Archive for April, 2006

Healh knowledge distance

Thursday, April 13th, 2006

Till the end of World War 2, the medical domain was small enough for every practitioner to know what the skills and knowledge of each and every other actor were. For example, whatever the surgical act, a General practitioner (GP) perfectly knew how the surgeon operated; and even if his hands couldn’t have done it, the GP’s brain knew how to do it.

From this time to now, the technological big bang has dramatically enlarged the medical knowledge area. We can actually say that it has been acting as a centrifugal force, pushing practitioners away from one another through a process of over specialization in order to cover an ever increasing knowledge surface.

In the current situation, it is possible to assert that a given actor knows very little about other specialists’ behaviour. One major side effect is that when he/she receives a report coming from a specialized colleague, then most of the information this report contains have no prognostic meaning for him/her.

Hopefully, we are living a crucial moment since there is clear evidence that the centrifugal force is largely decreasing: in the drugs domain, no genuine blockbuster is awaited, and class actions like Vioxx show that niche products can’t artificially be over marketed; in the same way, in the hardware domain, the electronic, then computer revolutions are behind us, and no major innovation is awaited.

The expected innovation boost is in a pipeline that will probably be longer than expected: genomic drugs and nanotechnologies won’t be ready soon as something else than a niche market. So, we actually are reaching an asymptote for usual technologies, and will have to follow this nearly flat curve for some years. In such a situation, new products are hardly better than old ones, but any little improvement leads to a major rising in price. Very few societies, if any, can afford that.

Our challenge now is to find new directions and discover how we can keep people as healthy as possible at an affordable price. Continuity of care is certainly the most promising candidate: knowing and organizing a person’s health journey can permit to optimize care delivering, but also opens the door for prevention. The most important aspect is probably that this approach is focused on the person, and no longer on the disease: our subject evolves from a patient to a person, and he/she gains the ability to envision his/her health as a precious asset he/she has to manage all life long.

Since each health actor is now seen as a contributor to a common journey, the knowledge distance between them is the major issue to address if we want to put such systems at work. And since the citizen also becomes an actor, we now have to deal with another kind of knowledge distance.

The new revolution in the medical domain will probably happen from information and communication technologies (ICT): by leaving data management behind, and entering the knowledge management realm… for citizens’ sake.

Oshca is back

Thursday, April 6th, 2006

Oshca means Open Source Health Care Alliance, and this is the place where most of the open sourcers in the medical domain have been able to meet and eventually become friends.

Oshca was initially created by Brian Bray and his partners from Minoru, a company that had received a budget from the European Community to establish an open source community in ICT for health.

The first and most important achievement of Minoru probably is the Openhealth mailing list, but Oshca was the place where we could physically meet, and this is of utmost interest.

I attended the 2001 Oshca meeting in London, with the sponsorship of the NHS, and the last one in 2003 in Geneva, where the audience was much scarcer, in a little conference room kindly provided by the University Hospital of Geneva.

Brian Bray already went back in Canada and there was no longer any genuine official organization. I remember that Joseph Dal Molin and Adrian Midgley had done a pretty good work allowing this meeting to occur, and that there was a nice group of Vista boys. Anyway, it was clear that it was the end of something.

Three years after, it seems that Oshca will be born again and that the open source community will have a place to meet. This is undoubtedly a very good news… and a very good opportunity to start this blog ;-)