NHS on Slashdot

From OpenEGov

Comments from Dr. Adrian Midgley

1. Hospitals is what the NHS is looking at nowadays, Practices have solutions (actually we lead the world, but being typically British and understated don't make so much fuss about it) From this end, the need is for ways of sending messages between systems, which IMHO FLOSS people are likely to be better at avoiding combinatorial explosions on a large scale than closed/proprietary ones are.

For hospitals there is VISTA, in which respect the US VA looks like a world-leader (and the three US gov services that use software suites based on the same core seem the closest analogues of the NHS that are readily available, with software.)

This produced a corps of maintainers and supporters http://www.hardhats.org (the history is well-worth reading) http://www.openvista.org who are a good bunch, the interesting example of one of the business models for making your crown jewels Open Source (GPL) with Sanchez' GT.M - on Sourceforge but mainly they do big iron stuff for banks.

So, there is an open (public domain, FOIA, with embellishments) hospital and patient management system and medical records system available.

(It has been translated into Finnish, German - Berlin Heart Institute) and Arabic (cancer hospital in Cairo) so there is a sporting chance it can be translated into English - there would be a fair few changes needed to fit into what we use instead of billing and the work the USN MC at San Diego was doing to extend it with Paediatric modules would need to be continued at least, but it is a plausibly promising system with a long pedigree)

VISTA has been ported by WorldVista to run on GT.M which of course runs on Linux. VISTA I am told was designed early on to move platforms, with a bit of alteration to a shim layer, and survived moves across different sorts of M and Unix (and I think VMS before that) so the alteration to run on GT.M and on Linux was not a large task (it looks like a big job to me, but Rick Marshall et al seemed quite happy with it - key points: there is experience, there are people, it was designed for it.)

There is a GUI for VISTA.

Thing about this - a GUI is not a good choice of interface for a proportion of tasks commonly done in healthcare organisations. SO having a GUI that goes alongside a functional plain terminal interface makes excellent sense.

The GUI is behind stuff in use in General Practice in the UK in its development at present, but is generically usable, and does not trail the state of the art in hospitals.

It is in Delphi, so if we use Windows on a desktop that is fine, I do not doubt that it could be ported to Kylix or otherwise moved to GUIs on newer operating systems as they take over.

Tools exist as Open Source and in production, to connect GT.M to SQL and to the Web, so a web interface is a reasonable approach. Jim Self in LA has done a lot of this rather impressively for the Veterinary Hospital he is at.

Others

There is also the Care2Ex project which has a lot of energy going into it in Europe, and is a cross-border effort (a nice thing to see in the evolving European Confederacy) this is aimed at hospitals, the University Hospital of Geneva has been using its BolinOs system for Radiology and other records and administrative tasks for a while, and there are a stack of Practice systems in early stages. My source code is available, but in VIsual Basic, so possibly best left buried for now; but Horst Herb's GNUMed project based in Australia www.gnumed.org and www.gnumed.net are promising approaches to doing it all in a provably correct fashion - and hence are taking a long time.

The ontologists - a proper medical automation system requires a sound ontology to be based on or else you end up with a local curiosity - are agreed AFAICS that medical ontologies do not work unless they are Open SOurce and Open Licence (Galen which is one based in Manchester University in the middle of England) has a slogan "Making the impossible very difficult" which semes to accurately reflect the level of complication involved - anyone who reckons they can throw together an ad hoc system and carry on from tehre is an optimist and/or doesn't understand all the problem, and the OpenGEHR project which also migrated to Australia has progressed a long way.

The EC SPIRIT project listed many of these and Brian Bray is keeping that up to date in Paris - http://www.euspirit.org

A thriving community listens to the OpenHealth list, and the archives are available.

OSHCA - the Open SOurce Healthcare Alliance is quiet at present - most people are off working with older more general organsiations now, because the message has been absorbed - Ars Longa, IT Brevis: Open SOurce is a condition for success.