Another View: Ten

This article first appeared on 24.7.12 on digitalhealth.net.

I think I’ve been infected by my programmer friends’ attitude to software. They tell me the key to getting the most out of software is being willing to change.

Use a web product for a while, get as much out of it as possible and every now and again look up and around at what else is available. If it is better, switch.

This approach, of course, needs everyone to have general IT skills – rather than being a 5th Dan in Microsoft Word.

My friends claim that there are loads of solutions that are either open source or low price and only need a bit of tweaking to meet your needs – so there’s no need to invest from scratch.

They also say that one product will never fulfil all your needs and that you must pick a range of them; using each product for what it does best. On the other hand, they say you should pick products for their ability to talk to each other and get on.

They cite example such as Evernote – which allows other programs such as Skitch (which it now owns) into it – or DropBox – into which loads of apps connect – or Plaxo which acts as a calendar for loads of other web solutions.

From one product to many

One of my colleagues was arguing for a massive website that would cover off all the operational aspects of the CCG and all the educational and informational bits that we would like to share with our local GPs.

He wanted it a bit like the old primary care trust site, which was basically a SharePoint site with numerous microsites for different departments.

It had a document store, news sections, starters and leavers page, and even a buy and sell page.

It needed a team of people to maintain and actually I didn’t think it was that good; you could never find the document you wanted and it wasn’t easily accessible from home.

So I disagreed with my colleague; perhaps coloured by the advice given to me by my developer friends.

I don’t think there is one product that will do all of that cheaply and without needing a team and a lot of development work; which our CCG budget can’t afford.

So we are looking at Huddle for project management – it now has IL3 accreditation and a competitive NHS price – and we are looking at Caucus to act as a local source of referrals advice and expertise.

Each of these products does what it does quite well and is affordable. My colleague isn’t convinced and has gone (hopefully temporarily) quiet. This is a shame, as we need him to help get people using them.

His last comment was that there will be too many passwords to remember if we use so many different pieces of software.

Dealing with the password curse

Unfortunately, he is probably right in this. Passwords are the curse of modern computing, particularly cloud-based computing.

For example, I’m a principal investigator for numerous research trials, all of which have electronic data capture, and I must have 40 usernames and passwords for the job.

They are all in different formats and all of them need changing at regular intervals. Even using an excellent password program to remember them all is a pain.

I can, therefore, see my colleague’s point; which brings us to the N3 question. He liked the old PCT site because he didn’t need a username or password to get to most of it.

This was because he logged-in every morning to a domain server on the network that validated him to the intranet. However, this method of authentication was the reason he didn’t have access at home or at a patient’s house – which is a huge request from most GPs – without using a VPN system.

Virtualise – but what?

This got me thinking. I use lots of apps on my iPad and I don’t need a password program. I log onto the iPad and it brings up a range of apps, all of which work offline when there is no signal but connect to the internet as required, giving enhanced functionality.

I tell each app my username and password once and it just keeps using them, making it all seem seamless.

Could this concept help us? Could we all move to tablets? Perhaps this isn’t as daft as it sounds. Most of our Windows XP desktops are so old I doubt they will take Windows 8 or 9, so instead of upgrading PCs it may be time to move platform.

In the US, a top-up program has been popular with some companies. They pay a minimum agreed amount for a machine, with users topping-up to get features they like on a machine they will live with. Could the NHS do this?

Previously, I’ve believed we would move to a virtual desktop environment; but I don’t see how having a virtual PC that runs the same desktop – which still isn’t integrated and seamless – is any better.

Instead of virtualising XP desktops with competing programs, we could virtualise this app concept and provide it as a layer on top of what we are using so that it seems seamless – the most obvious choice would be for the clinical suppliers to do this.

If they were to create an environment in which there was an app store that sold apps, that allowed these apps to work in a secure sandbox environment, that were allowed access to the data that had a common update and messaging system similar to Apple’s update and notifications centre, wouldn’t this be great?

Just as Apple does, the clinical suppliers could sell their own apps for the big stuff; but not worry if some chose competitors for core functionality or custom needs.

They’d be doing what Apple does, which is take 30% of all their competitors’ money. Have Apple shown us the way forward?

So do we move to tablets and demand that the clinical suppliers provide software that works on it. Or do they provide the platform for healthcare related IT?