To make it short : medical knowledge management can only be born through
open source.
And, as shifting from data management to knowledge management is the only
way we can achieve genuine helper systems in medicine, open source has a
great future.
I am very glad I begin to convince more and more people of that in France
(to be honnest, commercial systems are so bad - especially for the price
they charge - it is not difficult to convince people to accept a new deal).
Regards,
Philippe
> > This forum is about open systems. Is there a successful
> > argument that open systems will deliver, say a prescribing
> > system, that follows a different (and better?) purpose then
> > the other 20 or so commerical prescribing systems?
>
> Well, the argument I would put forward, is as follows:
>
> First of all, its worth saying at this point that most arguments relating
to
> open source have grown up in relation to discussions about how to develop
> software devices. To fulfil our hopes for intelligent medical systems -
like
> prescribing support - its not primarily software devices that we're
missing,
> but sufficiently large, complex and interlinked knowledge bases. Resources
> like SNOMED and UMLS are just the tip of the iceberg in this department.
> UMLS may be vast, but you couldn't build a prescribing system using it and
> nothing else.
>
> The level of detail that must be captured about drugs and diseases, in
order
> to support a prescribing system that does not infuriate clinicians, is
very
> complex. The knowledge base alone to cover essentially all drugs, the
> diseases they treat, interact with or cause, their mechanisms of action,
> chemical substructure etc, is some 400,000 facts.
>
> Additionally, whatever ontology/terminology you use to represent that
> complexity has to be able to interface with whatever terminology is used
in
> the medical record you intend to link to. You have to be able to get from:
>
> atenolol - CONTRAINDICATION - asthma
>
> ...to whatever code or codes represent asthma in your local record.
>
> This makes the whole endeavour both very large, expensive to quality
assure
> and vulnerable to changes in the external schemes that must be referenced
> (e.g. central mandate that an entirely new coding scheme must be used in
the
> EPR). A single centralised approach, especially a commercial one, is
> unlikely to take the economic gamble. Additionally, medical end users have
a
> tendency to resent 'paying for words', and also believe that things which
> appear to be public good should be free or at cost. Thus the market is
only
> willing to pay a modest price, and major investment can be hard to recoup.
>
> But even assuming that some rich benefactor or state body did fund such a
> project, one of the key open source arguments is that any centralised
> development - however funded - develops cultural blind spots. The result
> performs adequately, but never becomes the best it could be. The more
> complex the project, the greater the risk that this happens.
>
> So, the argument summarised is: better clinical systems require (much)
> better clinical knowledge bases. These are expensive to build, hard to
sell
> for profit and so complex that a closed organisation or editorial process
> will naturally settle for a compromise that is significantly less complex
> than ideal, but can at least be managed.
>
> Open sourcing such KBs spreads the cost, eliminates the question of profit
> and removes the centralised accountability for possible failure in a very
> complex project. This removes those barriers that otherwise frequently act
> to prevent something becoming all that it could be.
>
> Jeremy
