0:00:00.339,0:00:02.819 Wow that was a bit of an introduction 0:00:04.480,0:00:06.480 We we've had 0:00:06.609,0:00:09.119 quite a bit of what and how and 0:00:09.880,0:00:13.380 I thought I'd give the CIO's perspective 0:00:14.139,0:00:16.139 bit of a confession first 0:00:16.149,0:00:23.189 Before I started doing this crazy day job. I'm actually I suppose always will be a software engineer, so I'm actually obsessively 0:00:23.740,0:00:25.740 Interested in the what and the how 0:00:26.230,0:00:31.769 But you know as a CIO, it's not about the what and the how it's all about the why initially 0:00:32.500,0:00:39.600 So I thought I'd just spend a little bit of time explaining the thought process we had to go through to set out our strategy 0:00:39.960,0:00:43.140 Because if you can't make the case for this type of approach 0:00:43.300,0:00:47.160 To integrate a digital care record you're never going to get into the what and the how 0:00:47.980,0:00:53.340 And you know it'll be hopefully useful to other CIOs so Derriford hospital. I'm the CIO 0:00:54.000,0:00:55.840 director IM&T here 0:00:55.840,0:00:57.250 still I 0:00:57.250,0:01:05.040 Think one of the largest single-site hospitals in Europe one massive block of concrete doesn't win any architectural awards at all 0:01:05.500,0:01:09.419 But it is in a very very nice place and very functional because it's all in one place 0:01:09.700,0:01:13.280 We're pretty much typical of an acute trust I think 0:01:13.340,0:01:19.220 talking to colleagues, so we're about 900 to 1200 beds depending on what you can as a bed 0:01:19.540,0:01:26.099 We've about 6,000 staff. We're a major trauma center, and we're a tertiary center, so we're pretty normal acute trust 0:01:28.000,0:01:31.640 We've got pretty standard IT I believe 0:01:31.760,0:01:34.040 We've had a Best of Breed Interface strategy 0:01:34.140,0:01:40.620 we'd buy better preclinical products since 99 when I joined the trust and we interface them together with HR 7 0:01:40.800,0:01:42.300 and standards 0:01:42.310,0:01:44.229 We've replaced up housing 99 0:01:44.229,0:01:50.069 We've got an open standard interface engine we use into systems ensemble for those indices with people in the crowd 0:01:50.070,0:01:52.769 I've done your plug. I want to reduce license fee next year, please. 0:01:54.009,0:01:56.009 We've got fully rolled out order comms. 0:01:56.350,0:01:59.399 Pack summaries, I'll talk about a bit later on we've done three times 0:02:00.120,0:02:07.000 And we've got something unique called Salus, which is home developed. It's a patient flow solution 0:02:07.720,0:02:12.900 that becomes a bit more interesting later on where I'll talk about what we're using that for and how it will benefit others. 0:02:13.660,0:02:15.280 And 0:02:15.290,0:02:18.489 Thomas said we've got a 170 0:02:19.340,0:02:23.619 departmental solutions, you've underplayed the problem. We've actually got a 190 0:02:24.280,0:02:28.000 departmental clinical solutions, so these are wholly independent 0:02:28.820,0:02:30.840 proprietary clinical applications 0:02:30.920,0:02:37.220 by specialty, and they say I don't think we're unique. I think most people are nodding that's pretty sort of normal, I think. 0:02:38.300,0:02:40.300 And this is the diagram that 0:02:40.700,0:02:45.280 freaks me every time I see it. This is actually our interface architecture, and you can see at the top 0:02:45.890,0:02:50.859 July 2017 so that's pretty current so the level of complexity 0:02:51.230,0:02:57.489 to do just what we've done and actually we've still got 190 per spoke solutions, it's incredibly complicated 0:02:57.920,0:02:59.920 So that's where we started from 0:03:01.160,0:03:04.779 We've got a few issues other than complexity 0:03:05.510,0:03:07.510 We're wholly locked in 0:03:07.720,0:03:10.400 We can't change many of those solutions 0:03:10.400,0:03:15.880 because we're wholly locked in and we find ourselves in a really strange place. 