Ian Rodrigues
On a clinician-led procurement, the clinical safety review behind each release, and what happens when you report harm to a vendor who is not listening.
Part of the OpenEyes Conference interview series, recorded on 16 September 2026 in Cardiff, UK.
Clinician-Led Procurement and Clinical Safety Review at Guy's and St Thomas'
Why would that decision be imposed on people, by people who are not using it? It's bizarre.
About Ian Rodrigues
Ian Rodrigues is a consultant ophthalmologist at Guy's and St Thomas' Hospital in London and a member of the OpenEyes senior design authority, with a role in its clinical safety review.
Interview summary
Ian Rodrigues first saw OpenEyes around fifteen years ago, when Bill Aylward demonstrated an early version to him as a senior registrar. What caught his attention was that ophthalmology suited digitising and nothing then on offer did it: very high volumes of outpatient and surgical patients, and repetitive structured information. When he started as a consultant, St Thomas' was running a procurement for an ophthalmic record, OpenEyes was chosen, and he was asked to implement it in the glaucoma service before joining the committee and design authority.
The appraisal was semi-formal and, he stresses, clinician-led: the people who would use it were clear about usability. What decided it was the graphical interface, on the grounds that ophthalmologists look at and draw things, so a visual representation is familiar. He is open that he doubted this - he is comfortable with numbers and tables and thought the pictures were close to gimmicky - and changed his mind in use: seeing many patients in a short time, information comes off an image faster than off a table.
He puts the selection principle strongly. The decision should rest with the people who will use the system, within technical and financial limits, and imposing it on them is bizarre - it also means clinician buy-in from the start, which helps the implementation. He notes the appraisal drew on real experience, since colleagues had used OpenEyes at Moorfields and others had used the alternatives elsewhere.
What he says distinguishes it is that the clinical need comes first and the technical work follows, rather than the reverse. He contrasts that with systems that add a field because a process requires it: if there is no clinical purpose, clinicians will not complete it, and if it is made mandatory it becomes a standing frustration. He attributes the difference to its origin with a clinician who understood the problem, to feature decisions resting with experienced clinicians who use it, and to a technical team that has been there long enough to know what has been tried.
On regulation he is careful to say he is not certain whether it is a class I or class IIa device, and describes the regulatory load as low: it makes no clinical decisions and has no AI, storing what users enter and presenting it back. The safety process he does describe in detail - new features reviewed from a clinical safety perspective at the design stage, and every feature analysed and signed off at release, with risks either mitigated or explained so users understand them. His analogy is that a hammer is a lethal weapon and is still sold: no record system is risk-free, and what matters is knowing the risks and the limitations.
The sharpest comparison in the interview is with another record system he uses regularly. When his team reports a problem there, he says the response is often simply ignored, even where clinical harm is associated with it, and is not escalated as he would expect either as a clinician or as a patient. He allows that this reflects how hard change is in a large system, where one organisation has little say and may have no route to the people who could act.
Asked about weaknesses, he names a perception rather than a fault: that an open source product might fade away with no support behind it. He considers that answered by the governance, structure and financial security now around it. Being not-for-profit rules out some ways of operating, but he regards revenue going to the product rather than to shareholders as the model working.
His advice to anyone choosing a system starts with a risk he takes seriously: a standalone ophthalmic system is vulnerable whenever an organisation wants one system for everything. So decide first whether a specialist system alongside a larger one is wanted, weighing that a specialist system does that part far better, and that ophthalmology's volumes and safety risks make it worth considering. Then decide on the clinicians' judgement of what will be usable long term, and look at the trajectory: a product that has not changed for years tells you what to expect, where active development and a mechanism to influence it tell you something different.
Without it, he says, paper would be unthinkable and the quality now delivered is far higher - which means better care and more patients treated. In glaucoma, where he specialises, there is not enough resource to see everyone and patients are delayed; without the efficiency, those delays would be worse. He adds that having used it shapes how he has configured the other system he works with, replicating the features he valued.
He credits the community directly: a close working relationship with the committee chair, who shared his own configuration and the route he had taken, let St Thomas' replicate what had worked without repeating the effort. His wish is to have OpenEyes back at the place he works most.