Sunday, July 29, 2012

Can Github Save Your Life?

As of late I've had a renewed interest open-source medicine, specifically evidence-based medicine.  My exposure while at Zynx Health and a talk given on OpenEMR is what engendered the interest, and it was recently rekindled by these articles: The Most Important Social Network: GitHub and How we use Pull Requests to build GitHub.

Briefly, the correlation there is that Github is a language-agnostic content management system, with strong versioning and collaboration capabilities.  In evidence-based medicine, treatment and diagnostic decisions are based on rigorous statistical analysis of outcomes. In reality, though, physicians are, like the rest of us, innumerate and busy.  (cf. Do physicians understand cancer screening statistics...). Therefore it is incumbent in practicing evidence-based medicine to distill the research and analysis into clinical pathways that can be employed at the point of care.  Github could be used to author those clinical pathways.

In fact, git as a distributed, decentralized, collaborative, open, secure content management system is ideally suited for this task, when leveraged by the powerful collaboration features offered by Github.  On Github everyday the foremost experts in their field, collaborating from nearly every country on Earth, produce tools that they go on to employ in their work.  The value of this activity then filters down to the rest of the practitioners through third-party systems.

I'm describing software, but I could be describing evidence-based medicine.  

Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. Evidence-based Medicine[...]

In a world where the clinical pathways were created by the foremost experts in their field and made readily available to medical professionals in the field: we make all practitioners more effective; we get lower costs and better outcomes; we can afford to save lives.  

Open-source clinical pathways would provide grist for the mill of healthcare innovation.  Entrepreneurs would create mobile applications that combine location, biometric, and symptom data to suggest diagnostics and treatments with high specificity.  Like the Linux kernel, clinicians could use "builds" from a distributed trust model, where updates to clinical pathways were controlled through the kind of real-world trust and control models that are in place to keep us safe.

What is needed is programming ecosystem for clinical pathways.  I mean that literally.  We need a "byte code" (portability standard), languages, compilers, linkers, theorem provers, IDEs, package managers, etc.  We need all of this to create a bazaar of healthcare innovations, and we need it soon.

Your life may depend on it.