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NHS spends £300,000 on US exchange

8 July 2013   Rebecca Todd and Lis Evenstad

The NHS is spending nearly £300,000 on an exchange programme with the US Veteran’s Health Administration to investigate its use of open source software and telehealth.

Information obtained by EHI via the Freedom of Information Act reveals that the Department of Health allocated £285,000 over three years, “to support the NHS and their work with US Veteran Affairs in relation to digital health solutions.”

NHS England head of innovation strategy and programmes, Rachel Cashman, told EHI the responsibility for the three-year exchange programme with the VA had passed from the DH to NHS England.

It previously sat with the 3millionlives team and focused on telehealth and mobile working. NHS England is now taking stock of work done so far and what the exchange should focus on going forward, taking into account NHS England’s broader strategy.

One area being explored is the creation of an NHS version of the administration’s open source electronic medical record, VistA.

Ahead of guidance issued this week on creating integrated digital care records, senior figures from NHS England visited the US as part of the exchange to see VistA in action.

Impressed with what they saw, the guidance says NHS England will spend some of the £260m Technology Fund on developing it for the UK market.

“We are looking to adopt some of the ethos behind [VistA’s] creation and potentially part, or all, of the technical product, in combination with others, to generate ‘NHS VistA’,” the guidance says.

A team of experts has been working with US representatives of VistA this month to test the possibility of anglicising the software.

Beverly Bryant, NHS England’s director of strategic systems and technology and lead on the new guidance, told EHI that some district general hospitals feel that the available proprietary software is too big and expensive for their needs.

An open source option reduces costs and creates a mixed economy for trusts to choose from.

While the project is called NHS VistA, the ultimate product may have very few elements of the US product and include elements of existing NHS open source projects, she explained.

Project director of the open source EPR project at Moorfields Eye Hospital NHS Foundation Trust, Bill Aylward, said it looked at VistA a while ago.

“While it does have a great deal of functionality, a lot of it is not required, and the effort required to customise it to UK requirements may exceed the effort required to add the same functionality to existing open source efforts,” he told EHI.

The original aim of the exchange with the VHA was to explore its extensive use of telehealth and mobile working.

The 3millionlives initiative, which aims to have three million telehealth users by 2017, organised three trips to the US focused on the administration’s telehealth and mobile working strategies. A fourth delegation flew to the US on Saturday, which Cashman is part of.

Earlier this year, a 2020health report called “making connections” marked the launch of the three year exchange programme between the two organisations.

 

 


Related Articles:

3 Insight: New acronym; new hope? | 1 July 2013
4 News: NHS England wants open source option | 28 June 2013
12 News: NHS England introduces IDCR | 1 July 2013
Last updated: 9 July 2013 09:38

© 2013 EHealth Media.


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Pilot Sites for NHS VistA

Ewan Davis 63 weeks ago

NHS England have been encouraging Trust to bid solutions based on the open-source VistA platform for funding from their 260 million Tech. Fund "Safer Wards, Safer Safer Hospitals" Deadline for expression of interest is 31 July. It not onerous to submit an EOI, but it is urgent

See

http://www.woodcote-consulting.com/a-pilot-site-for-nhs-vista-please/

for more


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NHS should stick to its real role!

HealthCTO 64 weeks ago

Given the NHS has been so successful dabbling in the world of software in the past, what possesses them to think they'll do any better this time? VistA is a fine system and has served the US VA very well over the years...and yes, they contributed it to the open source world. I'm not sure if anybody in the NHS knows that there are several companies who have taken up the software and created commercially supported versions (as others have done with commercial versions of Linux, an open source operating system).

NHS should establish the desired outcomes (objectives), create incentives and penalties (to stimulate the appropriate action), and then monitor performance/accountability.

Too much misplaced control by bureaucrats with insufficient expertise to field a solution while hampering those with the competence and motivation to do so. If they set goals, drive standards, offer incentives, and allow a robust market to establish itself without continuous incompetent interference you would be amazed by the positive possibilities. Otherwise, you'll get more of what you got...a lot of money be spent with little or no value being created.


