If you’ve been watching the news or twitter over the past week, you may have seen the appendicitis-related headlines about unnecessary operations being performed. The RIFT collaborative and Dmitri Nepogodiev have really spearheaded some cool work looking at who gets unnecessary operations, which are all well worth a read:
(Selected news coverage):
So, when Dmitri asked if I could develop a web application for risk scoring to help identify those at low risk of appendicitis, I was very excited.
Having quite often used risk calculators in clinical practice, I started to write a list of what makes a good calculator and how to make one that can be used effectively. The most important were:
- Easy to use
- Works on any platform (as NHS IT has a wide variety of browsers!) and on mobile (some hospitals have great Wi-Fi through eduroam)
- Can be quickly updated
- Looks good and gives an intuitive result
- Lightweight requiring minimal processing power, so many users can use simultaneously
Now we use a lot of R in surgical informatics, but Shiny wasn’t going to be the one for this as it’s not that mobile friendly and doesn’t necessarily work on every browser that smoothly (sorry shiny!). Similarly, the computational footprint required to run shiny is too heavy for this. So, using codepen.io and a pug html compiler, I wrote a mobile friendly website (Still a couple of tweaks I’d like to make to make entirely mobile friendly!).
Similarly, I get asked why not an app? Well app development requires developing on multiple platforms (Apple, Android, Blackberry) and can’t be used on those pesky NHS PCs. Furthermore, if something goes out of date or needs to be updated quickly – repairing it will take ages as updates sometimes have to be vetted by app stores etc.
My codepen.io for the calculator:
Codepen.io is a great development tool and allows you to combine and get inspired by other people’s work too!
I then set up a micro instance on google cloud, installed the pug compiler and apache2, selected a fixed IP and opened the HTTP port to the world and all done! (this set up is a little more involved than this but was straightforward!). The micro instance is very very cheap so it’s not expensive to run. The Birmingham crew then bought a lovely domain appy-risk.org for me to attach it to.
Here’s the obligatory increase in CPU usage since publication (slightly higher but as you can tell – it’s quite light: