The Royal National Orthopaedic Hospital (www.rnoh.nhs.uk) has now gone live with a Paediatric Early Warning Scores (PEWS) solution, provided by Interneuron.

Interneuron’s Observation module has been live for 9 months and is successfully delivering results in line with the NEWS2 (National Early Warning Scores) standard. This further development of the Paediatric component enhances the ability of RNOH to deliver quality care at the bedside for all its patients. The browser-based application provides device independence at a much more attractive price point and allows the Trust to continue using their current devices (iPads).

The Observation module is just the first component of our strategy to deliver an Open Standards, Open Source Modular Electronic Care Record. Working in partnership with RNOH has enabled the creation of clinically led solutions to a range of patient focussed activities. (For full details on this, see RNOH signs partnership with Interneuron). In addition, RNOH and Interneuron will be making this new technology available to the whole NHS. Other Trusts will now not only be able to freely download, test and implement the software developed, they will also be able to get support from Interneuron by using a procurement Framework provided by RNOH for this very purpose.

Paul Fish, CNO and Deputy CEO at RNOH says that “This completes the rollout of our digital patient observations implementation and builds on our adult NEWS 2 rollout. Now, all patients at the Royal National Orthopaedic Hospital have early warning scores calculated, at risk patients are identified and further actions, such as the sepsis protocol, can be taken”

Saroj Patel, Executive Director, Chief Digital & Innovation Officer says that “This is the first step on our open platform digital strategy and will be followed by several other nurse facing applications. Our aim is to greatly increase our digital inpatient data levels and accuracy, in order to continue to improve quality of care”

About Interneuron: Interneuron is a different kind of health + care software company.
We are different because we have a different purpose: unlike typical Limited Companies (Ltd), Interneuron is a Community Interest Company (CIC) that exists primarily for the benefit of those in need of health and social care services and not for the profit of our shareholders. To this purpose we are committed to being open, ethical, and accountable. www.interneuron.org

About RNOH: Royal National Orthopaedic Hospital NHS Trust (Stanmore) is a specialist orthopaedic hospital located in Greater London, United Kingdom. It provides the most comprehensive range of neuro- musculoskeletal health care in the UK, including acute spinal injury, complex bone tumour treatment, orthopaedic medicine, and specialist rehabilitation for chronic back pain. The RNOH is a major teaching centre and around 20% of orthopaedic surgeons in the UK receive training there.

For further details please contact peter.askew@interneuron.org

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There are many Health+Care specific platforms now widely available and in use throughout the NHS. However, not all platforms are equal.

Our strategy at Interneuron is a platform+apps approach so the platform is fundamental to our success with almost half of our engineering team focusing on it at any one time. In fact, one of our core engineering principles is ‘Platform-first’ – if something can be centralised, shared and re-used then it should be a service or function of the platform rather than the client.

We are proud of the architecture we’ve designed and implemented so far, but we still have a long way to go. We recently released v1.1 and with several NHS deployments under our belt, we want to take a moment to share some of the thought process that has gone into designing our flagship product – Interneuron Synapse.

There are three aspects of Synapse that set it apart:

  1. Common and extensible data model
  2. Open and extensible APIs
  3. Insert-only data persistence

Common and extensible data model

One of the biggest benefits of a platform+apps approach is the ability to re-use data across applications – but without a structured, human readable and extensible data model its just not possible. Whilst there are some attempts to standardise Health+Care data models, we didn’t feel any of these were mature or extensible enough for our customers. Interneuron Synapse includes our Studio tool for managing, extending and building your own data models.

Open and extensible APIs

We want it to be as easy to get data out of the platform as it is to get data into it, but we also do not want to constrain how the data is accessed. We have therefore implemented:-

  • Dynamic object-based APIs – These APIs allow the persistence, update and logical deleting of any object within the platform
  • List and Base View APIs – These APIs allow you to create your own views of the data through the creation of SQL views which are then exposed, through our security model as APIs.
  • Data Export Services – We know that sometimes you need to extract large amounts of data – for use-cases such as Business Continuity, so we enable the generation of extracts based on any List or Base View.
  • Anonymisation and Pseudo-Anonymisation APIs – For research and other use-cases where identifiable datasets are not permitted.

Insert-only data persistence

We believe it’s important to be able to go back to any record at any point in time and be able to see exactly what was available at that point – therefore, we made the decision that our platform would be insert-only. The platform automatically versions, collapses and archives your data so you don’t need to worry about it. A full audit trail is available through our Open APIs too!

