When I was a med student in 2009, I did my surgery rotation at a community hospital outside of Boston. Each morning two students were responsible for copying down overnight vital signs from the EHR onto paper. The job took upwards of 45 minutes, and morning rounds were at 6am...
I didn't mind driving through icy Boston roads at five in the morning -- but I did mind the fact that I was doing a job that computers should be able to do far faster and more accurately.
The EHR was a terminal-based system, and I wound up routing traffic through a local proxy, analyzing the logs, and figuring out how the protocols worked. (I'm sure that reading about terminal emulators would have been more effective than reverse engineering them; I can only blame sleep deprivation.) I ultimately built a Python script to drive the terminal based on a list of medical record numbers, recording vital signs and slotting them into pre-formatted progress notes for printing. It even plotted sparklines for fever curves.
It worked. And the chief of surgery loved it. He wrote me a stellar evaluation that prominently mentioned my work with the computer system (I also did good clinical work and all).
Two months later when the medical school dean read my evaluation, I got a very angry phone call. She was horrified that I had "hacked" into the computer system and taken matters into my own hands. I tried my best to explain how the system worked, and why it wasn't a threat. But I didn't really get the message across.
The upshot, though: I realized just how broken healthcare information systems were -- and that I enjoyed working on solutions. After medical school I joined the research faculty at Boston Children's Hospital, where I'm working on open specs, tools, and standards that make it easier to integrate third-party health apps with clinical data and EHRs [1]. It's been an interesting ride -- and I've learned an incredible amount about health interoperability, politics, data, and security along the way.
Do you know the guys working on XTK [1]? They are also working out of Boston Children's Hospital. They have an awesome medical library for webGL based applications. If so, tell them I say hi!
Your story reminds me of my current struggle with a massive medical company in orthopedics and when I learned to never say the word hack again. I was brand new to medical working with WebGL to create a web based bone cutter app for surgeons. Marketing was behind this project idea and had to have it on the Ipad. I used ludei [2] to natively port it to Android and iOS support wasn't completely implemented when I presented to marketing. They demanded it be on the Ipad, I could promise if & when it would be available but suggested a possible 'hack' to get around the Ipad's webGL limitation. They flipped shit on the word hack and went bezerk. I feel your pain.
Somewhat offtopic---do you have an opinion on ludei vs. phonegap, or know someone who does? Working on a js project I'd like to port to mobile, and somewhat bewildered by the choices...
PhoneGap just runs on the built-in web controls of the platform. Ludei reimplements the web control to run faster. Generally you only use the latter for games and graphics intensive apps.
I haven't personally used phonegap. I have had a fried/co-worker who really likes it though. For me personally, ludei solved the problem of getting WebGL to run on the other devices and that's why I used it. I think phonegap is more well known compared to ludei (just my personal feeling) and thus may have a bigger community around it. If it's an application I would say look into phonegap if it's a game look into ludei. Or try both and see which one you prefer.
She was horrified that I had "hacked" into the computer system and taken matters into my own hands.
I've never understood this reaction (which I've gotten from elementary school teachers upon showing them a C64 program that printed my name). Probably something to do with insecurity and ignorance.
This is an area that liability is called into play. If the wrong details are printed out for a patient and a bad decision was made based upon them, then you probably know what a hard time you would have had.
It is fantastic to see that you are working to help fix the problems!
Comments
When I was a med student in 2009, I did my surgery rotation at a community hospital outside of Boston. Each morning two students were responsible for copying down overnight vital signs from the EHR onto paper. The job took upwards of 45 minutes, and morning rounds were at 6am...
I didn't mind driving through icy Boston roads at five in the morning -- but I did mind the fact that I was doing a job that computers should be able to do far faster and more accurately.
The EHR was a terminal-based system, and I wound up routing traffic through a local proxy, analyzing the logs, and figuring out how the protocols worked. (I'm sure that reading about terminal emulators would have been more effective than reverse engineering them; I can only blame sleep deprivation.) I ultimately built a Python script to drive the terminal based on a list of medical record numbers, recording vital signs and slotting them into pre-formatted progress notes for printing. It even plotted sparklines for fever curves.
It worked. And the chief of surgery loved it. He wrote me a stellar evaluation that prominently mentioned my work with the computer system (I also did good clinical work and all).
Two months later when the medical school dean read my evaluation, I got a very angry phone call. She was horrified that I had "hacked" into the computer system and taken matters into my own hands. I tried my best to explain how the system worked, and why it wasn't a threat. But I didn't really get the message across.
The upshot, though: I realized just how broken healthcare information systems were -- and that I enjoyed working on solutions. After medical school I joined the research faculty at Boston Children's Hospital, where I'm working on open specs, tools, and standards that make it easier to integrate third-party health apps with clinical data and EHRs [1]. It's been an interesting ride -- and I've learned an incredible amount about health interoperability, politics, data, and security along the way.
1. http://smartplatforms.org/
Do you know the guys working on XTK [1]? They are also working out of Boston Children's Hospital. They have an awesome medical library for webGL based applications. If so, tell them I say hi!
Your story reminds me of my current struggle with a massive medical company in orthopedics and when I learned to never say the word hack again. I was brand new to medical working with WebGL to create a web based bone cutter app for surgeons. Marketing was behind this project idea and had to have it on the Ipad. I used ludei [2] to natively port it to Android and iOS support wasn't completely implemented when I presented to marketing. They demanded it be on the Ipad, I could promise if & when it would be available but suggested a possible 'hack' to get around the Ipad's webGL limitation. They flipped shit on the word hack and went bezerk. I feel your pain.
[1] http://www.goxtk.com
[2] http://www.ludei.com
Somewhat offtopic---do you have an opinion on ludei vs. phonegap, or know someone who does? Working on a js project I'd like to port to mobile, and somewhat bewildered by the choices...
PhoneGap just runs on the built-in web controls of the platform. Ludei reimplements the web control to run faster. Generally you only use the latter for games and graphics intensive apps.
I haven't personally used phonegap. I have had a fried/co-worker who really likes it though. For me personally, ludei solved the problem of getting WebGL to run on the other devices and that's why I used it. I think phonegap is more well known compared to ludei (just my personal feeling) and thus may have a bigger community around it. If it's an application I would say look into phonegap if it's a game look into ludei. Or try both and see which one you prefer.
Winslow, would you send me an email? Thanks, Jim
I've never understood this reaction (which I've gotten from elementary school teachers upon showing them a C64 program that printed my name). Probably something to do with insecurity and ignorance.
This is an area that liability is called into play. If the wrong details are printed out for a patient and a bad decision was made based upon them, then you probably know what a hard time you would have had.
It is fantastic to see that you are working to help fix the problems!
Great story josh, thanks. Medical IT systems are similarly antiquated here in the UK.
Winslow, your thoughtful comment here is dead, not sure why, best contact admins.
Meditech?