Would that it would happen here.
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In Short, no.
We donāt have enough population and expertise to support home-grown office/application software.
Canāt do much about the population but expertise is another thing. Not much chance of growing, and every chance of diminishing, it the more we outsource - and we have been working to offshore that expertise for decades. But we can still buy it and grow it if there is a will. Security is another issue.
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Sorry Sam, I have to disagree.
Well, I do agree that we canāt easily support a full home-grown software stack.
However, this is different. It is open source, not home grown. This means that we take existing software and configure it to our needs. We maintain our local configuration, and the wider software community maintains the code.
This is exactly what we do here on the eHealth Forum (with the open source Discourse platform), and this is many times more cost efficient (and powerful) than proprietary alternatives.
If we went in this direction (i.e. Linux based OS vs Microsoft Windows), we would develop the capability pretty damn quickly. In fact, this was proposed (with a working prototype) by some rogue elements in the UKās NHS 9 years ago:
It was shot down at the time by the somewhat incongruous accusation that it infringed on the NHSās copyright. Short-sightedness was the true reason.
We could do this in a flash if the will existed within our central agencies. It might be a bit rough and ready at first (and upset a lot of people with Stockholm syndrome), but would become something beautiful quite quickly if it continued to get love.
As to an appropriate office suite, our European colleages are doing the heavy lifting at the moment:
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It is exciting that other jurisdictions are able to launch their own sovereignty based solutions.
My issue is that as a government, there are standards for interoperability, and we donāt have sufficient expertise at the price point wise to keep a system going without finding that our systems are subsequently compromised through vulnerabilities unbeknownst to the community of developers.
Itās a 10+ year strategic journey including technical and digital workforce development. Doing it overnight or within a project time line in this country without a clear and realistic support structure means we will have rounds of outsourcing again, even if we get something working.
Yes agreed but considering all the āhigh levelā documents plans and strategies around (ie worthy visions and not much substance or funding for implementation) this is one aspect that is rarely mentioned. Actually IT in general is rarely mentioned. Managing our own data should at least be identified as a long-term goal.
Extending this a bit to health:
The news comes after France announced it would be migrating its national healthcare database from US-based providers to an unnamed new platform earlier this month. Itās also set to pivot from using Microsoft Teams for video conferencing to the French-made tool Visio across all government departments.
From this:
Does anyone know what national healthcare database France has been using?
Good on them. I would also prefer to see a reduced dependence on American software in this region. US EMRs have captured Australiaās acute hospital market, but I believe this is unwarranted due to cheaper, local alternatives that would free up funds for other healthcare priorities. I sincerely hope NZ doesnāt go down the same track as Australia and follows Franceās example instead.
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We should make a clear distinction between operating system software (Windows, Linux, macOS, etc.) and applications software such as EMRs, Media Platforms, etc. Even if Health NZ (or the NZ government as a whole) decided to migrate from Windows as an O/S they would need all their commercial software suppliers to re-platform their products, far from a trivial task. To some extent, software as a service, lessens the coupling to a particular client O/S, but then there is another huge question about the dependency on overseas cloud platforms.
Yes it is. This is why we should have started it 10 years ago. France actually did (well, 20 years ago):
I may be mistaken, but I believe that our gaming colleagues have essentially solved this problem with Wine.
This makes it a lot more trivial, albeit with some difficulties which occur when clinical software depends on Windows / Edge vulnerabilities though!!
Maybe. Most client apps in the NZ digital health ecosystem are written to run in managed execution environments, notably Java or .NET, that are theoretically multi-platform; although, in the case of .NET, that requires using .NET Core whereas many are still using the Windows specific .NET Framework. However, Iād still argue that large-scale O/S migration is a massive task and thatās based on actual experience albeit in a different domain (Oil Exploration)ā¦but letās see how the French government fares.
Does anyone know what national healthcare database France has been using?
To answer this one - there is no ānationalā healthcare database, or at least not a single product, neither in France nor Germany. There are different solutions being used in different spaces. A lot of the decisions in the health informatics space have had odd reasoning and implementation, and minimal clinical staff support to help, typically leaving the vendor to work with clinical staff who get next to no non-clinical time. Hence the result.
Also a very perverse-insentives political class dictating decisions at patient-clinician interaction level and therefore data from that interaction. A lot of dependence on self sacrifice from clinical staff to make things work. No future planning whatsoever for the culture change about to hit them - incoming junior clinical staff not interested in the same degree of self sacrifice for the system. Which is entirely understandable.
So, on balance: there are lots of lessons on what not to do in this space, if we are interested in learning. Equally, they also clearly get a LOT of things right too - including moving away from Microsoft. Letās just hope implementation wonāt be too arseways and then we can all learn what can be done well.
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Yes itās the clinical interface that concerns me. I see all the standards systems being rolled out, but where there is no electronic records connection paper records have to be scanned and I donāt think that info goes to the national portal so what how accurate are our records?