These are just some of design decisions we have made to date and we invite you to view our source code on GitHub – all feedback is welcomed. In a future blog post, we will take you through our microservice architecture pattern for Interneuron Synapse.

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Press Release – Friday 5th April 2019

From left to right:  Wayne Gibson, Matt Conway, Saroj Patel (RNOH CIO), Joel Ratnasothy, Rob Hurd (RNOH CEO)

Interneuron has signed a contract with The Royal National Orthopaedic Hospital (RNOH) NHS Trust to develop, deliver and support an open source clinical data platform.

The project will see RNOH replace their legacy technology with a world-class clinical data platform that will revolutionise the way in which data is integrated, collected, stored and used by end-users.

The platform approach will permit RNOH to embark on an innovation led strategy where new applications can be developed on top of the clinical data platform. Initial applications will support electronic bed boards and nursing observations.

In addition, RNOH and Interneuron will be making this new technology and applications available to the whole NHS. Other trusts will not only be able to freely download, test and implement the software developed, they will also be able to get support from Interneuron by calling off this framework contract.

Our vision is that in time others will join RNOH to gain the benefits of their investments, develop new world class applications and dramatically reduce the total cost of ownership of healthcare software in the NHS.

For more information, Contact Us

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We need to be more open

Outside of healthcare, open source software dominates. The internet is driven by it, most mobile phones are powered by it. It has become a byword for reliability, scalability, and security. Its promise to accelerate innovation has been proven time and time again. So in healthcare – what’s holding us back?

The answer I think, is found in a combination of three different aspects of our industry: Healthcare culture itself; the need for software suppliers to grow; and, above all, the need for those who do build open source projects to control them. And it’s this last point that I want to stress: if we want to accelerate innovation in healthcare software, we just need to be more open.

Healthcare culture

Healthcare is, quite rightly, a highly regulated industry. New services, new treatments, new software and even new ideas, are thoroughly evaluated before being adopted. This is as much a cultural norm as it is an operational requirement. Innovation carries risk and risks in healthcare can have serious consequences. As a result, the main question asked when a healthcare provider buys new software is: where has this software been used before? This presents a real challenge to software suppliers who need to strike a balance between innovation and maintaining an evidence-base for legacy systems. Clearly, at its extreme, if the entire healthcare market only adopted software already in use – nothing new would ever be developed.

Supplier profit and growth

Many companies move into healthcare from other industries, taking a product that is in current use and trying to adapt it for healthcare. For ‘back office’ applications this might not be that hard – there is nothing healthcare specific about payroll or email. But for clinician and patient-facing applications, these companies usually run into problems. The first is that healthcare is not a single industry: it is a meta-industry. Changes made for one specialty will require additional changes for the next – a cause of constant frustration for the naive market entrant. The second is related to the first. The need to continually adapt the product can limit business growth. While a company can generate profit with a few customers, the need to continually, exponentially grow, is practically impossible. The final problem is market demand. Why would companies that have established simple products need to innovate when they can simply sell what they already have? A risk averse market does not reward innovation.

A need to control

While it might require unusual effort from both software suppliers and healthcare providers, innovation does happen in our health service and there are many impressive isolated examples. The problem is trying to replicate these elsewhere. Obstacles to wider adoption are often attributed to ‘resistance to change’, ‘not-invented-here syndrome’ or ‘healthcare complexity’ – but I find these explanations unconvincing.

From my perspective, the biggest obstacle has been the need to control by the innovators themselves. When a healthcare provider develops a homegrown solution, almost immediately the question of selling the solution to others is raised. Care providers are not set up to commercialise software or sell it to others and the need to protect their (now financial) investment can stifle wider adoption.

When a software supplier takes the time to really understand their customer and builds a solution that ‘just works’, pressure for growth and a return on their investment, prevents more money being spent to make the changes required for the next customer – and again wider adoption stalls.

Few now question that the best way to ensure wider adoption of innovative software is to open source the code. However, the desire for control can still lead to problems resulting in projects that are open source in name only, with code not being readily available, out of date, or just too difficult to use. There are sadly too many examples of this in healthcare.

This last point is for me the most important and is why is Interneuron is supporting the new OpenChain project backed by the Linux Foundation.

