*** Vinegar, the patient from hell, on NHS Hack Day, an attempt to devise useful apps to improve health
Earlier this year I asked: Where have all the IT champions gone? My grumble was that, on one side, geeks in NHS IT departments are not pushy enough and, on the other, clinicians and NHS bureaucrats who had in their youth been techie-minded, had lost the fire in their bellies. The result is that nobody in authority in the NHS pushes the self-evident benefits of digital healthcare. This is bad for patients.
To my delight, I find I was wrong. There are hundreds of potential champions lurking around out of sight: 120 of them came out of the woodwork two weekends ago for the NHS Hack Day. They were inspired by Dr Carl Reynolds, a clinical fellow at the Department of Health, who is "frustrated by the software I use at work".
I know what he means. The clinical-hostile software was probably written by some programming clone, working for what Frank Dobson once called "the intergalactic rip-off merchants". These are people who rule the world of IT, but do not understand how to write a doctor-friendly, nurse-friendly or patient-friendly man-machine interface.
Carl's idea of NHS Hack Day was to assemble as many "geeks who love the NHS" as possible. They would include doctors, designers, developers and researchers. They were given the task of designing a useful app in 24 hours, and presenting it to the panel of judges. If successful, it could smash to bits the traditional ways of designing and procuring systems in the NHS, and make many of the large expensive private sector software houses bankrupt.
Sadly, I couldn't attend the hackday myself, but I read from various sources that the formula worked. The important thing, I gather, was that the doctors and geeks worked seamlessly together, chucking ideas and expertise back and forth in real time. This is a change from the traditional method of writing hospital software, where the design is filtered down like Chinese whispers to the programmers, who know nothing about what happens on a ward.
The hackday method is revolutionary for the NHS, only matched in the 1980s, when a lot of geeky GPs got fed up with clinical practice and wrote the first versions of the GP-friendly software we know and love today.
The whole point of the weekend was to be disruptive. The rules for the competition included a section called policy bombs. "Submissions that severely damage a government policy, or a well-funded project, simply by existing, should get an honourable mention (and their presentation sent to the appropriate bit of No 10)." I don't believe any submissions in fact earned this honourable mention, which was disappointing.
This may have been because the judges were establishment figures such as Sir Liam Donaldson, the former chief medical officer for England, and Dr Clare Gerada, chair of the Royal College of GPs. The only non-establishment figure on the panel was Ben Goldacre, writer of the Guardian's Bad Science column, who suggested in a tweet that the NfP IT's £12bn should have been given to this lot. Clare Gerada was also impressed; she hit a nail on the head when said that this kind of event could "show where the gaps are". She was hoping to see solutions where "the usable meets a need". The weekend told the establishment figures something they did not know before: the way to write clinician-friendly software. For them, it was a road-to-Damascus moment.
The winner was called Patient List, a check list for doctors on handover in a ward. This is addressing a "key critical aspect" of the space where clinical mistakes are made, and patients are most at risk. It was timely for judges to select this app in a week when it was revealed that more inpatients die in the first week of August when doctors begin their new rotations, and clearly have difficulty with the handover process. But I remember seeing something like this checklist, when I went round the Cerner demonstration rooms a year or so ago. It is not really innovative.
I understand that the geeks on the hackday would have preferred the judges to have chosen a mobile app which scrapped the Drug Formulary for doctors to check their drug prescriptions. Yes, that would have been great, but an American friend told me a year ago that such apps were common in the United States. I want to see British innovation.
Daniel Curto Millet, one commentator on the event, regretted that nurses were not present, despite being some of the heaviest users of hospital IT. The apps were designed mostly for doctors. I agree, and would add to this that patients were not there either. I am ashamed that I was not there myself. Patients are the end users, particularly in the modern age when they are supposed to get control over their own health, and they also have mobiles to help them. The patient-friendly interface is something that the developers have yet to learn.
But I mustn't carp about my personal grumbles. The NHS Hack Day was a eureka moment in the history of IT in the NHS. I am delighted that follow-up hack days will happen in Liverpool and Oxford. I am delighted that the establishment types on the judging panel have seen the light. They will ensure that the hack day will not just become another NHS pilot, which will fade away and be forgotten. Above all, I am delighted that at last the self-evident truth that clinicians should drive NHS IT, aided and abetted by developers and geeks in real time, looks likely to sink in.
Beware, however, there are powerful vested interests: multinational corporations, Department of Health bureaucrats and hospital chief information officers, who will try to kill the hack day spirit at birth. You, the new NHS IT champions, have a fight on your hands.
Read the complete post at http://www.guardian.co.uk/healthcare-network/2012/jun/06/nhs-hack-day-apps-patient-hell
Jun 06 2012, 03:30 AM
Healthcare Network | guardian.co.uk