Public Services > Healthcare

Moorfields opens eyes to open source

Gill Hitchcock Published 20 September 2012

Moorfields eye hospital NHS trust's consultant surgeon Bill Aylward tells Gill Hitchcock about the benefits of developing patient software in-house


Many NHS trusts are in the process of buying electronic patient record systems following the failure of the NHS National Programme for IT to provide these. Some may choose to follow Moorfields eye hospital in developing their own systems, or even adopting the NHS foundation trust's OpenEyes open source system themselves.

OpenEyes will replace the trust's legacy system, ePatient. Bill Aylward, consultation surgeon and former medical director at Moorfields, explains: "We have a patient administration system which is electronic, but all the clinical information is currently on paper. One of the aims of this project is to eliminate the need for paper notes by the end of 2013."

OpenEyes began as a small scale pilot in November 2010, and was rolled out across all 13 of the hospital's sites in January this year with functionality that includes booking and waiting list management. In September Moorfields introduced a major upgrade, with new modules for recording the clinical details of operations, electronic prescribing and a correspondence module to enable the generation of letters to GPs, referring clinicians, patients and others.

"It's a very funny order, starting with the boring stuff," says Aylward. "But the imperative was to replace our previous electronic system which did booking, and there was a need to replace ePatient because support was about to be withdrawn."

Clinical modules currently being developed include pharmacy, opthoptics, optometrists, pre-operative assessments, audit and research facilities. The goal is that the entire system will be completed by the end of next year for a total cost of £3.5m, excluding the pilots.

Aylward is project managing the development team, which includes a product manager, who co-ordinates collaboration with ophthalmologists elsewhere in the UK. There are also four software developers, and a project manager who co-ordinates the implementation of the software within Moorfields, and a quality assurance person, responsible for testing modules before release.

Asked why Moorfields decided on in-house development, Aylward responds: "The commercial model providing the sort of functionality that clinicians need has utterly failed. That's a very brief summary of the national programme, but if you throw £11bn at a problem and you don't get any results, it is unlikely that it is the right model.

"We looked at all the commercial systems available and there was nothing that even comes close to matching our requirements from the clinical point of view, so it was really the only solution to get what we wanted."

He maintains that the OpenEyes model involves real clinical engagement; ophthalmologists are specifying what they want and within a very short timescale Moorfields' IT team are turning that into something they can use. But he points out that the development has included clinical input from many other hospitals across the UK. For example, the product manager is liaising with a team in Cardiff about the glaucoma side of the project.

According to Aylward, the collaborative approach adopted by Moorfields contrasts with a relatively common experience across the NHS where clinicians contribute to the development of commercial software which they are then unable to use. "This happened recently with a diabetic system in north west London," he explains. "A group of clinicians got together, specified what was required, it took them hours and hours, lots of meetings, and then a commercial company turned the idea into a piece of software which was for sale, and the trust where they worked can't afford to buy it."

Clinicians benefit from "owning" their data, he argues: "It is a very widespread problem in health systems that people are coding, but when clinicians look at the coding they say 'this is wrong'. So if they are actually inputting the data themselves they are owning it and it improves the overall quality.

"One immediate benefit for clinicians - just from the booking module - is that we now have a properly coded and trusted diagnosis index for all the procedures going on at Moorfields."

And for patients? Aylward says that if they need treatment they are immediately offered an appointment during a consutation. For example, if a consultant agrees that they need a cataract operation, rather than going away and being contacted later, the consultant books them in. "So patients really love that," Aylward enthuses.

The basic modular structure of the system is not specific to ophthalmology, so it is possible that it could be used elsewhere in the NHS. "If a cardiology unit wanted to use it, they might want an app for patient records; an orthopaedic hospital might want an app for x-rays or whatever. They can all plug into the same infrastructure, and that is a key part of the design," he says.

Despite the benefits of OpenEyes, Aylward is doubtful about whether other NHS IT departments could develop a similar open source software system, however. In his experience, the way most NHS hospitals work is to purchase a new piece of software and then use an external contractor to install and maintain it.

"With open source it's different," he says. "Although it's free, you need someone in-house to download, install and maintain it and most NHS IT departments simply do not have this resource."

Moorfields, Aylward believes, is lucky: "Clearly the benefits are enormous in terms of sharing and producing quality products, but it is very difficult to do and I think we are very fortunate in having the structure to do it."


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