OpenChain

The OpenChain Specification defines a core set of requirements every quality compliance program must satisfy – making open source compliance simpler and more consistent. Organisations can display their adherence to these requirements and build trust for both customers and partners.

If we want faster innovation in healthcare software, something has to change. We aren’t going to change the culture of healthcare or the nature of commercial industry, but we can change how open our open source projects are – and we can insist they comply with new industry standards like OpenChain.

If you’d like to know more about what we’re doing please visit our website check out our GitHub repository or just drop us a line.

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This week our new health secretary, Matt Hancock, spoke on the radio about the importance of technology in our healthcare system. His interviewer started by asking:

“Why is it that the kind of seamless use of technology that you get from so many of the services you use – the technology that remembers who you are, what your preferences are, what services you need and use – why is it that that is not widely available and widely used in the NHS?”.

Essentially, the interviewer was asking why NHS IT hasn’t caught up with consumer industries.

This is a good question. Although it is not a new one, it is one we keep failing to answer properly.

The lazy answer is the need for more money. As past projects (NPfIT) have shown us, more money does not guarantee success. US healthcare provides a good example of how increased technology spend can do little or nothing to integrate care.

So what makes this question so difficult to answer? The problem lies in thinking of healthcare as a single industry.

I often hear the medical industry compared to other ‘more mature’ industries. Usually this is done by salesmen, but sometimes, more worryingly, by politicians. There is a belief that the problems faced by our health service would benefit from adopting the approaches used in “other industries”. It’s worrying because trying to use the metaphor of another specific industry to help manage and improve a whole health service simply doesn’t make sense.

The argument goes: Our healthcare service “…should be more transactional, like banking”, “…should be more focused on safety, like the airline industry”, “…should be more consumer-focused, like the retail industry”, “…should reduce waste and empower employees, like the ‘lean’ automotive industry”. The list goes on.

From the outside you might be forgiven for thinking healthcare is just another industry: after all, we use a single name for it. But take a deeper look and you will see it is actually multiple different industries labouring under the same banner. The truth is that medicine itself is a ‘meta-industry’.

So what does that mean in terms of answering the question?

Modern medicine – and by modern, I mean in the last 2000 years – is built on the notion that human beings are so similar, it is possible to describe things that go wrong with them independent of the individual affected. A disease can be defined, described and studied in the abstract. This abstract idea gives rise to a very general approach: identify a problem; diagnose a disease; prescribe a treatment.

This approach is applied in many different problem domains and each new domain gives rise to a different medical specialty. Some domains might be defined anatomically (orthopaedics, gastroenterology, cardiology); others physiologically (endocrinology, haematology, immunology); and many cut across both (primary care, intensive care, oncology). And after each new scientific discovery that explains more about the human condition, there are opportunities for entirely new specialties (genetics, fertility, cybernetics).

It doesn’t stop there. The success of this general approach means it has been applied in non-healthcare industries as well. The output of a production line is likely to produce products that are far more similar than a population of human beings. It makes sense then to “diagnose a fault” or the use “diagnostic systems” with analogous classification of system problems, faults and fixes.

My point is that each medical specialty is akin to a specific industry in and of itself. While they all adhere to the same general approach (we can discuss psychiatry another day…) each specialty is different: Obstetrics has as much in common with ENT as the airline industry has with banking.

So trying to apply a specific industry practice to the whole of medicine simply betrays a lack of understanding of what medicine actually is: a meta-industry.

This to me explains why healthcare software has lagged behind other industries. The comparison is simply not a fair one. And while Matt Hancock is correct when he answered the question on how to fix the problem:

“There will be required standards of data protection, standards of cybersecurity (and) crucially standards of interoperability so systems can talk to each other”

… he must go further than standards alone. He must support the adoption of software that embodies these standards. And the best way to get these adopted is to provide it open source.

Open technologies that implement required standards, freely available, could have the same effect for healthcare IT as the Android operating system has had for smart phones: a common platform that embodies standards that engineers and developers can work against, that can be applied in many different industries (and medical specialties).

Interneuron CIC is looking to make this approach a reality. We are a healthcare IT software company with a very flexible approach to technology and a business model that fits.

If you’d like to know more about what we’re doing please visit our website and drop us a line.

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I have seen our healthcare industry from several different perspectives: as an NHS doctor, an academic, and a commercial supplier of healthcare IT. The motives that drive the many elements of the system are complex and so it’s taken me a while to figure out and accept that at the heart of it all, the healthcare industry is driven by money: Commissioning business cases must be approved; Departmental budgets must be spent; Public sector savings must be made; Company sales targets must be hit.

