NHSbuntu

An operating system for the NHS

marcus.jpg

@marcus_baw

    GP & former Anaesthetist

    Clinical informatician / ‘General Hacktitioner’

    NHS.UK Alpha, RCGP HIG, Endeavour Health, Apperta Foundation, Eyedraw/OpenEyes, Professional Records Standards Body, NHS Healthy Child Programme, NHS WiFi Programme, NHS Hack Day, CCIO Network, UKHealthCamp, Clinical Software Usability Survey 2015-2016...

    ‘Open Source is the Only Way For Medicine’

NHSbuntu project:

a group of enthusiasts

4 months

completely voluntary

'unofficial' from NHS and Canonical POV

Apperta backing £40k since April

What is NHSbuntu?


NHSbuntu takes plain Ubuntu and optimises it for the NHS

unofficial: not directly affiliated to NHS or Canonical organisations

removes packages the NHS doesn’t need

adds packages the NHS needs, develops custom elements

adds familiarity by configuring look & feel, branding etc

provides services around NHSbuntu - customisations, Disaster-recovery Live USB version, custom development.

What is Ubuntu?


Ubuntu is ‘Linux for Human Beings’

A more friendly wrapper around Linux

Backed by Canonical, who provide support services

The most popular Linux variant, with millions of deployments worldwide

We have taken Ubuntu and pre-configured it to work with the NHS’s most common needs and requirements.

What is Linux?


A free, open source UNIX based operating system

Released 1991 by Linus Torvalds, Finnish Computer Science student

Now running on 96.6% of the world’s top 1 million websites

It’s the operating system inside Android devices and Chromebook laptops

It’s used by the giants of the web including Amazon, Facebook and Google

Apple, Oracle, and IBM all use free UNIX variants

What's wrong with just using Windows?

it's very costly

£700 to license a new machine

1300 machines / organisation

5 year lifetime of applications

>500 'major' sized organisations in NHS (CCG + Acutes + MH)

£455m

source: best guessing, CIO interviews, and http://www.nhsconfed.org/resources/key-statistics-on-the-nhs

£455m

there's no upgrade path for some trusts

legacy clinical apps with pre-Win10 dependencies

no resources to migrate off those legacy clinical apps

increasing security risk from these older dependencies

NHSbuntu proposes to wrap WinXP legacy software in virtual machines

There Is No Plan

Windows 7 End Of Support: January 14th 2020

New hardware will not work with older Windows versions

Old hardware may not perform well with Win 10

Clinical apps may not work with Win10 or Edge

1) You have to migrate to Win10 before 2020

2) You have to replace all legacy clinical apps before 2020, to do 1)

3) You need to upgrade all your hardware in order to do 2)

You can’t afford to do 1), 2), and 3) at the same time (cash/staff/training)

You’re stuck.

it leaks patient data?

Windows 10 sends data to Microsoft in over 30 ways (incl raw keystrokes)

This can be over-ridden in your org - but it is extra work, and not easy

Third party / home PCs accessing NHSMail, VPNing into trust systems are beyond organisational controls, and may leak data, so as we develop wider data sharing, it will be impossible to prevent keystrokes being sent to Redmond, WA, USA.


We may not be able to stop privacy-critical PID keystroke data being sent to Microsoft via Windows 10 PCs

We need to think hard about whether Windows 10 is fit for the NHS.

80%

~80% of NHS desktops are for backoffice/admin


(discuss)

Libre Office suite

NHSmail2 Email

Modern browsers Firefox & Chromium/Chrome

Windows ‘shared drive’ (eek)

Network printers

Scanner app / drivers

Active Directory Support

demonstrating NHSmail, browser, office apps for the 80%

20%

20% of NHS desktops are used for direct clinical work

PAS (Patient Administration Systems)

EPR (Electronic Patient Record)

GP Clinical Systems

Clinical portals

NHS National Services on Spine:

Summary Care Record

e-Referral Service

Patient Demographic Services

Often heavily coupled to Windows ecosystem

More difficult to Linuxify

Hard dependencies on:

Internet Explorer

Microsoft Word

Microsoft OneNote even!

seamless clinical applications demo: TPP SystmOne

No we did not do WannaCry ;-)


The worldwide cyberattack on 12th May 2017, which hit NHS badly

Was well timed for us in terms of publicity

We didn’t do it, honest guv BUT

NHSbuntu (as with all Linux) would not have been vulnerable

NHSbuntu in even low-volume use could have provided herd immunity

Linux is not proof against all malware, but its attack surface is smaller and it’s (arguably) harder to do real nasty stuff

installing NHSBuntu

Other NHSbuntu use-cases

Disaster Recovery

hscni-respin

Distributed Computing

harness the off-duty CPU/GPU of every NHS computer, by including a swarm client in NHSbuntu by default

eg Folding@home - a distributed protein folding computation platform

Are there other good projects?

Could we grow UK-based projects for the platform?

Bioinformatics in the NHS

Bioinformaticians deal in big genomic/phenotypic data

They routinely use Linux and OSS for this

But they often have to maintain honorary contracts with the local University in order to get Linux installed on a machine they can use for work

NHSbuntu could solve this for them by obtaining 'NHS-wide' premission for use & packaging commonly-required Bioinformatics software in a metapackage for them

What are the team working on right now

Native Linux Identity Agent (for NHS Spine Smart cards)

Automated build chain tooling so we can programmatically make changes to image definition files and have the ISOs build and test automatically.

Exploration of the ‘NHSbuntu for Disaster Recovery’ use-case

Performance testing of LiveUSB version on fast USBdrives/USB SSD

Discovery work regarding different desktop environments - we’re thinking of switching to Cinnamon DE (from Gnome3 DE)

getting involved

download the ISO, install and play!

read more here: www.nhsbuntu.org

join our Slack team

tell people about NHSbuntu

Follow us on Twitter @nhsbuntu