0:03:15.880,0:03:16.849 I'm sure this will 0:03:16.849,0:03:18.840 some of you will actually pick up on this one, I'm sure 0:03:19.700,0:03:23.440 We buy licenses in perpetuity 0:03:24.220,0:03:28.460 To make software read-only because we can't migrate their data when we buy a new one 0:03:28.460,0:03:30.620 and we do that a lot if I'm honest 0:03:31.180,0:03:33.180 That's a big big problem for us 0:03:33.500,0:03:36.160 proprietary vendor locking because of the proprietary nature of the data 0:03:37.660,0:03:42.400 Note to migration nightmare and it's there's no strategic fit at all if we're really really honest 0:03:43.190,0:03:44.569 so 0:03:44.569,0:03:47.400 we're starting from a place where we know we've got to move 0:03:48.140,0:03:50.240 and where are we trying to get to? 0:03:50.240,0:03:55.640 There's quite a few people here of my age, so you probably remember in old money we had 0:03:55.880,0:03:59.200 EPR one to six, everybody's trying to get to EPR six 0:04:00.100,0:04:02.900 Nowadays, it's HIMSS level 7 0:04:04.700,0:04:09.080 In EMR adoption model we're all trying to get to 7. That's our aspiration 0:04:09.500,0:04:13.020 You know we don't do this sequentially. We're probably around 2 at the moment 0:04:14.449,0:04:20.798 We've pretty much done PACS three times, we've got e-notes. We've done observations, 0:04:22.060,0:04:26.000 order coms, so we're starting to do this in pieces 0:04:27.000,0:04:29.280 OPENeP I'm going to talk about in a minute 0:04:29.280,0:04:34.680 So what we're starting to get towards that level 6, level 7 a bit at a time 0:04:35.110,0:04:42.819 But there's one real kicker. There's one thing that we can never nail on our current strategy, and that's level 4 0:04:43.460,0:04:50.260 Clinical decision support, proper, true clinical decision support, connecting those 190 solutions 0:04:50.680,0:04:52.620 in a real way that makes absolute sense 0:04:53.060,0:04:58.080 and enterprise-wide scheduling. So that's the type of thing that if a doctor on the ward 0:05:00.400,0:05:05.260 requests a specific test and it comes back and says the patient's allergic to an antibiotic 0:05:05.260,0:05:07.780 it goes off and tells pharmacy and pharmacy prescribes another one 0:05:07.900,0:05:12.200 That's the level we're talking about real-time decision support. 0:05:13.190,0:05:18.100 I don't know anybody worldwide. That's managed to achieve that with the architecture we've got 0:05:18.620,0:05:22.820 and there's one fundamental reason that would be 0:05:23.600,0:05:28.760 Unbelievably complicated if we try to do that in that architecture. 0:05:28.760,0:05:34.840 Even as a software engineer, I don't believe that's possible and I've never ever said anything is impossible as a software engineer everything's possible 0:05:35.090,0:05:37.119 But I don't believe we would ever get there 0:05:37.550,0:05:44.859 And the fundamental reason, I believe, this is this is my take on this is that to achieve that you've got to have a truly 0:05:45.260,0:05:51.249 integrated single digital care record. You've got to have that data in a single integrated form 0:05:51.620,0:05:58.450 to achieve that level of interoperability for enterprise-wide scheduling and real-time clinical decision support 0:05:59.570,0:06:01.570 Couple of ways you can achieve it 0:06:01.580,0:06:03.820 You can buy your way into it 0:06:04.180,0:06:10.400 So you can go down the "Big Box" solutions. You can do the EPIC's, the Cerner's, the Lorenzo's, the TrakCare's 0:06:10.420,0:06:13.720 There's you know, as well as I do, the Allscripts has lots of them 0:06:14.740,0:06:16.940 very, very proven, it's a very proven model 0:06:17.120,0:06:19.360 you deploy it for the 0:06:19.780,0:06:24.300 level of functionality it provides you, you pretty much get benefit out of the box when