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Stick to its real role?

Daniel Defoe 63 weeks ago

Oh dear, HealthCTO; I can only guess that it's either your youth or inexperience which are obvious in your comments above. (By the way, see also my comment at the very bottom of this thread.). In fact the NHS has, in the past, been VERY successful in "dabbling" not only in the world of software but also that of hardware, infrastructure, networking etc. What killed off that success was the political "dabbling" which resulted in the disaster that was (and still is in some places) NPfIT/CfH/CRS/Shared Services/HISs etc. It's only because of this "dabbling" that the majority of NHS Trusts, especially the Acutes currently have in place the bare bones of enough operational IT to keep the "business" running as usual until either somebody in the DH mandates a workable IM&T strategy which mandates standards, requirements, outputs etc., or does what it did 25 years ago, and lets everybody get on with what they think best. (By the way, if you have any doubt, I think the former is probably better.)


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Yes, stick to its real role!

HealthCTO 63 weeks ago

Daniel,

I am neither young nor inexperienced having lead one of the largest successful EHR deployments in the work - for Kaiser Permanente. That plus 20 odd years of other experience in healthcare IT - in the US, UK, and globally - allows me the grace to make the following observations:

1. With apologies to Winston Churchill, "Never have so many spend so much time and money to achieve so little" in term of providing meaningful technology innovation to the NHS. After 10+ years and billions of pounds spent, the NHS should have far more than your "bare bones of enough operational IT to keep the "business" running..."

2. I have worked with the NHS off and on for over 10 years and have seen very little useful software development come out of the service. NHS has on occasion partnered well with technology companies to deliver astonishingly successful solutions but this is the exception not the rule.

3. NPfIT attempted rigorous standardization and it was a large part of that programs failure (along with quite a bit of idiotic political gerrymandering). The area of absolute agreement we share is that somebody at DH/NHS/CB/whatever needs to deliver a cogent IT strategy that creates a framework for execution that mandates standards for at minimum data and connectivity; provides incentives for compliance (and penalties for those who fail); a certification environment for solution vendors to demonstrate systems that are validated to run in the standard environment so trusts have some assurance around suppliers; and, some templates/guides around system architecture and leadership demands necessary for success (to address the human element).

The key is for somebody (DH/NHS) to think systemically (standards, etc.) and let the implementation/adoption occur locally through a robust marketplace for the solutions. Otherwise, it is being done "to" them instead of "by" them...and that was the biggest failing of all in NPfIT.

In this model, NHS is emphatically not in the business of delivering software but in the business of improving healthcare (through the adoption of technology alongside changes to the delivery of care). There is a big difference between the two.


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You hit the nail on the head

Ewan Davis 64 weeks ago

The NHS should as you say "establish the desired outcomes" and then seek to procure products and services that can deliver these outcomes. They should not concern themselves with the software licensing model (open or closed) beyond the extent to which it might influence the desired outcomes, which in some specific areas may be critically significant but in other cases is irrelevant.

Those NHS organisations that choose open-source solutions would be well advised to seek a commercial partner who can put a service wrap around its' delivery and provide some warranties with regard to safety and performance. There are an increasing number of companies who can demonstrate they know how to do this in health and a significant history of success in the broader open-source community.


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Desired Outcomes

John Pyle 63 weeks ago

Pretty high on the list of desired outcomes is usually (or should be) the ability to 'change one's mind' to a greater or lesser degree. 'Desired outcomes' when interpreted as, for example, Outcomes Based Specifications are poor tools to deliver systems which reflect the current and future business requirements, and are particularly unhelpful when delivered via products which are presented as 'black box' solutions (or 'services' as they are sometimes known.) So long as the requirements include the flexibility to change the service and to do so in a cost effective way, the open source philosophy (irrespective of which particular licensing model is chosen) is incredibly valuable in focussing the contracting parties' minds on these kind of desired outcomes.


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GNU Health version 2.0 released !

