services – SMART Wrapper – ITK - API Business Services

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

Link to

Other ESBs

Link to

Other ESBs



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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 sourceEHR

• VistA has been widely implemented and demonstrated how itcan 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



Woodcote Consulting

Alternatives

• Stick with proprietary systems but demand open

interfaces

• Other open source EHRs

– GNU Health – Seems like only serious contender and seems to be theplatform of choice for a number of existing NHS Projects

• Consider proprietary products that might be made

available as open source

– IMS Maxims

– UHB PICS



Woodcote Consulting

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

• [email protected]

http://www.woodcote-consulting.com/blog






Documents

Ewan Davis - CAMTA 14 Nov 2013.pptx