UKUUG: Free and Open Source Software in the Health Service

I was interested in learning about an area of software engineering that I have not dealt with yet, hence I attended Anand Ramkissoon’s talk Free and Open Source Software in the Health Service.

Anand outlined the history of medical lab software:

In the 1980s: various in house systems have been built, which were
– well specified
– unique to specialism
– unique to individual lab
– constrained by hardware
– not portable
– driven by enthusiasm with no budget

Then, in the 1990s, commercial systems became available that descended from in house systems. Their characteristics:
– mainly multi specialism
– mainframe based
– written to a simplistic specification awkwardly extended
– quality could be higher

Since 2000 and onward, we see the death of in house systems. The Y2K compliance killed off the last in house systems. Also, a retreat from strategic involvement in specification by the medical labs can be observed, which is to Anands oppinion “a huge mistake”. Another characteristic of the current situation is the commercial lock-in, mainly due to proprietary data formats. In this regard, the medical labs have a lack of power in negotiations, because the main companies simply refuse to port old data, allthough it is a requirement by the labs. And the vednors refuse even if there are no technical constraints. Hence, the buyers have to believe it, because they have no influence in the development process

Anands alarming general statement is that “the quality of software currently used in UK labs is poor, absolutely poor”. The reasons are that there is virtually no competition with 3 different software systems in the UK, and globally not many more. Why are there not more vendors, he asked himself? And answered: There’s no balance of power in the market and the software is hard to specify as it requires detailed knowledge.

The reality is that people at health services invest an awfull lot amount of time to clean up after the software. This situation is paired with the counter-productive philosophy in higher and middle management of health services, that investing in new technologies is only possible when employees are laid off.

In summary, the health services in the UK, maybe even world-wide, and especially the medical labs are currently in the phase of vendor lock-in (sounds familiar to me when thinking of the general history of FOSS). Consequently, Anand started the project “Ganesh” to find a common standard for data interoperability, as well as developing an Open Source reference implementation.

The aims of the project “Ganesh”:
– portability of databases, extracts and records
– global specimen identifiers
– not an obvious idea to medical houses
– vertical processes
– sepcimen centred: log, aliquot, test, refer, report, validate, comment, authorise, store, discard
– horizontal processes
– “back room”, QA, QC, workload measurement, global test QA
– modular extensible

Anand, good luck!

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