[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:00.34,0:00:02.82,Default,,0000,0000,0000,,Wow that was a bit of an introduction
Dialogue: 0,0:00:04.48,0:00:06.48,Default,,0000,0000,0000,,We we've had
Dialogue: 0,0:00:06.61,0:00:09.12,Default,,0000,0000,0000,,quite a bit of what and how and
Dialogue: 0,0:00:09.88,0:00:13.38,Default,,0000,0000,0000,,I thought I'd give the CIO's perspective
Dialogue: 0,0:00:14.14,0:00:16.14,Default,,0000,0000,0000,,bit of a confession first
Dialogue: 0,0:00:16.15,0:00:23.19,Default,,0000,0000,0000,,Before I started doing this crazy day job. I'm actually I suppose always will be a software engineer, so I'm actually obsessively
Dialogue: 0,0:00:23.74,0:00:25.74,Default,,0000,0000,0000,,Interested in the what and the how
Dialogue: 0,0:00:26.23,0:00:31.77,Default,,0000,0000,0000,,But you know as a CIO, it's not about the what and the how it's all about the why initially
Dialogue: 0,0:00:32.50,0:00:39.60,Default,,0000,0000,0000,,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
Dialogue: 0,0:00:39.96,0:00:43.14,Default,,0000,0000,0000,,Because if you can't make the case for this type of approach
Dialogue: 0,0:00:43.30,0:00:47.16,Default,,0000,0000,0000,,To integrate a digital care record you're never going to get into the what and the how
Dialogue: 0,0:00:47.98,0:00:53.34,Default,,0000,0000,0000,,And you know it'll be hopefully useful to other CIOs so Derriford hospital. I'm the CIO
Dialogue: 0,0:00:54.00,0:00:55.84,Default,,0000,0000,0000,,director IM&T here
Dialogue: 0,0:00:55.84,0:00:57.25,Default,,0000,0000,0000,,still I
Dialogue: 0,0:00:57.25,0:01:05.04,Default,,0000,0000,0000,,Think one of the largest single-site hospitals in Europe one massive block of concrete doesn't win any architectural awards at all
Dialogue: 0,0:01:05.50,0:01:09.42,Default,,0000,0000,0000,,But it is in a very very nice place and very functional because it's all in one place
Dialogue: 0,0:01:09.70,0:01:13.28,Default,,0000,0000,0000,,We're pretty much typical of an acute trust I think
Dialogue: 0,0:01:13.34,0:01:19.22,Default,,0000,0000,0000,,talking to colleagues, so we're about 900 to 1200 beds depending on what you can as a bed
Dialogue: 0,0:01:19.54,0:01:26.10,Default,,0000,0000,0000,,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
Dialogue: 0,0:01:28.00,0:01:31.64,Default,,0000,0000,0000,,We've got pretty standard IT I believe
Dialogue: 0,0:01:31.76,0:01:34.04,Default,,0000,0000,0000,,We've had a Best of Breed Interface strategy
Dialogue: 0,0:01:34.14,0:01:40.62,Default,,0000,0000,0000,,we'd buy better preclinical products since 99 when I joined the trust and we interface them together with HR 7
Dialogue: 0,0:01:40.80,0:01:42.30,Default,,0000,0000,0000,,and standards
Dialogue: 0,0:01:42.31,0:01:44.23,Default,,0000,0000,0000,,We've replaced up housing 99
Dialogue: 0,0:01:44.23,0:01:50.07,Default,,0000,0000,0000,,We've got an open standard interface engine we use into systems ensemble for those indices with people in the crowd
Dialogue: 0,0:01:50.07,0:01:52.77,Default,,0000,0000,0000,,I've done your plug. I want to reduce license fee next year, please.
Dialogue: 0,0:01:54.01,0:01:56.01,Default,,0000,0000,0000,,We've got fully rolled out order comms.
Dialogue: 0,0:01:56.35,0:01:59.40,Default,,0000,0000,0000,,Pack summaries, I'll talk about a bit later on we've done three times
Dialogue: 0,0:02:00.12,0:02:07.00,Default,,0000,0000,0000,,And we've got something unique called Salus, which is home developed. It's a patient flow solution
Dialogue: 0,0:02:07.72,0:02:12.90,Default,,0000,0000,0000,,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.
Dialogue: 0,0:02:13.66,0:02:15.28,Default,,0000,0000,0000,,And
Dialogue: 0,0:02:15.29,0:02:18.49,Default,,0000,0000,0000,,Thomas said we've got a 170
Dialogue: 0,0:02:19.34,0:02:23.62,Default,,0000,0000,0000,,departmental solutions, you've underplayed the problem. We've actually got a 190
Dialogue: 0,0:02:24.28,0:02:28.00,Default,,0000,0000,0000,,departmental clinical solutions, so these are wholly independent
Dialogue: 0,0:02:28.82,0:02:30.84,Default,,0000,0000,0000,,proprietary clinical applications
Dialogue: 0,0:02:30.92,0:02:37.22,Default,,0000,0000,0000,,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.
