A new and frenzied debate has opened up in the world of healthcare technology- should NHS technology be open source? A move to open source would potentially mean vast reductions in licence fees for the NHS, the ability for the NHS to develop systems to their bespoke needs, no more supplier lock-in - which results in NHS organisations struggling to get the IT products they use to work with another supplier's - and of course, no need for "one size fits" all contracts such as we saw with the National Programme for IT.
However, one of the counter arguments of moving to open source is that at a time of dwindling resource, the onus could shift to the NHS to develop and support IT systems themselves. Not only could this leave NHS organisations (or providers) feeling overwhelmed but also some suppliers threatened and obliged to make their systems open source or place a far greater emphasis on services, consulting and support rather than the provision of products.
Having been involved in numerous open source projects including the development of the electronic patient record system Vista in the US, my strongest advice would be for the NHS to walk before breaking into a canter. I believe that open source has its place initially within the NHS's central and mission critical infrastructure. Here it would be easier to mandate the incorporation of open standards, plus being free of commercial IP constraint would be hugely beneficial. But at this stage we should be very careful in trying to go beyond that before first witnessing and understanding its implications.
There are numerous organisations that have moved their products to open source and have had incredible success in doing so. Take Red Hat Linux for example, an operating system that was designed to provide personal computer users a free or very low-cost solution. Unlike Windows and other proprietary systems, Linux is publicly open and millions of contributors work to modify and extend it. The company makes its money predominately through providing subscription services, support and maintenance.
Whether there is enough appeal in building or developing a bed management system, for example, to attract a large enough number of contributors to make the solution truly fit for purpose - when compared to a ubiquitous and horizontally appealing operating system – has to remain questionable. Without a critical mass of talented engineers contributing their free time to such a cause it is dubious whether this will really provide the opportunity and benefit open source applications have brought in other sectors. We have to remember that healthcare is a vertical rather than horizontal industry which, although huge, is also finite.
Another area that may have been overlooked is the problem of providing a one size fits all approach for the NHS. Regardless of whether an IT system is flexible and open source like VistA, or rigid and closed source, unless we fully standardise entire operational processes in every NHS organisation and make every one a clone of the next, a single system for the whole NHS simply could not provide functionality to suit everybody.
In fact, if we looked to other industries we will see that one single solution does not work there either, instead, an organisation chooses what is suitable for them and then ensures it interoperates with their industry's standards. For example, it does not matter what financial system or bank you use, if it supports BACS/SWIFT/CHAPS etc, then you can move money. In healthcare our biggest priority in this area should be creating a similar, centrally managed exchange that allows us to do just the same - transact information irrespective of the source system.
Despite these areas of obvious concern, I have no doubt that offering the NHS the opportunity to more widely implement open source solutions will encourage the formation of a new industry enterprise with a diverse array of developers, consultancies and SMEs capitalising on the opportunity.
As for existing suppliers, if trusts were to begin to demand the provision of open source solutions, we would not necessarily see a wave of suppliers releasing their code but we probably would see a whole raft of suppliers being forced to build open interfaces that other solutions can be 'plugged in to' or be pushed out the market. Interestingly, this is precisely what we have seen with VistA over in the VA.