Wednesday, 5 March 2014

Student Nurse Perspective: Computer Systems



In my time with the NHS I've had my chance to try and several computer systems that they use. So far I've worked or been on placement with four different NHS trusts. IT has been a hot issue in the UK mainly because it's expensive and is something that will take a long time to implement and has taken a long time to implement.

The main motivation for writing this blog is of course because Microsoft will stop supporting WinXP and Office 2003. And all the trusts I've worked with use WinXP. Admittedly one of them has finally started upgrading some computers to Win7, which is a major improvement on top of what they've already got.  But to be honest it's not the choice of OS that has annoyed me as much as the software they use. Specifically when that software is optimized for WinXP. Though it doesn't help when you have staff that refuse to move with the effing times.

The trusts I have been in have bought new computers with first Vista then Win 7 on a fairly regular basis, but always somehow insisted on backporting them into WinXP. Which just always blew my mind when I saw that. Still does in fact.

One of the biggest challenges in this day and age to the NHS is to do with finances and how to stay within budget. A fair chunk of that budget goes into IT. Nearly everything that is done now in hospitals is computerized. Though some wards insist on copying everything in paper, which is quite frankly a waste of money and a waste of nursing time.

So my suggestion is to use Open Source Software.  Fairly recently the GCHQ which serves as the IT security branch of the UK decided to look into the most secure Operating System and Linux (In the form of Ubuntu) rather comprehensively beat the competition.

After all buying new operating system is going to cost money. A lot of money. And in some cases they would have to buy new computers. But why bother with that? Why not instead go for a Linux based operating system. Currently Linux is everywhere. Don't believe me, look at your phone. If you are running a phone with Android, you are running a phone with Linux. Using Linux is not the venue of a computer nerd any more. In fact why not just stop using Microsoft products all together? Because the UK government are even thinking of replacing Word Document with Open Document. Again there are multiple programs for that the two most prominent ones being OpenOffice and LibreOffice. They wouldn't be the only ones who have done that. Munich have done it, quite successfully, they even went as far as to distribute a copy of Ubuntu to all of it's citizens in order to wean them of WinXP. Bristol did it. But of course Microsoft have tried crying foul. Leeds Teaching Hospitals decided to use open source software, mainly in form of patient records. And so far it seems to be working very well for them. If they can do it, then why can't other trusts? 

It is not something that hasn't been achieved before. Going from one operating system to another. The London Stock Exchange went from using Windows to using SUSELinux, with great success in 2008 after the Windows Servers crashed and cost them quite a bit of money. NASA uses Debian Linux for well, everything.  Google runs their own version of Ubuntu called Goobuntu. And so on and so forth. So it's not outside the realm of possibility to go from one system to another. So far I've mainly touched upon Ubuntu, but that is mainly because Ubuntu is the most used Linux distribution going. And Ubuntu also has a fairly sizeable company, called Canonical,  behind it that also deals with Servers and the like. The other thing that this ties with is there is already a medical version of it, called Ubuntu-Med. The good thing about this distro is the fact that it also uses KDE as a desktop environment. The big bonus being that it looks and feels very much like Windows does, so the adaptation time for newbies and "technophobes" would be minimal. The second distribution that would be good to look at is OpenSUSE-Medical, which is supported by another big company called Novell. That one also runs with KDE but the bigger advantage would be that Novell has more experience in assisting and supporting big organizations, for instance London Stock Exchange.  So any trust that decides to jump the shark and forge ahead with Open Source systems and tools, wouldn't be without assistance. And then there is Debian-Med, which is based on the rock-solid base of Debian Linux. The downside there is that there isn't a firm behind it in the same way as Ubuntu and OpenSUSE. But on the other hand if a Trust decides to go this route they can hire IT personnel and make it their own.

The DoH had set out a programme called 'NHS Connecting for Health', which was a very ambitious project and had a huge potential. But sadly suffered from mismanagement and ran way over-budget. Now, nearly every trust have got their own Medical IT System. The ones that I know of and have used are e-CPA, Lorenzo, PCIS and Emis.

Probably my biggest bugbear, and the inspiration of writing this, is that monster of a system Lorenzo. I think I have only met one person who actually likes it. But oh lord it is shit. Slow and cumbersome. It's like a blind drunk Cave-Troll of medical systems. And somehow it seems to be optimized for WinXP, which just makes that system even more shit. Not even worth fertilizing potato fields with. It doesn't really help when the DoH state that it isn't fit for purpose, yet we still have one trust that insists on using it.  Despite every other trust dumping it in favour of something different.

GNU Health is a system that was first developed in 2008, mainly for rural areas in South America, Africa and Far East Asia where cost certainly plays into it. And today it has developed into a fully fledged system in it's own right, the Jamaican Ministry of Health have decided to adopt it whole sale. The main features of it are:
  • Strong focus in family medicine and Primary Health Care
  • Major interest in Socio-economics (housing conditions, substance abuse, education...)
  • Diseases and Medical procedures standards (ICD-10 / ICD-10-PCS)
  • Prescription writing
  • Billing
  • Patient Genetic and Hereditary risks : Over 4200 genes related to diseases (NCBI / Genecards)
  • Epidemiological and other statistical reports
  • 100% paperless patient examination and history taking
  • Patient Administration (creation, evaluations / consultations, history ... )
  • Doctor Administration
  • Lab Administration
  • Medicine / Drugs information (vademécum)
  • Medical stock and supply chain management
  • Hospital Financial Administration
  • Designed with industry standards in mind
It's also cross-platform so if a trust decides to stick with Windows they could still dump whatever system they are using and still save money. What the trust can also do is modify whatever Operating System they choose and whatever medical system they use to suit their own practice.  GNU Health is by no means the only open source alternative, there are others and you can read about those here. Thankfully there is an open source and free alternatives to nearly everything, for example Medical Imaging. More software can be looked at and obtained from Medfloss.

This is a subject that I am fairly passionate about, and I don't understand why more NHS trusts haven't gone down this route especially in the light of tighter financial restrictions. What I do know is that there isn't enough awareness of this, and in most people's minds it doesn't matter to them what system is used. But if they can save money in the IT department yet have even more secure system in place then why not take the plunge? Especially with the support for WinXP going away. And if these trusts are still running computers with WinXP after the deadline I can assure you that there is going to be a major cock up somewhere as they've left their systems vulnerable to outside attacks, with many hackers patiently waiting. Or alternatively they could hire said hackers and put them to good use as evidenced by NHS Hackday

Edit:
For an even more detail analysis there is this fantastic report done by Karopka, et al about using Free and Open Source Software in Health Care.

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