Open source software as a model for health care - Strata

"Medical research and open source software have much to learn from each other. As software transforms the practice and delivery of medicine, the communities and development methods that have grown up around software–particularly free and open source software–also provide models that doctors and researchers can apply to their own work. Some of the principles that software communities can offer for spreading health throughout the population include these: Like a living species, software evolves as code is updated and functionality is improved. Software of low utility is dropped as users select better tools and drive forward functionality to meet new use cases. Open source culture demonstrates how a transparent approach to sharing software practices enables problem areas to be identified and corrected accurately, cost-effectively, and at the pace of change ... Open data is now a rallying cry for advocates of public information and more effective governments, but the lesson of the open source movement is that the mathematics and algorithms used to process data should be open as well. This applies to health care because data is inert in itself. Some kind of processing must be applied to extract useful information, and it this takes the form of open source code, many people can check it for accuracy, reuse it, and upgrade it. It is this continuous activity of sharing and upgrading that drives and defines quality and value over time. In other words, the community is the purveyor of value .  A good example of open sharing to nudge health event streams in optimal directions is PatientsLikeMe. However, this sharing behavior need not be limited to folks with chronic diseases. In health, we have no way currently of knowing if our post-op course or our health journey is 'on track.' Are we reaching what is reasonably 'reachable'? Many conventions that support self-organization were developed in the open source and free software movement. Although a key principle is that anyone can offer software code updates (no contribution is too small), members of a team accept the need for a central authority or group of experts to keep malicious or poorly designed changes out. The term 'benevolent dictator' often applies to the person or people whose authority to approve code is broadly accepted. Linus Torvalds, who invented Linux, now maintains it in consultation with many advisors. Again, as many elements change rapidly, the work to be done must spread to a wider base of experts.  Innovations in health care are often controversial at first, and an open source attitude toward experimentation seems inconceivably reckless, especially in cases where the therapeutic window is narrow. In these cases, the cost of errors is high.  However, lifestyle management recommendations often enjoy a wide therapeutic window, so that adjustments in one direction or another are less likely to be dangerous. Evidence-based lifestyle management, learned through an open source attitude toward experimentation, may be an ideal way to teach free living communities the skills they need to protect against evolving threats. In this way the self-organized group becomes the trusted entity.  Perhaps the media may suggest that a cold breakfast cereal has the power to reduce cholesterol. Using an open source attitude armed with wireless health devices enabling home testing of cholesterol levels, the crowd can test this claim themselves. Social networking enables a few hundred friends to unite the quest of testing the” lowers cholesterol” claim. After 6-8 weeks of cereal ingestion and sharing pre and post cholesterol levels, this group can determine whether the claim is valid when applied to their free-living community.

This proposal is not entirely hypothetical..."