NHS and Vista Integration
CAMTA Annual Meeting – London
14 Nov 2013
Ewan Davis Woodcote-Consulting
and HANDI Health
Woodcote Consulting
My Credentials
• Founding Director of HANDI Health CIC – A not-for-profit company
supporting the Architects of the Digital Health Revolution
www.handihealth.org
• Director of Woodcote Consulting Ltd www.woodcote-consulting.com
• Past Chair of TechUK Healthcare Group and current member of
• Healthcare Council (was Intellect) http://www.techuk.org
• Past Chair of BCS Primary Health Care Group
• Clients include NHS England – But not speaking for them or sharing
anything not in the public domain
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VistA
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VistA is the EHR (mega suite) developed using MUMPS by the US
Veterans Administration who deliver healthcare to 8 million US Veterans
Core VistA code is public domain as a result of US Freedom of
Information laws
VA uses Cache (but have been careful to limit the use proprietary
extensions) while some other implementations use GT.M
VistA has been implemented in the VA with strong end-user
engagement using agile methodologies and is credited with playing a
central role in the remarkable transformation of VA care from “Basket
Case” to “Best Care Anywhere”
There are a number of VistA implementations outside of the VA in the
USA and outside the US (e.g. Jordan)
There are a number of VistA versions supported by both commercial
and non-commercial entities and a number of organisations (large and
small) able to offer services around VistA
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My Journey
• Initially suspicious of open source but now convinced
that open source has an important role to play and
creates commercial opportunities.
• A view that VistA had missed it moment in the NHS
• A view that VistA was “A better way to do the wrong
thing”
• A concern that the success of the VA transformation had
been conflated with the success of VistA
• A change of heart as I learnt more about the technology,
commitment and ambitions of the VistA community
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NHS VistA
• Longstanding support from the UK MUMPS community
for a NHS version of VistA
• No real expectation that the NHS would consider either
open source and/or VistA
• NHS Campaign for VistA http://nhsvista.net/
• Open source gains momentum in NHS
• NHS England announces plan for NHS VistA
• NHS England changes its’ mind about VistA
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Where are we Today?
• NHS England will facilitate NHS Trust to procure an open
source EHR system
• Hope and expectation that someone will bid VistA
• Plans for centrally funded VistA localisation dropped
• Any one bidding VistA will either have fund localisation at
risk or include localisation cost in bid
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NHS Open Source
• Open source now central in NHS thinking driven by a desire
to:
– Comply with Government policy
– Drive value by avoiding vendor lock-in
– Facilitate end user engagement using open source approaches based on
user-centred, agile methods very much hoping to mirror the successful
approach used by the VA with VistA
– Disrupt market and encourage proprietary vendors to “play nicely”
• About much more than Just VistA
• About open standards and open systems as well as open
source
– OpenEHR (CEN 13606)
– OpenClinical
– HL7
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NHS Open Source
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Long history but until recently no material use of open source software in NHS
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Last 5+ years have seen a number of projects reach a material level of use but
still insignificant compared to proprietary solutions.
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OpenEyes – Moorfields Hospital www.openeyes.org.uk
Leeds Portal – Leeds Teaching Hospital
http://forge.tactix4.net/gf/project/ocp_client/
WardWare – Kings College Hospital http://www.wardware.co.uk/
King’s ESB using Apache Service Mix http://www.ibm.com/developerworks/java/library/j-hsb2/
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NHS Spine http://www.woodcote-consulting.com/spine-2-and-the-second-coming-of-the-greatprophet-zarquon/
eRefferals – (replaces Choose and Book) http://www.ehi.co.uk/news/ehi/8862/bjss-wins-e-referralscontract
Recently – Two major NHS national systems being redeveloped as open
source.
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£260 million NHS Tech fund actively soliciting bids based on open source
approaches http://www.england.nhs.uk/ourwork/tsd/sst/tech-fund/
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Suggestion that a number of established made be made available as open
source to NHS.
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Future Vision
• That actors in the health care system will have a set of tools that
support their role.
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Accessing knowledge and information
Store and manage information they create
Provide decision support
Digitally manage healthcare transactions
Help create data resources (“Big Data)
• That these tools will be
– Functional and desirable
– Work seamlessly together – Interoperable, orchestrated, consistent
– Be device and form factor agile
• Create a Ecosystem to
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Help actors to find safe appropriate tools to use or recommend
Provide the technical infrastructure to support the vision
Support sustainable business models
Create a community to drive the vision
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Digital Health Ecosystem
User interface components (Apps)
Web Services – SMART Wrapper – ITK - API Business Services
Link to
Other ESBs
Link to
Other ESBs
Enterprise Service Bus (ESB)
Ecosystem Services - Data Persistence, Knowledge, App Stores Other Services
PDS, EHR, EPR, Decision Support, Identity Management, Consent Management
Choose & Book, EPS, Security Broker – Some/all could be duplicated
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Where does VistA fit?
• VistA community appear to share the vision
• How can we evolve VistA towards the vision?
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MWDS
Open MWDS
SMART
Browser technologies
• Should the NHS participate in VistA evolution?
– Why would NHS start from here?
– How do we integrate with other NHS open source initatives
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VistA Strengths
• VistA is the most functionally rich of any of the open source
EHR
• VistA has been widely implemented and demonstrated how it
can support user engagement – But not in NHS
• Established mainly open source stack available
• Large global community
• VistA has a number of knowledgeable UK based advocates
• The MUMPS database remains a good choice for EHR
persistance
• VistA evolution is already underway with significant
investment from VA and others.
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VistA Weaknesses
• MUMPS code base is unattractive to developers,
complex and difficult to maintain.
• CRRS Is dated and relies on proprietary tools
• Limited implementation, so far, of browser based UI
• Workflows and clinical content entangled in code
• No UK implementation and localisation effort will be
seriously non-trivial
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Alternatives
• Stick with proprietary systems but demand open
interfaces
• Other open source EHRs
– GNU Health – Seems like only serious contender and seems to be the
platform of choice for a number of existing NHS Projects
• Consider proprietary products that might be made
available as open source
– IMS Maxims
– UHB PICS
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Questions and Discussion
• More information see my blog
www.woodcote-consulting.com/blog
• If you are interested in health and care apps and
lightweight digital tools (open or closed source) join
HANDI
www.handihealth.org
• Email me
• ewan@woodcote-consulting.com
Woodcote Consulting