you start, so it works 0:06:24.300,0:06:30.900 and and you've got a consistent user interface. It's one system for the functionality it provides, and you heard earlier 0:06:30.910,0:06:34.960 it doesn't provide everything obviously. A couple of cons however, 0:06:35.960,0:06:37.960 boy, are you locked in! 0:06:38.670,0:06:43.969 You know EPIC for one, and I'm sure the others will tell you the same. They make a big play about the fact 0:06:43.970,0:06:45.970 they've never lost a customer 0:06:47.700,0:06:48.740 It is a good system 0:06:48.740,0:06:53.500 but you know if you actually take all the effort to put in something like EPIC or Cerner or Lorenzo or whatever 0:06:53.660,0:06:56.020 would you really want to migrate away? 0:06:56.200,0:07:03.260 So true, but you know you are wholly locked in and you've got that same data migration nightmare 0:07:03.440,0:07:06.260 and as we know it's incredibly expensive 0:07:07.710,0:07:14.539 Mostly probably followed Gartner reports. I read a couple of weeks ago about the US actually that they've now cited 0:07:15.540,0:07:19.200 implementations of Allscripts, Cerner and EPIC, I'm not singling any out here, 0:07:19.340,0:07:26.240 as "eye-watering" the costs, the level of costs. Now ten years ago, they were citing these as a model of how to do it 0:07:26.550,0:07:32.449 They've suddenly realized now billions and billions of dollars are spent on regional implementations 0:07:33.180,0:07:36.110 That's probably not surprising to anybody, but here's the thing 0:07:37.140,0:07:43.309 they're no closer now to having a truly integrated digital care record for the patient than they were twenty years ago 0:07:44.040,0:07:48.080 Because none of them interoperate in the states 0:07:49.350,0:07:53.540 21st century Cures Acts which you're probably familiar with it's probably going to 0:07:53.670,0:07:57.020 make that change over the next few years at an interoperability level 0:07:57.570,0:08:02.809 But if you're a patient, and you're at the center of a region where you've got an Allscripts 0:08:02.810,0:08:06.890 and you've got an EPIC and you've got a Cerner you will have three patient held records 0:08:07.440,0:08:09.120 You won't have one. 0:08:09.240,0:08:14.920 And to me that's an absolute frightmare, if I'm really honest, and that's not where we want to go 0:08:14.920,0:08:19.300 I know we're a little bit behind in terms of implementing big boxes, but I don't want to be there at all. 0:08:20.000,0:08:22.120 So we wanted another approach 0:08:22.200,0:08:26.689 So we thought okay if we can't buy our way in, can we build our way in? 0:08:27.210,0:08:31.909 So if there was an open standard framework where we could 0:08:32.549,0:08:34.549 set out an aspiration of true 0:08:35.159,0:08:37.969 vendor neutrality at every level of the stack 0:08:38.460,0:08:40.559 wouldn't that be something sensible to do? 0:08:40.640,0:08:43.520 So that was kind of our vision. It fits with our strategic thinking 0:08:43.780,0:08:48.440 we've always had that best-of-breed interface on standards approach, so it kind of fit. 0:08:48.600,0:08:54.780 We could do it a bit at a time. We wouldn't have to try to make this case this huge thing and do it all at once and 0:08:55.480,0:08:57.900 a key one for me is, we would start to reinvigorate 0:08:58.450,0:09:02.759 that small to medium enterprises marketplace that the national program killed stone dead 0:09:02.950,0:09:08.129 You know those of you that used to go to Harrogate like me saw the marketplace pre-national program 0:09:08.129,0:09:10.120 And if you go to the NEC and see it now 0:09:10.140,0:09:14.600 it's wholly different, and you know the national program did that so we want to really get that back. 0:09:14.720,0:09:19.100 We want to reinvigorate the SME marketplace and really start to get this ecosystem built 0:09:20.380,0:09:23.010 Once we've done it, we've