Hack the programme

The “geeks of the NHS” turned out in force this weekend for the very first NHS Hack Day at the University of London.

And before anyone uses the comment box to complain, “geeks” was the proud description used by event organiser Dr Carl Reynolds.

NHS Hack Day 2012 was born out of his frustration at the computer systems he has been subjected to since he started work in the NHS, and a conviction that things could be better.

The idea of the day – or rather the weekend – was simple. Software developers, doctors, and healthcare leaders had two days to come up with “disruptive solutions to problems in healthcare,” using open source software to improve the lives of NHS staff and patients.

Nice hacking

The inspiration for the event was the hack day culture that is hugely prevalent in North America, and which has even filtered through to the Cabinet Office in the UK.

However, when Anant Jani, who is part of the QIPP Right Care programme, was approached by Dr Reynolds with a proposal for the event, he was slightly concerned about the connotations of the name.

“When he used that word initially I thought the word ‘hack’ wouldn’t be politically correct. So, initially, when we were marketing it to the big wigs we called it an NHS software development day,” he told eHealth Insider.

“But eventually we gradually replaced software development day with hack so we could get the programmers we really needed on board.”

The Right Care programme, which is led by Sir Muir Gray, co-sponsored the energetic event.

It also garnered the enthusiastic support of such big wigs as the medical director of the NHS, Professor Sir Bruce Keogh, and the former chief medical officer for England, Professor Sir Liam Donaldson.

But on the day, it was the geeks who did the work – fuelled by copious amounts of coffee, a few sandwiches, and a lot of adrenaline.

“We’ve had a lot of fun,” said Dr Reynolds at the end of the event. “But we’ve also got a lot of stuff done and we really showcased the power of openness, open source, open governance and letting the small guys get on with it.”

Very different from CfH

More than 120 people attended the event, which took place over a hot weekend that most of the rest of London spent barbequing.

There was a more or less even split between clinicians and software developers, while a sole member of NHS Connecting for Health was spotted. He said Hack Day was “dynamic, interesting, productive, stimulating and very different to working for CfH!”

After registering at 8.30am on Saturday, the ‘hackers’ got busy devising solutions. These ranged from simple, yet effective, software for managing patient checklists to quite complicated computational programmes for scheduling. But each of the dozen groups had just over 24 hours to make them work.

The highly esteemed judges arrived on Sunday to see what they had come up with, and to suggest that a sea change may be underway in thinking about IT in the NHS.

Dr Clare Gerada, chair of the Royal College of GPs, told EHI that it was good to see that “it’s not the mandarins in Whitehall deciding on an IT strategy.”

“This is the young people in the profession looking at where the gaps are in their day to day practice, working together with people in IT to develop novel solutions; sometimes some simple stuff,” she said.

“It’s very nice being around people from a different environment and could potentially achieve some substantial solutions to some of those nitty, nitty issues that we face every day.”

Impressing the judges

The judging panel, which also included Sir Liam, Dr Ben Goldacre, author of the ‘Bad Science’ column, and Phil Koczan, chief clinical information officer for UCL Partners, came up with a shortlist of three potential winners, before eventually plumping for ‘Patient List.’

This was a solution for improving handovers between clinical teams. This has been a pressing issue for trusts that have had to introduce more shift working to cope with the cut in junior doctors’ hours over the past few years. 

Although, in fairness to the old guard, it is an issue that has been addressed by some NHS IT teams and commercial suppliers. Sir Liam, who has a longstanding interest in patient safety, was impressed.

“So many of the problems in healthcare, the errors, the mistakes the lapses in standards of care occur during handovers of care from one team to another,” he told EHI.

“In this modern era of restrictive hours, there is much more of a tendency for there to be a loss of continuity of care. So it is absolutely vital that the key things that need to be done for a patient can’t be overlooked or ignored.”

Given a choice, though, the geeks in the room would probably have picked the ‘Mobile Formulary’ as the winner.

A team of rebel developers scraped the British National Formulary website and put the details on an easy-to-read platform; where it could be accessed by GPs without their having to pay £30 every six months for the information.

While the move might not have been absolutely and totally legal, the BNF has certainly been forced to sit up and listen. Tweets since the event have indicated that discussions between the organisation and the developers are set to take place.

Move over NPfIT

So what did the event achieve? Ewan Davis, of Woodcote Consulting, showed that it wasn’t just the ‘youngsters’ who were keen to embrace the open platform space.

“So much has been achieved today in a way that we haven’t seen before. If you compare the progress made in the ten years and £12 billion of the [National Programme for IT in the NHS] with what has gone on today it’s a little bit embarrassing, shall we say.

“Most of the clinicians here are from the acute sector and before they have been disenfranchised and disengaged. But suddenly they have found through open source, apps, tablets and mobile devices that they can get engaged and it’s wonderful and really exciting.”

Dr Goldacre, not known for sitting on the fence, went that little bit further, tweeting: “Imagine if you gave this lot the £12 billion that was spunked away for no good output on NHS Connecting for Health.”

Sir Liam even went as far to suggest that the NHS information strategy that came out last week might have looked somewhat different if this event had occurred before its publication.

And so to the organiser himself, Dr Reynolds. By the end of the weekend he looked like he had aged a few years – organising the geeks and keeping them to schedule was by no means an easy feat – but at the conclusion he was delighted.

“I thought the event went amazingly well – the individual developers who came their talent was manifest and I think going forward this really represents an opportunity to kick-start an improvement in NHS IT.”

Next stop, Liverpool

The greatest challenge with these types of initiatives is often ensuring that the momentum is not lost. However, attendees were optimistic that Hack Day would not die.

The funding for the next two Hack Days in Liverpool and Oxford has been received, and planning is underway. But Dr Reynolds wants more.

“I think the NHS and people with procurement positions in the NHS should take note of the strategic competitive advantage that the cost reduction you can achieve by employing software developers directly or smaller business like open source can really achieve,” he said.

Sir Liam agreed. “There has been a lot of bonding between people who did not know each other before. Relationships have been developed and I’m pretty sure some of the individuals will carry out their work outside of an organised setting like this.

“It has opened up the opportunity for information and IT to move through the NHS as much more of an organic force, instead of being massive, centrally planned IT initiatives.

“This is going to be bottom-up and bottom-up things are often much more relevant to the needs and wants of patients and doctors.”