Guest post: Improving public services using technology – Open versus closed

Nat Wei (@natwei), is a social entrepreneur. As Baron Wei of Shoreditch he has an interest in the emergence of the cluster of startup technology companies in the Shoreditch/Hoxton area of London which has come to be known as Silicon Roundabout and which has informed the UK government’s new “East London Tech City” initiative. This is the third in in a series of guest posts on the use of technology in re-building civic society. The first is here, the second here.

There are dramatic changes happening in the way public services are evolving to become more citizen led and people driven. In the UK there is a huge amount of activity currently underway to reform and open up public services so that decisions are made more locally and on the front line, so that workers in public services have more say in how their services are shaped and can respond better to citizens who are being armed in turn with more data, and in how providers will be rewarded (or not) for their outcomes. A forthcoming White paper on public services will shortly set out the framework for this change.

Even before the bills are passed however, public service reform is already underway, and technology has had a crucial role to play and will have even more of role moving forwards. One of the critical differences emerging in this landscape is how organic versus planned public service platforms will be. On the one hand there are emerging models like Clinical Current, an online application that will be launched later this year for medical professionals. On the other hand there are already models such as The Key. And thirdly there is the forums and discussion board format which has been around almost as long as the Internet itself.

In this post I want to consider the challenges ahead for apps like these, which are leading the way in bringing together frontline professionals who are geographically diffused in a shared online space where they can benefit from each others’ knowledge and improve the delivery of services all over the country. The tension for developers will be a balance between user-generated and more curated, edited content. Who will define professional knowledge and where will the power be held? Apps like these will have to retain their professional credibility as well as maintaining a high standard, whilst catering to the needs of their users who will benefit from a less firm hand on the tiller.

Neil Cooper is the joint founder of Doccrates, which is launching Clinical Current this coming October. Neil’s background is the pharma research industry, which has given him a grounding in the healthcare system and enabled the development of an online space where doctors can network effectively – which he calls a ‘bit of a linked in’ for medics. Doctors, whose relationships tend to be at the local level and not beyond their local boundaries unless they are attending seminars and symposia, are also acutely aware that knowledge in their field is constantly developing and sometimes at a rapid pace. As a rule therefore they are open to sharing information, keen both to learn and to help others learn.

From the outset, Doccrates are holding to the philosophy that the users should lead the way on how their model develops. This network will initially be purely web-based app, but Neil and his company already have plans for smartphone and iphone apps. Importantly, though, they want to watch closely how doctors use the site before they progress the design further. Such a site could be used for sharing more than just medical knowledge; with the new health care professional consortia proposed, for example, in the UK it might be beneficial for doctors and other health workers to develop a plurality of relationships with people that they may not have come into contact with in the past – technology can help to open these up. Similarly, if health care workers are going to be able to bid for patients that lie outside of their previously existing allotted areas, being able to communicate in such a networked way could become a significant tool.

The other broad approach developers can take is that of The Key, a support service site for school leaders. For a fee, headteachers and the rest of their team can access over 2,000 regularly reviewed and updated articles, specifically addressing issues in their profession. Topics relate to school status, local authorities, inspections, improvements – basically anything that the membership determine is salient and ask to be dealt with that will help them save time and money. Here the members are determining what the content should be, but writers and editors are creating it. All writing and reviewing activity is driven by the demands and feedback of the school leaders, moulding the shifting knowledge base in a highly efficient (but quality assured) way. The comparative trade-off might be said to be quality control against direct user input.

My own hunch is that closed models such as the Key will thrive, but like Apple’s iPhone, will be suited for a more niche professional market. The Key’s parent company already has plans to provide services for other professional groups in health and social care. The ‘traditional’ and tried and tested discussion board will continue to have mass appeal, whether using relatively bespoke platforms such as Doccrates or more universally focussed ones such as twitter/facebook etc.

However, for this kind of technology to be a help and not a hindrance in the public sector, we need a broad culture shift in the way government approaches technology in three ways.

The first is a greater openness and willingness to collaborate in the design and programming of platforms. Something which is happily already being done in the UK is the opening up of government alpha source code and APIs to developers through hack days and online. This has been done both at the national level, with and now with the site, and at the municipal level around the country. For example, Sandwell Council and others have opened up their archiving and records systems to programmers who believe that they can combine forces to improve usability and functionality. Collaboration and early testing and prototyping together is the way forward.

Second, we need less reluctance towards sharing information. This could be achieved in many cases by the lowering of firewalls. Another solution could be to have two networks where in the past there has been one – an internal, restricted government database which links to a second, cloud-based network. This is a proto version of solutions that the US (who are ahead in many ways in this area) have already implemented in healthcare, which allow hospitals to use apps from third-party providers that act as portals to centrally held, secure patient information.

Whichever model comes to dominate, changes will be needed in how government encourages its workers to use social media and even private devices. I believe that the greater use of personal devices like iPads, iPhones and other smartphones and the secure information that can be held on them will represent a big step forward (as in the US) whether in health or in other public sector areas. In health, there is mileage to be gained from harnessing the fact that doctors are comparatively higher users of smartphones than the rest of the population and tend to be on their feet a lot, not having many opportunities throughout the day to use a computer, so iPhone and iPad and other smartphone apps that access secure patient information quickly and easily would be of great benefit to them.

Whichever models ultimately go mainstream, open or closed, there is one certainty when it comes to the use of technology in the public sector: the days of monolithic one sized fits all platforms expensively procured are over. We shall see how long it takes for their nimbler replacements to gain adoption.