Jon Edwards wrote:

> (That's not to say that a European/Worldwide list is not valuable, just that
> I was thinking of ways to help the adoption of open-source in the NHS...
> which, I think, was what Douglas' original post was hinting at?)

This summarises the issue well. What we have to do is think about pulling
all the disparate resources that already exist into a coherent document that
looks like the kind of material that Derek Wanless (and by extension, Gordon
Brown, Alan Milburn, Tony Blair) will find helpful and influential.

I think the politicians and senior civil servants are aware that they can't
micromanage every aspect of IT. Our task is to show them where our
initiatives meet their top down strategies.

> 1. It would be great if the "barriers to entry" posed by RFA accreditation
> could be somehow lowered a little for open-source clinical systems. Not that
> the standards should be lowered, just the cost of going through the
> accreditation process!

I'd be concerned about this. Politicians can't be seen to favour one
supplier over another. I think anyone in that business will have to find the
money, open source or not. And I'm sorry to say that all of the demos of OS
practice software I have seen are frankly not competitive with currently
available proprietary practice software.

> 2.
>> a Sourceforge-like repository of locally developed healthcare
> applications;

Obviously both Spirit and OIO will be valuable building blocks for any NHS
initiative, but I think that, for reasons largely connected with quality
assurance and ease of licensing, the NHS will want to give its imprimatur to
an official distribution of its own. It should of course fund the necessary
development, and release the fruits of its labours back into the free
software community. Julian Todd had a vision for this at OSHCA2:
http://www.carnall.demon.co.uk/oshca2/jt.htm

> 3. Maybe some guidance for businesses who might want to open-source their
> existing products? I'd love to see one of the smaller GP-systems suppliers
> open-source their software as a way of competing against the dominance of
> the few big companies.

The situation is complex: Microsoft have just announced their alliance with
BT, Cisco, SchlumbergerSema and others in a partnership codenamed LightBulb.
Its main purpose will be to challenge the existing suppliers to the UK
market, Torex, EMIS, McKesson HBOC and the like.

Although there is IBM, they've made it pretty clear that their support for
open source is at the level of the operating system: their profits will come
from running proprietary application software on top of it. By definition
OSHCA is interested in open source at this higher level, where we don't, to
my knowledge, have battalions of suits pressing our case. I agree that an
open source release of an already accredited GP system would be the most
efficient way of getting a quick win here. Maybe if LightBulb squeezes
existing systems suppliers hard enough, one (and it only takes one) will see
the light. (sorry ;-) )

Ray Henry's talk at OSHCA2 documented one real life example where open
sourcing an NHS-developed application proved difficult:
http://www.carnall.demon.co.uk/oshca2/rh.htm
He might have liked to read Sebastion Blondeel's advice on how to release
free software: 
<http://cvs.idealx.org/cgi-bin/cvsweb/documentation/publish/www/doc.pdf>
(10k) had it been available to him. (published last month)

Thanks for all the comments to date (Brian: that list of business case links
is impressive!). I'll get to work on a draft response to share with you all.

D.

-- 
Douglas Carnall

tel:+44 (0)20 7241 1255
fax:08700 557879 
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http://www.carnall.org/
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