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It’s encouraging to see Matthew Gould, the CEO of the newly formed NHSX is spending time at  

the clinical frontline before he formally starts in his post in July.  After reading Matthew Gould’s most recent blog, it’s clear his time so far with care professionals is helping inform his views; recognising that health IT is frustratingly clunky, siloed and way behind other sectors.

We recognise that there is some important new thinking and messages with his most recent welcome declaration;

“we’re going to focus on standards and platforms, keeping the centre as ‘thin’ as possible”. 

This shift is an acknowledgement that the health IT market is underperforming, one size doesn’t fit all and we need a new approach to health IT.

This latest initiative by NHSX, has a good deal in common with the work of the Ripple Foundation. In advocating user centred design, the use of open standards and open source for healthcare, and now this focus on the platform approach in healthcare, these principles resonate with us very much. This more open approach is a good fit with the clinical community too, where sharing knowledge and research for the betterment of health outcomes is understood as a public good. 

While we welcome this shift towards a healthcare platform by NHSX, our experience has taught us this is non-trivial challenge, so would urge NHSX to learn from others in this field tackling this same challenge, both in the UK and abroad such as the Global Goods initiative from Digital Square. 

The state has an important role to play in supporting companies tackle this fragmented market that is dominated by a few big tech players.  If done right, a platform based approach can help to stimulate new entrants to the market and drive innovation. 

One particular challenge NHSX will face will be finding the balance between coordination and control of platform development while letting innovators innovate at the frontline, to get the right information, at the right time, to help care professionals deliver the best possible care. 

What does the NHS mean by a platform in healthcare anyway?

We believe NHSX, should be working towards the definition of an open platform, as defined by Apperta Foundation and  therefore start the move away from closed platform/monoliths, which both Yorkshire & Humber LHCR and NHS Scotland are already working towards. 

Open platforms liberate both data and applications making them portable and interoperable across different platform implementations…. The open platforms approach is vendor and technology neutral, eliminates lock-in, facilitates innovation and competition, and forces vendors to compete on quality, value, and service”. 

Indeed the Apperta paper on Defining an Open Platforms, defines 8 core platform principles:

  1. Open Standards Based 
  2. Shared Common Information Models 
  3. Supporting Application Portability 
  4. Federatable 
  5. Vendor and Technology Neutral 
  6. Supporting Open Data 
  7. Providing Open APIs 
  8. Operability (as in DevOps) 

So as well as continuing to meet care professionals at the frontline, we, Ripple Foundation and Apperta Foundation, would welcome a conversation with Matthew Gould and NHSX colleagues to discuss our learnings and expertise in this field as well as to discuss strategic investment into open platform innovation via the 1% Fund to enable a small safe start, the iterative curation of common platform components and collaboration between the frontline and NHSX.

Ripple Foundation’s showcase stack encompassing three open source elements – front end UX/UI framework, middleware and backend/data repository.  Each component harnesses the power of open source and aims to demonstrate open standards in action to show that there is a different way to provide technology to our care professionals and patients.

Ripple Foundation was established in 2016 to support the adoption of an open health and care platform internationally.  As part of its mission, the team has supported the development of a leading edge UX/UI framework which they’ve recently launched called PulseTile. The clinically led team has also been reviewing complementary products and components that meet the increasing demands of the modern day health and care system.  They are proud to support and promote the incredible versatility of both the middleware – JSON API oriented QewdJS framework led by Rob Tweed of MGateway Ltd, plus the openEHR compliant backend of EtherCIS led by Christian Chevalley of ADOC Software Development.   

Dr Tony Shannon, Director of Ripple Foundation said, “We are promoting Ripple Foundation’s showcase stack to demonstrate how health IT can be done in the complex and highly pressurised health and care system.  For years care professionals have had to put up with inadequate, antiquated clinical systems and we believe this showcase stack shows what can be applied to any health and care setting to help provide a better solution for both the clinical requirements but also the business needs of health and care technology.  Information and data that you can access, store and exchange securely is an option if you adopt an open source, open standards underpinned by open architecture approach.

“I’m calling out to the health and care community to take a look at our showcase stack and have a play with what’s now openly available to reuse.  At Ripple Foundation we are here to support you and can answer any questions you may have and help to move health IT into the 21st Century.  

Tony continued, “We are also appealing for an open digital platform challenge fund that we have called #1percentfund.  Diverting 1% of available healthcare IT funds to an open digital challenge fund we believe could improve the care of 99% of the population by stimulating and supporting both the creation and adoption of an open digital ecosystem internationally.  We hope this Open Platform Challenge Fund could help any interested clinical and technical leaders out there to implement a different approach to issues we are facing.”

It is clear that Health IT is not good enough to support 21st Century care, Ripple Foundation believe their showcase stack components, used separately or in combination will help to meet the needs of clinical systems that are easy to use but also communicate and interoperate using open source and open standards.

The showcase stack can be explored from the Ripple Foundation website, including full “showcase stack” documentation.