In my work, both within NHS England and as a judge in the EHI awards I have come across a number of promising bits of home grown software development in NHS organisations. Also as I talk to people in the NHS find that as well as these publically acknowledged systems that there are many others that are often a unknown beyond the project or service that use them and typically invisible to IT departments. On Director of ITC of a teaching hospital of my acquaintance who went looking and found many hundred such systems and was sure he hadn’t found them all and termed them “feral systems” comparing them to the feral cats that also infested his hospital.
The hundreds of “Feral Systems” in an average large hospital represent a goldmine of knowledge and innovation that could be harness in the design of digital systems that really work, but as they are today they also create a massive technical debt and create safety, governance and reputational risks for the organisation in which they are used.
We have to enable these developments to continue without too much interference but we need to make it as easy to do this in ways that are as safe, scalable, interoperable and sharable as it is currently with those tools and approaches that are not.
There are two things I’m involved in that I think can help, The first is the NHS England Open Source Programme www.nhsopensource.org and the second is HANDI www.handihealth.org and in particular HANDI www.handihealth.org HOPD www.handi-hopd.org
Typically these developments have been by people who are amateur software developers with other day jobs in the NHS (clinical, management or IT) who are not professional trained in Computer Science or Software Engineering. They have produced these, typically small programmes or apps, because they are frustrated by the ability of their enterprise systems to meet their specific needs in a timely manner and because they understand what’s needed and have the skills and the modest resources needed to just do it.
These developments are often great, because the author is very close to the user (probably they are one of the users) knows exactly what’s needed in their environment and is on hand to rapidly deal with bugs, support issues and enhancement requests.
This approach has much positive aspect but raises many serious issues.
1) Stuff that could be really useful in other places lies undiscovered and in any case is not actually in a fit state to be easily used and developed elsewhere if it is discovered. (see also my piece “Making the most of NHS IPR” )
2) There are multiple people doing similar things who would achieve even more if they knew about each other and had a way of working effectively together. Judging the EHI awards I saw lots of examples where I knew of other similar work of which the entrants were unaware and even multiple entrants independently doing similar things unaware of the others.
3) These systems tend to grow, because their developer is so close to and responsive to user needs, such that systems originally intended to do just a few limited things becomes the mainstay of the IT supporting a unit or service and it all falls apart when the original author moves on.
4) These systems are typically written to do just what’s seen as essential and pay scant attention to security, information governance and interoperability issues. This is fine initially but is a major source of future problems and exposes the organisation to significant risk and the response of senior management and IT Departments is often to try and shut these things down on the rare occasions they find about them.
The last thing I want to do is inhibit this sort of development as it is a massive potential source of innovation and a great way to get frontline staff engaged in the development of digital systems but I do want to make it easier for them to create systems that are safe and interoperable and help make any innovations that have value available to the wider community as a sustainable product. I’m also keen to help ensure that when the problem has already been solved or partially solved elsewhere that people know this and that when multiple people are working on the same problem that they are encouraged to think about teaming up.
There are two things I’m involve in that I think can help, The first is the NHS England Open Source Programme www.nhsopensource.org and the second is HANDI www.handihealth.org and in particular HANDI www.handihealth.org HOPD www.handi-hopd.org
Open source is a natural way do collaborative projects and ensure good work is available to others. In many case developers have no desire to commercially exploit their IPR, but there are also lots of ways to build successful commercial enterprises around open source products. If you want help and advice on creating open source software or taking an existing product where you or your organisation own the IPR email the team email@example.com and I or one of my colleagues will be very happy to help you whatever your ambitions are for your product (see also see my blog piece “What makes an Open Source community?”
HANDI-HOPD is the HANDI Open System Demonstrator and will give you access to enterprise quality components, tools and knowledge sources to help you build prototype apps in a way that will address many of the interoperability, orchestration and governance challenges that are otherwise really hard to deal with, with minimal effort. It can also provide free compute resources in the Cloud with free access to knowledge sources and test data in a realistic simulated environment where you can create and refine your app and engage with a community of other likeminded people. HANDI-HOPD is vendor neutral and agnostic as to whether your business model is proprietary or open source. It’s strictly for experimentation and non-operation use with test (fictitious) data but because it’s based on open standards apps developed on the HOPD should be easily transportable to one of a number of production environments (offered by our partners and others) for operational use or your own live environment if you support the same open standards.
Making software functional, desirable, safe, robust, scalable, maintainable, interoperable and fit for collaborative development requires skills and knowledge that most gifted amateur developers don’t have (and in many cases don’t have the time or inclination to acquire). Indeed, many IT professionals in the NHS, whose expertise lies in implementation and support or more traditional development approaches, and many of the commercial organisations currently service the NHS don’t have these skills either. However, there are a few organisations working with the NHS and more outside who do know how to meet these challenges (in particular some of the successful Enterprise Open Source companies offering more generic and commodity products) and some specialist SME currently servicing open source projects in the NHS. It is critical that we identify these organisations, find ways to get them effectively engage in the NHS and increase the capacity and capability of those that are already engaged. The NHS England Open Source Team are keen to hear from organisations that think they have the skills required.
However, as well as NHS England Open Source and HANDI there are many organisations who can provide advice on basic things you can do to help ensure your software has these desirable characteristics and for those who want to find a commercial partner who can help you address these issues, help you deploy, support and develop your own or others open source solutions we can also help – We are also interested in hearing from both commercial and social enterprises that are able to provide such services or want to better understand the opportunity to do so – Please email either firstname.lastname@example.org or email@example.com
HANDI-HOPD provides a safe simulated environment to easily develop the sort of tools that typically get designed as feral systems, but the standards and approaches used make them safe, scalable, interoperable and sharable with minimal overhead. HANDI-HOPD itself does not provide a hosted environment for operational deployment, but actually uses the technologies that can (Elastic Cloud Computing, Software and Platform as a Service (SaaS and PaaS) and Docker Software Containerisation) and we know other will mirror these with Internet and N3 Hosted Operational service. This creates the opportunity to create a simple app in a few hours on the HOPD and deploy it at scale in a few minutes on a laptop, data-centre, private or public cloud and it many case for small scale use this first tier of service will be free to us.
Lets herd those feral cats!