Interview with the Dr. Pieter Kubben, the Digital Neurosurgeon and iPhone Medical App Developer – From checklists to the future of EMR

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It is a great pleasure to present this interview with Pieter Kubben, a Dutch neurosurgeon who is an impressive amalgam of clinician, researcher, and software engineer. He is currently in a neurosurgical residency while completing a PhD in intraoperative MRI-guided surgery for brain gliomas. As if this is not enough, as a “hobby” (his term), he also writes software, with a particular interest in computerized decision-support systems.

He has three iPhone applications currently in the App Store, including his newest one implementing the WHO surgical checklist(iTunes link). His other apps, Neuromind and SLIC, have been downloaded 8,000 times. Importantly, he is not just writing the software, but is also publishing his ideas in medical journals to spur changes in the way clinical decisions are made in the future. We encourage you to follow his blog at http://digitalneurosurgeon.com or on Twitter @DigNeurosurgeon. It is exciting to see a one individual with so many talents and to think about the great ideas yet to come from someone with such broad perspectives – we delve into some of those ideas in this interview.

1. When did you first start programming ?

My parents bought their first pc when I was 17 years old. I started web development in HTML one year later, and my first programming experience was Delphi. Afterwards, I started focussing on web development with PHP and MySQL. Using these technologies, I created a collaborative web-based framework focused on web and mobile computing and won two international awards. Now I am working in Adobe Flex / ActionScript and the iPhone for clinical decision supporting systems (CDSS). More information is available from my website (http://dign.eu if you don’t like typing long URLs ;-) ).

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2. Did you ever consider a career in software or IT ?

Yes, I even have been invited for a healthcare IT job by an international medical software company. They found me using a headhunter, which was quite flattering. However, I do have some strong ideas, which I suspect would not fit well within such companies at this moment in my career. I prefer the combination of being a clinical doctor (neurosurgeon in training) while spending a part of my time on healthcare IT. That is the reason why all my software is currently free. Maybe I need to incorporate some financial aspects in the future, to keep the system running. But at this moment, that’s not keeping my mind occupied. My goal is improving the software in such a way that it can really make a difference.

3. Why do you think doctors have been resistant to adopting information technology in their work ?

There are many ways to Rome, and one is not necessarily better than the other. Up to now, you could talk about “believers” and “non-believers” but current research is starting to show the benefits of CDSS and mobile computing for physician guideline adherence, and this may help to convince more doctors in the future. I suggest looking at the study “A Computerized Handheld Decision-Support System to Improve Pulmonary Embolism Diagnosis” by Roy et al (Ann Intern Med 2009). With regard to evidence-based practice, I think this study did an important job. Further, the young doctors who are more familiar with such technology will be more likely to use it, which will also help to demonstrate the added value of such techniques. I hope this will lead to initiatives from medical doctors. I would not want politicians and healthcare insurance to tell us doctors how to practice medicine.

4. How did you decide to implement cervical spine injury classification as an iPhone app ?

Cervical spine injury is an important issue in neurosurgery and orthopedic surgery. It requires urgent diagnosis and a treatment plan. There is a good classification available by Vaccaro et al (Spine 2007, vol 32 (21) p 2365-74 ) and evidence-based guidelines for surgical treatment by Dvorak et al (Spine 2007, vol 32 (23) p 2620-9 ). Both offer imporant advice, but you need to bring it to the patient. For my own work, I am convinced that having it available on a mobile platform helps. That’s why I developed the software, and wrote a manuscript about it which I intend to offer for publication within some months.

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5. How did you decide to implement the WHO Surgical Safety Checklist as an iPhone app ?

For the same reason. A publication by Haynes et al (NEJM 2009) has shown clear benefits of using this checklist. The book “The Checkllist Manifesto” by Atul Gawande, the WHO Safe Surgery programme leader, is also very inspiring. Whether you prefer to talk about checklists, e-guidelines or CDSS, I think the message is the same: we cannot remember everything, and we make mistakes. If we’d remember 9 out of 10 issues, we do great in high school. However, we may cause disasters in medicine if that last 10th item is crucial. For that reason I do believe we should use CDSS and stop pretending we’re too good for that. We’re not.

6. How has blogging affected your work as a doctor ?

Not that much, I guess. I try to update my blog a couple of times in a month, sometimes twice a week. Most of my IT time goes into software development, but I also like to explain a little of what I am doing. And both my blog and Twitter give me a chance to get in contact with similar minds. So if people have questions or want to contact me, they can visit my website or Twitter.

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