Hacking a Better Health System

Who knew hacking might help us reinvent our health care system?

I must be old-fashioned, or at least not a true techie, because I still thought of hacking as a bad thing, like all those cyber-criminals trying to get at our sensitive data, a problem for which health care continues to be a target.  I was thus surprised to read in The Wall Street Journal that “hackathons” are a trend for the good in health care. 

For others who are also behind this particular curve, hackathons are intense, all-night (or more) sessions when a small groups of programmers band together to attack tough specific problems with concentrated coding efforts.  If you’ve seen The Social Network or other depictions of the tech world, with scenes of unkempt young men (and they are almost always young men) sitting around furiously pounding away on their keyboards while surrounded by cans of Red Bull and boxes with leftover pizza slices, you probably get the picture.

The Journal article highlighted MIT’s Hacking Medicine’s Grand Hackfest, which is part of MIT’s Hacking Medicine initiative.  MIT has been at this since 2011, seeking synergies between MIT’s technical expertise and the vaunted Boston-area medical community.  They believe hackers can help health care with: Scaling Medicine, Accelerating Data, Identifying and Tackling Big Opportunities, Hacking Ethos for Lean Medical Innovation, and Infecting Non-Life-Scientists with the Mission. 

Pretty lofty list of goals.

Health 2.0 – which “promotes, showcases and catalyzes new technologies in health care” -- has their own version, which they call Code-a-thons.  They offer some $6.5m in prizes in their developer challenge, and have several events and challenges scheduled in the next few months.  As their recent San Diego code-a-thon illustrated, these are not necessarily big prizes nor huge breakthroughs, but they serve the purpose of getting more people excited about solving problems in health care.

Goodness knows that health IT has never been known for being either nimble or on the cutting edge, so some fresh blood with new perspectives certainly seems like a good idea, right?  As one clinician whose mobile app benefited from solutions suggested at the MIT hackathon said, "Sometimes when you are too close to something, you stop seeing solutions, you only see problems.  I needed to step outside my own silo.''

Not to be outdone by Boston, New York-Presbyterian Hospital recently held what they claim was the first Hackathon for New York Hospitals, which the specific aim of helping them improve myNYP, their patient portal.  I’ll be interested to hear if and how they incorporate the results.

Out on the other coast, UCLA-Berkeley has had three iterations of their own version, Hacking Health.  Last year’s event focused on Digital Health, and attracted 18 teams working on a wide variety of problems, such as Google Glass-enabled paramedic app. 

Stanford has their Medicine X initiative, described as “the intersection of medicine and emerging technologies.”  At their annual conference, one of the events is the IDEO Design Challenge, which aims to attract various stakeholders to develop solutions to use technology improve patient care.  This year it will focus on assisting chronic care patients with managing their condition through technology. 

Just to rub us oldsters’ noses in it, there’s an organization called YTH (youth + tech + health) that believes the “#selfie generation” can do better.  As Jamia Wilson, YTH’s Executive Director, says, “the time has come for young people to be treated as designers and developers for health technology solutions that serve them and their communities on their own terms.”  They just hosted their own Health Hackathon in conjunction with their YTH Live 2014 conference.     

The trend is not limited to the United States.  The British National Health Service has NHS Hack Days, in Canada there is Hacking Health, and in Europe there’s CPH Health Connect HackDay in Copenhagen and Hacking Health Stockholm.  I’m sure this is by no means an all-inclusive list, but it is big enough to indicate there is something going on here.

Not to wander too far away from health, but the health sector is not the only one which seeks value in hacking.  Late last year Intel bought Hacker League,  a platform for managing hackathons, while Booz Allen Hamilton just announced a partnership with start-up incubator 1776, formalizing a collaboration they’ve had for the past year as they’ve hosted “hackcelerators,” which aim to combine hackathons and small business accelerators.  If stalwart companies like Intel and Booz Allen Hamilton see a future with hacking, it could mean it is here to stay…or that its moment has already passed.

Looking back at last fall’s healthcare.gov debacle, or more recent reports of similar issues with various state exchanges, one has to wonder if they just should have held a hackathon.

PwC’s 6^th Annual Digital IQ Survey found that healthcare CEOs were far ahead of other industries in championing information technology as an integral part of their strategy.  I rather doubt that many health systems or payors are using hackathons for their big mainframe-based systems – like eligibility, billing, claims payment, or (most) EHRs – but mobile efforts are natural targets for this kind of approach. 

There’s no shortage of targets.  Payors are finding ways to use mobile technology to cut administrative costs, engage members, and manage patients’ care.  Aetna is one payor in particular which brags about their IT strategy, especially in mobile, such as their iTriage app and an upcoming monitoring device called Scanadu Scout. 

The Mayo Clinic recently reported one of their apps reduced cardiac readmissions by 40%, no small triumph in an era when Medicare and private payors are hitting hospitals with penalties for readmissions.  And, of course, Apple is rumored to soon be getting in the health space, through a body monitoring device called Healthbook. 

Still, in a recent Robert Half Technology survey of CIOs, health care led the pack in lacking a mobile strategy, with 36% reporting their organization had none, which perhaps why the Harvard Business Review recently pointed to insurers’ untapped digital opportunity. 

No wonder they might be looking for hackers.   

It’s great to bring in new ways of attacking the many problems of health care, but I do worry what happens when they hit the may brick walls health care has.  I’ve been seen several instances where non-health care companies – especially financial services firms -- dipped in to health care, thinking they could bring their expertise to bear, only to be shocked at how messy much of the data is.  Exactly who the patient/member is, what services they received, how much should be paid – questions whose analogs in other industries would be clear-cut are often very murky in health care.

And, of course, people have proven dismayingly stubborn about how they take care of their own health – just look at our obesity rates.  For all the buzz about the potential for “wearable technology” in health care, a recent survey found that a third of users stopped using it within six months.   Changing bad health habits is hard, hard work.  There’s not just an app for that.

It’s one thing to build a nifty single purpose app in the health space, but the heavy lifting is connecting all the many pieces and players together, especially in a way that patients understand and buy into.  And, of course, the usual M.O. in health care is to charge lots more even for small improvements, as The New York Times recently highlighted.  A typically close minded approach in health care is the trend towards “medical scribes” to transcribe into an EHR (which I’ve talked about before) instead of simply making EHRs fit better into how physicians practice.  Why reengineer processes and technology when we can simply add costs?   

That’s got to change. 

What I like best about the hacking in health movement is twofold – bringing in new kinds of expertise and an attitude that problems can be solved.  Those have been sorely missing in health care.  Or, as Mark Twain once put it, “all you need in this life is ignorance and confidence, then success is sure.” 

Hack away!