The clinician-programmer: designing the future of medical practice

Those with skills in computer programming have many opportunities to improve the way we learn and practise medicine. While such skills were once the preserve of computer scientists, some clinicians are learning to harness this technology for the benefit of doctors and patients.

Almost three quarters of UK junior doctors carry smartphones,1 presenting the would-be software developer with a wide market for healthcare apps. As of June 2013, almost 20 000 active medical apps were available to download from the iTunes store.2 These range from widely used clinical calculators, evidence based medicine tools, and reference texts to more esoteric tools, such as an app for remote diagnosis of otitis media with a phone mounted otoscope.

Doctors have contributed to these growing numbers in response to identified clinical needs, such as the BurnMed mobile app.3 Although the clinical accuracy of some apps can be difficult to ascertain and few have been externally validated, the potential for improving work efficiency and patient care is undeniable.

Beyond apps, efforts have been made to assess objectively the utility of e-medicine interventions. One such example is the automation of data collection in the management of chronic diseases.

Canadian primary care physicians collaborated with a healthcare information technology (IT) company to develop an easy access “dashboard” of collated information for regular diabetes check-ups. This decreased time spent using the computer and increased accuracy of information retrieval from health records.4

An approach to audit that has existed for a long time in the commercial and finance sector is now being adopted to combine electronic decision support and clinical data collation. A group of Australian general practitioners, collaborating as part of the Treatment Of cardiovascular Risk in Primary care using Electronic Decision suppOrt (TORPEDO) study, aimed to improve the care of patients with cardiovascular disease.5

The tool created to tackle this, HealthTracker, uses an algorithm to estimate cardiovascular risk based on established clinical risk calculators and collates data for audit and quality improvement, which are automatically exported to an online database.

Such approaches show how doctors can take a leading role in creating and improving healthcare IT systems, in collaboration with software designers and as designers themselves.

Beyond clinical practice, training and revalidation are now largely electronic, with the e-Portfolio, e-Logbook, and e-Learning modules replacing their paper counterparts. Effective training and revalidation software must be simple to access, high quality, and deal with feedback from users.

The Royal College of Physicians has called for doctors to be involved in the design and approval of the online revalidation portfolio currently under development by IT company Equiniti 360o Clinical. Some doctors are even programming their own open source portfolio to rival the existing NHS model.6

The Department of Health has also recognised the need for doctors to engage in modernising healthcare through IT. The department’s Information Strategy,7 launched in May 2012, has outlined proposals to fully connect patients to healthcare services via the web within the next decade.

A forerunner to these plans was the NHS Direct mobile app that supplements the telephone service. The app, now one of the most frequently downloaded medical apps, was created with input from a team of nurses and tested and approved by a variety of healthcare professionals including doctors.

Doctors are also taking a more active role in identifying clinical problems and developing workable solutions through programming. The newly established NHS Hack Days (http://nhshackday.com) is an example of this in action, as a regular interdisciplinary event for doctors, software engineers, and other healthcare professionals. Outputs from these sessions have included the Wait Less project (http://waitless.herokuapp.com/), which allows patients to compare waiting times for their local emergency services in real time.

For those interested in learning a programming language, access to high quality online tuition has never been easier. The rise of Massive Open Online Courses (MOOCs), as profiled in a recent BMJ article,8 has had an enormous impact on medical learning, and computer programming is no different.

Free courses in the basics of computer programming languages such as HTML, Java, and Python can be found on websites such as Code Academy, Code School and W3Schools. For those looking for an informal introduction, the Digital Doctors podcasts and blog (http://thedigitaldoc.co.uk) created by a group of UK based clinician-programmers provide a healthcare focused viewpoint.