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NHS Number Open Source Software: Implications for Digital Health Regulation and Development

A national example of open source digital healthcare is critiqued. The code for implementing numeric patient identifiers is surprisingly naïve and bug-ridden, despite patient identifiers being computationally trivial and a critical component of reliable healthcare. The issues raised are shown to be widespread, long term, and apparently unrecognized. Problems are traced back to inadequacies in the relevant standards, and, at every stage, regulation through to development, inadequate Software Engineering input. An important finding is that the relevant healthcare standards are inconsistent and written without sufficient rigor to be at all constructive for implementing digital systems. The widely recognized problems of interoperability may be traced back to diverse (and buggy) interpretations of vague standards.