Everyone’s got a smartphone app, or so it seems, but sometimes the most useful mobile technology doesn’t come in app form.

That’s one of the key takeaways from a live demonstration of “agile programming” between two development teams at the first-ever HIT X.0: Beyond the Edge subconference Wednesday at the annual HIMSS conference in Orlando, Fla.

In the inaugural Iron Programmer Challenge -- HIMSS’s answer to Iron Chef, complete with the theme music from the cooking show -- the young duo from start-up mobile app developer HealthFinch threw down with HTML5 rather than an application programmer interface because it works on most any device with a Web browser. Their competitors, San Francisco online media professional Hunter Whitney and Washington, D.C., technology marketing specialist Douglas Naegele, went with a rudimentary but useful iPhone app.

The exercise was intended to demonstrate that programming doesn’t have to flow through a large, enterprise-wide system, according to session moderator Dr. Lyle Berkowitz, medical director of clinical information systems at Northwestern Memorial Physicians Group in Chicago and Director, Szollosi Healthcare Innovation Program (SHIP). Such a strategy can help vendors “build a recipe” for serving small but important needs of providers, Berkowitz said.

Both approaches were meant to save time and money in meeting the challenge, based on the “secret ingredient,” a form to allow physicians to send electronic “expect” notices to hospital emergency departments. This being programming and not cooking, the two teams learned that secret 2½ weeks ago, rather than at the start of the hour, à la Kitchen Stadium.

The common theme between the TV show and the HIMSS event is that the competitors had to move quickly and adjust to the twist thrown in by the “chairman.” Berkowitz asked the programmers to make modifications on the fly, with the audience voting on whether each should repurpose the form or change how messages are sent.

(Unfortunately, due to the smaller-than-expected turnout for the closing session of HIT X.0, Berkowitz didn’t ask attendees to choose a winner, as had been planned. Update: Berkowitz told MobiHealthNews in an email: "There was never any intention to name a winner on this one... the intent of the session was to explain what agile programming meant and to show some varying styles.")

Naegele and Whitney quickly repurposed their form to make it suitable for a school infirmary, for example, to report sports injuries. HealthFinch co-founders Jonathan Baran and Ash Gupta tweaked their “ExpectER” program to output SMS text messages rather than make automated phone calls in a computerized voice.

Though Naegele and Whitney were slowed by Internet connectivity problems on the stage, both teams got the job done in a matter of minutes.

“The beauty of the agile approach is flexibility,” Gupta said.

“We love working in an agile environment. Organizations don’t,” added Baran.

Of course, getting organizational buy-in is a challenge in itself. One reason is that an agile strategy calls for users to accept an app early in the development process -- the “first inning,” as Naegele described it -- while typical software doesn’t make it to beta testers until more like the “seventh inning.” Seeing something so early could make it seem like the programmers don’t know what they’re doing, Naegele said.

Indeed, the apps on display were pretty simple, but that was as much because of the intended purpose as it was the agile strategy. According to Whitney, the ED is a hectic, distracting environment, so he and Naegele wanted to provide a minimum level of information to support better care for when an on-call doctor gets paged in the middle of the night.

Their app included just the patient’s name, date of birth, medication and allergy lists, past medical history, a clinical summary, the hospital name, the form of transportation and the method of notifying the ED. With the basic app in place, users later can opt for extra features, such as the ability to attach a digital photo to the “expect” notice, Whitney explained.

In agile programming, there’s a mantra: “Release early, iterate often and keep pace with reality,” Whitney said.