Fostering openness through open source software

Open source software (OSS) can provide a range of benefits to the NHS that are not usually achievable by purchasing commercial off the shelf software (COTS).

‘Some argue that the total cost of ownership of OSS is lower but others say the evidence is inconclusive’

Some of the benefits are self-evident: the ability to see what the software is doing; the opportunity for more rigorous and detailed auditing and testing; and avoidance of vendor lock-in, which provides business continuity cover should you wish – or need – to change supplier.

But the term ‘open source’ has also come to mean more than just the ability to see the source code. It is part of a spectrum of openness, from design principles to user engagement to the support community, which allows for sharing innovation, faster development, higher quality deliverables and more productive relationships between customers and suppliers.

Cost of ownership

Some argue that the total cost of ownership of OSS is lower but others say the evidence is inconclusive. Undoubtedly, OSS offers positive benefits around sharing innovation, security/defect transparency, interoperability and business continuity, as well as the initial licence cost savings.

As an example, with COTS, the testing process requires users to predict all the scenarios the code might execute. With open source, having visibility of the code allows informed verification of potential calculations and processes.

‘Over time, the supply and demand model supporting OSS encourages the development of a competitive marketplace for providers of support’

However, in many parts of the NHS secondary care sector in England there has been a reluctance to use OSS in clinical settings on patient safety grounds as there is a risk making the code readily available to be changed could result in the software being inadvertently (or maliciously) corrupted.

In fact, the same levels of security and control can be inserted over the executable and source code as exists for commercial software. This would simply be done by the IM&T department instead of the supplier.

Organisation size

Another area of concern is the provision of enterprise level support. The economic realities of the OSS market mean suppliers have tended to be small organisations. As OSS has become more widespread, so the availability of support has grown; recognition of the issue has driven a better approach to the procurement of OSS solutions as a service rather than time-bound implementation project.

Over time, the supply and demand model supporting OSS encourages the development of a competitive marketplace for providers of support.

NHS England supports using OSS in the NHS and, as part of the Safer Hospitals, Safer Wards Technology Fund, detailed an NHS VistA program to bring together several open source offerings and help promote their development and use in the NHS. This includes the possible customisation of VistA for NHS use as well as other OSS products developed by the NHS.

This provides a great opportunity for competition and innovation within the market, and provides NHS trusts with alternative approaches to achieving higher levels of integration and digitisation of care records.

Beverley Bryant is director of strategic systems and technology at NHS England