Hackday system has best chance of overcoming bureaucratic regulatory process that stops apps getting traction they need
It is no accident that General Practice has innovated and embraced IT, whilst Hospitals are still in the dark ages. GPs are self employed and have some control over their own business, whilst consultants are now mainly disengaged from the managerial process… and have no holistic overview to help facilitate the universal primary care based IT system that is needed in hospitals.. In The Information Age patients expect to be empowered, and to exercise choices. Social workers should be able to access the necessary information from hospital notes which are joined up with the GPs. Given this deficiency, and the difference in speed and quality in private systems, those able to are using their feet more and more, thus creating a more unequal and two tier society…… Rationing by reducing access and standards in OT, Physio etc. is not an ethical way to proceed.
Two years ago, I came across a great new way of writing healthcare software at an NHS hackday. The idea behind a hackday is that clinicians and software writers decide on an app for solving a “real-ward” problem; design and write it within 24 hours.
This disrupts the traditional way of writing hospital software, where administrators give a series of Chinese whispers to systems analysts in an intergalactic software house possibly on the other side of the Atlantic. The systems analysts transmit further Chinese whispers to a set of programmers who have no idea what happens in an NHS hospital. The resulting system overruns by several years, costs millions and proves to be non-implementable by nurses and doctors on the ward.
The hackday system has a better chance of success, because the clinician is at the heart of the design process. The system is designed to be tweaked; if it does not work, it can be binned, and because it is written in open source, it can be latched on to mainstream systems.
Attracted as I was by all this disruptive thinking, I was worried that the young chaps writing apps would not realise three things; the importance of making their programmes interoperable, that regulators will demand proof that the apps are safe, and that selling and marketing software in the NHS IT chaos is a nightmare.
To see how these disruptive guys were getting on, I attended the Handi Digital Health Spring Symposium last month. Handi (Health Apps Network for Development and Innovation) helps startups to write apps for healthcare and is the intellectual powerhouse behind the hackday approach to writing healthcare software. It believes in open source, fast prototyping, co-production (clinicians and geeks), crowdsourcing, multiple platforms – PCs, tablets and smart phones – and disruption, to keep the hospital IT bosses rattled.
At the symposium, I found that the Handi people were not just innovative geeks with bright ideas, but were well aware of the “real world”. They have to get through a bureaucratic NHS approval and regulatory process, to have the app registered on the NHS app store. One speaker claimed that testing could take eight months.
They had to learn how to design user interfaces that are suitable for the customer. The interface for clinicians, nurses and patients would have to be very different from one another. The medical content has to be “both trustworthy and engaging”.
They have to cope with an evolving and rather chaotic world of standards: syntactical, communications and semantic. One speaker claimed that “semantic interoperability in health is impossible”. And even if an app developer conforms to interoperability standards, they will have to allow for fussy hospitals to make hospital-specific tweaks.
But the real nightmare is marketing the apps. The developers will have to cope with the NHS’s pervasive NIH (not invented here) syndrome. “Kent might order your app but Sussex will not.” And it is no good trying to get central support for your app, as the local level will reject any directive “top down” from the centre. And clinicians will demand evidence of the effectiveness of your app. They seem to think that evidence is the result of the kind of RCT (randomised controlled trial) that is used in approving drugs. The startup software house would be bankrupt by the time such an RCT were completed. Not a very helpful environment, then, for apps to flourish.
One fruitful approach would be for developers to associate themselves with hospital trusts or charities, and work with them to develop apps. That interest from trusts interested in co-operation of this sort was shown by the number of delegates from trusts – about a third of the total – who attended the symposium.
Another target of co-operation is large computer companies. Last week, there was a breakthrough. Apple launched Healthkit, a platform on its iPhone, iPad and iMac, to gather “health-related data from a variety of sources”. In the past, Apple and other developers have built health applications, but these have been standalone. Healthkit is “designed to give users a big-picture look at their entire health profile: exercise, sleep, eating and even metrics like blood pressure and glucose levels”.
Apple is signalling its entry into the healthcare market. Samsung made a similar announcement the previous week. We can expect the mobile apps market to burgeon over the next few years, with sensor-laden iWatches and other wearable devices.
I hope British Handi-style apps developers will join, or maybe lead, the gold rush. But the danger is that the fragmented anti-innovation culture of the NHS will kill them off.