Dialogue: 0,0:02:38.30,0:02:40.30,Default,,0000,0000,0000,,And this is the diagram that
Dialogue: 0,0:02:40.70,0:02:45.28,Default,,0000,0000,0000,,freaks me every time I see it. This is actually our interface architecture, and you can see at the top
Dialogue: 0,0:02:45.89,0:02:50.86,Default,,0000,0000,0000,,July 2017 so that's pretty current so the level of complexity
Dialogue: 0,0:02:51.23,0:02:57.49,Default,,0000,0000,0000,,to do just what we've done and actually we've still got 190 per spoke solutions, it's incredibly complicated
Dialogue: 0,0:02:57.92,0:02:59.92,Default,,0000,0000,0000,,So that's where we started from
Dialogue: 0,0:03:01.16,0:03:04.78,Default,,0000,0000,0000,,We've got a few issues other than complexity
Dialogue: 0,0:03:05.51,0:03:07.51,Default,,0000,0000,0000,,We're wholly locked in
Dialogue: 0,0:03:07.72,0:03:10.40,Default,,0000,0000,0000,,We can't change many of those solutions
Dialogue: 0,0:03:10.40,0:03:15.88,Default,,0000,0000,0000,,because we're wholly locked in and we find ourselves in a really strange place.
Dialogue: 0,0:03:15.88,0:03:16.85,Default,,0000,0000,0000,,I'm sure this will
Dialogue: 0,0:03:16.85,0:03:18.84,Default,,0000,0000,0000,,some of you will actually pick up on this one, I'm sure
Dialogue: 0,0:03:19.70,0:03:23.44,Default,,0000,0000,0000,,We buy licenses in perpetuity
Dialogue: 0,0:03:24.22,0:03:28.46,Default,,0000,0000,0000,,To make software read-only because we can't migrate their data when we buy a new one
Dialogue: 0,0:03:28.46,0:03:30.62,Default,,0000,0000,0000,,and we do that a lot if I'm honest
Dialogue: 0,0:03:31.18,0:03:33.18,Default,,0000,0000,0000,,That's a big big problem for us
Dialogue: 0,0:03:33.50,0:03:36.16,Default,,0000,0000,0000,,proprietary vendor locking because of the proprietary nature of the data
Dialogue: 0,0:03:37.66,0:03:42.40,Default,,0000,0000,0000,,Note to migration nightmare and it's there's no strategic fit at all if we're really really honest
Dialogue: 0,0:03:43.19,0:03:44.57,Default,,0000,0000,0000,,so
Dialogue: 0,0:03:44.57,0:03:47.40,Default,,0000,0000,0000,,we're starting from a place where we know we've got to move
Dialogue: 0,0:03:48.14,0:03:50.24,Default,,0000,0000,0000,,and where are we trying to get to?
Dialogue: 0,0:03:50.24,0:03:55.64,Default,,0000,0000,0000,,There's quite a few people here of my age, so you probably remember in old money we had
Dialogue: 0,0:03:55.88,0:03:59.20,Default,,0000,0000,0000,,EPR one to six, everybody's trying to get to EPR six
Dialogue: 0,0:04:00.10,0:04:02.90,Default,,0000,0000,0000,,Nowadays, it's HIMSS level 7
Dialogue: 0,0:04:04.70,0:04:09.08,Default,,0000,0000,0000,,In EMR adoption model we're all trying to get to 7. That's our aspiration
Dialogue: 0,0:04:09.50,0:04:13.02,Default,,0000,0000,0000,,You know we don't do this sequentially. We're probably around 2 at the moment
Dialogue: 0,0:04:14.45,0:04:20.80,Default,,0000,0000,0000,,We've pretty much done PACS three times, we've got e-notes. We've done observations,
Dialogue: 0,0:04:22.06,0:04:26.00,Default,,0000,0000,0000,,order coms, so we're starting to do this in pieces
Dialogue: 0,0:04:27.00,0:04:29.28,Default,,0000,0000,0000,,OPENeP I'm going to talk about in a minute
Dialogue: 0,0:04:29.28,0:04:34.68,Default,,0000,0000,0000,,So what we're starting to get towards that level 6, level 7 a bit at a time
Dialogue: 0,0:04:35.11,0:04:42.82,Default,,0000,0000,0000,,But there's one real kicker. There's one thing that we can never nail on our current strategy, and that's level 4
Dialogue: 0,0:04:43.46,0:04:50.26,Default,,0000,0000,0000,,Clinical decision support, proper, true clinical decision support, connecting those 190 solutions
Dialogue: 0,0:04:50.68,0:04:52.62,Default,,0000,0000,0000,,in a real way that makes absolute sense
Dialogue: 0,0:04:53.06,0:04:58.08,Default,,0000,0000,0000,,and enterprise-wide scheduling. So that's the type of thing that if a doctor on the ward
Dialogue: 0,0:05:00.40,0:05:05.26,Default,,0000,0000,0000,,requests a specific test and it comes back and says the patient's allergic to an antibiotic
Dialogue: 0,0:05:05.26,0:05:07.78,Default,,0000,0000,0000,,it goes off and tells pharmacy and pharmacy prescribes another one
Dialogue: 0,0:05:07.90,0:05:12.20,Default,,0000,0000,0000,,That's the level we're talking about real-time decision support.
Dialogue: 0,0:05:13.19,0:05:18.10,Default,,0000,0000,0000,,I don't know anybody worldwide. That's managed to achieve that with the architecture we've got
Dialogue: 0,0:05:18.62,0:05:22.82,Default,,0000,0000,0000,,and there's one fundamental reason that would be
Dialogue: 0,0:05:23.60,0:05:28.76,Default,,0000,0000,0000,,Unbelievably complicated if we try to do that in that architecture.
