Douglas, You make some positive observations about eEnvoy/eEnvoy's Office approach to OS, i.e.
'However, I think the office of the eEnvoy and other more tech-savvy departments are much more up to speed and pro-active in promoting open source software.' 'eEnvoy certainly is on side. The rest not particularly AFAIK.' Can you point me in the direction of some evidence for this? So far, our research suggests that they are not really interested in promoting it. See E-Government Bulletin Issue 113 (http://www.headstar.com). Certainly, I've never heard anything but cringe-making e-speak from Pinder himself, e.g. 'It's an e-change, not a sea-change', etc, etc. However, I may have missed something important... ----- Original Message ----- From: "Douglas Carnall" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Cc: "Open Health List" <[EMAIL PROTECTED]> Sent: Thursday, June 20, 2002 1:27 PM Subject: Re: Delivering IT in the NHS Trevor Kerr > Medical Microbiologist > Southern Health Pathology > Melbourne Australia > [EMAIL PROTECTED] wrote: > http://www.doh.gov.uk/ipu/whatnew/deliveringit/deliveringit.htm > > Is it possible to say where OSS may be in this plan? > > I found very few pointers. Dear Trevor, Thanks for drawing this to my attention. My reading of the situation is that both the IPU (which is Whitehall-based, and is politically-focussed on serving the minister's needs) and the NHSIA (which is more "owned" by the NHS Executive) are aware of the arguments for open source, if not universally convinced. However, I think the office of the eEnvoy and other more tech-savvy departments are much more up to speed and pro-active in promoting open source software. I think the departments are arch pragmatists: they want what works, and I doubt if they care very much who they pay to make it work, though of course, they have the spectre of the Wessex scandal (in which >�60m. of taxpayers' money produced absolutely nothing in the '80s) hanging over their heads. The recent decision to opt for Windows desktops throughout the NHS was controversial, but then again, it was controversial within the OS community as to whether Linux was ready for the desktop. Arguably it is, in which case the government just made the richest man in the world �50m richer for no good reason, but there you go. The British civil service is hardly known for the brilliance of its innovation, and the problem with open source is that there are rather fewer suits around to support it in depth and hold stakeholders' hands. I think the recognition that open standards are needed does reflect the success of the open source/Un*x lobby, and I think there are sufficient tech savvy people not using Microsoft to at least raise a stink if Bill starts to play his usual game of extending standards with proprietary extensions that start to break other platforms. There is still, for example, Microsoft's foolish/wicked decision to pollute the ISO-8859-1-Latin1 standard by dumping codes for smart quotes where they oughtn't. (see http://www.perl.com/language/misc/ms-ascii.html for exposition) I don't think they want to be pinned down to any particular technology. But I think also there is a recognition that the NHS does not itself employ enough programming talent to produce all the needed software in-house, although it has some, and could produce some. > 2.3 National Programme Architecture > > Partner with eGov & IT Industry to deliver compliant, open systems & > clinical applications. > > [And, in the same chart] > > Build National data and data-interchange standards based on open > technology >>> > > In the Summary paper > http://www.doh.gov.uk/ipu/whatnew/deliveringit/deliveringit.htm the same > phrase is used, but with 'XML' inserted. Does that make a difference? > > << Build National data and data-interchange standards based on open XML > technology >> As I understand it, using XML shifts the potential for incompatibility from the clients and servers to the "document type definitions" themselves. i.e. if you can't agree what data elements should be part of the DTD you're still going to have compatibility problems. But as I understand XML, an XML document is rendered after the browser has downloaded: the DTD, the data, and the any style information. All three elements are openly defined and readable, and should be renderable on any platform, so this would be a step forward. > From the main paper - > << > 3.1 Strategic decisions required to deliver the Vision > 3.1.1 There are a number of critical strategic elements that must be in > place to deliver the IT vision for the NHS. These are: > o an increase in the level of national direction given for IT by > evolving and simplifying the management structure and responsibilities > within both the DH and NHS at regional and local levels; > o a phased approach to deliver change quickly - focus at any one time on > quickly delivering a limited portfolio of activity, nationally, that can > be built on by subsequent phases; > o management of increased levels of funding with clear central direction > and control; > o a structured partnering approach with Industry to deliver new IT > systems across the NHS; > o coordination, acceleration and where appropriate simplification of > procurements to ensure we get value for money while moving at a fast > pace, and do not add unnecessary time and cost to our industry supplier > base. We will consider radical outsourcing options that add > pace and value to the programme; > o changed working practices in the NHS; > o benchmark progress against best practice companies. This centralisation is interesting. I think there was a clear recognition that previous modernisation funds got swallowed up meeting clinical priorities, so they are going to ringfence the money to stop that happening in future. > What does "radical outsourcing" mean? Presumably that they are not afraid to, for example, outsource appointment booking systems for hospital outpatients to third party ASPs (application service providers) and fire all the poor bastard clerks operating the clunky paper systems at the moment. > Moving on. > << > 3.6.2 Option 2 is the preferred route forward. Characterised as > Strategic Outsourcing, this approach gives the best spread of risk, has > achievability, retains