In this article, I don’t want to discuss the complex financial drivers of the public sector but rather those of the private sector and specifically those of healthcare software suppliers to the public sector.

For the sake of argument, I’m going to divide these private sector software companies into two groups: those that are privately owned and those that are publicly owned by shareholder investors.

The primary motive for both types of company is profit. But there is an important difference between the publicly and privately owned company which has a big effect on how they behave – and it’s the difference between profit and growth.

If a small company in a given year makes £100,000 surplus, it has achieved its primary purpose – profit. In a private company this is great. Everyone gets paid their salary, and might even get a small bonus. The challenge for the private company is to decide how much of the profit to invest back into the company in research and development (R&D) to retain its competitive advantage.

The private company can continue to make exactly the same amount of profit every year (in-line with inflation) and – as long as it doesn’t make bad investment decisions or take too much money out of the company (as dividends) – it continues to achieve its primary purpose: profit.

All is good for the well run private company – until its owners decide to sell the shares and become a publicly owned company.

In a public company (with numerous shareholder investors) things are a little more complex. A profit of £100,000 in year one might be acceptable. The team expands, growth targets are set. If exactly the same amount of profit is made in the second year then there is a problem and the company might ‘pivot’ as the strategy is reviewed. Should the same profit be made in the third year then restructuring with loss of personnel is now a very real option and by year four, with all the stress and internal change, achieving even the same profit as the previous year becomes highly unlikely. The company is ultimately headed for closure, merger or acquisition.

This different behaviour is brought about by the need for growth and when I use the term growth I do not mean linear growth I mean exponential growth.

Exponential growth happens in consumer markets (business to consumer or B2C markets). A software product is a hit and consumers buy it. It goes viral – and like a virus its growth is exponential. There are literally millions of potential customers and early growth can be astonishing. There are thousands of competitors and the market evolves quickly.

This is not the case in the public sector market (business to business or B2B markets). Here a software product is built and marketed, a customer organisation wishes to buy it and gives notice of a public tender, a handful of competitors are selected to bid and the tender is awarded on the best response. The process usually takes 6 – 12 months. The number of potential customers is only in the hundreds. Tenders tend to happen sequentially (smaller organisation like to follow the lead of larger ones) which means selling is slow. Lastly, there are only a few competitors as the tender regulations exclude many organisations. The market evolves slowly.

At first glance the public sector healthcare industry appears to be a lucrative sector for the shareholder investor looking for exponential growth: Healthcare expenditure is in the billions and is only going to go up. But for the reasons outlined above, exponential growth in this market under the current regulations is simply unrealistic. Add to this scenario the fact that future public sector funding is directly linked to the economy (where periods of recession are inevitable) and continuous exponential growth appears all but impossible.

If we want to move the world of healthcare software forward we need to recognise that this is an integral part of the problem and address it head-on.

And I believe there is a viable solution: the creation of commercial organisations where the primary motive is neither profit nor growth. Let me explain.

In 2005 the UK Government introduced a different kind of limited company, something called the Community Interest Company. While virtually identically to a regular limited company (it can be guaranteed by shares, own property, sign contacts etc.) there are some fundamental differences. Firstly, its primary purpose is not for the profit of its shareholders. Instead, its directors must pursue a specific purpose that is for the benefit of a defined community: a ‘community interest statement’. Secondly, it must comply with an ‘asset lock’ – a legal clause restricting the amount of money that can be taken out of the company – thus ensuring the majority of any surplus remains. Thirdly the company must be approved by the government regulator.

While the idea of the CIC (pronounced ‘kick’) might have originally been to provide a vehicle for charitable organisations to provide more commercial services, or for communities to run community social enterprises, the CIC company structure is proving increasingly popular in many other domains.

Interneuron CIC was incorporated at the end of 2017 to provide health+care software services to the UK public sector. We believe our business model, which demands neither profit nor growth – just sufficient surplus to sustain our long term vision – is the perfect commercial vehicle to move the industry forward. By focusing on the design, delivery and implementation of healthcare software services and not exponential growth, we believe we have a strategic advantage over our competitors, that in the long term will enable us to deliver the safe, secure and flexible software solutions that we believe the industry needs.

If you’d like to know more about what we’re doing please visit our website and drop us a line.

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