got no vendor lock-in 0:09:23.740,0:09:26.580 Because our data is completely abstracted 0:09:27.490,0:09:31.440 We'll have no data migration issues. We can swap pieces of functionality in and out and 0:09:32.380,0:09:34.590 everything will just carry on working as it did before and 0:09:36.790,0:09:43.530 Incremental investment is both less, and you don't have to make these massive investment cases 0:09:44.890,0:09:46.570 to an NHSI 0:09:46.570,0:09:51.570 You know try taking an 80 million pound investment case to the NHSI... good luck on that one 0:09:52.180,0:09:54.270 It's not something I particularly would like to do 0:09:54.850,0:10:00.719 So it does give us the ability to incrementally invest year-on-year business cases year-by-year to do pieces of the puzzle 0:10:02.100,0:10:07.100 So we've ruled that one out and we set our strategy on an open standard approach. 0:10:07.420,0:10:11.220 This is interesting. How do you do one bleep on two strings? 0:10:12.100,0:10:14.820 So bottom right in that diagram 0:10:15.700,0:10:17.700 The bottom layer is the data layer 0:10:18.070,0:10:20.429 The bottom right actually says PACs, hopefully 0:10:21.580,0:10:26.100 We've changed PACs three times in the time I've been at the hospital 0:10:26.540,0:10:28.700 we had Agfa for pre-national program 0:10:29.140,0:10:34.140 the national program came along and asked us politely to change it, so we changed it to GE 0:10:34.640,0:10:37.840 and then the national program kind of came to an abrupt stop 0:10:38.230,0:10:42.210 as did the contract, so we had to do something else, and we've now got Insignia 0:10:42.339,0:10:47.909 So we've had three completely separate pieces of software for clinicians to use and you know what? 0:10:49.150,0:10:56.549 Wholly seamless. We trained clinicians to own a new product, and they just carried on as they did the day before simply because 0:10:57.490,0:11:02.339 it's got a data standard DICOM been there like forever as far as I can remember 0:11:02.830,0:11:06.600 So because the data was holding it in a data vendor neutral format 0:11:06.670,0:11:10.170 we could simply swap out one solution with another solution, train our users 0:11:10.170,0:11:15.149 and they just carried on as they did before and that was kind of the lightbulb moment for me 0:11:15.660,0:11:16.920 that was the 0:11:16.920,0:11:24.660 wow, what if we could do that on the left-hand end of that bottom stack which is the 190 solutions 0:11:25.420,0:11:28.540 If we could get to a point that each one of those has 0:11:29.770,0:11:32.429 unique functionality, fine, but had a 0:11:33.100,0:11:34.140 non-proprietary 0:11:34.140,0:11:35.470 open data model 0:11:35.470,0:11:38.080 we could then compete supplier against supplier, 0:11:38.360,0:11:45.720 swap software out and not have any lock-in at all. So that was my kind of lightbulb moment, all sat under our nice 0:11:46.060,0:11:48.060 open architecture. 0:11:48.190,0:11:52.080 For us, it's Ensemble, but it could be anything you like really as long as it's open standard based 0:11:52.200,0:11:57.420 We've had standards there for years. We've had hl7, we've had ITK remember that? 0:11:57.420,0:12:02.120 We've had IHE, now we've got FHIR and FHIR isn't 0:12:04.080,0:12:07.620 a competitor for openEHR if you want my opinion, I know there's a lot going on about this 0:12:08.290,0:12:11.279 They're totally and utterly complimentary to each other 0:12:11.980,0:12:13.450 discuss 0:12:13.450,0:12:17.960 Then we've got an application stack across the top, all delivered through Salus, which I showed you earlier 0:12:17.960,0:12:22.500 That's our view. We want it all delivered through a common portal to any device 0:12:22.700,0:12:26.240 So that's kind of our aspiration 0:12:27.040,0:12:29.040 Then we had a bit of good luck 0:12:31.600,0:12:36.149 We actually went out to procure an electronic prescribing