Koray Atalag, M.D.: Thoughts on Open Source, Healthcare Informatics, Evidence-Based Medicine, Reference Implementations [ Update ]

I just found out Koray finished his Ph.D. and his project, "Archetype based Domain Modelling for Health Information Systems", Submitted to Department of Information Systems, Middle East Technical University (METU), July 2007, Supervisor: Prof.Dr. Semih Bilgen, is posted here in PDF.

I want to point out a more unfortunate situation still happening in Medicine: Not even in such an established and trusted profession has truly embraced so called Evidence Based Medicine (EBM) or even Problem Based Learning in their medical education curricula! I had been taught that the facts (Science of Medicine) in some thousand page terrifying textbooks/boring journals or the "Art of Medicine" as taught in clinical wards by word of mouth or mostly stored in brains of older clinicians. I strongly disagree that Medicine is an "artistic" profession in essence; I hope that it is truly "Scientific". This is some philosophic part of my research but shortly I found out that there are two sources of knowledge in Medicine: Research LABs and Clinical Wards. And most of this knowledge is generated in the latter by digesting and discovering new knowledge from years of accumulated information from patient encounters. Why it is kept unstructured? Mainly because they don’t really materialize these and they become "insights". Or not infrequently of course most do not need to formalize and disseminate it as it professionally brings him some strategic advantage. Maybe write some papers giving pinpoint part of it but never expressing the "whole picture" as needed. And believe me these are not bad people at all; it is how they are trained. Well I guess an extensive IS capturing structured and sharable data from these wards will make most of this information available for processing and this will yield vast amount of new knowledge I very much hope. Apart from practical purposes of sharing health data, I am much more interested in this aspect.

Although I agree with the idea of evidence based health informatics, I feel sorry that my life span won’t be good to see that :( However a realistic and medium term solution might be first having of course the "essential" standardization work finalized, digested and implemented. But more important is making sure that people/industry "obey" these. And this can only happen (by free-will, of course) if health informatics becomes a "real" profession by implying some sort of control over practice and education. [V]ery practically, even though I am in love with what I do, I have hard time to explain to my Mom or other "normal/ordinary" people what I do :D She keeps on saying: Oh my son you have studied medicine and now this computer thing, what are you waiting to be a real successful (moneywise) man?? Funny ha…

One criticism I want to make for long time is that, for openEHR and possibly other innovations in the open source domain, it shouln’t take sooo much time to see "real" reference implementations publicly accessible somewhere. As time goes by, this is unfortunately the case for cutting-edge R&D, that they start "loosing-blood" because there are many other sharks out there… I guess the patient has not died, or even near to that, but I know that it will take much longer now to fully recover. Also, one important warning is that, being open source/spec is not a complete protection as in many cases of FOSS products, propriety products are still preferred for mainly three reasons: 1) There is a switching-cost, 2) Integration issues with other apps around 3) In most cases total cost of ownership is lower in propriety products in short to medium term. Of course these are my ideas again.

As a last comment and a wish, I really think the main body of industry will jump into openEHR based products after seeing for themselves some big reference implementations; not just R&D projects. I don’t think the end-users or buying organizations will have much influence on their decision. Because an openEHR based system is expected to do "at least" what is currently being done and "plus"  more… And this plus will take some time to materialize in people’s mind. So the users will not see much change when using their Hospital IS. An important "buying point" is that I am sure openEHR will let most of these vendors do these things more consistently and cheaper and also offer totally new features (such as on the fly translation, or provide context sensitive decision assistance) So to cut short: High impact industrial "reference" implementations are needed.