title: Clinical software development for the Web: lessons learned from the BOADICEA project.
abstract: BACKGROUND
  In the past 20 years, society has witnessed the following landmark scientific advances: (i) the sequencing of the human genome, (ii) the distribution of software by the open source movement, and (iii) the invention of the World Wide Web. Together, these advances have provided a new impetus for clinical software development: developers now translate the products of human genomic research into clinical software tools; they use open-source programs to build them; and they use the Web to deliver them. Whilst this open-source component-based approach has undoubtedly made clinical software development easier, clinical software projects are still hampered by problems that traditionally accompany the software process. This study describes the development of the BOADICEA Web Application, a computer program used by clinical geneticists to assess risks to patients with a family history of breast and ovarian cancer. The key challenge of the BOADICEA Web Application project was to deliver a program that was safe, secure and easy for healthcare professionals to use. We focus on the software process, problems faced, and lessons learned. Our key objectives are: (i) to highlight key clinical software development issues; (ii) to demonstrate how software engineering tools and techniques can facilitate clinical software development for the benefit of individuals who lack software engineering expertise; and (iii) to provide a clinical software development case report that can be used as a basis for discussion at the start of future projects.
  
  
  RESULTS
  We developed the BOADICEA Web Application using an evolutionary software process. Our approach to Web implementation was conservative and we used conventional software engineering tools and techniques. The principal software development activities were: requirements, design, implementation, testing, documentation and maintenance. The BOADICEA Web Application has now been widely adopted by clinical geneticists and researchers. BOADICEA Web Application version 1 was released for general use in November 2007. By May 2010, we had > 1200 registered users based in the UK, USA, Canada, South America, Europe, Africa, Middle East, SE Asia, Australia and New Zealand.
  
  
  CONCLUSIONS
  We found that an evolutionary software process was effective when we developed the BOADICEA Web Application. The key clinical software development issues identified during the BOADICEA Web Application project were: software reliability, Web security, clinical data protection and user feedback.
authors.affiliation: Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK. alex@srl.cam.ac.uk
authors.forename: Alex P
authors.initials: AP
authors.lastname: Cunningham
authors.forename: Antonis C
authors.initials: AC
authors.lastname: Antoniou
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Easton
mesh_terms: D000465:Algorithms; D019313:BRCA1 Protein / Q000235:genetics; D024682:BRCA2 Protein / Q000235:genetics; D001943:Breast Neoplasms / Q000235:genetics* / Q000517:prevention & control; D003198:Computer Simulation; D020000:Decision Support Systems, Clinical / Q000458:organization & administration* / Q000592:standards; D019544:Equipment Failure Analysis / Q000379:methods / Q000592:standards; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D020407:Internet; D008957:Models, Genetic; D009154:Mutation; D010051:Ovarian Neoplasms / Q000235:genetics* / Q000517:prevention & control; D010865:Pilot Projects; D018570:Risk Assessment / Q000379:methods / Q000592:standards; D012985:Software Design
chemical_list: D019313:BRCA1 Protein; D024682:BRCA2 Protein