NHS Hack Day 10 - London

Last weekend saw us reach a milestone as we brought NHS Hack Day back to London in our tenth event in just three years!

NHS Hack Days are weekend events that bring together patients, healthcare and technology professionals and other “geeks who love the NHS” under the banner of making NHS IT less bad. It’s always a pleasure to see so many talented people come together to share their time, skills and experience to create something together, and this was no exception.

The event started with clinical staff, patients, and anyone else who felt they had a way to make the world a little better pitching ideas that they wanted to work on. Pitches start with a User Need - for instance the surgeons who need a way to track their continuing professional development, or the doctor who wants quick and easy offline access to formulary information. The attendees then pick what project they want to work on, and form teams to try and build a prototype over the weekend.

At the end of the weekend, we gathered together to share what we’d learned and what we’d built over the weekend.

Some of the stand-out projects from the weekend were The Locumator - an app which helps hospital schedulers and doctors to fill vacant slots with bank staff, and Take Your Meds - a low-tech phone reminder application that sends a configurable audio message via phone call to a patient, reminding them to use the mouthwash, or take their medication.

You can see the whole list here.

Locumator’s presentation



More information on Take Your Meds is available from their Github account

This time, our cat-herder in chief was the amazing @deckofpandas - and we’d like to thank her again for all of her hard work in making the event such a great experience for everyone involved.

Next time looks like being Manchester in Autumn 2015 - although the venue & exact date are yet to be confirmed. We’d love it if you joined us though - so do sign up to the mailing list to be kept in the loop !

Photo credits: Cléon Daniel

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What is the most cited retracted paper?

At Open Health Care we believe in Evidence Based Medicine.

Which is why we create digital health services that support research.

Unfortunately the current infrastructure supporting evidence based medicine has some shortcomings. One of these is that when a research paper is retracted because, for example, the author made up the results, there is little or no means to propogate this update in the wider medical literature.

Supposing, as a doctor, I look to a systematic review on the management of heart attacks to inform how I treat my patient, I sadly have no assurance that the systematic review does not rely on research papers that have been retracted. This is suboptimal.

Open access, post-publication peer review, and better version control would be three useful features that a modern scientific publishing model optimized to enable good science should support.

In the meantime, inspired by a lunchtime conversation with our friend and director Ben Goldacre (it was all his idea), we pondered the question:

What is the most cited retracted paper?

It turns out PubMed already has a nice API that can return a list of PubMed ids for papers that have been retracted. Next we needed a means of knowing how many times each retracted paper was cited. There are a few ways of doing this but we went with using google scholar after Alf Eaton told us about it on twitter. It’s possible to search google scholar for the articles citing a particular pubmed id, here’s an example.

Finally, we used wget to download all of the google scholar search results. This infamous paper ‘Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.’ was the winner with 2070 citations!

Here’s the top ten:

Citations Title Author Journal Pubdate
2070 Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Wakefield AJ Lancet 28/02/1998
2050 Visfatin: a protein secreted by visceral fat that mimics the effects of insulin. Fukuhara A Science (New York, N.Y.) 21/01/2005
1550 Purification and ex vivo expansion of postnatal human marrow mesodermal progenitor cells. Reyes M Blood 01/11/2001
1250 Combination treatment of angiotensin-II receptor blocker and angiotensin-converting-enzyme inhibitor in non-diabetic renal disease (COOPERATE): a randomised controlled trial. Nakao N Lancet 11/01/2003
1040 Spontaneous human adult stem cell transformation. Rubio D Cancer research 15/04/2005
825 Regression of human metastatic renal cell carcinoma after vaccination with tumor cell-dendritic cell hybrids. Kugler A Nature medicine 01/03/2000
805 Evidence of a pluripotent human embryonic stem cell line derived from a cloned blastocyst. Hwang WS Science (New York, N.Y.) 12/03/2004
755 Multiple atherosclerotic plaque rupture in acute coronary syndrome: a three-vessel intravascular ultrasound study. Rioufol G Circulation 13/08/2002
732 Structure of MsbA from E. coli: a homolog of the multidrug resistance ATP binding cassette (ABC) transporters. Chang G Science (New York, N.Y.) 07/09/2001
616 Synergistic activation of estrogen receptor with combinations of environmental chemicals. Arnold SF Science (New York, N.Y.) 07/06/1996
607 Contribution of human alpha-defensin 1, 2, and 3 to the anti-HIV-1 activity of CD8 antiviral factor. Zhang L Science (New York, N.Y.) 01/11/2002

You can reproduce our results or view our workings over on Github.

