Better value digital health: the medium, the market and the role of openness

Abstract

IntroductionThe first ever NHS 'hack day' took place in London recently. 1 Supported by NHS Right Care and the NHS Information Centre, the event brought together more than 120 volunteer doctors, developers, designers and other 'geeks who love the NHS' (the NHS hack days' tagline) to work on disruptive digital health technologies that improve the NHS for patients and healthcare professionals.The event demonstrated the relatively untapped technological understanding, skill and creativity of the junior doctor body. Prototypes made over the weekend included OpenBNF.org (a more accessible and useful version of the BNF), ChecklistHQ. com (a website for making and sharing check lists rather than relying solely on memory) and an open-source patient list app. 2 At present there are too many unnecessary barriers in the NHS which prevent it benefiting from the willingness and ability of junior doctors and other 'geeks who love the NHS' to improve NHS information technology (IT). Doctors and patients are right to trust their sense that the digital health technology they use could be much better. In this article, I describe how IT in the NHS could be improved and set out what is needed to deliver better value digital health. NHS IT systems are not as useful or usable as they should beNHS IT systems do not support core functions such as comprehensive information retrieval, audit and research across the NHS. Because of poor interoperability and limited functionality, systems do not support the task of delivering high-quality care in an efficient manner. Due to poor design and poor usability, inefficiencies, such as the unnecessary duplication of work, are commonplace.Clinicians and patients are frequently frustrated by systems that do not make life as easy as they should -by not being joined up and by having counterintuitive and laborious user interfaces. For hospital clinicians, simple common tasks such as referring a patient require phone calls to switchboard, fax machines and bleeps. For patients, a hospital appointment cannot be rearranged online, requiring phone calls, waiting and letters of confirmation.Systems are frequently unreliable and full of bugs. For example, it is rare to find an electronic discharge summary system that does not lose formatting input by the user, such as space between paragraphs, on saving or printing. This significantly reduces the readability of discharge letters. A very long list could be made, but sadly, to date, little systematic effort has been made to collect, and act on, user experience feedback, as is the case with other systems -from Amazon to Sage Accounting. Poorly designed software is wasteful and threatens patient safetyWorse than just being a nuisance, poorly designed software costs valuable clinical time, threatens patient safety and may increase mortality. [6][7][8] Data about safety incidents relating to computer systems in the NHS are collected through clinical incident reports submitted to the National Patient Safety Agency's Better value digital health: the medium, the mark...

Free/Libre Open Source Software in Health Care: A Review

“…The UK has a long tradition of FLOSS-HC and very recently has made considerable progress and has without doubt the most active and vibrant FLOSS-HC community in Europe. In 2012 a series of "NHS Hack Days" [ 88 , 89 ] have been started each bringing together around "120 volunteer doctors, developers, designers and other 'geeks who love the NHS'" [ 40 ] with the objective to improve currently available solutions or find solutions for existing problems.…”