some elements of this talk you may think are not necessarily applicable to 21stC health IT, I mean to talk about the future
alchemy
science advanced only very slowly when ideas/knowledge were secrets
age of enlightenment brought freer sharing of information and rapid scientific progress
like many 'revolutions' technology lit the fuse (printing press)
book industry... journals... peer review...
evidence based medicine
"standing on the shoulders of giants"
age of enlightenment
invention of printing press
you can only stand on the shoulders of giants when the giants publish!
journals, exchange of ideas, peer review
invention of Internet has allowed change in way collaboration can be done
evidence based medicine 1960s 1970s 1980s 1990s
Medicine
medical IT has become an intrinsic part of medicine
line between the medicine and the technology increasingly indistinct
so medical IT should be treated the same way as Medicine
software as medical devices
example of how QOF means that now would be impossible to run a general practice without computers
stop: does anyone NOT accept that argument? if so => we do not consider writing to be distinct from the professions employing it
hardness
medical IT one of the biggest challenges in medicine
monolithic approaches have failed (spectacularly) to meet this huge difficult challenge
'iterative' development seems to work well for large difficult things (see The Internet as an example of this)
open source does iterative better than anything else
better than anything else because existing solutions can be built ontop of, rather than starting again
brain-scarcity
re-Solving a solved problem is a waste of time, money, and brains
Creative brains are a valuable, limited resource. They shouldn't be wasted on re-inventing the wheel when there are so many fascinating new problems waiting out there.
To behave like a hacker, you have to believe that the thinking time of other hackers is precious — so much so that it's almost a moral duty for you to share information, solve problems and then give the solutions away just so other hackers can solve new problems instead of having to perpetually re-address old ones.
example: think about how much time and money has been spent and re-spent designing a good Blood Pressure data model
quality
if nobody can examine the code, how do we know this medical device is:
safe?
secure?
adequately tested?
We Don't: "The Alchemist Says It Works"
for 'closed source software' read 'medical treatment'
improvements
if you want to improve something and have the skills, with OSS you can
if you want to improve something and don't have the skills, with OSS you can hire someone to do it
if you improve something, it can be shared with the community
and in return you get to share community developments too
clinicians not directly employed in software are more likely to contribute to an open source project than a closed source commercial product
The NHS and OSS
NHS has an intrinsically Sharing philosophy
we share the risk of illness and derive protection from this
we share medical knowledge (eg journals, conferences)
we share organisational knowledge (eg networks)
NHS staff readily comprehend the idea and benefits of OSS
M$!
Microsoft ports .NET to Linux and Macintosh and open-sources the entire stack
open source is 'the age of reason' brought to computing
there is no other scientific way to do medical computing
it is an opportunity, not a risk
the NHS is particularly fertile ground
Only 2555102068725 days, 20 hours, 41 minutes, and 43 seconds left until earth annihilation
(artist's impression)
sun will become a red giant in about 7 billion years
we need to get our act together before then
solving the same problems over and over again will not get us there!
