The adoption of open source clinical information systems in the NHS is gaining momentum, but there remains some common misconceptions for NHS providers. Is it really cheaper? Who safeguards the code so it is clinically safe? How will the software be upgraded? In this article, Leesa Ewing from IMS MAXIMS describes the journey and helps to demystify some of the myths of open source in the NHS
A common misconception of open source is to think that a supplier who has dramatically changed its business model must somehow become more profitable in other areas
I look back over the last two years with both pride and sadness.
Since the launch of openMAXIMS in June 2014, the software now includes enhanced functionality to the patient administration system, emergency department and theatres functionality. Further updates are also due later in the year, which will cover patient level costing, community working, and mobile apps, to name but a few.
It is fair to say, however, that our journey to get to this point has not been an easy one. Along the way, those that aren’t familiar with open source have raised concerns about whether the code would lead to incomplete or incoherent software, while others have queried its clinical safety. But, by far the most-common concern has been about cost – will we try and compensate for the source code being open by increasing costs elsewhere?
Remaining competitive
A common misconception of open source is to think that a supplier who has dramatically changed its business model must somehow become more profitable in other areas. For example, by increasing support costs and so in the end there is no real difference or added benefit when compared to a traditional proprietary software model.
For us, it’s not the case. Our support costs, are and will remain, competitive and responsive to both the changing needs of the market place and the local needs of our customers. We recognise that if we don’t do this, we run the risk of another company offering a more-attractive offer to our customers.
Service transformation
It was a significant business decision to move to open source and in turn give away over £45m worth of investment in our software. However, we don’t see it as a corporate financial loss, but as a service gain for the NHS
It was a significant business decision to move to open source and in turn give away over £45m worth of investment in our software.
However, we don’t see it as a corporate financial loss, but as a service gain for the NHS.
By its very nature, open source software is more open to public scrutiny than proprietary alternatives, which in turn can reduce the cost of risk associated with a major transformational change project that is underpinned by information technology. Unlike proprietary software, customers can validate its safety and appropriateness before they decide to buy it.
Similarly, while we will remain the custodian of the code - verifying and validating enhancements and deeming them clinically safe - as the community of openMAXIMS developers grows, so too does the potential for the NHS. They can ensure that new exploits and enhancements are patched quickly to further improve both patient safety and efficiencies.
As more people are able to view the source code, the software will improve more rapidly, with fewer bugs, improved usability ,and greater functionality.
These rapid updates alone, over the life time of the project, will afford the NHS massive savings and benefits. Our accreditation as a supporter of the Code4Health initiative is testament to this, where we are sharing ideas, changing working practices, and building solutions with the Code4Health community.
By its very nature, open source software is more open to public scrutiny than proprietary alternatives, which in turn can reduce the cost of risk associated with a major transformational change project that is underpinned by information technology
End-user organisations will ultimately have a greater say in the future direction of the product, directly influencing enhancements and modifications, customising faster at a local level to meet local needs, collaborating and sharing medical knowledge among clinicians, and combining and promoting best practice. This is unlike any proprietary software vendor, where a customer can be locked into a 10-year contract and, as a result, their enhancements aren’t made if they don’t align with the supplier’s agenda, or they pay a high price to have them done.
Total cost of ownership
When debating the cost of open source it’s important to consider that the software is only one element of any transformational change programme that the NHS adopts. It has to be considered in the wider context of the total cost of ownership of the programme. This will include, not only the hardware and services required to successfully deploy and support the open source software throughout its life cycle, but also the investment required from the trust to make the project a success, for example through education and training.
While we will not be increasing our support fees to compensate for the open source code, there will still be costs to the NHS to implement the software. However, in the longer term the service transformation will be significantly more economical.
A game changer
End-user organisations will ultimately have a greater say in the future direction of the product, directly influencing enhancements and modifications
We purposefully chose to disrupt the marketplace with this unique offering because we believe wholeheartedly that there is another way to develop code for the wider benefit of the NHS. By changing our business model from a proprietary software vendor, to that of delivering an implementation and support service, we can fulfil our development aspirations and roadmap for openMAXIMS a lot quicker, and with significant clinical engagement.
We want to be the vendor of choice for the NHS; by delivering the best-quality software to the NHS that will support generations to come at a fair and reasonable price. That’s what motivated us to provide open source code and we are delighted to see the NHS reaping its benefits, with much more to come.