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Taunton and Somerset FT leads the way with open source EPR

Taunton and Somerset NHS Foundation Trust has rolled out the first open source electronic patient record (EPR) in the UK.

The system – now live in A&E, theatres, outpatients and the hospital’s 30 wards – is pioneering changes in the NHS as trusts have always depended on proprietary software to record and manage patient information.

NHS England has previously recommended an open software approach due to its flexibility and the freedom it provides to organisations to purchase systems, share innovation, accelerate technology developments and nurture relationships between customers and suppliers.

Its head of programme commissioning, Richard Jefferson, said the deployment of the open source programme in an NHS hospital represents a “landmark moment” in the state services and “validates the idea that open source can play a significant role alongside proprietary offerings”.

He added: “The growing numbers of open source communities such as those within NHS England’s Code4health initiative are an exciting opportunity to deliver innovation, quality and value through collaboration and are putting clinicians at the heart of decisions.”

The FT has adopted software called openMAXIMS after its firm released the code for its open source EPR technology to the NHS just over a year ago.

Open source software has previously “been praised” for encouraging doctors and nurses to engage in the deployment of major IT systems , thus allowing IT teams and developers to work together to design and implement bespoke software that meets the clinical needs of each organisation.

Dr Chris Swinburn, clinical lead for the project at the trust, said: “Our clinicians have been involved right from the start, from influencing the procurement of the software right through to the design of the system to suit our clinical needs and processes.

“Following the go-live, we believe we have developed a robust EPR system that can be replicated in other hospitals. This can deliver wide-reaching benefits across the NHS.”

And Malcolm Senior, director of IT at the trust, said the open source option presents an “affordable, flexible system that will deliver the functionality we need”. He added that clinicians found it “intuitive to use and have taken to it very well”.

Senior wrote for NHE last year, explaining the changes in more detail.

Functionalities in the programme include the patient administration system that records demographic details, scheduling, and referral to treatment (RTT) status of the trust’s 500,000 yearly patient visits.

Theatre and anaesthetic departments will also be able to update record digitally instead of relying on paper-based processes – a recommendation previously outlined by health secretary Jeremy Hunt. The FT will also be able to move towards hospital-wide “paper-lite working” by developing apps for ward staff, clinical notes, e-prescribing and interoperability with other NHS IT systems countrywide.

Patient data across all departments were migrated from existing system into the new open source software within two days, preceded by an “extensive training programme” for 2,500 staff, including clinicians and administrative users.

In our September/October 2015 edition, NHE has an interview with Wye Valley NHS Trust, which recently became the second trust to pick an open-source EPR from IMS Maxims, and is working closely with Taunton & Somerset.

(Top image c. Nick Chipchase)


Scott   07/10/2015 at 17:03

How will the Trust handle all the inquiries it will now inevitably receive regarding perceived insecurities as 'hackers' have access to the source code and can find 'back doors' much more quickly. I'm surprised this wasn't even mentioned.

John   08/10/2015 at 13:09

Even if a 'hacker' finds a 'back door' within the publicly available code it is unlikely to help them. They would need a connection to the hospital system so as to exploit any such 'back door' and typically such systems are on a private network so probably a trip to the hospital would be needed to find a WiFi access point or similar. The source code used to build the system that is in use at the hospital would have started out as a copy of the publicly available code, but may well have been changed along the way and is also securely held by the hospital, so the 'back door' may no longer exist. The hospital will have several layers of security in place such as firewalls and user access validation that will likely need to be overcome before any potential 'back door' can even be reached. For all of the patient health data that 'leaks' out of such systems the vast majority is via authorised user accounts, rarely from 'hackers' as the information generally has little monetary value.

Paul Cooper   08/10/2015 at 16:22

I echo John’s comment. All healthcare software, whether open or closed, is run in a secure environment. The systems administrators inside a hospital, such as the team at Taunton, have procedures in place to prevent malicious code injections, viruses, worms, etc., into their core systems. In fact, there remains a common misconception that proprietary software is safer. I would argue that with open source software anyone can look at the source code and prove to themselves that the functionality has been implemented correctly. The more people that are able to check the source code, the quicker bugs will be found. When assessing the clinical safety of an EPR, open source software can be proven to be safe whereas proprietary software can only be assessed based upon its behaviour or the claims of its supplier. This makes open source software inherently safer.

Jim   22/10/2015 at 12:23

Well done to them for a smooth project launch. As far as Scott's worries go- just consider if VW car software had been open source, all of their problems would have been known about years ago, so open source would have been protecting the public from the company's failings.

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