Accepted for/Published in: JMIR Human Factors
Date Submitted: Sep 12, 2024
Date Accepted: Jun 23, 2025
Digital capability, open-source use, and interoperability standards within the NHS in England: A survey of healthcare trusts
ABSTRACT
Background:
In 2016 NHS England sought to drive digital transformation within select NHS organisations through the Global Digital Exemplar (GDE) programme. While the programme did advance the NHS’ integration with digital technologies, disparities in digital maturity persisted between GDE-funded and non-funded NHS organisations. The Department of Health and Social Care (DHSC) launched a data strategy in 2022 that aimed to develop the appropriate technical infrastructure and data architecture to enable more effective and efficient use of its data. Given the diversity in digital capabilities, open-source adoption, and interoperability standards within NHS services, official guidance has continued to struggle to provide effective unification. Data about capabilities and technologies from application development teams in the NHS trusts, crucial for advancing these areas, remains insufficient.
Objective:
The objective of this study was to document further the capabilities and technologies used in the NHS to develop digital capacity. Comparing those with standard funding against those with additional GDE funding. This comparative analysis provides a foundational understanding for evaluating current practices and identifying potential areas for improvement in the NHS digital transformation efforts.
Methods:
Data were compiled from responses to: (1) Freedom of Information (FOI) requests to NHS trusts between July 2020 and July 2021, and (2) systematic website searches for technology were conducted between August 2020 and July 2021.
Results:
A total of 191 (84.5%) of the then 226 NHS trusts completed the FOI request and 161 of the 191 (84%) had software/app development, website, innovation teams. One hundred and twelve (70%) teams developed front facing service user websites/apps. One hundred and fifty (93%) worked with clinical staff to formulate innovative ideas. Fifty-five (34%) carried out developments for other trusts and external entities. Thirty-five (22%) had attempted to secure an innovation grant. One-Hundred and thirty-eight (86%) disclosed the technologies they use. A total of 84 technologies were identified: 28 programming languages, 19 frameworks, 10 libraries, 11 databases, 7 interoperability standards, 5 application programming interfaces / web services and 4 continuous integration / continuous deployment platforms. Twenty-five (16%) said they always used open-source technology and 9 (6%) said they used it sometimes. Twenty-four (15%) disclosed technologies referred to interoperability standards in their responses.
Conclusions:
The NHS must adopt a cohesive strategy and overhaul its policies and programmes of effort to ensure the success of its digital, open-source, and interoperability standards initiatives. Five recommendations toward greater organisational interoperability are made by the authors.
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