Volume 32 Number 5
[Don't Get Me Started]
I'm Still Flying
By David Platt | May 2017
I’m still flying. I just finished the best class I’ve ever taught in my life. I’m still waking up at night, pumping my fist and saying, “Yeah!” Come, see what my students and I accomplished.
I speak of the Advanced UX class that I taught this past January at Harvard Extension. It was a three-week intensive session, for which students flew in from as far away as Colombia. I decided that we’d all work together on a project, a good, important, challenging project. Where could I find such a thing?
I found a good one from Isaac Kohane, M.D., Ph.D., the chair of Biomedical Informatics at Harvard Medical School. I’d seen him speak at a Grand Rounds (a major hospital-wide presentation), decrying the innumeracy of the medical establishment, a significant impediment in this data-driven age. You might think that a guy with these credentials would be haughty and unapproachable, but exactly the opposite is true. I always found him friendly, open, interested and interesting. He goes by the nickname of Zak. And he liked the copy of “Why Software Sucks” that I gave him. When I pinged him last fall, he had a serious bee in his bonnet, and wondered if my class and I could extract it for him.
Zak’s mother lives independently at age 92. She has congestive heart failure (CHF), a condition in which the heart’s pumping action declines. Untreated CHF patients essentially drown in their own body fluids. Traditional maintenance treatment is a diuretic pill called Lasix, which causes patients to excrete their excess fluid, reducing the volume that their weakened hearts need to handle. Lasix is well understood, well tolerated and cheap ($10 for a 90-day supply at Walmart).
Patients encounter trouble when they start retaining more fluid than their regular Lasix dose can handle. Their hearts pump even less well, leading to more fluid retention, starting a vicious cycle. If you detect this situation quickly, you can reverse it with more oral Lasix. But if you don’t catch it within a day or two, the oral route stops working. The patient then needs hospital admission to get dried out with a Lasix intravenous drip over four or five days. Naturally, the patients hate that, leaving their comfortable homes for needles and catheters, antibiotic-resistant infections, and roommates who snore. Or scream. Their loved ones hate it, too, having to drop their own lives and hang out in hospitals for a week.
In addition to being unpleasant, these hospital episodes cost about $25,000 each. About 6 million adults in the United States have CHF (see bit.ly/2msAnbh). The admission rate is stubbornly stuck around 1 million per year (see bit.ly/2mJ9sbU). Do the math and you’ll see that the cost of this one problem is approaching 1 percent of the total U.S. health care budget.
Micro or macro, these CHF hospital admissions really suck. Could my class help?
After his mother needed two hospital admissions in 2015, Zak wondered if he could detect excess fluid retention by monitoring her weight, intervening in time to correct any imbalance orally. He gave her a Fitbit Aria bathroom scale (fitbit.com/aria), which uploads its measurements to a user’s Web account. She stands on it every day, usually in the morning, and Zak checks the value sometime during the day. If she’s up a pound or more, he tells her to take another Lasix, and checks the next day to make sure that she’s back down. Following this regimen, he managed to avoid any admissions in 2016.
Now Zak had a proof of concept. Not-too-invasive monitoring on consumer-grade hardware and software could produce large benefits. How much better would a dedicated program be? He wanted to view the patient’s weight without the other distracting items in the full Fitbit UI. He wanted to scroll back and forth to see the patient’s weight history graphically. He wanted to record when and how much medication he prescribed. And, of course, he wanted it to run on his iPhone. Could we design one for him quickly?
Watch this space next month for the exciting conclusion. Be there! Aloha.
David S. Platt teaches programming .NET at Harvard University Extension School and at companies all over the world. He’s the author of 11 programming books, including “Why Software Sucks” (Addison-Wesley Professional, 2006) and “Introducing Microsoft .NET” (Microsoft Press, 2002). Microsoft named him a Software Legend in 2002. He wonders whether he should tape down two of his daughter’s fingers so she learns how to count in octal. You can contact him at rollthunder.com.