Dialogue: 0,0:05:28.76,0:05:34.84,Default,,0000,0000,0000,,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
Dialogue: 0,0:05:35.09,0:05:37.12,Default,,0000,0000,0000,,But I don't believe we would ever get there
Dialogue: 0,0:05:37.55,0:05:44.86,Default,,0000,0000,0000,,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
Dialogue: 0,0:05:45.26,0:05:51.25,Default,,0000,0000,0000,,integrated single digital care record. You've got to have that data in a single integrated form
Dialogue: 0,0:05:51.62,0:05:58.45,Default,,0000,0000,0000,,to achieve that level of interoperability for enterprise-wide scheduling and real-time clinical decision support
Dialogue: 0,0:05:59.57,0:06:01.57,Default,,0000,0000,0000,,Couple of ways you can achieve it
Dialogue: 0,0:06:01.58,0:06:03.82,Default,,0000,0000,0000,,You can buy your way into it
Dialogue: 0,0:06:04.18,0:06:10.40,Default,,0000,0000,0000,,So you can go down the "Big Box" solutions. You can do the EPIC's, the Cerner's, the Lorenzo's, the TrakCare's
Dialogue: 0,0:06:10.42,0:06:13.72,Default,,0000,0000,0000,,There's you know, as well as I do, the Allscripts has lots of them
Dialogue: 0,0:06:14.74,0:06:16.94,Default,,0000,0000,0000,,very, very proven, it's a very proven model
Dialogue: 0,0:06:17.12,0:06:19.36,Default,,0000,0000,0000,,you deploy it for the
Dialogue: 0,0:06:19.78,0:06:24.30,Default,,0000,0000,0000,,level of functionality it provides you, you pretty much get benefit out of the box when you start, so it works
Dialogue: 0,0:06:24.30,0:06:30.90,Default,,0000,0000,0000,,and and you've got a consistent user interface. It's one system for the functionality it provides, and you heard earlier
Dialogue: 0,0:06:30.91,0:06:34.96,Default,,0000,0000,0000,,it doesn't provide everything obviously. A couple of cons however,
Dialogue: 0,0:06:35.96,0:06:37.96,Default,,0000,0000,0000,,boy, are you locked in!
Dialogue: 0,0:06:38.67,0:06:43.97,Default,,0000,0000,0000,,You know EPIC for one, and I'm sure the others will tell you the same. They make a big play about the fact
Dialogue: 0,0:06:43.97,0:06:45.97,Default,,0000,0000,0000,,they've never lost a customer
Dialogue: 0,0:06:47.70,0:06:48.74,Default,,0000,0000,0000,,It is a good system
Dialogue: 0,0:06:48.74,0:06:53.50,Default,,0000,0000,0000,,but you know if you actually take all the effort to put in something like EPIC or Cerner or Lorenzo or whatever
Dialogue: 0,0:06:53.66,0:06:56.02,Default,,0000,0000,0000,,would you really want to migrate away?
Dialogue: 0,0:06:56.20,0:07:03.26,Default,,0000,0000,0000,,So true, but you know you are wholly locked in and you've got that same data migration nightmare
Dialogue: 0,0:07:03.44,0:07:06.26,Default,,0000,0000,0000,,and as we know it's incredibly expensive
Dialogue: 0,0:07:07.71,0:07:14.54,Default,,0000,0000,0000,,Mostly probably followed Gartner reports. I read a couple of weeks ago about the US actually that they've now cited
Dialogue: 0,0:07:15.54,0:07:19.20,Default,,0000,0000,0000,,implementations of Allscripts, Cerner and EPIC, I'm not singling any out here,
Dialogue: 0,0:07:19.34,0:07:26.24,Default,,0000,0000,0000,,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
Dialogue: 0,0:07:26.55,0:07:32.45,Default,,0000,0000,0000,,They've suddenly realized now billions and billions of dollars are spent on regional implementations
Dialogue: 0,0:07:33.18,0:07:36.11,Default,,0000,0000,0000,,That's probably not surprising to anybody, but here's the thing
Dialogue: 0,0:07:37.14,0:07:43.31,Default,,0000,0000,0000,,they're no closer now to having a truly integrated digital care record for the patient than they were twenty years ago
Dialogue: 0,0:07:44.04,0:07:48.08,Default,,0000,0000,0000,,Because none of them interoperate in the states
Dialogue: 0,0:07:49.35,0:07:53.54,Default,,0000,0000,0000,,21st century Cures Acts which you're probably familiar with it's probably going to
Dialogue: 0,0:07:53.67,0:07:57.02,Default,,0000,0000,0000,,make that change over the next few years at an interoperability level
Dialogue: 0,0:07:57.57,0:08:02.81,Default,,0000,0000,0000,,But if you're a patient, and you're at the center of a region where you've got an Allscripts
Dialogue: 0,0:08:02.81,0:08:06.89,Default,,0000,0000,0000,,and you've got an EPIC and you've got a Cerner you will have three patient held records
Dialogue: 0,0:08:07.44,0:08:09.12,Default,,0000,0000,0000,,You won't have one.
Dialogue: 0,0:08:09.24,0:08:14.92,Default,,0000,0000,0000,,And to me that's an absolute frightmare, if I'm really honest, and that's not where we want to go
Dialogue: 0,0:08:14.92,0:08:19.30,Default,,0000,0000,0000,,I know we're a little bit behind in terms of implementing big boxes, but I don't want to be there at all.
