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Hacking better outcomes

Yale Medicine Magazine, 2014 - Autumn


A marathon brainstorming session to find better ways to make hospitals more patient-friendly and better predict hospital readmission rates drew about 150 students, doctors, nurses, entrepreneurs, designers and engineers from as far away as Germany and Florida in late March.

The “hackathon”—a weekend of high octane innovation—produced a mother lode of potentially revolutionary proposals. The rich vein of ideas included a pad that monitors pressure points to prevent bed sores; a system to route, prioritize, and reduce hospital room alarms; computer apps to improve nutrition, monitor dementia patients, and provide home nursing care; an improved data model for predicting hospital readmissions for heart attacks; and a redesigned asthma inhaler.

Chris Loose, Ph.D., executive director of the Yale Center for Biomedical and Interventional Technology (CBIT), was “thrilled” with the results. “I think the quality of what we saw today was very high,” Loose said. “It was great to see the teams learning from people of other backgrounds and changing their ideas very quickly.”

Hackathons, which originated in the computer industry, throw together people from diverse backgrounds and challenge them to solve a problem. Hackers form teams that innovate solutions over a short period, typically a weekend. Mentors circulate, encouraging, criticizing, and guiding. The emphasis is on teamwork, creativity and marketability—ideas must not only address the problem, but be economically viable. The goal: supercharge and accelerate innovation.

“It’s about the notion that you can come through as problem solvers, that you can be part of the solution, part of the difference,” Harlan M. Krumholz, M.D., the Harold H. Hines, Jr. Professor of Medicine (cardiology), and executive director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation (CORE), said in his keynote address on Friday evening. Krumholz, whose group was the hackathon’s other organizer, emphasized the event’s collaborative nature. “We are not competing against each other,” he told participants. “We are competing against disease. We are competing against the indignities and inefficiencies of the medical system.”

The Hackathon grew out of discussions between Krumholz and Loose, whose group encourages medical innovation and entrepreneurship and sponsored the university’s first health hackathon in October. Inspired by that hackathon’s success, Loose wanted to do another. The pair soon realized that the goals of CORE and CBIT made for the perfect hackathon. “It just seemed like a great match,” Krumholz said.

The resulting event, held from March 27 to 29, was more than twice the size of the CBIT’s initial effort last year. The hackathon had 245 applicants, compared to about 120 at the first event.

The participants were also more diverse. Last year’s hackers came from the Yale community, but this hackathon included participants from the University of Connecticut, Johns Hopkins University, A-list Wall Street firms, and pharmaceutical companies. Many were older, including a number of accomplished doctors. Students from Yale School of Medicine, Yale School of Management, Yale School of Engineering and other schools, as well as undergraduates, also participated.

“It kind of takes a village to be innovative,” said Yale President Peter Salovey, Ph.D., who addressed the hackers on Sunday afternoon and noted that the hackathon is in line with his goal of encouraging innovation at Yale. “It’s great to see so many people from all parts of Yale, and also from all parts of the Connecticut community and beyond.”

The hackathon kicked off in lecture halls at the School of Management. Hackers were divided into groups, one looking at improving the patient experience and reducing hospital readmissions. A smaller group of statistical specialists was challenged to create better models for predicting hospital readmissions—now not much better than flipping a coin—for heart attack and chronic obstructive pulmonary disease patients.

Hackers looking at the patient experience first defined a problem and then proposed a solution. Issues ranged from the inadequacy of hospital call buttons to the difficulty of obtaining an admitted patient’s list of prescription drugs. The participants then formed teams and brainstormed solutions in the form of viable products and business plans to be presented to a panel of judges the next afternoon. The participants, some of whom worked through the night, gathered around tables and in conference rooms, where they fleshed out proposals, checked out existing products, tweaked, and tested.

One group worked in a conference room on a system to reduce multiple alarms that annoy clinicians and keep patients from getting rest. “I was blown away that there’s no notification except for the noise that it (an IV) is out,” said team member Terri Smalley, director of health and medicine IT at Yale, giving her perspective as a patient.

At a table in another part of the school, mentor Beth Hodshon, J.D., M.P.H., R.N., project director for the Yale Center for Healthcare Innovation, Redesign and Learning, encouraged a team working on an idea to put patient prescriptions on an ATM-like card. “To just swipe and read, how wonderful is that?” she said.

On Sunday, the teams presented their ideas to judges, who awarded prizes ranging from $250 to $500. The winner of the top prize, Best Patient Experience Solution, was a redesigned asthma inhaler that shows the patients if they are using the device properly—improper use is a major problem that leads to preventable hospital admissions “We’re thrilled,” said team member Justin Koufopoulos, who works for a marketing startup. “We actually hacked together two medical devices”

The team’s product was simple and inexpensive. To an inhaler, they added part of an existing instrument called a spirometer that measures inhalation rates. That enables the user to assure that their inhalation rate is correct, a common challenge when taking asthma medication. The team also added a timer so patients breathe in for the prescribed time, and a mouthpiece extender that gives them greater control.

“It goes back to that idea of dumb technology,” Koufopoulos said, noting they used existing items. “It costs $2.50 to make one.”

In the spirit of the hackathon, team members had come together randomly at lunch, discovered a shared interest in asthma—one suffers from the disease—and decided to build a better inhaler. The other winning team members were Catherine Jameson, a Yale mechanical engineering undergraduate, Angela Hasler, a Yale School of Nursing student, Linda Fong, a Yale biomedical Ph.D. candidate, and Karl Langberg, M.D., a resident at Yale-New Haven Hospital.

All three data teams shared the data prize, with one creating a new model that predicts heart attack patient readmission rates on par or better than current models. “And they did so in 36 hours,” said Krumholz.

The judges also gave prizes for best presentation, best design, best pivot and most creative use of resources. In addition, event co-sponsor Infinity Homecare awarded a prize for best change of mode/location for patient benefit and cost reduction. Teams will compete on April 23 for a $3,000 Grand Prize in which they’ll present their progress in advancing their ideas to improve patient care. “Our ultimate goal is to have these ideas mature into real products that can help patients,” Loose said. And, he is already planning more medical hackathons. “We’ll be doing this again next year and choosing a new theme and keeping it fresh,” he said.

The event was organized by CBIT and CORE, in Partnership with MIT Hacking Medicine and the Agency for Healthcare Research and Quality.

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