Rob Dyke 64 weeks ago

Such serendipitous synchronicity:

Posted yesterday by GNU Health:

"I'm proud to announce the release of GNU Health 2.0.0 !" writes Luis Falcon

GNU Health 2.0 comes after 5 months of very hard work, and brings the best version so far. The following highlights some of the main achievements of this release: blog.gnusolidario.org/2013/07/dear-all-im-proud-to-announce-release.html?view=classic


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GNU Health / openERP

Rob Dyke 64 weeks ago

@ehealthsolutions & @ewandavis

Thanks for the nods towards GNU Health. This project provides the Hospital Information System adopted by the United Nations University, International Institute for Global Health. It began like as part of openERP so in addition to providing a long list of EPR/PAS functions (listed here health.gnu.org/main-features.html ) is also gives an engine that can be built on to deliver other health ecosystem aspirations.

As Eckhard Schwarzat wrote on another EHI article:

"Efficiency and Efficacy in Healthcare provision can only be achieved when finally back-office and front line staff as well as processes can flow without boundaries in healthcare organisations. Only looking at EPR without taking one step back and looking into processes is dangerous, as it will not deliver the benefits which a lot of actors have been talking about, but are nowhere to be seen."

The Tactix4 view is that healthcare needs to integrate EPR and ERP in order to deliver things like Activity Based Costing and care processes under statistical control (LEAN / Six Sigma) using a process perspective.

The clinical systems we are build for a number of Trusts embed both ERP and EPR functions. Our current work on Wardware 2.0 makes use of the process orientated scheduling in ERP to give a 'whole Trust' view of capacity/throughput derived from the Acuity of patients (clinical information) and the available resources (beds and nurses).

With some many components in GNU Medical & openERP which make use of modern languages and development techniques, skills which are readily available in the UK, NHS-E should take a closer look.


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NHS VistA

Ewan Davis 64 weeks ago

Have a look at my Blog talks about many of the issue raised here.

http://www.woodcote-consulting.com/nhs-vista-and-nhs-open-source

This concludes with a couple of key thoughts:

"I remain fervently opposed to the idea of VistA as a single system for the English NHS, but see value in implementing it with the minimum necessary localisations in a few suitable NHS trusts as a step on the journey to the creation of an open digital health ecosystem."

".... the success of many open-source projects lies in the open, agile and collaborative approach that open source naturally engenders, rather than narrowly on the licensing model%u21D There is a danger that the NHS could treat open-source projects (and particularly NHS VistA) as like a open-source version of the NHS NPfIT. The Centre has a role in catalysing and enabling open-source in the NHS, not in managing it. Leadership, needs to come from the frontline and the focus has to be on agile user centred design with clinicians and other frontline health and care professional working with their patients and service user, supported by the very best digital engineers and other informatics professionals to rapidly and incrementally deliver digital tools that support the delivery of high quality care"

You will have to read what is a rather long blog to see why I come to my conclusion.

BTW I also think GNUHealth is well worth a looks

Ewan


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Coal face?

CertaCitrus 64 weeks ago

Are any trusts interested in VistA?

If not, why is an organisation remote from end users, which has its own data capture needs, investigating this? It seems to be setting up a new Lorenzo, where the centres needs (datasets) will outweigh the end users and not meet end user requirements.

Surely it would be better to encourage trusts to extend their own developments, sharing across trust boundaries, pooling resources. If they have interest in VistA, then support it.


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The only difference being...

PressureDrop 64 weeks ago

Lorenzo at the inception of its implementation, had not been tried or finished. Whereas VistA has been around for over 20 years and is used internationally in Mexico, Samoa, Finland, Jordan, Germany, Kenya, Nigeria, Egypt, Malaysia, India, Brazil, Pakistan, and Denmark. Other than that, they would be identical.


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That info raises further questions

in arduis fidelis 64 weeks ago

First, with such global credentials and having been around for so long, why has it not been looked at way before now by the Acute Trusts or by NPFiT/CfH

Secondly (and more importantly) if there are deployments of Vista in Finland, Denmark and Germany, why is HSCIC using £300,000 on a US exchange programme, surely it would be more cost effective working with European health organisations that have already adapted the software to fit their health structures??


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here here

in arduis fidelis 64 weeks ago

The more I looked at this the more a familiar pattern started to come together and Lorenzo was its name.

I thought the idea of "the Big EPR debate", the new DoH/NHS E guidelines for EPRs was to support the digitisation by 2018 pipedream. So surely the impetus should be to get those Trusts that have not yet started with EPRs (haven't they had long enough now) to take the first steps on the road. Surely looking into another non-NHS product and how to develop it to fit an NHS Trust and then taking the time to programme, develop, test and pilot a new system is just presenting laggard trusts with another excuse to delay any action!

Is there a full deployment of Lorenzo anywhere since it was first "evaluated" (i use the term loosely), selected and presented as the National option for an EPR system all those years ago - almost a decade?

I'm all for open source, but surely there must be home developed systems that are closer to being a finished product than an NHS development of the US VAs Vista system.


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Other modern open source EPR's are available...

ehealthsolutions 64 weeks ago

If NHS England is serious about developing an open source EPR then they should examine ALL the free/open source alternatives.

I have been very impressed with the development of GNU Health. This uses a modern programming language - Python - and a modern open source database server - Postgresql.

It comes pre-loaded with with ICD-10 codes and a WHO recommended medicines dataset.

Why choose an old, complex, complicated admin based system (Vista) when an easy to develop, brand new, WHO approved system is available for immediate download and testing?


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ICD-10 in electronic health records - when will you learn

personal opinion 63 weeks ago

Would someone please tell me why they think it is useful/desirable/essential to use ICD-10 in an electronic health record?

ICD-10, along with OPCS are CLASSIFICATIONS and were never designed to be used within a medical record. They are simply "buckets" in which to throw information in order to obtain population statistics. Seen in the context of a single patient record they are - by and large - meaningless to a clinician who is trying to treat that patient.

For example what does K91.9 Postprocedural disorder of digestive system, unspecified tell you about the patient?

I would argue that the only thing that is clinically useful in this code is that it is telling you the patient has undergone some sort of procedure at some unspecified time in the past and that this has resulted in some sort of problem with his digestive system.

As a diagnosis, I would say that this is about as useful as a chocolate fireguard.


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Terminologies in EHR

Ewan Davis 63 weeks ago

If you are seeking to create a structured and computable EHR, Then using an appropriate terminology is a key part of what you have to do - This has been very successful demonstrated over the past 25 years by the UK GP systems used Read/CTV3 Codes and still do. There is tremendous power in an EPR built on a terminology (because it separates content from the database schema) which few outside general practice properly understand and works particularly well with GP records which are generally terse. See my blog "Tonsillitis Pen V" http://www.woodcote-consulting.com/tonsillitis-pen-v/

However, if this is your aim as personal opinion says, ICD-10 is about a much use as a chocolate teapot. He's right this is not what ICD was designed for (it started as a classification of cause of death) and remains intended as a tool for collecting statistical data.

If you want to use a Terminology in a EPR it really has to be SNOMED - Although exactly how you do this still seems to elude us with arguments about the extent to which it possible or desirable to use post coordinated SNOMED expressions, the boundary and bindings between the terminology and the clinical content models in which they sit and the extent to which you need to constrain it using subsets. Certainly in most examples of SNOMED in EPRs it is use primarily like a glorified set of Read codes (which is not necessarily a bad thing) and if you use SNOMED you can of course extract relevant data as ICD-10.

GNU-Health uses ICD-0, but it is not a terminology driven system. Great that you can tag those things that you want/need to report as ICD-10 but you can't build a clinical adequate EHR with ICD-10.

Ewan


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Oh God

starslikedust 64 weeks ago

Oh god, it's written in MUMPS. Perhaps some of the £300k can be spent replatforming it.


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Oh God, it's written in MUMPS

CertaCitrus 63 weeks ago

Maybe onto C# and SQL Server, then we could outsource it away to India or use cheaper local staff - either inexperienced.

It worked brilliantly on NPfIT..... or maybe not.


