Many NHS trusts have started implementing electronic patient record (EPR) systems to improve efficiency and reduce paper waste. At a time of budget cuts, however, the multimillion pound price tag attached to an EPR implementation can be off-putting.
As an alternative, some are looking at open source software, in which the underlying code is made available for free, and users are able to tailor it to their own needs for no extra cost. This is different from proprietary software, where the supplier controls the source code and may charge licence fees.
Those using open source EPR enthuse about its flexibility – but warn that it is not a cheap or easy choice.
In January, Bolton NHS foundation trust started using OpenEyes, a specialist EPR suite first built by Moorfields eye hospital and now managed by a charitable foundation. Other users include health boards in Wales and East Kent Hospitals University NHS foundation trust. Bolton is already using the software for patients for cataract surgery and plans to extend its use to medical retina and glaucoma cases, which means OpenEyes would be used for the vast majority of the trust’s eye patients.
David Haider, a consultant ophthalmologist and a chief clinical information officer (CCIO) at the trust, says the trust assessed commonly-used proprietary software from Medisoft as well as OpenEyes. “The advantage of OpenEyes within ophthalmology is it’s very clinician-led,” he says. Its open source status helps: “It encourages the free donation of people’s time.”
OpenEyes handles many of ophthalmology’s unusual requirements, such as specialists’ interest in eye pressure rather than blood pressure, which is highlighted within the system. Ophthalmologists have to submit cataract surgical outcomes to a national database, with some of the data gathered by high street optometrists who carry out follow-up checks after surgery. OpenEyes helps by pulling in the required data from local optometrists’ Optomanager software, replacing paper forms, faxes or secure email.
Open source requires passion and commitment
But Haider stresses that open source projects do not necessarily save money. The project has a budget of around £500,000 from the Department of Health, of which less than half went on software.
Rather than paying licence fees, Bolton used the money to add use of HL7 standard messaging, allowing OpenEyes to exchange information with many other medical software packages. All users will be able to take advantage of Bolton’s development work, and future adopters will pay less if they are happy to use what has already been developed. Haider says there is interest in using a single ophthalmic system across Greater Manchester as its health services become integrated, and OpenEyes could do this job.
He adds that open source works very well in specific circumstances. “It needs people who are passionate and interested,” he says. “It’s probably taken a lot more of my time than buying off-the-shelf software, because I have been able to feed into the design. I see that as a good thing, but if you were in a unit where everybody has conflicting priorities and no one has a particular interest or passion for what goes in, maybe an open source solution could be a little tougher.” Bolton is currently considering EPR software for use across the trust’s departments and Haider says it has looked at both open source and proprietary options.
Several NHS trusts have already chosen a general-purpose open source EPR, openMaxims. The software was previously proprietary, managed by UK supplier IMS Maxims, until the company decided to make it open source in spring 2014. This happened as Taunton and Somerset NHS foundation trust was about to select the software on a proprietary basis, partly to save around £1m a year from the costs of paper records.
At the time IMS Maxims had to convince the trust of the benefits of open source, but it is now an enthusiastic convert. “It helps to underpin the really close relationship that we have with the company,” says Luke Gompels, the trust’s joint CCIO and a consultant rheumatologist. “We can deploy something which is an agile solution.”
It’s easier to customise
Its open source status makes it easier to customise, often an expensive process with proprietary software. The trust took advantage of this for its waiting list request cards system. “It was based very much on the input we provided, and tailored to the way that we work at this trust,” says Tom Edwards, Taunton and Somerset’s other joint CCIO and a consultant colorectal surgeon. “It’s been very successful.”
“It does mean that you’ve got teams which are engaged with the development of the product,” adds Gompels. “Any kind of digital change has implications for the organisation, for the clinicians and most importantly for the patients. You’re getting a closer bond between those three.”
Last September, Taunton and Somerset was chosen by the government as one of 12 global digital exemplar trusts to lead the NHS England’s shift to paper-free working, and will receive up to £10m in funding. Gompels says that with smaller IT projects standardised software can be the best option, but adds: “I can’t imagine that everybody would want an off-the-peg system when they’re becoming fully digitised.” Following in Taunton and Somerset’s footsteps “gives trusts which are different shapes and sizes, and doing different things, the ability to be flexible”.
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