Like many British people, Stuart J Mackintosh – the CEO of OpusVL - is a fan of the National Health Service. Created on a surge of idealism in the postwar era, the NHS was built to be free at the point of delivery, offering all citizens equal access to healthcare. He believes that because of its ethos, people are attracted to work in healthcare for subtly different reasons to other countries: in Britain, to work in the NHS can be about giving something back.
Openness
Stuart’s other great obsession is openness. In computing, this idea began with open systems: the once-radical idea, now taken for granted, that computers from different manufacturers should be able to easily share software and exchange data. Then it evolved further with the idea of open-source software, in which a code base is maintained by a community of developers and is freely available for anybody to take and adapt.
Openness has brought down giants before - for example, the UNIX operating system, developed by a small team in the 1970s, eventually became a de-facto standard, and rapidly ate into the market share of the dominant computer companies that had locked users in to their own, proprietary operating systems. Similarly, the TCP/IP network protocols, resulting from a research project by the US military, became the global standard for networking, despite the giants – from Novell to Microsoft – having their own (now long-forgotten) offerings.
The lesson is that openness can be a force with the power to sweep away the established ways of doing things. Stuart suggests that the NHS spends billions of pounds each year on software that is often a poor fit to requirements. OpusVL’s mission is to bring the power of openness to the NHS and other organisations, and thereby break the expensive lock-in of incumbent suppliers. Its strategy to achieve this is its Open Digital Approach, which uses a combination of standards, open-source software and partnership to deliver systems at a lower cost than that offered by incumbent suppliers. Via this approach, not only can project teams develop solutions based on tried-and-tested free software, but the work of those teams can potentially be fed back into the open-source community to be used (free of charge) on future projects elsewhere.
OpenEHR
OpenEHR (pronounced openair) is an open standard for describing clinical facts, and is central to OpusVL’s approach to the NHS. Health data – for example related to blood pressure – might be described and stored in multiple ways by different systems. Once an OpenEHR schema for blood pressure has been defined, systems conforming to that schema can freely interchange data in useful ways – and so health providers can begin to link the information silos together.
When the Covid-19 pandemic began, it took only two weeks to create an OpenEHR schema to describe the disease. This was ratified in June 2020, allowing software developers to rapidly create systems to manage the pandemic.
OpusVL’s Solutions
Most existing NHS systems are not OpenEHR-compliant. OpusVL’s answer to this to this has been to create EHRtap (pronounced airtap), software that interfaces with multiple legacy NHS systems and makes the data more easily available via APIs. This legacy data retrieved by EHRtap can then be picked up by another OpusVL product, CakeStack. Cakestack converts data into OpenEHR formats and makes it available to OpenEHR applications.
EHRtap and CakeStack thus enable the NHS to join up the data held in multiple, unconnected proprietary systems, and open it up to be used in third-party applications; and all this without disrupting existing operations. In this way, OpenVL’s vision of bringing openness to the NHS (and weakening the hold of big suppliers) can be achieved gradually. If the approach is successful, reliance on expensive legacy systems can be diminished over time until – potentially at least – they can be phased out.
As Stuart describes it, this provides benefits beyond cost savings. “Rather than try to replace big databases, we work alongside them. Without disrupting existing systems, we tap data from them. Our measure of success is that the NHS is no longer paying just to stand still. All those billions... think how much progress we could make.” Opening up healthcare data can also create local economic benefits. NHS trusts, no longer reliant on faraway product development teams, can outsource software development work to nearby businesses, which develops the local economy and local knowledge. “Think of the value this offers to the citizen – and ultimately, that’s the purpose of the open approach.”