# Health IT is a growth area for programmers

## New report covers areas of innovation and their difficulties

O’Reilly recently released a report I wrote called The Information Technology Fix for Health: Barriers and Pathways to the Use of Information Technology for Better Health Care. Along with our book Hacking Healthcare, I hope this report helps programmers who are curious about Health IT see what they need to learn and what they in turn can contribute to the field.

Computers in health are a potentially lucrative domain, to be sure, given a health care system through which $2.8 trillion, or$8.915 per person, passes through each year in the US alone. Interest by venture capitalists ebbs and flows, but the impetus to creative technological hacking is strong, as shown by the large number of challenges run by governments, pharmaceutical companies, insurers, and others.

Some things you should consider doing include:

Join open source projects

Numerous projects to collect and process health data are being conducted as free software; find one that raises your heartbeat and contribute. For instance, the most respected health care system in the country, VistA from the Department of Veterans Affairs, has new leadership in OSEHRA, which is trying to create a community of vendors and volunteers. You don’t need to understand the oddities of the MUMPS language on which VistA is based to contribute, although I believe some knowledge of the underlying database would be useful. But there are plenty of other projects too, such as the OpenMRS electronic record system and the projects that cooperate under the aegis of Open Health Tools

Like the rest of the software industry, health innovators are moving to Software as a Service. In fact, SaaS may be inevitable because so much in health depends on access to large quantities of data (such as patient symptoms or hospital quality metrics), thus calling for a cloud solution. Developing a SaaS product does not conflict with releasing valuable code as open source. Doing so permits more contributors and more eyes on bugs, as well as letting other experts assure you the code is accurate and secure.

Aside from coders, open source projects can also use help with requirements definition, documentation, marketing, and business models. Weaknesses in these areas may be the reason free software has not been adopted as widely as perhaps it should. The Information Technology Fix examines more of the reasons free software goes with health.

Data science

Health care in supremely amenable to improvements through the application of statistics, data mining, natural language processing, and related technical disciplines. If you have training in any of these areas, seek out health-related specifics and consider putting your valuable knowledge to use curing humanity. The O’Reilly book Anonymizing Health Data is an example of the applied knowledge available in such areas.

Health data reflects the challenges of data in every field, but often to an exaggerated degree. Take data quality, for instance: arbitrary differences in the ways clinicians code and enter data make the extraction of useful insights from patient data pretty hairy. The representativeness of data sets is also shaky: what you get from any particular insurer or hospital is skewed toward the particular population they get, affected by things such as geography and ability to pay.

Privacy concerns also get nearly hysterical at times. The HIPAA law and regulations are famous and rightly feared by doctors and administrators, but aren’t something most programmers have to deal with. Such legal provisions apply mostly to choices made by clinicians and their institutions. Your own privacy concerns should focus on treating patients with respect and not doing things that would freak them out. In addition, follow good practices in secure coding: robust authentication, static analysis of code or other techniques for detecting bugs, and segmenting data sets so an attacker cannot easily link a patient to sensitive information.

Develop medical apps and devices

Big advances can come from bringing data and analysis right into the palm of the doctor or consumer. New hardware is promising, and people who can hook up a new device to electronic records may unveil whole new ways for people to get healthy. But an impressive amount can be done with the devices and computing power of a typical smartphone too.

Don’t worry about the FDA, which has been in the news recently. The FDA has an important job protecting the public, but you will know long in advance whether you need to conform to their regulations. They have no desire to regulate thousands of apps, or to keep clever developers from innovating. Still, if you claim to fill a medical role, you will have to run studies to prove you do it right. Whether or not the FDA regulates you, doctors and insurers will want evidence they’re investing in something that works.

Go to hackathons and challenges

These are great ways to meet people in the health field, notably the clinicians and patient advocates who can explain what they really need from you, as well as people bringing valuable disciplines like design and marketing. Hackathons are routinely offered by hospitals, insurers, and government agencies, drawing experts from hundreds or even thousands of miles. Indeed, successful businesses have been formed by people who met at hackathons.

Learn the standards

There are so many standards in health IT that you’d think the industry has its act together, much more than they really do (or want you to think they do). As one example of the gap between aspiration and achievement, makers of imaging equipment have come to universally support a standard called DICOM for representing the image. But they are all on their own when representing the radiologist’s markup, which is what clinicians need to make sense of the image. Another example of problems with standards is the creation of a Frankenstein XML format on top of an old set of standards, HL7. Finally, at the center of health care where the patient’s electronic health record reigns, no standards exist–the variety of formats will make you dizzy.

Nevertheless, adhering to standards is sometimes critical. For instance, put the wrong diagnosis code on a patient visit and you don’t get paid for it. Clinicians desperately need programs that convert between standards or compare data in different standards. Right now, US hospitals are preparing to submit diagnoses to insurers in two formats–versions 9 and 10 of the International Classification of Diseases–as the country makes a transition from the older version to the newer.

So remember that if you talk about “coding” to a doctor or hospital administrator, they’ll think you’re talking about writing up patient information. And find out what standards exist in the area of health where you want to work. Learn the standards, and advocate for their adoption or their replacement with something better.

If these things pique your interest, check out my report for more background that can help you choose a path. I’ll just end with two pieces of advice.

First I’ll reiterate the importance of respecting patients when collecting and using data. The world of health apps is just taking off, and already we see questionable ethics among practitioners, who are hoarding data and using it for marketing. We have to find business models that don’t bring shame when publicly revealed.

Second, user interfaces are crucial. The programmer doesn’t have to be a UI or UX designer, but should respect the time and limited technical training of the patients, doctors, and other people using the systems. Find out exactly what they need at each crucial moment when they’re interacting with you, and give them just that. Don’t overwhelm them with detail, don’t mindlessly pop up windows, and use intelligent programming to minimize keystrokes. Keep small form factors in mind, because everybody wants their data on the go and will expect mobile devices to display your application.

I look forward to more discussion of these trends. Feel free to comment here, and write your own articles about your experiences. Expand on my report, or rebut parts. If you want to comment to me privately–or suggest ways to promote the report–please write to infofix@oreilly.com.

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