An award winning electronic patient record system could help convince the NHS of the value of licence fee free software.
Doctors need to be able to access patient data in the same way as air traffic controllers monitor aeroplanes, believes Bill Aylward, a consultant ophthalmic surgeon at Moorfields Eye Hospital foundation trust.
“The role of the air traffic controller is quite similar to a doctor, in that they both have to make frequent decisions in limited time, that have an impact on people’s lives,” he explains. “The difference is that the air traffic control has all the information required on the screen in front of them, or at the touch of a microphone.”
Disparate electronic systems, imaging devices, emails and paper notes mean that this rarely possible in hospital trusts. But Aylward believes open source software – where the lines of programming instructions (source code) are freely available to view, and licence fees are not paid – could hold the answer.
As part of a team of eight staff at Moorfields, Aylward has been working on OpenEyes, a collaborative, open source electronic patient record (EPR) project for opthalmology. As a collaborative framework able to integrate with different applications, it will allow NHS staff to work more efficiently and prevent the need to access multiple systems, each of which has to be logged in and out of separately.
“You would sit down on one machine, with one log in, and there would be everything you wanted to know about the patient in front of you,” says Aylward. “That’s our vision, and it will make real improvements to patient care.
“One of the key aims of OpenEyes is to give the doctor that air-traffic controller screen, so that all the data they need is right there in front of them,” he adds. Currently Moorfields has 18 separate silos of information, and some other trusts are rumoured to have many hundreds of different clinical systems, hindering the process of diagnosis and treatment.
To explain OpenEyes, Aylward uses the analogy of an iPhone, which can run apps (software) from both its maker Apple and from approved third-party providers for a range of functions. “In other words, you’re providing an infrastructure that comes with all the basics you would expect, like security, writing correspondence, prescribing, which are generic to the whole of medicine, but will accept apps that do specific things within that infrastructure.”
OpenEyes has been piloted in the paediatric accident and emergency department at Moorfields since last November and recently won the best business case at the Smart Healthcare Live Open Source Awards. It will be implemented widely at the hospital and a satellite site from this November to improve the surgery booking process, both for patients and staff. “It’s working well, it’s got good user acceptance and we’ve learnt a lot in terms of the design and the function of the system which is now going into the first release in November,” says Aylward. He hopes that Moorfields will have fully adopted the system and subsequently be paperless by the end of 2013.
He added that the system has the potential to save several million pounds over three years as a result of improved efficiencies and the reduced amount spent on storage, fire protection and transportation of paper notes. The exact savings will depend on the phasing out of paper notes and their associated costs.
Opening up to open source
With financial rewards so high, the slow speed with which the NHS is adopting open source is surprising, believes Aylward. He thinks that a cultural stigma prevents healthcare adopting open source, unlike the Cabinet Office, which has made a point of reviewing contracts to see if they can use open source alternatives.
“The NHS is culturally different. It’s used to paying out for contracts and getting something back in return, even if what it gets isn’t very good,” he says. “If you have diminished expectations then you don’t mind what comes along, even if it’s not very good. So it’s trying to shake people out of that and there are signs that it is changing.”
The recent emergence of OpenEyes is especially pertinent in light of the ongoing problems of the National Programme for IT’s care records service, which has faced repeated severe criticism from MPs and the National Audit Office. “NHS IT is in a very parlous state,” says Aylward, who spent eight years as medical director at Moorfields prior to his current role. “It’s fragmented, it’s not fit for purpose and it’s not maximising its potential. Particularly at this point in time, when we’ve got lots of changes like producing outcomes data, checking patient records and the problems of paper notes, audit, research and revalidation, all of this is difficult.”
Reflecting on the failures of the National Programme and the future of NHS IT, Aylward said: “I think the commercial model is not one that is suitable to deliver it in my view, or at least it’s had its chance and failed. If you throw £11bn at a problem and commercial companies give it their best shot and fail, that’s telling you something.”
OpenEyes has additional benefits in that it can run on the internet as well as a trust’s intranet, meaning professionals currently excluded from secure health service networks, such as opticians, can be involved more closely in a patient’s care pathway. The organisers are looking for partners to help produce apps which will run on their framework and have already had lots of interest in the project.
Aylward acknowledges that Moorfields is unusual in being able to develop a system like OpenEyes, something that other trusts might not be able to do. But because the software is available in source code form and therefore has no licence costs, trusts without internal expertise can consider using OpenEyes, although even without licence fees they may have to pay a commercial company to install the framework and support system updates.
“In return, all we’d be interested in would be their feedback because the more users we have, the more feedback we get and the better product it’s going to be.” says Aylward. “Our final ambition is to make this not only work but make it the best possible software that can work.”