Dialogue: 0,0:08:20.00,0:08:22.12,Default,,0000,0000,0000,,So we wanted another approach
Dialogue: 0,0:08:22.20,0:08:26.69,Default,,0000,0000,0000,,So we thought okay if we can't buy our way in, can we build our way in?
Dialogue: 0,0:08:27.21,0:08:31.91,Default,,0000,0000,0000,,So if there was an open standard framework where we could
Dialogue: 0,0:08:32.55,0:08:34.55,Default,,0000,0000,0000,,set out an aspiration of true
Dialogue: 0,0:08:35.16,0:08:37.97,Default,,0000,0000,0000,,vendor neutrality at every level of the stack
Dialogue: 0,0:08:38.46,0:08:40.56,Default,,0000,0000,0000,,wouldn't that be something sensible to do?
Dialogue: 0,0:08:40.64,0:08:43.52,Default,,0000,0000,0000,,So that was kind of our vision. It fits with our strategic thinking
Dialogue: 0,0:08:43.78,0:08:48.44,Default,,0000,0000,0000,,we've always had that best-of-breed interface on standards approach, so it kind of fit.
Dialogue: 0,0:08:48.60,0:08:54.78,Default,,0000,0000,0000,,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
Dialogue: 0,0:08:55.48,0:08:57.90,Default,,0000,0000,0000,,a key one for me is, we would start to reinvigorate
Dialogue: 0,0:08:58.45,0:09:02.76,Default,,0000,0000,0000,,that small to medium enterprises marketplace that the national program killed stone dead
Dialogue: 0,0:09:02.95,0:09:08.13,Default,,0000,0000,0000,,You know those of you that used to go to Harrogate like me saw the marketplace pre-national program
Dialogue: 0,0:09:08.13,0:09:10.12,Default,,0000,0000,0000,,And if you go to the NEC and see it now
Dialogue: 0,0:09:10.14,0:09:14.60,Default,,0000,0000,0000,,it's wholly different, and you know the national program did that so we want to really get that back.
Dialogue: 0,0:09:14.72,0:09:19.10,Default,,0000,0000,0000,,We want to reinvigorate the SME marketplace and really start to get this ecosystem built
Dialogue: 0,0:09:20.38,0:09:23.01,Default,,0000,0000,0000,,Once we've done it, we've got no vendor lock-in
Dialogue: 0,0:09:23.74,0:09:26.58,Default,,0000,0000,0000,,Because our data is completely abstracted
Dialogue: 0,0:09:27.49,0:09:31.44,Default,,0000,0000,0000,,We'll have no data migration issues. We can swap pieces of functionality in and out and
Dialogue: 0,0:09:32.38,0:09:34.59,Default,,0000,0000,0000,,everything will just carry on working as it did before and
Dialogue: 0,0:09:36.79,0:09:43.53,Default,,0000,0000,0000,,Incremental investment is both less, and you don't have to make these massive investment cases
Dialogue: 0,0:09:44.89,0:09:46.57,Default,,0000,0000,0000,,to an NHSI
Dialogue: 0,0:09:46.57,0:09:51.57,Default,,0000,0000,0000,,You know try taking an 80 million pound investment case to the NHSI... good luck on that one
Dialogue: 0,0:09:52.18,0:09:54.27,Default,,0000,0000,0000,,It's not something I particularly would like to do
Dialogue: 0,0:09:54.85,0:10:00.72,Default,,0000,0000,0000,,So it does give us the ability to incrementally invest year-on-year business cases year-by-year to do pieces of the puzzle
Dialogue: 0,0:10:02.10,0:10:07.10,Default,,0000,0000,0000,,So we've ruled that one out and we set our strategy on an open standard approach.
Dialogue: 0,0:10:07.42,0:10:11.22,Default,,0000,0000,0000,,This is interesting. How do you do one bleep on two strings?
Dialogue: 0,0:10:12.10,0:10:14.82,Default,,0000,0000,0000,,So bottom right in that diagram
Dialogue: 0,0:10:15.70,0:10:17.70,Default,,0000,0000,0000,,The bottom layer is the data layer
Dialogue: 0,0:10:18.07,0:10:20.43,Default,,0000,0000,0000,,The bottom right actually says PACs, hopefully
Dialogue: 0,0:10:21.58,0:10:26.10,Default,,0000,0000,0000,,We've changed PACs three times in the time I've been at the hospital
Dialogue: 0,0:10:26.54,0:10:28.70,Default,,0000,0000,0000,,we had Agfa for pre-national program
Dialogue: 0,0:10:29.14,0:10:34.14,Default,,0000,0000,0000,,the national program came along and asked us politely to change it, so we changed it to GE
Dialogue: 0,0:10:34.64,0:10:37.84,Default,,0000,0000,0000,,and then the national program kind of came to an abrupt stop
Dialogue: 0,0:10:38.23,0:10:42.21,Default,,0000,0000,0000,,as did the contract, so we had to do something else, and we've now got Insignia
Dialogue: 0,0:10:42.34,0:10:47.91,Default,,0000,0000,0000,,So we've had three completely separate pieces of software for clinicians to use and you know what?
