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Open Source Software

At IMS MAXIMS our objective is to help healthcare organisations reduce clinical errors and improve outcomes for patients. Our latest generation of MAXIMS software has been built by working closely with clinicians to ensure that it fits their requirements and meets the needs of their trust. As part of our vision for MAXIMS to be the best software for use in the NHS, we are offering our full MAXIMS suite of products as open source. This will increase the number of users that can work with us to develop the code for the benefit of the wider NHS. The openMAXIMS product suite is identical to our proprietary solutions in every aspect except for the licence. The openMAXIMS software also forms a key element of the UK Government’s vision for transparency, open data and the move towards delivering safe and integrated care. In September 2016, Taunton and Somerset NHS Foundation Trust, the first UK site to deploy our open source electronic patient record, was named by Health Secretary Jeremy Hunt, as a Global Digital Exemplar.

Why should healthcare providers use open source software?

There are many potential benefits of using open source software including:

  • clinical empowerment and engagement – increased level of input from clinicians, nurses and other healthcare professionals on how the software is enhanced and used – important factors in digitising the NHS
  • collaboration – the ethos adopted by open source developers is akin to the sharing of medical knowledge amongst clinicians, meaning best practice is not only combined, but also promoted
  • open access – developments by other users can be added to further improve efficiencies and patient safety
  • ownership – trusts have a greater involvement as the software is modified by them to meet their needs if they wish
  • flexibility – bespoke software enhancements can be driven by healthcare providers
  • local control – products can be customised faster at a local level, safe in the knowledge that IMS MAXIMS staff can be on-hand to support if required
  • value for money – the initial capital outlay associated with the licensing of off-the-shelf products is reduced
  • no vendor lock-in – trusts are free to choose which supplier will provide support and maintenance services
  • recommended by NHS England – as an approach to delivering safe and integrated care within a paperless environment.

 

Custodianship

Within the NHS it is important for one organisation to be responsible for implementing the regulatory updates from the Standardisation Committee for Care Information (SCCI). That same organisation should also be responsible for, incorporating enhancements developed by the openMAXIMS community, validating updates against clinical safety and information governance standards, and producing updated releases of the software. This is the role of a ‘custodian’ and NHS England is supporting this approach.

openMAXIMS functionality

The latest generation of our full MAXIMS suite has become openMAXIMS, our first open source software product.

It has the same rich functionality and currently includes:

  • a full Patient Administration System designed for the NHS, including support for:
    • Choose and Book v3 (Full rollout approval from HSCIC)
    • Commissioning Data Sets
    • Referral To Treatment management (RTT)
    • Graphical Bed Management
    • Outpatient Appointment Management
    • CQUIN targets
  • an Electronic Patient Record including:
    • Order Communications and Results Reporting
    • Integrated Care Pathways
    • Observations and Notes
    • Emergency Department (A&E) including Tracking
    • Clinical Assessments
    • Clinical specialties (e.g. Oncology, Spinal Cord Injuries, etc.)
    • eDischarge process
  • HL7 interfaces (bi-directional) and open APIs for comprehensive integration with third-party systems

Our wide-range of products are fully integrated and have been built from the ground up in partnership with our NHS customers. This means that healthcare providers can now access years of expertise and investment at no cost. IMS MAXIMS strongly encourage the take up of a support contract. There is no one better placed to support, implement, train, develop, deliver change management, project management and programme management services for the MAXIMS product suite. Purchasing this via G-Cloud provides a hassle-free procurement option.

Why work with us?

We are known for being an innovative organisation helping to improve patient outcomes and reduce clinical errors through a flexible and powerful product suite, so moving to an open source model is a natural progression for us. Engaging with IMS MAXIMS will allow NHS trusts to:

  • reduce risk – by making our proven software open and free-of-charge, we are aiming to lower the risk that is sometimes associated with technology deployments. Common concerns such as vendor lock-in, extortionate charges for change requests, and excessive support and maintenance fees, are eliminated, because trusts can search for other alternative solutions from an open market at anytime
  • access wider clinical input and industry’s best practice – by developing openMAXIMS products, we believe there are new opportunities to enable the NHS to leverage intellect and skills from a wide range of sources, share success and ultimately help to implement more tailored, efficient systems at a far greater pace and far lower cost
  • work with flexible and reliable software – there is a clear demand for open source, with healthcare providers driving towards greater software flexibility and less one-size-fits-all pricing agreements. We believe that IT teams and healthcare professionals can enjoy the freedom to build on open source systems on a local level, safe in the knowledge they have the dedicated support of our experienced team if they need it
  • benefit from a responsive and agile support service – our support services provide rapid software changes, with a clinically-driven and flexible approach, making us agile and responsive to customers’ needs.

