Enabling local procurement with global open standards – the view from IHE-UK
Submitted by Malcolm Newbury, supplier co-chair of IHE-UK and director at Guildfoss*
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Healthcare imaging and informatics has had a date with destiny ever since the DICOM and HL7 protocols were invented. With a fair wind, the next few years will see these disciplines merge into one open architecture standard, with specialist areas of interest in modalities of creation and in the platforms for image presentation and use. Integrating the Healthcare Enterprise (IHE) appears to be winning over users and technologists, but there is one critical group of professionals who may have been overlooked that could stop this ambition in its tracks.
The procurement profession does not understand IHE. We are still living in a world in which centralisation of procurement is seen as the best way to get value from IT suppliers, even with this year's DoH strategy promising to reinforce the local procurement with a global open standards message.
When you factor in the timing and politics of current trust procurements of PACS/RIS, you may conclude that the really urgent task for all supporters of IHE is to educate NHS procurement professionals on the value and application of such standards and the importance of interoperability in system acquisition.
A small part of the answer may be IHE demonstrations, to be performed by a group of IHE-UK vendors at UKRC on stand 61. This year we will feature the scheduled workflow and radiation exposure monitoring profiles.
As well as demonstrations, IHE needs users, vendors and consultants to come forward and work with IHE-UK to get IHE standards and profiles embedded in all NHS thinking and procedures in IT purchasing.
A typical NHS trust budget for a PACS/RIS replacement starts at around £5m. How do trusts ensure that hard-earned public money is exchanged for the highest benefit? It is tempting to dust down the last PACS/RIS LSP contracts and reissue with different names and timing, but there are problems here:
Over-centralisation of purchasing and inflated scope of supply contracts;
Too many bespoke ‘integrations’ with local systems preventing economies of scale;
Lack of contract flexibility resulting in change and cost escalation;
Loss of customer intelligence through trend to outsource IT and informatics skills.
NPfIT thought that ‘major programme management techniques’ were the solution to the NHS IT problem. Now the DoH itself acknowledges that it was the lack of transparency and appropriate open standards that created the impetus for centralisation. It is a commonly held view that the programme was not as successful as it could have been because it was trying to centralise procurement with localised standards, when it should have focussed on defining global standards to sustain local procurement.
Local or regional procurement is essential for trusts to effectively direct and govern the services as delivered by their contracted suppliers. Local procurement and decision making around IT are also critical to encourage the growth of small to medium sized companies and IT skills within the trust to maintain an ‘intelligent customer’ capability. Economies of scale are only possible for commodities, and commodities in IT – particularly those involving software – need to be specified with appropriate standards. IHE’s open architecture – the profile frameworks – provides vendors and trusts with a guide to understanding and accurately deploying new services with respect to patients, clinicians and other IT applications.
In PACS/RIS, IHE can save trusts money, improve capability and re-energise the healthcare informatics market, but I think that everyone would agree that the IHE community has a lot of work to do to simplify its message here and we need users, vendors and consultants to help us make IHE's open architecture as accessible as the London Underground map.
Procuring with global open standards means cheaper through-life costs and procuring with a corporate social responsibility for interoperability. It also ensures that trust-acquired products and services remain compatible and competitive with the market, rather than creating a potential legacy and supplier lock-in burden for the next working generation to deal with.
IHE is not alone in this view. The Cabinet Office is currently conducting a public consultation (http:/
* Malcolm Newbury is a healthcare informatics consulting professional who has held senior positions in blue chip multinational technology companies and consulting roles. His company, Guildfoss.com, provides business development and consulting services to high growth infrastructure software companies.
Integrating the Healthcare Enterprise (IHE) is a not for profit international organisation offering an open architecture and testing framework for care professionals and software developers to design and deliver collaborative open systems. See IHE-UK.net for details.