The United Kingdom's National Health Service (NHS) is carrying out what some have called the most ambitious upgrade in the history of healthcare. The 10-year, £5 billion modernization plan, which the NHS began implementing in June 2000, will touch virtually every corner of the British public health system.

At the heart of the plan is a new technology infrastructure that will streamline operations, slash costs, significantly improve patient care, and allow medical practitioners and patients to communicate with each other securely and easily.

Open source and standards-based software seems set to play a central role in the British government's efforts to develop a thoroughly modern healthcare system. In December, Richard Granger, IT director for the NHS, announced that the agency would launch a trial of a Linux-based system from Sun Microsystems in an effort to ensure that the health service was using the best technology available while radically cutting the costs associated with proprietary software solutions.

If the trial proves successful, the Sun Java Desktop System will be rolled out on the 800,000 computers used by the health service's 1 million employees, replacing the Microsoft Windows operating system and Office productivity suite.

Global Governments Discover Benefits of Open Source Apps The NHS isn't alone in its choice of open source technology-based systems. Linux and compatible applications are showing up on desktops around the world, from China to Canada. In November 2003, Sun entered into an agreement with the China Standard Software Company (CSSC), an association of software developers supported by the Chinese government, to install the Sun Java Desktop System on up to 1 million computers throughout the country this year, according to a report in China Daily, an English-language Chinese news service. The plan is to deploy about 200 million copies of the Java Desktop System software by the end of the multiyear project. "Our partnership with Sun Microsystems is instrumental in advancing our technology strategy and helping CSSC to become a competitive force in the global market," says Han Naiping, CSSC general manager. In August 2003, Reuters reported that the government of India had launched its Linux India Initiative intended to broaden the use of the open source OS in schools and state agencies in order to save money while maintaining access to cutting-edge technology. Both the India National Stock Exchange and Bombay's Breach Candy hospital, a medium-size facility specializing in interventional cardiology, already use Linux, according to Reuters. Spain, France, Brazil, Japan, South Korea, Australia, and Russia are also exploring open source alternatives to proprietary operating systems and applications, according to various news reports. Sun is working with government agencies to develop localized applications that suit their country's unique needs. For example, Israel's Finance Ministry recently enlisted Sun's help to design a Hebrew-language version of OpenOffice software, an open source alternative to Microsoft's Office suite. The Israeli Finance Ministry, dissatisfied with Microsoft's licensing fees, also decided to suspend further purchases of Microsoft software, according to an Associated Press report. The ministry indicated that it may promote government use of the Linux operating system.

"Richard Granger has been quite open about his desires to replace pricey, license-hampered software with less restrictive, open source applications," says Piers Crisp, a networking consultant based in London. "Granger has spoken at many IT and public policy gatherings and has clearly stated that he is looking for solutions that are flexible, innovative, effective, and sensibly priced. He's also said that he expects software vendors to treat the NHS as a partner—not a victim.

"The general reaction among the technical community to the announcement that Sun Java Desktop System software was being given a trial run was jubilation," Crisp adds. "IT people know that an open source solution will make their jobs easier: No more waiting around worrying about what the next computer virus attack will bring."

The Trial Run

The Sun Java Desktop System includes the Linux operating system and the GNOME desktop environment, which provides a familiar user interface. The package also includes a full set of applications: StarOffice 7 productivity software, the Mozilla Web browser, and the Ximian Evolution e-mail and calendar application—all for one low price.

Charles Andrews, director of public sector sales at Sun, told the Guardian newspaper that switching from Microsoft products to Sun Java Desktop System software promises to save the NHS tens of millions of pounds just in licensing costs. "And we won't force people to upgrade computers and technology on a two- to three-year cycle, either. Customers can upgrade when they need to," Andrews added.

The NHS will conduct Java Desktop System testing in an incremental rollout to gauge functionality, user reactions, and integration with other existing systems, according to documentation made available by the NHS.

"Our evaluation of the Java Desktop System holds the promise of allowing a greater share of NHS funding to flow directly towards improved levels of patient service," Granger said in the December announcement. "If this solution were to prove effective, we could save the NHS and the taxpayer many millions of pounds while at the same time using rich and innovative software technology."

Granger also admonished other technology vendors who might come knocking on his agency's door hoping to grab a piece of its £5 billion budget: "Sun's innovation and flexible approach to addressing the business challenges of the NHS are an example which we would encourage all IT vendors to note."

Beyond the Desktop

The key projects in the NHS technology modernization program include building an upgraded broadband private network to connect healthcare providers and hospitals across the country; giving patients secure, easy access to information and allowing them to book appointments with caregivers online; developing a standardized nationwide electronic patient record (EPR) system; and developing a standard application for electronic prescriptions.

The electronic record system—known as the Care Records Service—will eventually complete 5 billion transactions a year, replacing what is now a primarily paper- and voice-based system. The system will also act as the foundation for the online appointment and prescription services.

BT, a leading European telecommunications provider and a Sun technology partner, has been awarded a 10-year contract to design, deliver, and operate a patient record system for all NHS patients in London.

"We are delighted to have been chosen by the NHS to deliver a key part of the National Program for IT, one of the biggest and most ambitious healthcare IT projects in the world," says Sir Christopher Bland, BT chairman. "Our technology and expertise will help to provide real benefits to NHS patients and staff. It will improve the working lives of nurses and doctors, offering easy and secure access to patient records. We look forward to working with the NHS to make this program a powerful force for improving patient care."

When fully implemented, the Care Records Service will enable NHS organizations to record and exchange patient and care information electronically, eliminating duplication of patient files and improving information sharing between healthcare professionals.

BT is the prime contractor and will deliver and operate the service through Syntegra, its systems integration subsidiary. Sun will provide the hardware and software to develop and manage the records database.

"Sun continues on its mission to enable the Java lifestyle, where everyone and everything is connected to the network," says Scott McNealy, Sun chairman, president, and CEO. "Innovations like our Java system, combined with support from great partners like BT, are making huge advancements in healthcare possible."

McNealy concludes: "The end game is more control over and secure access to medical information for U.K. citizens."