Open-source software: could this be the glue that holds the NHS together?

Good news stories don’t come around that often for Connecting for Health, the beleaguered national IT programme for the National Health Service in England.  But I think I might have found one in the making.  This month marks the mid-way point in a two-year project to build an “open-source community” for the NHS. 

For the uninitiated, open-source software is different from the “closed source” software that the health service typically uses because with open-source, the code in which the software was written is made open and public. With open-source software, anyone can scrutinise this code, borrow bits of it, adapt it, join it up to other bits of code, and use the new version for any purpose they like.

Open-source software has a number of potential advantages.  For example, it promotes collaboration and integration between software systems, has the potential to improve continually through an almost Darwinian process, and it can sometimes radically reduce IT costs.

Amongst the best known open-source programmes are Linux (a computer operating system), Open Office (a suite of desktop applications) and Mozilla Firefox (a browser).  However there is also a whole range of open-source software designed specifically for health care purposes.  For example there are open-source patient administration systems (PAS), appointment and prescribing applications, systems for ordering and viewing tests and images, and software for clinical documentation. 

Some of the world’s leading health care systems use open-source software, including:

• Hartford Healthcare in Connecticut, whose Chief Information Officer calculates that the organisation’s direct health IT costs have been slashed by 90% since going open-source;
• the Danish health care system, which like the rest of the Danish public sector is going completely open-source;
• the Veterans’ Health Administration (VA) where, according to a recent peer-reviewed analysis, the VA’s investment in IT has led to over $3bn in net savings;
• and the Jordanian National Health Service, which is downloading the VA’s open-source system free of charge, for use nationwide.

The NHS open-source project is a joint initiative between Connecting for Health and York University’s Management School.  It aims to stimulate demand for open-source software within the health service.  One way it hopes to achieve this is by developing a set of detailed standards and conventions for NHS open-source software.  Any software packages that comply with these rules will potentially be available for use across the health service.

Compliant software will have a particular, standardised look and feel to the clinicians who use them, which in theory should lead to fewer errors and improved patient safety.  Any compliant software should also be able to talk seamlessly to each other, which should help improve communication and integration between different hospitals and across primary, secondary and social care.  Being open-source, NHS clinicians and IT staff with a passion for improving and joining up software will be able to make changes to the software code without having to pay a fee as is often the case with closed-source software currently in use. 

The health service in England is bracing itself for the twin onslaughts of budgetary cutbacks and a set of reforms that risk driving a wedge between primary and secondary care. In these turbulent times, open-source software might just form part of the glue that helps hold the NHS together by keeping costs low and promoting integration. 

Who knows, Connecting for Health may be about to set free the NHS’s own big society of IT geeks, whose talents up until now have been shackled by the constraints of closed-source software.