Dialogue: 0,0:10:49.15,0:10:56.55,Default,,0000,0000,0000,,Wholly seamless. We trained clinicians to own a new product, and they just carried on as they did the day before simply because
Dialogue: 0,0:10:57.49,0:11:02.34,Default,,0000,0000,0000,,it's got a data standard DICOM been there like forever as far as I can remember
Dialogue: 0,0:11:02.83,0:11:06.60,Default,,0000,0000,0000,,So because the data was holding it in a data vendor neutral format
Dialogue: 0,0:11:06.67,0:11:10.17,Default,,0000,0000,0000,,we could simply swap out one solution with another solution, train our users
Dialogue: 0,0:11:10.17,0:11:15.15,Default,,0000,0000,0000,,and they just carried on as they did before and that was kind of the lightbulb moment for me
Dialogue: 0,0:11:15.66,0:11:16.92,Default,,0000,0000,0000,,that was the
Dialogue: 0,0:11:16.92,0:11:24.66,Default,,0000,0000,0000,,wow, what if we could do that on the left-hand end of that bottom stack which is the 190 solutions
Dialogue: 0,0:11:25.42,0:11:28.54,Default,,0000,0000,0000,,If we could get to a point that each one of those has
Dialogue: 0,0:11:29.77,0:11:32.43,Default,,0000,0000,0000,,unique functionality, fine, but had a
Dialogue: 0,0:11:33.10,0:11:34.14,Default,,0000,0000,0000,,non-proprietary
Dialogue: 0,0:11:34.14,0:11:35.47,Default,,0000,0000,0000,,open data model
Dialogue: 0,0:11:35.47,0:11:38.08,Default,,0000,0000,0000,,we could then compete supplier against supplier,
Dialogue: 0,0:11:38.36,0:11:45.72,Default,,0000,0000,0000,,swap software out and not have any lock-in at all. So that was my kind of lightbulb moment, all sat under our nice
Dialogue: 0,0:11:46.06,0:11:48.06,Default,,0000,0000,0000,,open architecture.
Dialogue: 0,0:11:48.19,0:11:52.08,Default,,0000,0000,0000,,For us, it's Ensemble, but it could be anything you like really as long as it's open standard based
Dialogue: 0,0:11:52.20,0:11:57.42,Default,,0000,0000,0000,,We've had standards there for years. We've had hl7, we've had ITK remember that?
Dialogue: 0,0:11:57.42,0:12:02.12,Default,,0000,0000,0000,,We've had IHE, now we've got FHIR and FHIR isn't
Dialogue: 0,0:12:04.08,0:12:07.62,Default,,0000,0000,0000,,a competitor for openEHR if you want my opinion, I know there's a lot going on about this
Dialogue: 0,0:12:08.29,0:12:11.28,Default,,0000,0000,0000,,They're totally and utterly complimentary to each other
Dialogue: 0,0:12:11.98,0:12:13.45,Default,,0000,0000,0000,,discuss
Dialogue: 0,0:12:13.45,0:12:17.96,Default,,0000,0000,0000,,Then we've got an application stack across the top, all delivered through Salus, which I showed you earlier
Dialogue: 0,0:12:17.96,0:12:22.50,Default,,0000,0000,0000,,That's our view. We want it all delivered through a common portal to any device
Dialogue: 0,0:12:22.70,0:12:26.24,Default,,0000,0000,0000,,So that's kind of our aspiration
Dialogue: 0,0:12:27.04,0:12:29.04,Default,,0000,0000,0000,,Then we had a bit of good luck
Dialogue: 0,0:12:31.60,0:12:36.15,Default,,0000,0000,0000,,We actually went out to procure an electronic prescribing solution. We went out to OJEU
Dialogue: 0,0:12:36.19,0:12:37.95,Default,,0000,0000,0000,,We got right through the end of it
Dialogue: 0,0:12:37.95,0:12:44.64,Default,,0000,0000,0000,,And we actually didn't shortlist anybody because we didn't find anybody actually that was capable of meeting the full requirement
Dialogue: 0,0:12:45.07,0:12:47.40,Default,,0000,0000,0000,,That's not a good luck. The good luck is
Dialogue: 0,0:12:48.13,0:12:52.59,Default,,0000,0000,0000,,CGI who we were working with at the time actually introduced us to MARAND and they've shown us their
Dialogue: 0,0:12:52.81,0:12:55.92,Default,,0000,0000,0000,,OPENeP product, and they've shown us their
Dialogue: 0,0:12:57.04,0:13:02.16,Default,,0000,0000,0000,,view of the world I guess their vision for how this should all hang together and
Dialogue: 0,0:13:03.88,0:13:08.64,Default,,0000,0000,0000,,they're really alike and honestly we did not
Dialogue: 0,0:13:09.97,0:13:11.71,Default,,0000,0000,0000,,rob either
Dialogue: 0,0:13:11.71,0:13:18.06,Default,,0000,0000,0000,,We certainly ever said to Thomas before we certainly didn't rob theirs, that's for sure. These were created totally in isolation
Dialogue: 0,0:13:19.43,0:13:24.97,Default,,0000,0000,0000,,But you can see a complete similarity and when we when we actually met with these guys we looked at the product
Dialogue: 0,0:13:24.97,0:13:30.30,Default,,0000,0000,0000,,we looked at their philosophy and the openEHR platform the Think!EHR
Dialogue: 0,0:13:30.30,0:13:34.32,Default,,0000,0000,0000,,that they developed and their ethos around open standards. There was a there was a unique fit there for us
Dialogue: 0,0:13:37.40,0:13:42.31,Default,,0000,0000,0000,,We then said okay, we'll take OPENeP as the first application on that application stack
Dialogue: 0,0:13:43.40,0:13:49.57,Default,,0000,0000,0000,,Based around an interoperable framework with the openEHR platform as the vendor neutral data layer
Dialogue: 0,0:13:49.82,0:13:52.30,Default,,0000,0000,0000,,That would be our first line strategy
Dialogue: 0,0:13:54.20,0:13:56.20,Default,,0000,0000,0000,,Where we are now? We started that
Dialogue: 0,0:13:58.10,0:14:01.76,Default,,0000,0000,0000,,January? April? It seems a long time ago now, so we've been doing this
Dialogue: 0,0:14:02.66,0:14:04.66,Default,,0000,0000,0000,,Yeah, you nodded, right about April time
Dialogue: 0,0:14:05.78,0:14:08.59,Default,,0000,0000,0000,,We're first of type for OPENeP in the UK
Dialogue: 0,0:14:09.77,0:14:11.69,Default,,0000,0000,0000,,It's open source
Dialogue: 0,0:14:11.69,0:14:13.84,Default,,0000,0000,0000,,held in the Aperta foundation
Dialogue: 0,0:14:14.36,0:14:18.28,Default,,0000,0000,0000,,Not-for-profit organisation which is fundamentally us, so we own the source
Dialogue: 0,0:14:18.89,0:14:22.45,Default,,0000,0000,0000,,All set up nicely for us by NHS Digital, thank you very much Peter.
