[GLLUG] Comments please

Marco van Beek mvanbeek at supporting-role.co.uk
Sun Jul 23 13:44:23 UTC 2023

Hi All,

So my opinion on this is that the NHS's greatest IT weakness (the 
diversity of systems) is also it's greatness strength. Every "solution" 
i have read about over the last 10 or 15 years appears to be a 20th 
century solution for a 19th century problem, and what is needed is a 
21st century approach.

I believe it doesn't "need" an open source solution, it needs a common 
approach, like a set of RFC's, that allows everyone, closed and open 
source together, to move in the same direction, and by the very nature 
of the approach, be able to safely share data without a need to 
centralise it.

There are at least two sets of unique ID's floating around, National 
Insurance numbers and NHS numbers, and then there is a need to cater for 
people who don't have either, or who do but have just been dragged out 
from under a bus and annoyingly for some, cannot answer those sorts of 
questions until after they are treated.

There lots of really good examples of distributed databases. LDAP and 
DNS come instantly to mind. You just need an indexing system that is 
versatile enough to work with the idea that some people are going to 
have multiple entries, and in an ideal world they would eventually all 
get merged, but life isn't like that.

Having different systems means not having common exploits. There are 
regular stories in the press about hospitals getting their systems 
hacked and/or data encrypted. You really don't want them all to be the 
same and all get hacked at the same time.

I would start by identifying every data set you need as a healthcare 
provider, e.g. patient personal data, appointment data, pharmaceutical 
inventory, stock control, staff records, and so on, and  create a set of 
minimum requirements that would go on to create a common API definition. 
Then you make that legally binding for all new software purchases, 
including support/subscription renewals. If an original software 
provider either won't do it, can't do it, or has gone out of business, 
then you create a market for third party tools, and just like the NHS 
has the ability to force pharmaceutical patents into the public domain, 
it could force that software to open up it's source code, at least to 
those third parties plug-in providers. As time goes on, the API gets 
revised, improved and updated in the RFC's.

All this software could be closed source or open source, but they would 
all have to talk to each other, so while the source may be closed, the 
market isn't, and can't be, closed.

Anyway, that's just my opinion. You did ask :-)

Cheers all,


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