Being open about open source

IMS MAXIMS broke new ground in 2014 when it made the code for its big hospital IT systems open source. That meant it published the source code for its patient administration system and electronic patient record onto a well-known software development platform.  

The idea behind the open source movement is that developers should be able to download code and then improve, change and enhance it; so long as they publish their work for others in turn. Proponents argue that this leads to better products and encourages collaboration; something that fits well with the NHS’ ethos of teamwork and sharing.

However, IMS MAXIMS has been accused of ‘open washing’; or using open source for marketing instead of engaging properly with the open source community. The company’s chief executive Shane Tickell responds with an update on its open source experiment in a frank assessment of the challenges faced by a tech supplier to the NHS.

We never intended to become an open source company when we were established 33 years ago. However, we have been working in an almost open source fashion with the Health Service Executive in Ireland for more than 25 years; the HSE owns the code, but we are the custodians of it.

Then, around five years ago, English policy makers caught on to the idea. There was a lot of discontent with suppliers at the time. NHS customers complained that they couldn’t change or fix a product once it had gone live and using open source products looked like a solution.

NHS England representatives asked us if we could provide our PAS and EPR MAXIMS on an open source basis. After a lot of analysis and hard work, we decided we could. We felt this would help to disrupt the market and, most importantly, speed up adoption.

In 2014, a community interest company was created by the NHS and the first users of OpenMAXIMS. This meant NHS trusts could act, with IMS, as guardians for its golden code stream.

We then published on the open source distribution channel GitHub and invited people to download and use the software.

What happened next?

As some recent critics have spotted, we have not updated the original code for some time. Why?

Well, firstly, the focus of healthtech policy makers changed about three years into our experiment. A new team at NHS England was much more interested in traditional acute roll-outs.

Some of this switch in focus translated positively into the Global Digital Exemplar programme on which one of our customers, Taunton and Somerset NHS Foundation Trust, secured a place, along with its fast follower, Wye Valley NHS Trust.

More recently, there has been another shift, towards interoperability and open APIs, which is good news, as we have invested hard in interoperability, both for the MAXIMS product and for the industry through our support for the INTEROPen interoperability standards collaborative.

Secondly, we ran into an issue with the market, as it became clear that some NHS managers really just wanted to buy products from a supplier. Some were spooked by the phrase ‘open source’. They thought they would have to employ an army of coders and take full responsibility for the code and support.

It was quite a hard task to persuade them that this was not the case, and that what we are doing is safe and easy, if you know how!

Thirdly, I will acknowledge that we faced some technical issues. We are managing three major versions of the MAXIMS product portfolio, because we are not the kind of supplier that just switches off a customer using an older version.

That makes regular code releases a bit challenging. As does undertaking major developments, which have to be thoroughly tested before they can be safely released. The good news is that we are consolidating all previous versions of MAXIMS for our 2020 Global Digital Exemplar release, which we will be able to update annually.

Finally, it has been a tough market for PAS and EPR systems in the NHS in England, especially for indigenous suppliers. We are growing at IMS, but not at a pace that would help us feed even more energy and ideas into the product.

What next for the open source experiment?

Many people have downloaded the code experimentally. However, not a single person has said: ‘I have changed the code, enhanced it, and given it back to the community to use.’

I think that indicates that, whatever the mood music was five years ago, we are not failing our clients and we have a strong product. One of our clients uses a single instance across 60 hospitals and it is relied on by more than 10 million patients.

Still, our invitation is still very much to come on board and work with us. Five years in, we would love our experiment with open source to stop being an experiment and to become a movement at scale.

At the moment, user involvement tends to come via direct requests from existing users of MAXIMS or to be channelled via the IMS user group. More users would enable us to develop the community, spread the blueprint, and speed up adoption.

I have had the privilege of meeting Matthew Gould and some of his colleagues at NHSX several times. I am hoping to have a different type of conversation with them, about working in a collaborative mode, and about building on the assets that we have as a country.

I believe that IMS is not just one of those assets but a very important player in the British supply of EPRs. So, for me, open source is very much a project “not abandoned”; it remains a project that we would like to take further.


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