Dialogue: 0,0:14:23.15,0:14:25.10,Default,,0000,0000,0000,,and
Dialogue: 0,0:14:25.10,0:14:26.69,Default,,0000,0000,0000,,it's based on
Dialogue: 0,0:14:26.69,0:14:32.78,Default,,0000,0000,0000,,the Think!EHR Platform on an openEHR repository, and it's going to be delivered through Salus, absolutely happy days
Dialogue: 0,0:14:32.92,0:14:40.26,Default,,0000,0000,0000,,We go live in June next year. We have the test environment in place at the moment, and it's looking really really good
Dialogue: 0,0:14:40.27,0:14:41.51,Default,,0000,0000,0000,,I've got to say
Dialogue: 0,0:14:41.51,0:14:45.31,Default,,0000,0000,0000,,So all things are starting to really start to pull together with it
Dialogue: 0,0:14:47.00,0:14:51.76,Default,,0000,0000,0000,,As I say the Aperta foundation is the means by which we're going to hang all the source together certainly
Dialogue: 0,0:14:51.98,0:14:53.98,Default,,0000,0000,0000,,for OPENeP to start with
Dialogue: 0,0:14:55.31,0:14:59.59,Default,,0000,0000,0000,,But other things that come which I'll talk about in a second, and there's a key thing for me
Dialogue: 0,0:15:00.08,0:15:04.54,Default,,0000,0000,0000,,I'm not standing here saying we're trying to do away with commerciality
Dialogue: 0,0:15:04.54,0:15:08.95,Default,,0000,0000,0000,,I think a lot of people see this as what's in it for the software supplier,
Dialogue: 0,0:15:09.11,0:15:14.62,Default,,0000,0000,0000,,what's in it for the commercial partner and I get asked it a lot I've got to be honest and
Dialogue: 0,0:15:15.77,0:15:17.54,Default,,0000,0000,0000,,what I try to say is
Dialogue: 0,0:15:17.54,0:15:22.66,Default,,0000,0000,0000,,We we need relationships with software innovators. We just need a different type of relationship
Dialogue: 0,0:15:23.24,0:15:25.24,Default,,0000,0000,0000,,What I don't want is
Dialogue: 0,0:15:25.48,0:15:30.72,Default,,0000,0000,0000,,Licensed software that's licensed by site, by named user or concurrent user
Dialogue: 0,0:15:31.60,0:15:34.40,Default,,0000,0000,0000,,specific to me for X amount of money
Dialogue: 0,0:15:34.70,0:15:37.44,Default,,0000,0000,0000,,What I want is something a little bit more fluid
Dialogue: 0,0:15:37.44,0:15:42.46,Default,,0000,0000,0000,,Something that we can create an innovation partnership around. For argument sake and this is just throwing it out there,
Dialogue: 0,0:15:42.63,0:15:49.80,Default,,0000,0000,0000,,why wouldn't we license on patient rather than named users, sites, services and concurrency?
Dialogue: 0,0:15:50.23,0:15:55.89,Default,,0000,0000,0000,,So that for me instead of having my remit stopped at the end of that concrete block
Dialogue: 0,0:15:56.35,0:16:00.66,Default,,0000,0000,0000,,My remit now will have to go into the whole of Devon because we've got to interoperate across the whole of Devon
Dialogue: 0,0:16:00.66,0:16:06.45,Default,,0000,0000,0000,,I want to deploy software out of the hospital into the community, into primary care, into other acute trusts
Dialogue: 0,0:16:07.00,0:16:10.53,Default,,0000,0000,0000,,It's all the same patients. Why should I why should we pay again?
Dialogue: 0,0:16:10.93,0:16:15.93,Default,,0000,0000,0000,,We need a slightly different model because when we've looked at our existing framework,
Dialogue: 0,0:16:15.93,0:16:19.59,Default,,0000,0000,0000,,even if that software was capable of doing the whole community piece
Dialogue: 0,0:16:19.59,0:16:22.92,Default,,0000,0000,0000,,you know, what we couldn't afford to deploy it based on our current license model
Dialogue: 0,0:16:23.59,0:16:25.57,Default,,0000,0000,0000,,And that's just madness
Dialogue: 0,0:16:25.57,0:16:28.72,Default,,0000,0000,0000,,So there's a whole lot of work that needs to be done
Dialogue: 0,0:16:28.86,0:16:32.74,Default,,0000,0000,0000,,to work with our commercial partners to actually set that up.
