Open Living: Why it’s not too late to survive the proprietary EPR apocalypse
Hmmm; ok, so, assuming Thomas Webb is correct in his latest blog (here) about why the current crop of proprietary EPR/Clinical systems could be the equivalent of the cast of World War Z, it still won’t be an overnight change will it; we’re not about to go to bed one night and wake up the next morning to a zombified Frank Hester...are we?! Wow, what a thought!
Well, given the recent announcements by the Tech Giants to remove barriers to interoperability (here) perhaps it could be sooner than we thought?!
However, what does the short to medium term look like, pre-zombie apocalypse? How does a CIO tool up for the fight? How do you solve the age-old Conundrum of being between the rock (Mega-suite EPR) versus the hard place (Integration spaghetti for best of breed) in the meantime?
Whatever the future holds, we can’t predict it fully and we can only be sure that the technology landscape changes very quickly; why plan for 5-10 years in advance when we know the technology will be vastly different, the service needs will be vastly different and the funding will be...oh, wait there still won’t be enough funding will there?! Therefore, why should we lock ourselves in to lengthy contracts for a decade or more which restrict our options?
Yet the time and inconvenience involved with short-term contracts is also a burden to bear through repeated selection, procurement and implementation efforts...the pain of data migration from one proprietary system to another is a spectre that hangs over every Director of Digital / Informatics / CIO like the Guillotine it could be for their careers! There has to be a happy medium, another way, right?
How do you achieve flexibility, control, a balance of risks vs benefits, costs you can monitor, able to deliver short-term wins with an eye on the long-term Strategy, where the move to a mega-suite or future mega-platform is not ruled out but best of breeds can also be entertained?
One of the CIOs at the forefront of embracing this option is Ade Byrne. In Southampton, Ade considers an Open Platform as the middle ground where neither strategy is discounted yet it acts as an insurance policy against vendor lock-in, sell-out and bankruptcy; data migration issues; technology changes and money-pit implementation nightmares. He is a firm believer in open platforms, vendor neutral data, and that FHIR is the way forward for opening up proprietary data sources.
Running alongside existing proprietary platforms it gives opportunities and options to migrate interfaces across in a phased manner; contingencies in the event of cyber-attack, data corruption or failover/resilience issues; allows a safe-haven for clinical apps to be developed without risking the existing infrastructure; buys time to assess the correct strategy to release the pressure valve and therefore buying-power ‘over the barrel’ on mega-suite EPR procurements and allows control of upgrades, data reporting, hosting and security.
You may also have seen the publication from the Apperta Foundation “Defining an Open Platform” (here) which makes the case for open platforms and lays out a blueprint for an open platform architecture at a level of detail that would allow any willing party to build an open platform that would be interoperable with any other.
Since in publication there has been increasing interest with open platform technology being implemented by a number of NHS Trusts, Genomics England and The City of Leeds for its PHR.
Some of the team involved with the publication have also launched a new venture to build a platform based on OpenEHR with a number of pilot applications: inidus.com other vendors are available of course but it is worth a look if it saves you time and money!
You might ask “isn’t it a waste of money to invest in a platform that you might then dispose of if a mega-suite is chosen or the apocalypse doesn’t happen?” I say, possibly, yes and I accept that the dual approach could be flawed - however, if the common faith is that mega-suites are vastly over-priced and the proprietary vendor lock-in is stifling innovation and integration, is it really wasting money? A truly open platform approach could also be shared with others to bring down the overall cost.
You might also think that an open platform is an expensive insurance policy? Yet this, for us would be the worst-case scenario; you may infer from our enthusiasm for open that we are advocating a gradual approach to a more open future that doesn’t need insurance.
If others choose to follow Ade’s lead, perhaps the Open Platform approach will become the perfect weapon to protect ourselves from the existing system massacre whilst leaving ourselves an escape route to the technologies of the future?!