Ewan Davis - CAMTA 14 Nov 2013.pptx
Transcript of Ewan Davis - CAMTA 14 Nov 2013.pptx
8/14/2019 Ewan Davis - CAMTA 14 Nov 2013.pptx
http://slidepdf.com/reader/full/ewan-davis-camta-14-nov-2013pptx 1/15
Woodcote Consulting
NHS and Vista Integration
CAMTA Annual Meeting – London14 Nov 2013
Ewan Davis Woodcote-Consultingand HANDI Health
8/14/2019 Ewan Davis - CAMTA 14 Nov 2013.pptx
http://slidepdf.com/reader/full/ewan-davis-camta-14-nov-2013pptx 2/15
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
8/14/2019 Ewan Davis - CAMTA 14 Nov 2013.pptx
http://slidepdf.com/reader/full/ewan-davis-camta-14-nov-2013pptx 3/15
Woodcote Consulting
VistA
• VistA is the EHR (mega suite) developed using MUMPS by the USVeterans Administration who deliver healthcare to 8 million US Veterans
• Core VistA code is public domain as a result of US Freedom ofInformation 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 acentral role in the remarkable transformation of VA care from “BasketCase” 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 andsmall) able to offer services around VistA
8/14/2019 Ewan Davis - CAMTA 14 Nov 2013.pptx
http://slidepdf.com/reader/full/ewan-davis-camta-14-nov-2013pptx 4/15
Woodcote Consulting
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
8/14/2019 Ewan Davis - CAMTA 14 Nov 2013.pptx
http://slidepdf.com/reader/full/ewan-davis-camta-14-nov-2013pptx 5/15
Woodcote Consulting
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
8/14/2019 Ewan Davis - CAMTA 14 Nov 2013.pptx
http://slidepdf.com/reader/full/ewan-davis-camta-14-nov-2013pptx 6/15
Woodcote Consulting
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
8/14/2019 Ewan Davis - CAMTA 14 Nov 2013.pptx
http://slidepdf.com/reader/full/ewan-davis-camta-14-nov-2013pptx 7/15
Woodcote Consulting
NHS Open Source
• Open source now central in NHS thinking driven by a desireto:
– Comply with Government policy
– Drive value by avoiding vendor lock-in
– Facilitate end user engagement using open source approaches based onuser-centred, agile methods very much hoping to mirror the successfulapproach 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
8/14/2019 Ewan Davis - CAMTA 14 Nov 2013.pptx
http://slidepdf.com/reader/full/ewan-davis-camta-14-nov-2013pptx 8/15
Woodcote Consulting
NHS Open Source
• Long history but until recently no material use of open source software in NHS
• Last 5+ years have seen a number of projects reach a material level of use butstill insignificant compared to proprietary solutions.
– 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/
• Recently – Two major NHS national systems being redeveloped as opensource.
– NHS Spine http://www.woodcote-consulting.com/spine-2-and-the-second-coming-of-the-great-prophet-zarquon/
– eRefferals – (replaces Choose and Book) http://www.ehi.co.uk/news/ehi/8862/bjss-wins-e-referrals-contract
• £260 million NHS Tech fund actively soliciting bids based on open sourceapproaches http://www.england.nhs.uk/ourwork/tsd/sst/tech-fund/
• Suggestion that a number of established made be made available as opensource to NHS.
8/14/2019 Ewan Davis - CAMTA 14 Nov 2013.pptx
http://slidepdf.com/reader/full/ewan-davis-camta-14-nov-2013pptx 9/15
Woodcote Consulting
Future Vision
• That actors in the health care system will have a set of tools thatsupport their role.
– 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
– 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
8/14/2019 Ewan Davis - CAMTA 14 Nov 2013.pptx
http://slidepdf.com/reader/full/ewan-davis-camta-14-nov-2013pptx 10/15
Woodcote Consulting
Digital Health Ecosystem
Enterprise Service Bus (ESB)
User interface components (Apps)
Web Services – SMART Wrapper – ITK - API Business Services
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
Link to
Other ESBs
Link to
Other ESBs
8/14/2019 Ewan Davis - CAMTA 14 Nov 2013.pptx
http://slidepdf.com/reader/full/ewan-davis-camta-14-nov-2013pptx 11/15
Woodcote Consulting
Where does VistA fit?
• VistA community appear to share the vision
• How can we evolve VistA towards the vision?
– 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
8/14/2019 Ewan Davis - CAMTA 14 Nov 2013.pptx
http://slidepdf.com/reader/full/ewan-davis-camta-14-nov-2013pptx 12/15
Woodcote Consulting
VistA Strengths
• VistA is the most functionally rich of any of the open sourceEHR
• VistA has been widely implemented and demonstrated how itcan 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.
8/14/2019 Ewan Davis - CAMTA 14 Nov 2013.pptx
http://slidepdf.com/reader/full/ewan-davis-camta-14-nov-2013pptx 13/15
Woodcote Consulting
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
8/14/2019 Ewan Davis - CAMTA 14 Nov 2013.pptx
http://slidepdf.com/reader/full/ewan-davis-camta-14-nov-2013pptx 14/15
Woodcote Consulting
Alternatives
• Stick with proprietary systems but demand open
interfaces
• Other open source EHRs
– GNU Health – Seems like only serious contender and seems to be theplatform of choice for a number of existing NHS Projects
• Consider proprietary products that might be made
available as open source
– IMS Maxims
– UHB PICS
8/14/2019 Ewan Davis - CAMTA 14 Nov 2013.pptx
http://slidepdf.com/reader/full/ewan-davis-camta-14-nov-2013pptx 15/15
Woodcote Consulting
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