Dialogue: 0,0:16:32.74,0:16:34.54,Default,,0000,0000,0000,,Very early days, we don't have all the answers
Dialogue: 0,0:16:34.54,0:16:36.01,Default,,0000,0000,0000,,But the software
Dialogue: 0,0:16:36.01,0:16:38.28,Default,,0000,0000,0000,,certainly SMEs and some of the bigger players are working with
Dialogue: 0,0:16:38.47,0:16:45.12,Default,,0000,0000,0000,,very, very interested in having that discussion with us because they see the future and the future isn't "sell us a licence
Dialogue: 0,0:16:45.79,0:16:49.05,Default,,0000,0000,0000,,based on X number", that's not the future
Dialogue: 0,0:16:49.87,0:16:54.84,Default,,0000,0000,0000,,So this is Salus, just to give you a quick flavour of what we've what we've actually done
Dialogue: 0,0:16:56.62,0:17:00.12,Default,,0000,0000,0000,,This this is the piece we've written and you can see,
Dialogue: 0,0:17:00.64,0:17:02.64,Default,,0000,0000,0000,,we probably can't actually it's not particularly clear,
Dialogue: 0,0:17:02.88,0:17:08.00,Default,,0000,0000,0000,,there's a little tab at the top that says "meds" which was unique to this project. When they click on meds,
Dialogue: 0,0:17:08.64,0:17:12.68,Default,,0000,0000,0000,,in context, this piece down the bottom is actually OPENeP, the MARAND product, and
Dialogue: 0,0:17:13.60,0:17:16.56,Default,,0000,0000,0000,,my developers and the MARAND guys have been working joined-at-the-hip
Dialogue: 0,0:17:16.60,0:17:24.06,Default,,0000,0000,0000,,And they've actually seamlessly integrated these two; we're not talking interfacing now. We're talking absolutely bolted these things together
Dialogue: 0,0:17:24.78,0:17:28.64,Default,,0000,0000,0000,,at the, I guess, the doing level rather than the interface level.
Dialogue: 0,0:17:28.84,0:17:33.12,Default,,0000,0000,0000,,We're not passing messages, I think was one saying so there's no joins whatsoever with this
Dialogue: 0,0:17:33.46,0:17:37.74,Default,,0000,0000,0000,,It all appears to the user like it's Salus which is great for me because I get all the credit
Dialogue: 0,0:17:39.01,0:17:40.66,Default,,0000,0000,0000,,but behind the scenes
Dialogue: 0,0:17:40.66,0:17:47.04,Default,,0000,0000,0000,,MARAND have put in the OPENeP clinicality, that really safe clinical product
Dialogue: 0,0:17:50.05,0:17:52.32,Default,,0000,0000,0000,,So where from here?
Dialogue: 0,0:17:52.96,0:17:57.24,Default,,0000,0000,0000,,If you remember the application stack, we've done one, we've done OPENeP
Dialogue: 0,0:17:57.64,0:18:01.20,Default,,0000,0000,0000,,We want to do more now all based on that same stack
Dialogue: 0,0:18:01.20,0:18:08.07,Default,,0000,0000,0000,,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
Dialogue: 0,0:18:08.65,0:18:12.90,Default,,0000,0000,0000,,anything you like; whether it comes from MARAND,
Dialogue: 0,0:18:13.21,0:18:18.39,Default,,0000,0000,0000,,whether it comes from an open source community, whether it comes from other trusts that are involved in this game now
Dialogue: 0,0:18:19.39,0:18:22.92,Default,,0000,0000,0000,,We want as much as we can get and we want to deploy as soon as we can
Dialogue: 0,0:18:23.10,0:18:25.83,Default,,0000,0000,0000,,To start to build this this whole ecosystem up
Dialogue: 0,0:18:27.34,0:18:30.72,Default,,0000,0000,0000,,We're looking to make Salus which is the product we brought to the table
Dialogue: 0,0:18:31.27,0:18:38.100,Default,,0000,0000,0000,,open source through the Aperta foundation and NHS Digital so that for argument's sake our implementer is CGI
Dialogue: 0,0:18:39.00,0:18:41.64,Default,,0000,0000,0000,,it could be one of a number, but we're using CGI
Dialogue: 0,0:18:42.28,0:18:48.54,Default,,0000,0000,0000,,We want them to be able to come to another trust and for a fixed price deploy OPENeP
Dialogue: 0,0:18:48.54,0:18:52.14,Default,,0000,0000,0000,,And if the trust haven't got a portal they can deploy Salus as well
Dialogue: 0,0:18:52.14,0:18:55.56,Default,,0000,0000,0000,,And they can have all the benefits of bed management, patient flow and all that kind of stuff
Dialogue: 0,0:18:55.90,0:18:59.04,Default,,0000,0000,0000,,it should be as simple as that. There's a fixed price model for a
Dialogue: 0,0:18:59.20,0:19:03.58,Default,,0000,0000,0000,,commercial support partner to just come along and say you want that one, you want this one
Dialogue: 0,0:19:03.58,0:19:07.50,Default,,0000,0000,0000,,If they've got an existing portal deploy OPENeP and integrate it with that portal
Dialogue: 0,0:19:07.68,0:19:11.24,Default,,0000,0000,0000,,That's where we're trying to get that that framework set up
Dialogue: 0,0:19:11.58,0:19:14.24,Default,,0000,0000,0000,,And lastly, but for me probably the most important,
Dialogue: 0,0:19:15.07,0:19:18.99,Default,,0000,0000,0000,,we're all pioneers at the moment, you saw the nice diagram earlier. I wish I had that.
