kuang oon wrote:
On 23/04/2007, at 12:30 PM, Tim Churches wrote:
But gee, wouldn't an open-source primary care reference IT platform
would be a great way to turbocharge applied research and field
trials
into the use of SNOMED CT and classifications/codesets in real-life
settings, and research and field trials of DSS built on top of that?
As it stands at the moment, any academic group wishing to engage in
such trials needs to negotiate on a commercial basis with the major
closed-source provider(s) of GP clinical info systems, which is
why we
are seeing so little field work in this area. Australia can get a
jump
on the rest of the world here, if it moves swiftly.
Hi TimC,
I agree with your diagnosis that unambiguous computer
representation of
complex health data for decision support is a potential show
stopper.
Am not so sure that piling higher and deeper into a numeric coding
model will be a sustainable solution in the long run.
Kuang,
We've had this conversation (online) several times before. I
continue to
maintain that had you made the intellectual property behind your DOCLE
and DOCLEscript coding system freely available, ten years ago, then
there is some chance it would have caught on. But you didn't. Instead
you sought and obtained patents on the ideas behind DOCLE and have
refused requests for any form of royalty-free license to encourage
others to experiment with it. As a result, it has well and truly
missed
he boat and is now just a curious footnote in the (so far) inglorious
history of Australian medical informatics.
I digress here,
the following story may interest you. I was plowing through John
Wood's
"Leaving Microsoft to change the world" and his adventures in
founding
the Room To Read organization. On page 182 he talks of "But for the
Nepali women, the situation is even worse, with 75 percent of adult
women unable to read or write a simple sentence." Back to the main
thread. Could this quote hold the key to the sorry state of decision
support/e-health. The key is "A simple sentence" , or rather the
ability to string together a collection of simple sentences that
makes
sense - is the hallmark of literacy. Using a model (fixated on
vocabulary) based on millions of concepts assigned a unique number
SNOMED CT has about 350,000 concepts, not millions.
each, but without a syntax and grammar - the EHR systems we
have been
building are functionally illiterate like the women described by
John
Wood.
Sure "sentences" are important, and if you read some of my posts over
the last few years you'll see that I have opined that SNOMED CT by
itself is not enough. But words are also importnat and your patented
DOCLE system contains, as far as I know (since so little is published
about it and it can be downloaded for free to examine), only about
3 or
4 thousand terms, all put together and selected by just you. Sorry,
not
enough, not even for the mundane aspects of general practice. And
because of the way you have chosen to patent the system and not
license
it to anyone, you are going to have to work very hard in your
garage to
add enough terms to make it viable - probably another 40,000 are
needed.
What are the examples of such simple sentences in healthcare that
we need to code ?
This guy/gal has a family history of diabetes mellitus - diabm:fh
You mean diab:fm(Patented)
This guy/gal has diabetes mellitus as one of his list of
problems -
diabm:eval
diab:eval(Patented)
This guy/gal has chronic renal failure from diabetes mellitus -
crf:eval,from:diabm
This guy/gal has a right breast lump 2 cm on physical examination -
[EMAIL PROTECTED]:px,val:2cm,ctx;righ
This guy/gal has a cough for 2 weeks - coug:hx,for:2/52
This guy/gal has been losing weight for 6 months -
[EMAIL PROTECTED]:hx,for:6/12
This guy/gal is on gliclazide for diabetes mellitus -
glic:rx,for:diabm
This guy/gal is on gliclazide 30mg once a day -
glic:rx,dose:30mg,qty:1,freq:1/7
glic:rx,dose:30mg,qty:1,freq:1/7(Patented)
I'm not joking. Under the terms of the Australian nd international
patents you have on DOCLE, plus the copyright, I can't use any of the
above codes to transmit information to a colleague without getting
permission in writing from you first. Nor can I add new terms to your
DOCLE system. Nor can I deploy it in a system without getting
permission
from you in writing (presumably with exchnage of money involved, else
you would have given everyone a royalty-free license by now).
Sorry Kuang, that's the reality.
Docle closures** which are "context complete clinical codes" ,
are the
"simple sentences" referred to by John Wood.
As to moving swiftly and getting a jump on the rest of the
world....we
have already moved...to docle closures generated from natural text,
working with Ruby's string handling.
OK, show us the goods, Kuang, by licensing DOCLE and your Ruby code
in a
manner that allows us to examine and use what you have done without
having to ask your permission first, and without having to pay you
anything.
Tim C
