Hi Geoff, I accept what you say about the GP world needing motivation. As
for migration tools I would hope that the Text-to-SCT converter we have
created would be seen as the start to filling that role. Now with the
release of the general license I expect we will be able to a switch over
to delivering SCT codes on-line, so you will be all be able to see it
working easily. I am visiting NEHTA today to open discussions with them
directly about our work and how we might be able to collaborate with them.
cheers
jon

Quoting Geoff Sayer <[EMAIL PROTECTED]>:

> Hi all
>
> This all assumes that "average" GPs care about terming, coding and
> classification... evidence would suggest the contrary.
>
> Nearly all the GP clinical apps have controlled medical vocabulary
> already
> (and some have classification capability to international standards
> already)
> yet I have never heard a GP say (one that doesn't subscribe to GPCG)...
>
> "If only I had SCT I would record reasons for prescribing and provide a
> complete/current patient medical history... it was the lack of a
> suitable
> medical vocabulary that was holding me back"
>
> I think a standard is important but the fundamental lack of interest
> amongst
> the masses remains the same... I can hear a deafening silence from the
> mainstream on this development...
>
> We need to think about selling what the benefits of SCT will be to the
> end
> user from a day to day practical perspective... and great for research
> won't
> wash...
>
> What will it mean to those GPs who have recorded data
> inconsistently/consistently over the past number of years... got some
> migration tools ready to bring into the new SCT era or do we right of
> the
> past...
>
> What will it allow GPs to do now that they can't do now?
>
> This type of information on benefits may inspire vendors as well I would
> suggest.
>
> Geoff
>
>
> [EMAIL PROTECTED] wrote:
> > Quoting Tim Churches <[EMAIL PROTECTED]>:
> >> Just to clarify the architecture that I had in mind:
> >>
> >> a) most of the look-up and other functions exposed as Web services
> which
> >> can be called from any Web service-aware application, including GUI
> >> desktop clinical applications
> >>
> >> b) a separate Web browser front-end that uses those Web services, to
> >> allow browsing of SCT from anywhere there is an Internet connection
> > Tim, is it your intention that this evolve towards a "SNOMED module"
> > which can be served up to vendors on a platter, ready for integration
> > into their own products?
>
> Yes, exactly. By having the software module as cross-platform open
> source and the SNOMED-CT data freely available to all under the NEHTA
> sublicense, it would exert competitive pressure on clinical information
> system vendors to either incorporate the module into their software or
> to provide something better.
>
> > Hopefully this will partly answer the "it's too hard" excuse from
> vendors
> which
> > has stymied other attempts (as Ken Harvey knows) to get
> decision-support
> into
> > the GP's desktop.
>
> Yup. One less excuse.
>
> > For true integration you would need a local server otherwise the
> > EHR would experience a performance hit (to which users in this domain
> > are exquisitely sensitive)
>
> Yup, that's what I proposed.
>
> > Would you consider the LGPL licence, as this allows integration
> > but requires vendors to contribute back changes (to the module).
> > I agree BSD-type licence is much simpler and would be more reassuring
> > to them legally (even Microsoft use BSD licensed code)
>
> Either LGPL or Mozilla licenses would be fine - they are functionally
> equivalent in that they both require changes to the open sourced code to
> be contributed back to the community, but neither presents any
> impediment to tight integration of the open source code with closed
> source code in a vendor's product. BSD would also be OK but less
> optimal, although likely to be more favoured by closed-source vendors
> since it does not require them to make any enhancements they make tot he
> code available to others. After seeing how well the development of the
> PostgreSQL open source database proceeds using a BSD (non-copyleft)
> license, I am a lot more relaxed about the whole copyleft thing than I
> used to be. Ultimately it is up to Jon Patrick and his team at USyd how
> they might license the proposed modules, but I would strong recommend
> that they don't use the GPL, which would be sure to discourage other
> software vendors from using the modules.
>
> >> Automatic periodic refreshing across the Internet of the Web service
> >> software code and the SCT data which it uses should be built-in.
> >   ^^^^^^^^^^^^^
> >
> > I agree with auto-updating the SCT codes, but the software itself?
> > The could get needlessly complicated if done in the first iteration of
> the
>
> > module. IMHO users who want such a facility should select an OS that
> provides
> > it ;-)
>
> Yes, probably. I suppose I had in mind that the modules might use
> various soft-coded rules or other parameters which could be updated
> dynamically from time to time, rather than the compiled code. Whatever.
>
> > A client-side module which regularly (say ~1/month) polls the central
> > SCT webservice for updates would be simpler to adminster, as well as
> faster, as
> > it saves  the GP the adminstrative overhead of running a dedicated SCT
> server
> > on their own network, at the cost of some bandwidth (as each client is
> > independently updating) but this would not be significant given the
> size
> > of the data.
>
> Yup, that would work.
>
> > The question then is what interface to provide to the EHR. A C
> interface
> > (that is, "DLL" on Windows) is the most widely-acceptable solution,
> this
> is how
> > HeSA provide their module for HIC Online. You could also use
> .NET/Mono,
> but I'm
> > not sure how many EHRs are written in .NET at present.
> > I have nothing against webservices per se, but it's important not to
> let
> > them be a solution in search of a problem, there may be simpler and
> more
> > appropriate options.
>
> I only suggested that Jon mention "Web services" at every opportunity to
> keep NEHTA happy... BTW, Argus Connect should re-write all their
> promotional material to say they their products uses Web services (and
> in very, very fine print mention that the Web service runs on port 25 as
> a  Simple Mail Transfer Protocol service).
>
> Tim C
>
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