Hack into healthcare
Richard Thorley looks at why computer programmers have an increasingly important role in medical practice
Hack days, hackathons, or codefests are events that see computer program developers collaborate with professionals from a variety of disciplines to solve problems faced by a particular industry. Despite its traditional use, the word “hack” in this instance means to explore in a creative rather than criminal way. This summer, programmers joined forces with healthcare professionals and were asked to solve four medically related problems at the first BMJ hack day. The challenges involved building apps for medical students, developing evidence based practice materials for international users, creating a “zero harm” NHS that complies with the recommendations of the Francis report, and bringing the humble research paper into the 21st century. Over 50 hackers—including some medical students—attended the event, which spanned two days. Thirteen hacks were created in total, with two of those developed by medical students receiving awards.
The medical profession is becoming increasingly reliant on new technologies. In July’s Student BMJ, we explored how three dimensional printing could be used in surgery, and how the Department of Health is working on an app to help beat the bulge in efforts to reduce obesity.  Gone are the days of plain film radiographs on lightboxes and blood results on paper—medical notes are becoming increasingly computerised, with an ambitious aim announced for the NHS to become paperless by 2015. Journals too are moving towards digital publishing, with many now publishing their content online before going into print. Software can be used creatively to solve everyday problems for doctors and students alike—but to produce the most effective programs, healthcare professionals will have to collaborate with the developers.
Fear of failure
Although the need to introduce technology at a rapid rate may seem obvious, doctors often remain decidedly wary when presented with a new opportunity in this field. Perhaps that is because the NHS has had its fair share of failures where computers are concerned. The £12bn (€14bn; $18.6bn) project to streamline and update information technology systems in the NHS was virtually abandoned in 2011. The press vilified this project as an extraordinary waste of money, and said that the sum could have instead paid for 60 000 nurses for 10 years. In another example, the website HealthSpace gave patients the opportunity to track their medical details online, but was taken down in late 2012 because it was “too difficult to log on.”
“Sloth-like” modernisation process
The progress of modernising the NHS through information technology has been sloth-like. A government strategy in 1998, “Information for Health,” set out several objectives with the aim of “giving the people of this country the best system of healthcare in the world.” Yet we are still waiting for “round-the-clock on-line access to patient records . . . for all NHS clinicians” and “genuinely seamless care for patients through GPs [general practitioners], hospitals and community services sharing information across the NHS information highway.” General practitioners have been e-prescribing for 30 years, so why is this basic technology not used in hospitals? It would reduce or even eliminate the problems associated with illegible prescriptions, calculation errors, and drug interactions. Working with the hackers could solve these problems.
Iain Buchan is professor of public health informatics at the University of Manchester, and director of the Northwest Institute for Bio-Health Informatics. As an undergraduate, he developed statistical software that is used by 15 000 clinical researchers across the world. He continued to write software as a junior doctor and is now a consultant in public health. He explains that the NHS has a lot of catching up to do in the field of computing: “Hermann Hauser described health as the last bastion of computing. Across society we have fairly sophisticated information systems except in healthcare. The rest of society has moved faster than health and healthcare. The NHS is a very big organisation, changing it is like turning an oil tanker.”
“Street cred” in software engineering needed
However, as Buchan says, it is not all doom and gloom: “One of the encouraging signs is that there is more investment in informatics education. The NHS in the future . . . will ask suppliers for the things it really needs rather than suppliers guessing what it needs and selling it something out of date.”
Buchan believes that doctors and other healthcare workers need this education too: “For a clinician to be able to talk to a [software] engineer, they have to have some ‘street-cred’ in engineering. They have to know what it’s like to build great software. The UK is late to the party on this but we’re trying to catch up.”
David Carroll is a third year medical student at Queen’s University Belfast. He was a member of the team that created the Open Access Button at the BMJ Hack Day. He says that it is important for medics to know some basic code: “Programming is how we talk to computers; they are increasingly woven into our lives. If you don’t embrace this and learn how to speak to them, you’ll be left behind. Dealing with hospital IT [information technology] on a daily basis has been painful and frustrating. To paraphrase a friend, it is up to us to make NHS IT less bad.”
However, it seems that having a detailed knowledge of software development is not essential. Jon Hilton, a fourth year student at St George’s medical school in London, was behind one of the winning projects at the hack day, Focussing Students on Objectives (FSO). He demonstrated that it is possible to collaborate effectively with people from the computing world even if you have no skills in programming: “I went to my first hack day thinking that I was a bit of a geek and knew about computers. I quickly discovered that I didn’t. I owned up very quickly to my team that I couldn’t code. It didn’t matter; I brought other strengths to the team. I helped outline the problem and talked through the solutions.”
Buchan also thinks it is critical that medical students are involved in the development of software and computer systems: “Even at the very early stages of training as a doctor you have some really useful insights, because you get a flavour of lots of different parts of the healthcare system. You’re in a privileged and important position. If you’re frustrated that an obvious requirement for a piece of software doesn’t exist in clinical practice as you experience it, then channel that through.”
Specialise in clinical informatics?
Technology’s increasingly key role in healthcare is exemplified by the burgeoning world of clinical informatics: where healthcare professionals—sometimes doctors—who often have postgraduate computing qualifications lead the development of information technology in a hospital. They provide a link between the programmers and the clinical environment that goes some way to meeting Buchan’s call for “an effective way of everyone in healthcare knowing that they can feed requirements for better information systems back up through an informatics specialty.” For those who are especially keen in combining their medical career with their love of computing, a specialty training programme in clinical informatics could be established in the United Kingdom in the near future, such is the importance of this field. It is already a recognised subspecialty in the United States.