solution. We went out to OJEU 0:12:36.190,0:12:37.950 We got right through the end of it 0:12:37.950,0:12:44.640 And we actually didn't shortlist anybody because we didn't find anybody actually that was capable of meeting the full requirement 0:12:45.070,0:12:47.400 That's not a good luck. The good luck is 0:12:48.130,0:12:52.590 CGI who we were working with at the time actually introduced us to MARAND and they've shown us their 0:12:52.810,0:12:55.920 OPENeP product, and they've shown us their 0:12:57.040,0:13:02.159 view of the world I guess their vision for how this should all hang together and 0:13:03.880,0:13:08.640 they're really alike and honestly we did not 0:13:09.970,0:13:11.710 rob either 0:13:11.710,0:13:18.059 We certainly ever said to Thomas before we certainly didn't rob theirs, that's for sure. These were created totally in isolation 0:13:19.430,0:13:24.969 But you can see a complete similarity and when we when we actually met with these guys we looked at the product 0:13:24.969,0:13:30.300 we looked at their philosophy and the openEHR platform the Think!EHR 0:13:30.300,0:13:34.320 that they developed and their ethos around open standards. There was a there was a unique fit there for us 0:13:37.400,0:13:42.310 We then said okay, we'll take OPENeP as the first application on that application stack 0:13:43.400,0:13:49.569 Based around an interoperable framework with the openEHR platform as the vendor neutral data layer 0:13:49.820,0:13:52.300 That would be our first line strategy 0:13:54.200,0:13:56.200 Where we are now? We started that 0:13:58.100,0:14:01.760 January? April? It seems a long time ago now, so we've been doing this 0:14:02.660,0:14:04.660 Yeah, you nodded, right about April time 0:14:05.780,0:14:08.589 We're first of type for OPENeP in the UK 0:14:09.770,0:14:11.690 It's open source 0:14:11.690,0:14:13.839 held in the Aperta foundation 0:14:14.360,0:14:18.279 Not-for-profit organisation which is fundamentally us, so we own the source 0:14:18.890,0:14:22.449 All set up nicely for us by NHS Digital, thank you very much Peter. 0:14:23.150,0:14:25.100 and 0:14:25.100,0:14:26.690 it's based on 0:14:26.690,0:14:32.780 the Think!EHR Platform on an openEHR repository, and it's going to be delivered through Salus, absolutely happy days 0:14:32.920,0:14:40.260 We go live in June next year. We have the test environment in place at the moment, and it's looking really really good 0:14:40.270,0:14:41.510 I've got to say 0:14:41.510,0:14:45.310 So all things are starting to really start to pull together with it 0:14:47.000,0:14:51.760 As I say the Aperta foundation is the means by which we're going to hang all the source together certainly 0:14:51.980,0:14:53.980 for OPENeP to start with 0:14:55.310,0:14:59.589 But other things that come which I'll talk about in a second, and there's a key thing for me 0:15:00.080,0:15:04.540 I'm not standing here saying we're trying to do away with commerciality 0:15:04.540,0:15:08.949 I think a lot of people see this as what's in it for the software supplier, 0:15:09.110,0:15:14.620 what's in it for the commercial partner and I get asked it a lot I've got to be honest and 0:15:15.770,0:15:17.540 what I try to say is 0:15:17.540,0:15:22.659 We we need relationships with software innovators. We just need a different type of relationship 0:15:23.240,0:15:25.240 What I don't want is 0:15:25.480,0:15:30.720 Licensed software that's licensed by site, by named user or concurrent user 0:15:31.600,0:15:34.400 specific to me for X amount of money 0:15:34.700,0:15:37.440 What I want is something a little bit more fluid 0:15:37.440,0:15:42.460 Something that we can create an innovation partnership around. For argument sake and this is just throwing it out there, 0:15:42.630,0:15:49.799 why wouldn't we license on patient rather than named users, sites, services and concurrency? 