Clinicians who code, reigniting the underground railroad tradition :-)

[Carl Reynolds]

from http://www.scata.org.uk/blog.php?id=39 complements of the author


There is a thread on Doctors.net about 'clinicians who code'.

There are several attractions for suitably-minded people

- its a fine example of 'problem-based learning'. You look up
the resources to help you solve the problem in front of you.

- you may want an application that isn't available as a
program written by someone else

- I'm not going to let this ****** box of ****** defeat me .

- This is a more useful endpoint than completed sudoku grids.

My personal preference is for perl - practical extraction and
reporting language, or perhaps pathologically eclectic rubbish
lister , initially devised by Larry Wall, whose real job is a
linguist for Wycliffe Bible Translators.

Perhaps I'm just too old for Object Oriented Programming.

Anyway a common theme on Doctors.net is that many NHS IT departments
are shall we say 'less than helpful' when it comes to providing
assistance to interested clinicians who want to use computers to solve
a work problem.

The stated reason is often security.

Ive had a perl script that mimics my personal login to a telnet
system at work and then screen-scrapes and parses out information I
needed, The view of a head honcho in IT is that they cant sanction
people 'willy-nilly' downloading data. So it's OK for me to log in and
spend an afternoon reading screens and transcribing data, but not OK
for me to use my personal login (so they know its me) in a script that
will do the same thing in 10 minutes. Of course the several hours
spent writing and debugging the script and looking up VT100 emulation
isn't counted, but I'm happy to donate that time to the cause and the
ability to take 10 mins rather than an afternoon each time I want the
data is still a time-saver.

Go figure, as they say.

There are many positives in getting interested clinicians involved in
hospital IT systems.

· Projects are likely to reflect a local problem that needs
solving.

· There is immediate user buy-in and a willing tester of
interface/system and 'clinical champion'

· Potentially hours of time will be devoted to project at no
(or minimal) cost.

Of course there are also negatives

· Enthousiastic amateurs with limited insight can be a positive
hazard. I suspect code I write isn't as secure – at least at first go
- as stuff written by people who do it for a living. So knowing what
you don't know and being receptive to advice is important.

· Lots of little projects can lead to duplication of work.

· Changes 'upstream' can stop things working if the people in
charge don't know whats dependant on what they change. The script I
telnetted into the system with was waiting for a string of text to
appear that it used for parsing out data . They replaced the line on
the page that included 'Details', the text the script looks for , so
it stopped working.

Puzzling, tedious, frustrating but easily fixable.

Security is a reason often given for blocking and stopping things.
But in the greater scheme of things, how big a threat is accessing a
system from the computer in my office ?

I think the real reasons are different.

The default is to say no – then you cannot be responsible for any
imagined, actual or perceived problems. And I think many of the people
in NHS IT are just administrators who just apply rules and have little
knowledge or understanding of the technology and hence cannot decide
whether or not a proposal is reasonable and do-able or fatally flawed.

It was also pointed out that clinicians wishing to access data and
write code are usually single knowledgeable individuals bucking a
trend of relative ignorance, both within IT departments and
clinicians. To encourage these individuals will require more thought
around information governance and the in-house technical expertise. Of
course its easier to just say no.

Interested amateurs when encouraged and guided can achieve quite a
lot. I was at a meeting in London and Prof Les Hatton had a graphic
(included in this presentation). According to his graph, the linux
kernel is one of the most secure systems in existence and has been
largely written by interested amateurs.

So given the correct environment and encouragement 'clinicians who
code' could achieve quite a lot.

I wonder if the corporate NHS will try it out ? I won't hold my
breath.



2 comment(s)

Posted by Grant on 25-Jan 2012 16:01

As you know, there are lots of us in SCATA that write code. I've
written and deployed a web-based clinical messaging system that is
being used by GPs to seek clinical advice. I had to go through my
local IT procedures to get this sanctioned but it's been a success.
Alan has numerous projects running in his area, including rota
software, critical incident reporting and acute pain audits. There are
probably hundreds of clinician-authored systems in use up and down the
UK - maybe we should take a poll !

My IT guys would never let me Telnet into anything though - very
surprised you get that option.

Posted by Alan on 03-Feb 2012 13:02

It's a mixed experience being a clinician-coder, especially with
mission-critical stuff.

Every time I go on holiday I dread problems with my Rota/Leave
software which is indispensible in 3 hospitals now, and feels like a
noose round my neck.

And part of our RCA discussion on the future of logbooks was what to
do about the significant number of third-party "RCA-compatible"
logbooks, and their trusting Users who may suddenly become "RCA-
incompatible" overnight.

[Damian Roland]

Dear Carl

Thanks for this.

I am afraid to say a lot of the terminology here is way out of my
league. However the experience of dealing with immovable and
inflexible IT departments is not. In order to deliver a research
project I have been working on we have built a website that bypasses
out own hospitals IT systems completely (having obtained appropriate
ethics and governance). It seems a shame that this is such a common
theme

I know the ehealth competency framework deals with slightly different
issues and is probably not known to 99.8% of all medical trainees but
there may be an opportunity in future revisions to deal with some of
these issues

Damian
Chair of Academy of Medical Royal Colleges Trainees Committee
Amateur app enthusiast

On Feb 23, 9:26 pm, Carl Reynolds <drc...@gmail.com> wrote:
> fromhttp://www.scata.org.uk/blog.php?id=39complements of the author