A hackathon. If you’ve not heard the word, it’s a portmanteau of hack and marathon - hack being used in its original form as a byword for exploration. A hackathon is a social sprint where teams of nerds clatter out lines of code, shun sleep, quaff energy drinks and live off cold pizza. It’s the stuff of geek lore and, on the face of it, an unlikely bedfellow for the high regulated world of digital health.
Marcus Baw, a locum GP from the North West thinks differently. His CV lists working as a doctor in prisons, anaesthesia, critical care, emergency medicine and pain management. You’ll also find mention of Ruby on Rails, agile and his side project - the Leigh Hackspace.
He co-founded openhealthhub.org - a non-profit organisation dedicated to open government, open code and open standards in health IT. He’s an open source advocate and a huge supporter of NHS Hack Days. And, for the record, he doesn’t drink energy drinks or eat cold pizza, and thinks hackathons and the NHS real do work well together.
Positives from negatives
‘As I became involved in the general practice world, I became frustrated with the systems,’ Dr Baw says, explaining how his journey into hacking and digital healthcare began. ‘These systems are often held as international exemplars of good clinician-facing systems. They’re good, but they could be so much better. They can’t be built on to provide the sorts of functionality people expect these days.’
With the seeds sown, Dr Baw was determined to help find and build solutions to the frustrations he encountered. He’s a self-taught programmer who spent his lunchtimes working through Code Academy and, along the way picked up all the necessary Linux chops too.
Dr Baw’s fascination with technology isn’t just about geekery and tech for tech’s sake however. ‘When you see the size of the challenge in health technology,’ he says, ‘…when you see the size of the problems in NHS IT… It’s the biggest challenge in medicine.’
Why is it so complex? ‘It’s high risk,’ Dr Baw says. ‘It’s complex and it’s culturally bound. It’s costly to make changes and there’s a lot of legacy kit and process out there. It’s IT’s equivalent of a perfect storm.’
The biggest prize in medicine
Openhealthhub was Dr Baw’s first foray into digital health. Originally called Open GPSoC, the project aimed to disrupt how GP software systems were bought by government.
At the time Open GPSoC was just a name and some ideas - it was an open source clinical system for GPs. The idea was to use modern standards, APIs, and to focus on interoperability and on the ability to record patient consent.
This was in 2012 and, as the project developed, the team began to realised that it had potential outside just general practice.
‘If you’ve got a truly interoperable system - one that places patient consent at its heart - you could use it anywhere,’ he recalls. ‘It could work in all areas of the NHS, private practice, community medicine and community nursing. And, the latter few in that list have no decent system. They have no technical leadership and no clinical leadership and so they end up with nothing.’
Pausing for emphasis, he says: ‘These are the big NHS IT platforms that nobody talks about.’
A different view
And set against these struggling trusts are the digital exemplars. The idea runs, Dr Baw explains, that struggling trusts will follow the digital leaders. ‘But, sadly, there are places where that’s just completely impossible because of already stretched funds,’ he laments. ‘Without clinical or technical leadership, these places are maybe fifteen years away from digital maturity. Asking them to catch up is unrealistic and counter-productive.’
Dr Baw advocates a different approach. It would, he believes, be much more productive - and honest - to focus attention on ten NHS digital blackholes. ‘Find the worst,’ he says. ‘This speaks to everyone. It speaks to the Martha Lane Fox “reach the hardest to reach first” mantra. There’s no point pushing digital maturity with trusts that are already digitally mature. What you need to do is find the trusts that are immature and help them.’
Making a change
It’s against this backdrop that Dr Baw discovered and became fascinated by hackathons.
‘NHS Hackday is the hackathon I know best,’ he says. ‘It’s close to my heart because it’s my entry point into the world of health tech. Back in 2012 I was gritting my teeth because of the GP system I was using at the time. I started Googling NHS IT and NHS Tech. I wanted to know how I could get involved. There’s no orthodox career path in digital medicine.’
Dr Baw discovered an NHS Hackday was being held in Liverpool and went along. And, he says, it changed his life.
‘I met people who changed the way I saw my job and changed my perception of what I was supposed to be doing in medicine,’ he says. Since then he’s attended every NHS Hack Day and ran an event in Manchester during 2015.
The hacker recipe
Focusing in on how the days run, Baw spells out the recipe: a venue with excellent Wi-Fi and a good supply of coffee. Big NHS Hack Days can attract over 200 people so venues sometimes need to be big. When people arrive they gather together and share ideas for projects. People then have two minutes to pitch their ideas to the group - here they need to convey the user need and the problem that they feel needs solving.
‘Why should developers help, that’s what we want to know,’ Dr Baw explains. ‘We don’t expect people to think about solutions at that point. We’ll do that during the weekend.’
Traditionally the events attract between 15 and 30 presentations. When those are done, the hackers break for coffee and talk about projects.
‘We aim for a very mixed group of people. We want clinicians, we want patients, and we want NHS tech people from trusts and from NHS Digital. And, of course, we want programmers. And we try and mix them all up. They form themselves into groups and go off and get working. They start thinking about the problem, modelling the problem and they then try and build something to solve it.’
Around three o’clock on the Sunday everybody stops working and teams get around three minutes to present their project. Despite being hard work, Dr Baw says that the events place an emphasis on being accessible and fun.
Alive and working
So, what has all the coffee drinking and hacking produced? Are there tools alive and working in the NHS that were hacked together? The answer, Dr Baw explains, is a definite yes. He points to Cell Counter - a piece of software inspired by a haematologist who noticed that, while he was looking at blood samples through an £18,000 microscope, he was using a modified abacus to count the cells that he saw. The problem was, the mechanical device was so old that new cells had, since it was designed, been discovered. The machine didn’t have enough tally registers to accommodate the new cells.
‘And, aside from not having enough buttons, when you’d done your counting you’d have to copy down the numbers by hand and take them to where your electronic patient record lived,’ Dr Baw recounts. ‘It was ridiculous.’
At the NHS Hackathon the hackers designed a very simple Python-based application that made a PC keyboard act as a counter with keys mapped to different cell types. ‘It’s extensible,’ he says. ‘If a new cell type is discovered it can be added and subject to integration - and that’s always the problem in the NHS - that data could be dumped straight into the patient’s record.’
Across the span of NHS Hackathon, Dr Baw estimates there may be five or ten products that have been produced. But, in a way, that’s not the point. ‘Beyond the direct outputs - that’s where the gold dust lies,’ he says. Hackathons changed his life and it’s likely that they’ve had the same effect on countless other lives too.
In summary, Dr Baw says: ‘NHS Hack Days have brought many people into this army that we’re building - this army of tech savvy clinicians and clinically savvy techies. It’s an army that can fix NHS IT problems. You should join.’