open source
is the
only way
for medicine
General Hacktitioner
Software Developer, Clinical Informatician, Discourse Forum sysadmin,
RCPCH Digital Growth Charts, NHSbuntu, openGPSoC
Previous Lives: Emergency Physician, Anaesthetist, GP
open source
IS
the
only way
for medicine
open source
IS
the
only way
for medicine
to avoid procurement death
what is open source?
software which releases its source code publicly
users are granted some additional rights, governed by the Open Source License
it doesn't mean it's non-commercial
it doesn't mean it's free either!
total transparency fosters security, quality, and safety
examples: Android OS, Chromium browser, Linux, Apache, MediaWiki (Wikipedia),
Wordpress, Discourse
procurement hacking
procurement is now one of the most prevalent barriers to innovation in the NHS.
at the last Let's Do Digital conference, almost every presentation mentioned procurement as a blocker to
progress.
simple and very reasonable project needs became the subject of lengthy and expensive procurement processes
open source can be used to hack your way around procurement
roadblocks - you can try multiple solutions and see which one works
then either manage it using internal IT capability or pay for commercial support
agile working
everyone keeps talking about how we should be working in a more agile way...
but the NHS cannot function in an agile way while we are hamstrung by
bureaucracy and... procurement
agile is all about rapid, iterative experimentation
open source is a way to bring back the speed of experimentation
iterative
medical technology is one of the biggest challenges in medicine
monolithic closed approaches have failed spectacularly to meet this huge
difficult challenge
'iterative' development seems to work well for large difficult
things
(see The Internet as an example of this)
open source does iterative better than anything else
in-house development
some of the best success stories of NHS IT have been where we have created in-house development
capability rather than buying an off-the-shelf product
NHS Spine 2, NHS App, COVID app, homebrew EPRs
open source is a way to share the cost of development with other organisations, to build exactly what we need
and not what suppliers want us to have
"save your game regularly"
has anyone had the experience of putting a huge amount of work into a digital
project in the NHS and then had it die for a stupid reason?
"there's no funding stream"
"we're having another f&cq(ng restructure"
"the supplier has gone into voluntary administration"
open sourcing your work means you have 'saved the game' for the future
quality and safety
if nobody can examine the code, how do we know if closed source software is
safe?
secure?
adequately tested?
in closed source we can't: we can only take the word of the supplier
in open source we can audit the code, test it, and even improve it
brain-scarcity
re-Solving a solved problem is a waste of time, money, and brains
No problem should ever have to be solved twice.
Creative brains are a valuable, limited resource. They shouldn't be
wasted on re-inventing the wheel when there are so many fascinating
new problems waiting out there.
To behave like a hacker, you have to believe that the thinking time
of other hackers is precious — so much so that it's almost a moral
duty for you to share information, solve problems and then give the
solutions away just so other hackers can solve new problems instead
of having to perpetually re-address old ones.
NHS scale is ideal for open source
we have readily identifiable system-wide needs which are similar
collectively we have a large amount of development capability
we could build shared NHS digital platforms to comprehensively solve every NHS
business need
Open Source PAS? Open Source Guidelines? Open Source e-Referral? Open source NHS
operating system Open source website frameworks?
the NHS and open source
NHS has an intrinsically sharing philosophy
we share the risk of illness and derive protection from this
we share medical knowledge (eg journals, conferences)
we share organisational knowledge (eg networks)
NHS staff readily comprehend the idea and benefits of open source
improvements
if you want to improve something and have the skills, with OSS you
can
if you want to improve something and don't have the skills, with OSS
you can hire someone to do it
if you improve something, it can be shared with the community
and in return you get to share community developments too
clinicians not directly employed in software are more likely to
contribute to an open source project than a closed source product
open source myths
"open source is free, so it's anti-commercial"
"you can't make money with open source"
"open source is nerd niche and not for the mainstream"
"anyone can change your code - so it's insecure!"
open source recap
open source is 'the age of reason' brought to computing - there is no other safe and scientific way to do
medical computing
represents 'saved progress' in the game
it is an opportunity not a threat, you just need
the right business model
the NHS is particularly fertile ground for open source
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