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I've spent the last six years learning how to build apps for healthcare.

Simple apps, shuttling patient demographics between billing and clinical systems.

Beautiful apps, visualizing ED throughput and population health across time and space.

Complex apps: real-time, cloud-based decision support capable of analyzing thousands of interoperable HL7 clinical documents per second and sending out patient-specific, evidence-based, clinician-built interactive flowcharts at the point of care.

But I'm not solely IT-focused. I never have been. It's a set of tools--a means to my ends: healthcare.

I grew up a blend of Irish-Catholic/Japanese ethos: an emphasis on education & achievement, tempered with working-class humility & perspective. My youth was "student-athlete-athlete" as the compass goes, and the lifestyle introduced me to healthcare--EDs and ORs.

As the visits racked up, my naive presumption of quality medicine became mystical appreciation became respectful interest. I realized these safe havens were not the result of divine genius and inspiration--they were made of slow, hard, grinding progress; paved with dedication and sacrifice.

Volunteering at the crisis hotline in college was my first opportunity to be a positive, stabilizing force in a stranger's life. I learned how to explore callers' issues and empower them. I reassured, gave confidence, lent perspective--often I simply listened.

I joined the pre-health fraternity the following semester, and for the next year and a half immersed myself in preparation for a career in practicing medicine.

My trajectory would be altered radically, however, by the summer before junior year.

St. Lucia's HIV hospice & orphanage, framed by beautiful, rural East Africa: a confluence of uncoordinated government services, social ostracization, and the disease itself--juxtaposed against bright smiles, mountain waterfalls and Kilimanjaro.

I was invigorated by the community work at a local hospital, teaching kids, and trekking to remote villages to provide direct, basic medical care and education. On our excursions we handled simple wounds, supplied NSAIDs, and advised on retroviral meds. But lacking clinical expertise in our group, too often we could only refer patients to a "daktari" at Mount Meru. Just a short 17km trip--on foot--for bodies with that reliable-but-tired look of an old family tractor.

I focused on broadening the scope of my observations: from the patient to their home/family environment, community, health system. And beyond certain deficiencies inherent to any developing country, I found many of the problems facing patients and caregivers...oddly familiar.

A need for self-service medication management and reminders; better appointment scheduling and communications tools. A lack of accessible, comprehensible, update-able education materials--for both patients and clinicians themselves.

Strange too, I thought, that cell phones were everywhere in this tiny corner of rural Africa (circa 2009.)

"I wonder if there's a way..."

Then lightning struck. One of those "gifts" offered amid hectic move-outs: a roommate's old Java coding textbook.

A hidden world unfolded as I began investigating the bond this intoxicating wizardry shared with medicine. Quicker than basic research, tidier, yet relevant and impactful. Oh and to create! To will something purposeful, elegant into existence--Conway's game of life, genetic algorithms, telemedicine, secure texting & scheduling...

I immediately began moonlighting at a brain-computer interface lab and graduated early, soon finding work as an entry-level EHR analyst. Within a few years, I would catch up to my software development colleagues via (unpaid) overtime, night classes and eager, gritty persistence.

My desire now to practice medicine comes from having achieved a comfortable level of IT expertise, and a grounded, still-honest/idealist heart that wishes to treat patients directly at the bedside.

I want to see and work with patients as clinicians do: beyond bars on a chart and rows in a database--with the knowledge to intervene decisively, quickly, and confidently.

I want to go further than where I find myself now: passing off apps/analytics to clinical quality managers and researchers--never following the data to its conclusion; having little idea what they were trying, why, who it affected, or if any of our "Rapid Improvement Events" worked.

I want to Genchi Genbutsu--see for myself--what high-quality, cost-effective care truly means. Help deliver evidence-based care at the bedside and preventative-care at the curbside, by bringing scientific, clinical, and community minds together.

Given the chance, I promise to practice medicine in the only manner I know: with open-minded curiosity, compassion, and competence.

And given a chance...I promise to hack it because I can.

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