the incentives for innovation whilst insisting on > ruthless standardisation of a national infrastructure. It requires > robust > management of the resources at Strategic Health Authority level to > ensure that both new and baseline spend on IT is appropriately > protected. It also needs clear and explicit mechanisms for setting and > agreeing standards. >>> > "Ruthless" sounds good. Hmm. I don't think ruthless is ever good. One of the best things about the NHS is that it provides socially useful employment for about a million people. A lot of those people are currently employed rationing access to services in inefficient paper systems. Let's hope they can be redeployed in useful roles rather than just shown the door. And while, of course, it is good that standards are standard across a whole organisation, there'd better be a good process in place to revise and update the standards because undoubtedly the standards will have problems, and if we all standardise on a problematic standard then we have a problem :-) In other words, there's something to be said for diversity. > And > << > 3.8 Benchmarks - internal, external > 3.8.1 We are taking action to establish benchmarks for our planned IT > systems to enable comparison of progress against best practice. They > include: > o consulting best practice IT user companies across industries (eg > Cisco, BP, Shell, Ford, Microsoft); > o partnering with other Healthcare providers to exchange experience and > mentor each other (Kaiser Permanente, Norway, Spain); > o tracking international health IT strategy developments, e.g in New > Zealand, Australia; > o inviting external internationally respected experts to review > progress; > o supporting European Health Telematics standards development.; > o working with the Office of the e-Envoy; > o tracking the work of the WHO in developing international benchmarks; > o sharing experience, standards etc with colleagues in Scotland, > Northern Ireland and Wales. >>> > > Did you see any supporters of OSS (eg IBM - Linux) in there? eEnvoy certainly is on side. The rest not particularly AFAIK. > OSS got a bit of boost with the QinietiQ paper 'Analysis of the Impact > of Open Source Software.' > > http://www.govtalk.gov.uk/interoperability/egif_document.asp?docnum=430 Yes, I saw this, it was encouraging. Maybe we should add some comments on the site (there are currently none) > Scanning the e-GIF papers > http://www.govtalk.gov.uk/interoperability/egif.asp?order=title it seems > OSS proponents are still there, but is there any momentum for OSS? Good question. I think the message has been well-examined by the NHS; see for example: http://www.carnall.demon.co.uk/oshca2/index.htm But I haven't heard of specific funding for open source projects, such as writing a "Crown Public License" which would make it easier to release hand-rolled apps developed within the NHS, or of a proposed NHS open source repository. > Back to 'Delivering IT in the NHS' > > << > 4.5.2 To encourage the increase in capacity and competency in IT within > the NHS at both national and local levels, we will work to create and > manage IT career paths for both systems and Informatics professionals. > For informatics staff, the education sector provides learning content > and academic awards on Informatics, but the NHS Information Authority > will > award professional recognition (in a Register of Professional Competence > in IT) to those who meet both practice and qualification requirements. > We plan to hold an NHS IT & Informatics Professionals Conference in late > 2002, an event that should start to cement the feeling of community, > structure and progression in the IT workers throughout the Service. > Discussions to make the establishment of a Faculty of Health Informatics > an early component of the NHS University are underway. >>> > > Will the new academic centre be a strong voice for OSS? Will private > funding of this Faculty of Health Informatics be actively sought (and > lead to a distinct bias away from OSS)? This is an important point. I don't know who will be setting up this faculty or what its technological biases will be. My impression is that the high end, high reputation centres of medical informatics in the UK such as CHIME at UCL, and Manchester's Department of Computer Science are already promoting open source methods. But I have also come across disappointing examples of over-reliance on proprietary tools: for example, the Royal College of Surgeons of Edinburgh's Diploma in Informatics requires all course participants to build example applications using Microsoft products such as Access. My view is that the new Faculty should be catholic in its technological tastes and encourage its students to examine the merits of both proprietary and free software. For all the problems that proprietary products can bring, it can be hard to beat if it does what you want, easily, with a nice GUI, NOW, and off the shelf. But there are lots of good reasons why any public body that commissions custom software should release it under open source licenses. > At the level of the peak body NHSIA, it is hard to find a mention of > OSS. > http://www.nhsia.nhs.uk/def/pages/publications.asp > It could be there, but maybe they are waiting for the new, highly paid, > head of NHS IT to be appointed. Will this person be a champion for OSS > in health, or a lightning rod for more MS? http://www.nhsia.nhs.uk/def/pages/board/members.asp Bellingham is no fool, and I know (because I have bent his ear personally) that he is aware of open source. He's also been responsible for a clinical service in his time, so I trust him to make sure that the big picture helps the grassroots. Peter Drury (IPU head) is more of a career civil servant I think, and I'm not sure he's ever been a clinician. http://www.doh.gov.uk/ipu/develop/infpolbd.htm I'm not sure who you mean by the "new head of IT". Sir John Pattison? I don't know what his views on open source might be. Hope this helps, D. -- Douglas Carnall tel:+44 (0)20 7241 1255 mob:07900 212881 **system message: fax is down, number reserved http://www.carnall.demon.co.uk/ transitioning* to http://carnall.org/ [EMAIL PROTECTED] transitioning* to [EMAIL PROTECTED] *transitioning period=June2002 -- > Sept2002