There are of course many reasons other than the author making up the results for a paper to be retracted. There are also many circumstances in which citing a retracted paper is legitimate. For a more nuanced discussion of retractions there’s a nice Comprehensive Survey of Retracted Articles from the Scholarly Literature in PLOS and the excellent Retraction Watch covers the details of individual retractions as they happen.

Anyway, it was fun to examine retractions. We’d love to explore this further so if we can be of service to you do get in touch.

Perhaps a project for NHS Hack Day?

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London NHS Hack Day Meet Up

Calling all friends of NHS Hack Day:

We’re having a meet up on Thursday 16 April, and we’d love to see you there !

We’re going to be in the George Inn near London Bridge from 18:00, and we’d love to talk to people about not just the upcoming NHS Hack day, but also any of the other ways that technology and data can make the NHS better, make new friends, & even start planning how to make some of those ideas a reality!

Where: The George Inn

When: Thu 16 April 2015 18:00-21:00

Who: Anyone & everyone ! All welcome, no specialist skills or knowledge required…

How: Just turning up is fine, but you can also add yourself to our event page.

If you’re thinking of attending NHS Hack day, have a good NHS related problem that you want to see solved, or are just curious as to what all this is about, this is a great event for you! We’ll have the @NHSHackDay team on hand, and we’re excited to hear your great ideas ahead of the event next month!

Photo credits: Andrew Smith

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It’s time for NHS Hack Day 10

NHS Hack Days are weekend events that bring together “geeks who love the NHS” to have fun, build community, and work on digital projects that promote health.

NHS Hack Day began in 2012 when Carl (a doctor) complained to his friend Tom (a developer) that things were really very broken in NHS IT. Tom who’d recently had a good experience at a Cabinet Office GDS Hack Day said the NHS should have a hack day. So we did.

The format is that we begin on a saturday morning with people pitching real-world problems they’ve encountered in the NHS or in health care generally. Anyone can pitch. We end on Sunday afternoon with a competition for the best solutions made over the weekend. In between people pick projects to work on, work on them, and have lunch (provided).

Previous NHS Hack Days have looked something like this:

Do check out some of the projects that have come fom the event and read our summary of the previous NHS Hack Day

Why should I come to NHS Hack Day?

You’ll meet bright people from different disciplines you wouldn’t usually meet You’ll play a part in making NHS IT less bad You’ll have fun

We especially want people who aren’t sure if this is for them to come, a lot of the value of the event comes from the diversity of the participants, we need you! Imposters are welcome

How do I get involved?

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Open Politics

This is a guest post by Nicholas Tollervey

The purpose of this post is to explore openness in government technology. I’ve been asked to advise on this subject for NHS England. I shall be directing the civil servants I have been working with to this article.

To many people much of this post will be old news. Unfortunately we are in the minority. Hence the need for this summary.

As always, feedback and comments are most welcome; in fact, comments will be quite useful given the readership will include civil servants who can make changes within NHS England. Think of it as an unofficial opportunity for engagement with the unelected arm of the government.

The moral argument for openness in government is simple: it is a fundamental requirement for a democratic society. Without the ability to observe what and how the government is doing, how are citizens to evaluate politicians come polling day?

Yet openness is too broad a term - in this sense it is perhaps a virtue of a good political system. Therefore I will simply state three practical embodiments of the virtue of openness:

  1. Open data - data should be freely available without restrictions of copyright, patents or other controls;
  2. Open media - data generated by the government should be in a format that is accessible to everyone;
  3. Open processes - what the government does should be transparent, recorded and accountable.

The UK Government has been vocal in the promotion of open data (point 1). Yet it is not good enough to simply publish data. The format and structure of the data is critical (point 2), as is its provenance (point 3).

