Stop talking and start building with open source, open standards and agile methods
The next EBP report will focus on the role of digital design in achieving health and social care integration (this is the second report on the topic – the first being about the context of the challenge). As part of the research I interviewed Dr. Tony Shannon from Ripple – a clinically led team working to build an integrated digital care record platform, underpinned by open architecture. We talked about the benefits open source, open standards and agile development, and why the industry needs to stop talking and start building.
Tony Shannon is perhaps unusual, he is a doctor who has taken such an interest in technology that he did a fellowship in informatics and a masters in IT management. He understands how information intensive medicine is and he believes that we need more people with clinical expertise, who know what it’s like to be on the front line, working with technologists to build highly usable applications for health and social care.
“The bottom line is that healthcare is in crisis all over the world, not just in the NHS when it goes from crisis to crisis, and a lot of that is because we are still not in the 21st century properly… and poor technology and the health IT market is holding us back,” Shannon says. “I’ve been waiting the right big corporate sponsor to come along for 5-10 years and make a move on this but I think that they are all afraid that healthcare is too complicated or too difficult so they have stayed away from it, or they’ve tried and they’ve backed off. So that’s why we’ve started with Ripple in the other direction, which is starting small and trying to prove the approach from the bottom up,” he adds.
Having led a team as the CCIO (chief clinical information officer) at Leeds hospital, Shannon then went on to create the Leeds care record - joining up hospitals, GPs, mental health, social care etc. around a patient centred care record. Since then, over the last 18 months, having secured 1.3m funding from NHS England, he has been leading a team to create an open platform for others to reuse called Ripple.
Ripple is open source, with open standards and built with agile development methodologies – all ideas that Shannon had been pioneering in health care since his team built the records architecture at Leeds hospital. As Shannon explains, “the problem is that you have stand alone systems across health, care and local government – lots of small bespoke systems that do a job but don’t necessarily interoperate with one another. We’ve done that for a couple of decades now and we need to move beyond that.” He believes that, just as the mobile phone market has been transformed by iPhones initially but more importantly by Android (who expanded the market enormously with an open platform), Healthcare needs an Android like platform to stimulate massive change.
Shannon explains that the groundwork for change has already been done with a platform standard called OpenEHR, which is essentially an open platform that is modular like Lego bricks in the way it is built. He believes that Ripple is more than just creating a records architecture, it’s about disruption. “What we are tasked with is to try to positively disrupt both the clinical and the business side of healthcare by getting them to think along these lines. To stop throwing good money after bad, with old technology that will only get them so far but not resolve the problems, and also to stimulate the vendor market to begin to offer services around that,” says Shannon.
These are big ideas. But what about the practical application - how can others get involved? “Most clinicians struggle to know how to get started, you could ask them to do a piece of work on process analysis and requirements analysis but they struggle with that. What most clinicians need is to see something – so we have a demonstrator online. But we also have the intention that if you want to get started let’s just get something up and running as quickly as we can. So we have a set of scripts that can get something up and running in their own environment within a couple of minutes. You need a little bit of technical know-how to be able to do it but it’s not beyond anyone…” To progress, as is the agile way, participants can explore the technology with a development ‘sprint’, moving onto say 3-5 sprints to get into a much more serious construct.
Alongside technology development, Ripple have also done three softer pieces of work around requirements analysis, information sharing and citizen engagement. Providing a toolkit to help get started.
The principles of open source, open standards and agile, that underline Ripple, are about collaboration and actually building something. “For too long there has been workshop after workshop on technical architecture but no one was actually building anything. The vendors have been saying no we can’t adhere to those standards, because those standards that have been set centrally are difficult to implement. And there’s only one way that I can see to overcome those challenges - to get all parties to collaborate on an open source reference implementation of the standard,” Shannon says. “We are building this, using open standards and agile methods, to show would could and should be done,” he adds.
“Culturally, I would argue that there isn’t a much greater fit – in terms of peer review and sharing things with your colleagues and people contributing to it that health care. Doctors are brought up on the principle of publish your work or perish, that’s how medical science has progressed and I think that open source sits very well with that.”
The Local Government Executive Briefing Programme has published two reports into 'Health and Social Care Integration':
Part I: "Confronting the challenges".
Part II: 'The potential of digital' (featuring a Ripple case-study)