0:15:50.230,0:15:55.890 So that for me instead of having my remit stopped at the end of that concrete block 0:15:56.350,0:16:00.659 My remit now will have to go into the whole of Devon because we've got to interoperate across the whole of Devon 0:16:00.660,0:16:06.449 I want to deploy software out of the hospital into the community, into primary care, into other acute trusts 0:16:07.000,0:16:10.530 It's all the same patients. Why should I why should we pay again? 0:16:10.930,0:16:15.930 We need a slightly different model because when we've looked at our existing framework, 0:16:15.930,0:16:19.590 even if that software was capable of doing the whole community piece 0:16:19.590,0:16:22.919 you know, what we couldn't afford to deploy it based on our current license model 0:16:23.590,0:16:25.570 And that's just madness 0:16:25.570,0:16:28.720 So there's a whole lot of work that needs to be done 0:16:28.860,0:16:32.740 to work with our commercial partners to actually set that up. 0:16:32.740,0:16:34.540 Very early days, we don't have all the answers 0:16:34.540,0:16:36.010 But the software 0:16:36.010,0:16:38.280 certainly SMEs and some of the bigger players are working with 0:16:38.470,0:16:45.119 very, very interested in having that discussion with us because they see the future and the future isn't "sell us a licence 0:16:45.790,0:16:49.049 based on X number", that's not the future 0:16:49.870,0:16:54.840 So this is Salus, just to give you a quick flavour of what we've what we've actually done 0:16:56.620,0:17:00.120 This this is the piece we've written and you can see, 0:17:00.640,0:17:02.640 we probably can't actually it's not particularly clear, 0:17:02.880,0:17:08.000 there's a little tab at the top that says "meds" which was unique to this project. When they click on meds, 0:17:08.640,0:17:12.680 in context, this piece down the bottom is actually OPENeP, the MARAND product, and 0:17:13.599,0:17:16.560 my developers and the MARAND guys have been working joined-at-the-hip 0:17:16.599,0:17:24.060 And they've actually seamlessly integrated these two; we're not talking interfacing now. We're talking absolutely bolted these things together 0:17:24.780,0:17:28.640 at the, I guess, the doing level rather than the interface level. 0:17:28.840,0:17:33.120 We're not passing messages, I think was one saying so there's no joins whatsoever with this 0:17:33.460,0:17:37.740 It all appears to the user like it's Salus which is great for me because I get all the credit 0:17:39.010,0:17:40.660 but behind the scenes 0:17:40.660,0:17:47.040 MARAND have put in the OPENeP clinicality, that really safe clinical product 0:17:50.050,0:17:52.319 So where from here? 0:17:52.960,0:17:57.240 If you remember the application stack, we've done one, we've done OPENeP 0:17:57.640,0:18:01.199 We want to do more now all based on that same stack 0:18:01.200,0:18:08.069 We just want to roll applications out as quick as we can get our hands on them. We want order communications, we want electronic observations 0:18:08.650,0:18:12.900 anything you like; whether it comes from MARAND, 0:18:13.210,0:18:18.390 whether it comes from an open source community, whether it comes from other trusts that are involved in this game now 0:18:19.390,0:18:22.920 We want as much as we can get and we want to deploy as soon as we can 0:18:23.100,0:18:25.829 To start to build this this whole ecosystem up 0:18:27.340,0:18:30.720 We're looking to make Salus which is the product we brought to the table 0:18:31.270,0:18:38.999 open source through the Aperta foundation and NHS Digital so that for argument's sake our implementer is CGI 0:18:39.000,0:18:41.640 it could be one of a number, but we're using CGI 0:18:42.280,0:18:48.540 We want them to be able to come to another trust and for a fixed price deploy OPENeP 0:18:48.540,0:18:52.139 And if the trust haven't got a portal they can deploy