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A step at a time to wider acceptance of open source |
 Tony Kenny at his desk in Beaumont hospital, Dublin, Ireland.
“Your mission, should you choose to accept it, is to interview Messrs Kenny and Fitzgerald for that well known Australian open source champion, GPSpeak.” So wrote open source aficionado and one of the division’s IT GP project advisors, David Guest, in May in response to my emailing I knew well the Dublin hospital from which had emanated a report on its experiences with open source software.
The ensuing correspondence went something like:
“bugger - you want me to WORK on my holidays....”
“Yes. I insist. :-)”
“hmmmmm spose I could do it maybe the division will pay me 1/21th of my trip ha ha ha might be useful for the tax man..."
Curses says I halfway through the holiday, better try to set this interview up. Maybe Tony Kenny is on his own holidays fingers crossed. Delighted to meet you for a chat responds Tony to my email. Rats. Better an e-list lurker to be, obviously.
The interview’s to be the afternoon before leaving, so last lunch with friends is curtailed to factor in the possibility of having to sit in the appalling gridlock that seems to be Dublin traffic these days to get across town in time.
The 620-bed Beaumont Hospital is the amalgamation of two of Dublin’s city centre hospitals, which dated to the 18th century. Opened in 1987, the teaching hospital is one of the largest acute general hospitals in the country and Tony Kenny took over the running of its IT department in 1989.
The report that had excited such interest in David Guest and his OSS cronies was co-authored by Tony Kenny and describes the conversion of some software products at the hospital to open source applications. Beaumont estimates it will have saved eight million euro ($14m) over five years from its investment in OSS products, with most of this coming from an OSS digital imaging program. Considering Beaumont was granted academic pricing for its Microsoft products in 1995, the savings achieved were enough to impress the socks off David Guest et al.
Tony himself is likeably modest about his department’s achievements. His philosophy is to take the best of what is available and make it work for the organisation.
“I actually adopt a very pragmatic approach, I’m not an open source purist. If I have to mix them I’ll mix them.”
In some ways they have been forced down the open source path. The funding for IT departments in the health sector in Ireland is finite and if anything, contracting. Tony Kenny is adamant however, that organisations that make their IT funding go further should not have it reduced.
“My budgets have been slashed over the last three years, that’s why I got into this, but I’m doing more stuff today with less money, dramatically more. They’re going to keep slashing it, there’s no argument around that. I’m hitting back at that, because I’m saying what are you getting for your proprietary investments? We’re not lying down. I’m in the process of drafting them a paper, which analyses the alternative options and the costs.”
The health department has yet to be convinced of the benefits of OSS, but Tony is hopeful that with a softly softly approach and as the financial benefits become more apparent, public administration will become more receptive.
Other hospitals that have responded to his report are holding a watching brief. “We’ve adopted a policy that says this is not endless good news. We had lots of problems bringing something like Star Office in – you know the users would up in bloody arms. And we haven’t made any attempt to disguise that.”
They have put several good systems in place such as a rostering and nurse and dependency systems, but Tony concedes they have “singularly failed” to make changes in the medical management process where they have to cross organisational boundaries, such as an integrated discharge planning process.
“The biggest problem we have here is lack of beds… We’ve done some empirical research which shows that a huge number of bed days are consumed because of [these] tiny and inconsequential delays each in their own right. But to break that down you need every member of the orchestra and the choir, the guys who work the footlights and the people who are selling the tickets – you need them all in harmony and we’ve made an attempt to do that and it failed.”
The project started about 1.5 years ago, and they have now gone back to the drawing board. Tony agrees with a US Federal reserve study on a large number of hospitals that identified the trigger point where the impact of information technologies can be measured as five years post implementation.
“There’s a whole dissemination time in terms of shifting technology into organisations and that’s where open source comes in, because it does two things that really ameliorate the problem. The first one is it gets you out of this enormous budget justification curse, which crucifies IT initiatives.”
It also enables you to row with the process without having to constantly find more money for upgrades. Plus it begins to create a community of programmers exchanging solutions.
Resistance however can be stiff: “We’re semi rational animals, so if I suddenly invested in a whole pile of proprietary stuff, it actually takes a lot of balls to turn around and say, jaysus that was a mistake, let’s throw it out. People don’t do that kind of stuff. They say aw this is great, it’s much better than the other stuff. There has to be a sort of tipping point, where the tipping point is really the art of success if you can find and identify it. A couple of years ago I didn’t know anything about open source, I can’t expect the rest of the world to say, you know, you woke up this morning ... so it goes along slowly, but that’s allright, if it went any quicker it would be going out of control probably.”
To date Beaumont’s programs have just been evangelised locally as Tony wants to ensure the code is first class and free of bugs before being released. The rostering system will be released before the end of the year and is currently trialing with two other large Dublin hospitals. The nurse and dependency system is already being used in one hospital.
“People don’t have epiphanies you know like on the road to Damascus. It’s a step at a time, that’s really the only way to do it.”
He is currently looking at an American open source system called Vista, which was developed by the US Department of Veteran Affairs and which he believes will provide the basis for the next generation of the hospital’s entire information system.
“It’s such a rich and deep solution set that I think it’s going to meet all the requirements which we have going forward.”
Although at an early stage in the system’s evaluation, Tony estimates that the difference in implementing this versus the alternative proprietary solution being looked at by another hospital is 13 million euro ($22.5m).
“So this is open source bringing real pound, shilling and pence value as opposed to all the fluffy stuff.”
A note of caution comes from the Swedish experience however, where the 2,500-bed Helsinki University Hospital implemented an open source solution, which hasn’t yet spread beyond the hospital.
“It’s been there a long time, since the mid ’80s or something, so it hasn’t spread, so you have to ask yourself why?”
Tony himself does not know whether OSS is “going to flower or be crushed” in the health system in Ireland.
“Because it may be perceived as this is, you know, this is too radical, or it’s not so easy to control. I don’t know, but that’s all yet to be decided, but I think it largely depends on how it’s executed. The guys who work in public health administration are no more keen to throw money at closed source solutions than anybody, but also they don’t want to end up appearing before the public accounts committee saying why did you make a mess of this. In their own mind they’re weighing up what’s the advantage, what’s the disadvantage, so they’re going to need to be convinced.”
Katherine Breen Kurucsev recently travelled to Ireland. The division did not pay 1/21th of her trip.
View the full Kenny/Fitzgerald report on: http://opensource.mit.edu/papers/fitzgeraldkenny.pdf
http://www.beaumont.ie
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