[FOSS_health] moving focus of primary care client design (UK)

[Adrian Midgley]

Past efforts at writing software for general practice and other primary
care uses has generally aimed at producing a system owned by a practice
and operated within it.

In the UK, and perhaps elsewhere, government preference is now to take
control of medical records, moving them into data centres, and running
servers shared over hopefully reliable wide area networking with clients
in the practices and other locations.

Two approaches to working with this, using FLOSS, are apparent.

Firstly, this is yet another area where the arguments over publication
under public domain, GPL or similarly open licences of the API and
networking protocols need rehearsing, so as to avoid lockin to
proprietary client software.

One of the particular deficiencies in the UK at present is in rdesktop's
handling of the smart card authentication protocols.  Since a smart card
system is in use - or in the process of introduction - for identifying
authorised users and allowing access to records, no open source medical
record client can expect to join the services used in the NHS unless it
runs on a platform which can handle smart card, and the specific smart
card system, authorisation.

This represents an opportunity for progress in infrastructure.


Secondly, the remote desktop capabilities of various open source
platforms are already excellent.  Regardless of the server operating
system and technology, FLOSS clients could access it and present
sessions on the main system.

Those sessions may contain just a single application, or a complete
desktop - a model which has been the base of a successful business and
which I use in practice.  They may also usefully remain constant for a
given user between different days and different places of access.  This
is a model SUN attempted to popularise with their terminals and JavaCards.



Given this change in focus in health service IT planning there should be
an expectation built in to at least primary care record systems and
tools that they will be running not on their own dedicated server, but
on a machine shared between agencies.  This is on the one hand a
security challenge, and on the other an obvious hint toward movability
of an individual's healthcare or medical record from one practice or
agency's demesne to another, without rekeying or transmission.

-- 
Adrian Midgley
www.defoam.net
2007