How to download and use openMAXIMS

openMAXIMS is being made available for use under the GNU Affero General Public License version 3 (AGPL3). This means that you can download openMAXIMS for free, use it for free, and you are free to modify it in whichever way you like. All that we require, is that if you add anything or make any changes, you make these freely available to the openMAXIMS community under the same AGPL3 licence. Whilst all of openMAXIMS is initially licensed under the AGPL3 licence, we recognise that other proprietary systems may wish to closely link to parts of openMAXIMS to be able to provide a more integrated user experience. As we identify these parts of openMAXIMS, we intend to release the source code under the more relaxed LGPL v3 licence to enable you to achieve this integration without the need to release your entire product as open source. We anticipate that our IMSIDE SDK will be made available with a free-licence for the sole purpose of developing openMAXIMS or derivatives for use in the English NHS. Please contact us if you would like to purchase a licence for use in the development of openMAXIMS in other markets. The proprietary MAXIMS solution will continue to be used extensively by many of our NHS and private sector customers. The open source version – openMAXIMS – is supplied on an as-is basis with no implied warranties or support. However, we do offer full implementation, support and maintenance services; please contact us for a quotation or check us out on G-Cloud.

Dependencies:
openMAXIMS requires the following 3rd party products to run:

  • Windows (Server 2008 and above), AIX or Linux
  • Apache HTTP Server (version 2.2.25 and above)
  • Apache Tomcat (version 5.5 and above)
  • Java Runtime Environment (version 5 and above)
  • Hibernate ORM as modified by IMS MAXIMS and included in the package
  • A Hibernate supported database: Oracle, Microsoft SQL Server, or MySQL
  • Hermes Messaging Gateway (the ebXML gateway for Choose and Book appointments)
  • Internet Explorer version 7, 8 or 9

Further development

What next for openMAXIMS

In return for making openMAXIMS free to use, we welcome suggestions on how it can be improved. We are just starting this journey and are fully committed to open source, so if we haven’t got it quite right please help us improve. One area that we continue to work on is documentation. We have provided simple instructions on how to build openMAXIMS but there is much more to come in the near future. Remember that openMAXIMS is an enterprise scale application that can support several thousand concurrent users and so it has features and complexities that you will not find in desktop applications. The process for designing a full deployment platform (servers, switches, database, storage, networking, scanning, interfaces, etc.) is not simple and may require significant time to get it right. That said, you can install and run openMAXIMS on a high-end laptop computer running Windows Server 2008/2012 and access it through a local browser. The software development environment we use is the IMS Integrated Development Environment (IMSIDE). We use IMSIDE to help us develop MAXIMS and openMAXIMS software. You can develop the software without IMSIDE, but we will soon be making IMSIDE available for free to make enhancements to openMAXIMS for use in NHS England. Watch our website for news on IMSIDE release. We have placed the openMAXIMS source code on GitHub so that we can all benefit from the collaborative development features that it offers.

Downloads:

You can download the source code package for openMAXIMS from here: download

OpenMAXIMS frequently asked questions

Is openMAXIMS free?
Yes, but with freedom comes responsibility. The licence allows you to use and distribute copies of openMAXIMS software, but you must offer a copy of the source code to anybody who uses it.

Can anyone download openMAXIMS and modify it?
Yes. But if you use the modified version you are required to make the modified source code available under the same AGPL licence to anybody who uses the software.

Can I sell it?
You can try but as IMS MAXIMS is making it available for free, anybody can download it.

Isn’t open source software unsafe?
That old chestnut. Many people would like you to think this, but the reality is that the more people that can review the source code, the greater the chance of finding and fixing any problems. (Do not confuse ‘free’ software with ‘open source’ software; much free software is not open source and so you have no way of knowing how safe it is.)

What about clinical safety and information governance?
The fact that openMAXIMS is open source does not change our commitment to making it clinically safe and ensuring that it meets NHS IG requirements. And if you wish, we will provide you with a support contract and SLA that give you the same level of service, support and protection that we provide to customers using the proprietary MAXIMS software.

How can I benefit from any enhancements made by other trusts?
In collaboration with NHS England, we plan to setup an organisation to oversee the management of the openMAXIMS project and to provide ongoing enhancements to openMAXIMS. This organisation will establish the mechanism for both collaboratively developing openMAXIMS and also for enabling verified enhancements from other parties to be brought back into the mainstream openMAXIMS software. Regular releases of openMAXIMS will ensure that these enhancements are provided to anyone who wants to use them.

Why did you choose the AGPL v3 licence?
openMAXIMS is a network application (all users access the system from a desktop web-browser over a network), and the AGPL was developed specifically to protect the openness of such applications. With the ordinary GPL it is possible for any organisation to modify that code to produce an enhanced product and then to provide on-line access to the modified network application, but not be obliged to release the modified code (as the modified code is never distributed or sold). We think that openMAXIMS should be developed collaboratively and that everybody should have the ability to benefit from any modifications made by any other user.

What do I do if I find a problem in the openMAXIMS source code?
Please contact us on openMAXIMS@imsmaxims.com if you have any feedback on the openMAXIMS product suite and we will look to get back to you as promptly as possible. Our normal support desk contact details are only used by existing customers with support contracts.

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