Salus as well 0:18:52.140,0:18:55.560 And they can have all the benefits of bed management, patient flow and all that kind of stuff 0:18:55.900,0:18:59.040 it should be as simple as that. There's a fixed price model for a 0:18:59.200,0:19:03.580 commercial support partner to just come along and say you want that one, you want this one 0:19:03.580,0:19:07.500 If they've got an existing portal deploy OPENeP and integrate it with that portal 0:19:07.680,0:19:11.240 That's where we're trying to get that that framework set up 0:19:11.580,0:19:14.240 And lastly, but for me probably the most important, 0:19:15.070,0:19:18.990 we're all pioneers at the moment, you saw the nice diagram earlier. I wish I had that. 0:19:19.930,0:19:25.379 We're very much at the forefront of this, a lot of people don't even understand this at the moment and one of the things 0:19:25.600,0:19:28.800 we've got to do, I think one of our biggest challenges, is how we 0:19:29.320,0:19:30.360 we get out there 0:19:30.360,0:19:37.410 and we both evangelize it and we build this ecosystem; this thing that's going to take it from quite niche, 0:19:37.410,0:19:39.060 which is where it is at the moment, 0:19:39.060,0:19:45.440 to actually being fully mainstream such that it can challenge the EPIC, the Lorenzo, TrakCare and everything else 0:19:45.580,0:19:47.940 And for me involves a whole blended approach really 0:19:48.640,0:19:54.390 We need to invest locally in our own development teams and make them work differently because they're not going to be writing everything 0:19:55.420,0:19:57.959 We need to certainly invigorate local SMEs 0:19:58.830,0:20:00.730 and we need to be 0:20:00.730,0:20:04.380 connecting with bigger partners, for us people like education 0:20:05.020,0:20:06.660 when I was a kid in Plymouth 0:20:06.780,0:20:14.340 the school gates used to open in June and the dockyard gates used to open and kids used to flock out from school straight into the dockyard. 0:20:14.340,0:20:19.020 Now what we want to do is do that with with education. We want people graduates coming out of 0:20:19.320,0:20:22.360 University in Plymouth and spending 18 months to two years working with us 0:20:22.580,0:20:26.480 developing apps, building this ecosystem 0:20:26.500,0:20:29.160 Giving themselves a CV. 0:20:29.600,0:20:33.260 In two years they're going to go off to the industry they're gonna come up and work in London and make a fortune, 0:20:33.370,0:20:38.400 but for that 18 months to two years we want to get that vibrancy locally 0:20:38.710,0:20:39.850 with those those 0:20:39.850,0:20:44.460 very skilled people that can write these apps for a pastime if you put a little bit of rigor around them, 0:20:44.560,0:20:45.960 a little bit of structure 0:20:45.970,0:20:47.470 and 0:20:47.470,0:20:52.800 national global developments. Things like this, working with other trusts; we've got Salus you can have it for free 0:20:53.080,0:20:59.920 You've got a business analyst tool, we can have it for free. Moscow have written this fantastic thing, they'll charge us I'm sure, 0:21:00.060,0:21:01.960 but we'll come up with some deal 0:21:01.960,0:21:06.780 That kind of arrangement and the reason we can do it is because it's all based on one 0:21:07.420,0:21:09.420 open data record 0:21:09.640,0:21:11.640 Thank you 0:21:18.320,0:21:20.470 And II just as good as last time, thank you 0:21:20.990,0:21:23.529 We have a tech. We are a little bit over. But not too bad 0:21:23.530,0:21:26.110 thanks to all our speakers for keeping well to time and 0:21:26.390,0:21:31.150 You know it was a pact a pact program any questions before we break to break for lunch 0:21:33.530,0:21:35.530 We're hungry people 0:21:36.320,0:21:38.320 Somebody ought to have a slot before lunch 0:21:39.200,0:21:44.620 Yeah, we'll all be available to chat. Please go and enjoy lunch, and we're due to be back here