Dialogue: 0,0:19:19.93,0:19:25.38,Default,,0000,0000,0000,,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
Dialogue: 0,0:19:25.60,0:19:28.80,Default,,0000,0000,0000,,we've got to do, I think one of our biggest challenges, is how we
Dialogue: 0,0:19:29.32,0:19:30.36,Default,,0000,0000,0000,,we get out there
Dialogue: 0,0:19:30.36,0:19:37.41,Default,,0000,0000,0000,,and we both evangelize it and we build this ecosystem; this thing that's going to take it from quite niche,
Dialogue: 0,0:19:37.41,0:19:39.06,Default,,0000,0000,0000,,which is where it is at the moment,
Dialogue: 0,0:19:39.06,0:19:45.44,Default,,0000,0000,0000,,to actually being fully mainstream such that it can challenge the EPIC, the Lorenzo, TrakCare and everything else
Dialogue: 0,0:19:45.58,0:19:47.94,Default,,0000,0000,0000,,And for me involves a whole blended approach really
Dialogue: 0,0:19:48.64,0:19:54.39,Default,,0000,0000,0000,,We need to invest locally in our own development teams and make them work differently because they're not going to be writing everything
Dialogue: 0,0:19:55.42,0:19:57.96,Default,,0000,0000,0000,,We need to certainly invigorate local SMEs
Dialogue: 0,0:19:58.83,0:20:00.73,Default,,0000,0000,0000,,and we need to be
Dialogue: 0,0:20:00.73,0:20:04.38,Default,,0000,0000,0000,,connecting with bigger partners, for us people like education
Dialogue: 0,0:20:05.02,0:20:06.66,Default,,0000,0000,0000,,when I was a kid in Plymouth
Dialogue: 0,0:20:06.78,0:20:14.34,Default,,0000,0000,0000,,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.
Dialogue: 0,0:20:14.34,0:20:19.02,Default,,0000,0000,0000,,Now what we want to do is do that with with education. We want people graduates coming out of
Dialogue: 0,0:20:19.32,0:20:22.36,Default,,0000,0000,0000,,University in Plymouth and spending 18 months to two years working with us
Dialogue: 0,0:20:22.58,0:20:26.48,Default,,0000,0000,0000,,developing apps, building this ecosystem
Dialogue: 0,0:20:26.50,0:20:29.16,Default,,0000,0000,0000,,Giving themselves a CV.
Dialogue: 0,0:20:29.60,0:20:33.26,Default,,0000,0000,0000,,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,
Dialogue: 0,0:20:33.37,0:20:38.40,Default,,0000,0000,0000,,but for that 18 months to two years we want to get that vibrancy locally
Dialogue: 0,0:20:38.71,0:20:39.85,Default,,0000,0000,0000,,with those those
Dialogue: 0,0:20:39.85,0:20:44.46,Default,,0000,0000,0000,,very skilled people that can write these apps for a pastime if you put a little bit of rigor around them,
Dialogue: 0,0:20:44.56,0:20:45.96,Default,,0000,0000,0000,,a little bit of structure
Dialogue: 0,0:20:45.97,0:20:47.47,Default,,0000,0000,0000,,and
Dialogue: 0,0:20:47.47,0:20:52.80,Default,,0000,0000,0000,,national global developments. Things like this, working with other trusts; we've got Salus you can have it for free
Dialogue: 0,0:20:53.08,0:20:59.92,Default,,0000,0000,0000,,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,
Dialogue: 0,0:21:00.06,0:21:01.96,Default,,0000,0000,0000,,but we'll come up with some deal
Dialogue: 0,0:21:01.96,0:21:06.78,Default,,0000,0000,0000,,That kind of arrangement and the reason we can do it is because it's all based on one
Dialogue: 0,0:21:07.42,0:21:09.42,Default,,0000,0000,0000,,open data record
Dialogue: 0,0:21:09.64,0:21:11.64,Default,,0000,0000,0000,,Thank you
Dialogue: 0,0:21:18.32,0:21:20.47,Default,,0000,0000,0000,,And II just as good as last time, thank you
Dialogue: 0,0:21:20.99,0:21:23.53,Default,,0000,0000,0000,,We have a tech. We are a little bit over. But not too bad
Dialogue: 0,0:21:23.53,0:21:26.11,Default,,0000,0000,0000,,thanks to all our speakers for keeping well to time and
Dialogue: 0,0:21:26.39,0:21:31.15,Default,,0000,0000,0000,,You know it was a pact a pact program any questions before we break to break for lunch
Dialogue: 0,0:21:33.53,0:21:35.53,Default,,0000,0000,0000,,We're hungry people
Dialogue: 0,0:21:36.32,0:21:38.32,Default,,0000,0000,0000,,Somebody ought to have a slot before lunch
Dialogue: 0,0:21:39.20,0:21:44.62,Default,,0000,0000,0000,,Yeah, we'll all be available to chat. Please go and enjoy lunch, and we're due to be back here