Regarding point 2: what’s the point of publishing data if there’s no way for people to make use of it? After all, when data is read, analysed and interpreted it becomes useful information. Publishing data in a medium that only works with a single piece of software (such as releasing tabular data that can only be read by Excel) makes it frustratingly difficult use. While I welcome the publication of data I’d much rather it were in a friendly open format (such as releasing tabular data as a CSV).

Regarding point 3: what’s the point of publishing data if there’s no way to discover how it was compiled, by whom and with what intention? It should be possible to independently check the reports published by government through access to the raw data and (crucially) the algorithms, processes and pipelines used to aggregate, transform and generate the end result. Furthermore, an open process allows people to examine, test and improve the methodology involved in generating data. It will no longer be the case that compiling some-report-or-other is only understood by a couple of government statisticians - this essential organisational information would be available to all.

While this sounds like an onerous task for civil servants it is important to note that these three practices actually make life easier for all involved, including civil servants.

From a technical point of view, it’s impossible to work effectively in digital walled gardens where opaque solutions don’t quite work properly and are too expensive to migrate away from. Open standards allow anyone (including civil servants) the flexibility to use their own choice of tool for the job in hand as illustrated by the diagram below.

As the Cabinet Office minister Francis Maud states,

Government IT must be open - open to the people and organisations that use our services and open to any provider, regardless of their size.
We currently have many small, separate platforms operating across disconnected departments and IT that is tied into monolithic contracts. We need to have a platform for government that allows us to share appropriate data effectively and that gives us flexibility and choice.

Contrast this vision with the incumbant alternative (based on real life experiences working with statisticians within NHS England):

  • No-one wants to work in a world where the data they need for their report is held within a complex Excel spreadsheet with meaningless column names generated by a team who never answers email.

  • No-one wants to work with a spreadsheet that is subtly different each time it gets published causing doubts about its reliability and provenance.

  • No-one wants to work with a spreadsheet hosted on a website created in 2005 where the only way to get at it is to download a Java applet (the technical equivalent of the ruins of Ozymandias ) and manually press a button on a computer logged into the very special VPN that never works when you need it to.

Such a chain of opaque technology comes at great cost in terms of time, efficiency and job satisfaction. Highly trained NHS statisticians do not enjoy spending hours downloading, revising, copying, pasting and re-uploading shonky spreadsheets.

They want to work with data, not push it around.

They want to access the data, not spend hours clicking buttons.

They want to understand their colleagues’ work and know who to contact if there’s a problem.

Happily, there are signs of hope.

In the first instance civil servants should be following the Open Standards Principles from the Cabinet Office

It is a simple and easy to understand guide for using open standards in government. If you’re a civil servant working with data you should be following this checklist:

  1. We place the needs of our users at the heart of our standards choices
  2. Our selected open standards will enable suppliers to compete on alevel playing field
  3. Our standards choices support flexibility and change
  4. We adopt open standards that support sustainable cost
  5. Our decisions about standards selection are well informed
  6. We select open standards using fair and transparent processes
  7. We are fair and transparent in the specification and implementation of open standards

It is no longer acceptable to say things like, “but the needs of our legacy system mean you should use <closed technology X>”. If you hear such a remark, point the perpetrator at the checklist above. If they claim it would be too expensive to migrate, explain that it’s because it is so expensive to migrate that such a system needs changing (such expense only ever grows over time, change things sooner rather than later). If they assert that it’s not organisational policy to use open process Y ask them to justify themselves within the framework described in the policy document above (that became active on 1st November 2012). Cabinet Office advice when choosing technologies is that one should express requirements in terms of user needs and capabilities not incumbent institutional needs. Furthermore, when considering the choice of technology, they state,

All things being equal, picking technologies that developers and operations staff like will typically result in improved productivity.

A second positive is that there appear to be politicians of all affiliations who understand and have the political will to promote open standards.

Consider the following exchange between myself and Meg Hillier MP:

Here’s hoping NHS England leads the way in open standards. After all, they were born from a disparate collection of existing governmental organisations, each of whom did things differently. Openness is a way for NHS England to integrate, collaborate and work more effectively towards making the NHS the world class healthcare system it needs to be.

This is an opportunity that applies to the whole public sector. The cost of inaction would be to deny the government tools and processes essential for working effectively in a world in constant flux.

Panta rhei!

Photo credits:
Opensourceway
Pol Sifter

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