May 17, 2020

NHS technology: Being open to open source

4 min
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Written by Wayne Parslow NHS technology: Being open to open source For the past three years, Wayne Parslow, VP Harris Healthcare EMEA has controversial...

Written by Wayne Parslow

NHS technology: Being open to open source

For the past three years, Wayne Parslow, VP Harris Healthcare EMEA has controversially spoken out about the need for the NHS to embrace open source technology. Now NHS England is promoting the benefits of moving to this model, Parslow gives his view on what it could and should mean for the NHS and how we must walk before we try to run.

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.

About the Author

Wayne Parlsow, VP Harris Healthcare EMEA

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Jun 18, 2021

Skin Analytics wins NHSX award for AI skin cancer tool 

2 min
Skin Analytics uses AI to detect skin cancer and will be deployed across the NHS to ease patient backlogs

An artificial intelligence-driven tool that identifies skin cancers has received an award from NHSX, the NHS England and Department of Health and Social Care's initiative to bring technology into the UK's national health system. 

NHSX has granted the Artificial Intelligence in Health and Care Award to DERM, an AI solution that can identify 11 types of skin lesion. 

Developed by Skin Analytics, DERM analyses images of skin lesions using algorithms. Within primary care, Skin Analytics will be used as an additional tool to help doctors with their decision making. 

In secondary care, it enables AI telehealth hubs to support dermatologists with triage, directing patients to the right next step. This will help speed up diagnosis, and patients with benign skin lesions can be identified earlier, redirecting them away from dermatology departments that are at full capacity due to the COVID-19 backlog. 

Cancer Research has called the impact of the pandemic on cancer services "devastating", with a 42% drop in the number of people starting cancer treatment after screening. 

DERM is already in use at University Hospitals Birmingham and Mid and South Essex Health & Care Partnership, where it has led to a significant reduction in unnecessary referrals to hospital.

Now NHSX have granted it the Phase 4 AI in Health and Care Award, making DERM available to clinicians across the country. Overall this award makes £140 million available over four years to accelerate the use of artificial intelligence technologies which meet the aims of the NHS Long Term Plan.

Dr Lucy Thomas, Consultant Dermatologist at Chelsea & Westminster Hospital, said: “Skin Analytics’ receipt of this award is great news for the NHS and dermatology departments. It will allow us to gather real-world data to demonstrate the benefits of AI on patient pathways and workforce challenges. 

"Like many services, dermatology has severe backlogs due to the COVID-19 pandemic. This award couldn't have come at a better time to aid recovery and give us more time with the patients most in need of our help.”

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