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re: Oh God, it's written in MUMPS

mrtablet 64 weeks ago

No really it's all right... you can write nearly all your code in JavaScript

robtweed.wordpress.com/2013/05/24/making-mumps-acceptable-to-the-mainstream/

Reassured?


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New faces, new tricks

Rob Dyke 64 weeks ago

The people from NHS-E that are working on this VistA/Safer Wards, Safer Hospitals digital challenge are not exclusively ex-CfH and the people involved directly on VistA are all from VistA organisations (VA, OSHERA, WVA). New faces, new tricks.

On the whole its homegrown opensource products and the support for homegrown developer talent that I see, with 'NHS VistA' a synecdote for an open ecosystem.


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"...not exclusively ex-CfH..."

Daniel Defoe 64 weeks ago

Rob, how optimistic you are but of course you're entitled to be. As you say, and we take your word for it, the people from NHS-E working on VistA may not be the same old, same old. However, most of us see very little change in the "IT Strategy" personnel working elsewhere in the DH/NHS in other enclaves where approvals and decisions about IT have to be referred (for instance, check out the NPfIT/CfH zombie that continues to stalk "NHS South" when it comes to IT for the acutes). What we need to ensure is that this initiative doesn't develop some sort of life of its own without considerable support from potential taker-uppers; if we don't then we'll find that the £300k drop in the ocean (which it is) will suddenly turn into another NPfIT/CfH army.


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NPfIT/CfH zombies

Steve Fuller 64 weeks ago

Yes we know who they are too, but still no one has removed them from the Southern equation for acute or community.


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Who will carry the can for this?

spotlight 64 weeks ago

Many of us knew that NPfIT was doomed from the moment it was mooted. It was obvious it would never work to anyone with experience of healthcare IT and half a brain. However the "experts" who came up with NPfIT and pushed it through so ineptly never stood up to be counted. Some of them are still on the circuit, although I have noticed that they are saying different things about NPfIT now than they were ten years ago. The only casualties were those who tried to execute it (and patients, users and taxpayers of course).

So if the Centre is going to spend considerable sums of money on this scheme, let those people who are making the decisions put their names on this now. I don't like blame culture, but I don't know how else to break this white elephant cycle.


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Looking on the bright side...

mrtablet 64 weeks ago

.. in the good (ahem) old days of the B***r vanity project there could easily have been an extra five zeros tacked on the end of this sum.

300K is barely a rounding error... the haemorrhage of serious (new) money into Management Consultancy coffers in this area seems to have been staunched for now.


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Same old faces?

in arduis fidelis 64 weeks ago

I wouldn't be surprised to find out that it was the same "experts", after all HSCIC is basically CfH rebadged (most of the same staff at least).

Still at least this time they are spending the time and money looking at home grown products, programmers and companies, and not spending the money outside of the UK again.......hang on!!!!


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RCCs anyone?

Daniel Defoe 64 weeks ago

Just an idea, but why doesn't the NHS set up a number of their own "software houses" to do this sort of thing? Perhaps they might be called "Regional Computer Centres"? And then, if they were a success, perhaps they could be flogged off to the private sector?


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Why?

HealthCTO 64 weeks ago

Why spend NHS time and money to set up what the private sector is far more competent to do - and is willing to put its capital at risk to do so (if there was a reasonable market for the resulting product)? Conversely, if there is no discernible market and the private sector shuns the opportunity why should the NHS step into a space the market may not support? What a great way to spend the service's money that should be going to patient care...


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Be Careful Mr Defoe

Ewan Davis 63 weeks ago

Some of those your criticisms are aimed at my be ill-equipped to make considered judgments about health informatics, but quite a few of them are well equipped with Oxbridge Firsts in relevant subject like English Literature and will recognise your literary allusions and send the lads round to sort you out.

Ewan


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Daniel Defoe 63 weeks ago

At the risk of being considered a little archaic, HealthCTO, you might want to take a peek at Thomas Gray's "Ode on a Distant Prospect of Eton College", and see if you can spot a famous phrase or saying therein. Or perhaps Shakespeare, King Lear, 5:3.


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