IMS and Open Maxims – A big step forward for NHS Open Source

IMS’s recent decision to open source its Maxims EHR as Open Maxims  is to be very much applauded and their decision to do so under the AGPL licence is an encouraging indication of their commitment to a mainstream open source approach.

However, making the code available is just the first step. Exploiting the opportunities that we hope will arise requires the creation of a community of users (using and contributing to the product in many different ways) and vendors able to offer services in relation to the product to the user community in competition to IMS, who at the moment are the only organisation with the capacity and capability of doing so. The situation here is very different from building an open source product from the ground up or where an effective open source community already exist around a product.

I know that IMS are sold on the need to build such a community and have a sophisticated understanding how this can work commercially for them, knowing, as I do, those who lead IMS I am sure of their commitment to the creation of such a community and making a genuine open source project from IMS Maxims. If anyone doubts IMS’s determination and commitment they need only look to their MDs Shane Tickell’s recent 216 mile “walk to work” to see both his determination and willingness to take considerable pain for the greater good, but there are some obvious conflicts of interest and challenges for them in the process

I have an interest in seeing successful open projects created in the NHS both personally, through my work with HANDI (who what to support both open source and proprietary contributions to building a open digital ecosystem) and my work as a consultant to the NHS England Open Source Team. For NHS England for whom one key role is to support the creation of vibrant opens source communities and the supporting technical and governance infrastructure to enable their successful operation and ownership by the community.

NHS England will be working with IMS and others to create a custodian for an NHS “Gold Version” (a distribution of Maxims owned and controlled by the user community and quality assured for use in the NHS) Creating this custodian and procuring the services needed to run it will takes some weeks/months and once it’s up and running getting to the point where there is a fully effective community with multiple organisations contributing to the code and able to offer services around it will take some time, probably running into years, allow this depends on the speed at which the product is taken up and the enthusiasm of those in the initial community.

Turning away from the specifics of IMS. NHS England are currently looking at 4 potential sources of open source health systems.

Established open source projects which have an existing diverse community of users and vendors – there are a number of such projects globally of which VistA is the most obvious example, but none of significance currently deployed in the NHS.

  • Home grown NHS open source projects – There are many of these (including some that have emerged from NHS Hack Days) most are niche and/or relatively immature and few if any have active engagement beyond those involved in their original creation, although, a number are close to taking the next step and have great promise like OpenEyes, eOBS and OPAL.
  • Projects where NHS organisations or local authorities have developed  products in-house sometimes with thoughts of possible commercial exploitation or with no particular plans for its use beyond their organisations who are now interested in the benefits of releasing them open source.
  • Commercial vendors, thinking of taking a similar path to IMS.

Building vibrant open source communities in the NHS from these different starting points creates similar challenges but requires different approaches, but in all case NHS England are keen to work with all those with compatible objectives.

You can read more about what I think makes an open source community here

There are also some other projects which while strictly not open source software but which are nonetheless based on open IPR  and which represent key components of an open digital ecosystem. Specifically OpenEHR  and OpenClinical  – These both have the benefit of established global communities supported by open a number of vendors with both proprietary and open source tooling and implementations at scale.

HANDI are also keen to work with the open source community, particularly with HANDI-HOPD our Open Platform Demonstrator which made its first appearance at the recent NHS Hack Day in London and which will be launched properly in September. We hope HANDI-HOPD will provide a great experimental and learning platform bringing together open source and proprietary implementations of open standards with realistic data and open source clinical content in a ‘sandpit’ environment. While HANDI-HOPD is built on industrial strength components and work done on it should be transferable to a production environment HANDI itself has no ambition to offer production facilities which we hope will allow the platform to operate as honest broker promoting a vendor neutral environment true to HANDI’s agnostic position with regard to open source and proprietary approaches to the creation of an open digital ecosystem.

See for more about HANDI-HOPD and for more on open interfaces, open standards and open source and approaches to openness here

I’d also recommend Wolands Cat for some insightful stuff on open platforms and why traditional health IT projects often fail.

Finally, I hope HANDI-HOPD can provide a platform for Code4Health activity