As for the future of technology in healthcare, Buchan thinks that clinical practice must be much more influential than it has been so far. “A lot of the mistakes have been made because the technology has led the way, not the problem. Ubiquitous technology like smartphones and tablets . . . will be important. But more important is that the leading edge of that hardware (which is very rarely driven by medicine) is harnessed by creative medical thinking.” This demonstrates further the need for collaborative working.
The need to make technology applicable to the people that matter has finally been realised by the Department of Health. In July 2013, a fund worth £260m was introduced for a technology initiative called “Safer Hospitals, Safer Wards.” Projects will only be approved if the developers consult healthcare workers, creating a responsibility for clinicians and programmers to work together to make the most of technology, for the benefit of patients.
Learn to code
- Codecademy (codecademy.com)—provides simple exercises in a large variety of codes.
- “Learn by doing,” at Code School (codeschool.com)—provides a wide range of courses on selected programming languages and web tools, and screencasts and video lessons.
- Code Racer (coderace.me)—an interactive and live coding game, which teaches HTML and CSS makeup languages.
What can be achieved in just two days? Examples of successful apps at recent hack days
The following apps are still in development, but could be made available soon.
oPortfolio (the Open ePortfolio)
oPortfolio shows what can be achieved when the worlds of medicine and computing collide. The innovative project was developed at a recent NHS hack day, by and for doctors, in association with Meducation and Podmedics. The open source app is a universal online portfolio, designed to be fast, easy to use, and intuitive. It will operate between deaneries, hospitals, and academic institutions, allowing junior doctors across the country to record teaching sessions and assessments all in one place, online. Billed as “a single eportfolio from the start of medical school to retirement,” the oPortfolio can be accessed by mobile or online, and will integrate fully with existing portfolios.
The Open Access Button
Do you ever find journal articles on Medline that look like the answer to all your problems, only to be asked for $20 to purchase the paper? Your university hasn’t subscribed to the journal, and it’s hidden behind a paywall. The Open Access Button is designed as a way to register your annoyance. Readers press the button every time they are denied access to an article, and the app collects the reference. One of three winners at the inaugural BMJ hack day, the app builds a global “map of frustration,” and so uses people power to convince publishers to implement open access. David Carroll is convinced it will work: “If someone hits a paywall while alone in the forest, does it make a sound? They’re unlikely to shake the ivory tower of academic publishing. With the Open Access Button, we will capture those individual moments of injustice and show them, on full view, to the world. We will make this problem impossible to ignore.”
FSO (focusing students on objectives)
FSO is a tool designed to harness the power of social media and medical students’ competitive nature, allowing students to revise together online. Using questions from onExamination, the app could give students the opportunity to gain points and compare scores with friends.
Ad hoc clinical teaching from junior doctors can be invaluable, but how do you find out where and when it’s taking place? MEDiCal could be the solution. It is a calendar that allows tutors to upload sessions; students can then sign up to attend the teaching activity. Simple but effective, it was applauded at the BMJ hack day.
Can they hack it? Yes they can (BMJ 2013;347:f4437)
Correspondence to: firstname.lastname@example.org
I thank David Payne for his help with this article.
Competing interests: I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.
Provenance and peer review: Commissioned; not externally peer reviewed
- Payne D. Can they hack it? Yes they can. BMJ 2013;347:f4437.
- Weinberg I. For a mandible, press print. Student BMJ 2013;21:f4110.
- Smith DM. Run from the zombies. Student BMJ 2013;21:f3937.
- Limb M. NHS will be paperless by 2015, says commissioning board. BMJ 2012;345:e6888.
- Cross M. Original vision of NHS IT programme “will never be realised,” report says. BMJ 2011;342:d3125.
- Martin D. £12bn NHS computer system is scrapped... and it’s all YOUR money that Labour poured down the drain. Daily Mail 2011. www.dailymail.co.uk/news/article-2040259/NHS-IT-project-failure-Labours-12bn-scheme-scrapped.html.
- Limb M. Health department is to shut down patient records site that was too hard to use. BMJ 2012;344:e3739.
- Burns F. Information for health. NHS Executive, 1998.
- Ammenwerth E, Schnell-Inderst P, Machan C, Siebert U. The effect of electronic prescribing on medication errors and adverse drug events: a systematic review. J Am Med Inform Assoc 2008;15:585-600.
- NHS Careers. Clinical informatics staff. 2013. www.nhscareers.nhs.uk/explore-by-career/health-informatics/careers-in-health-informatics/clinical-informatics/.
- Safran C, Shabot MM, Munger BS, Holmes JH, Steen EB, Lumpkin JR, et al. Program requirements for fellowship education in the subspecialty of clinical informatics. J Am Med Inform Assoc 2009;16:158-66.
- NHS England. Safer hospitals, safer wards. 2013. www.england.nhs.uk/wp-content/uploads/2013/07/safer-hosp-safer-wards.pdf.
- Meducation. oPortfolio—a better portfolio for medics. 2013. https://www.meducation.net/blog_posts/129-oPortfolio---A-Better-Portfolio-For-Medics.
Cite this as: BMJ 2013;347:f5012