Much progress has been made in formalisms for encoding knowledge and building useful clinical applications over the past two decades. The panel took the view that enough is now known about these formalisms to permit the primary focus of research and development to be moved towards addressing the practical challenges involved in developing repositories of content which are sufficiently convincing to attract the support of publicly-minded contributors and also the attention of organizations which influence take-up of innovations in clinical practice. The latter include medical IT and publishing companies as well as healthcare service providers.
As we know from the Open Source software experience, the notion of publicly shared intellectual property is, to a considerable degree, opposed to the objectives of commercial organizations whose assumption is that competitive advantage depends on exclusive ownership of intellectual property. The vision of sharable medical knowledge is therefore only likely to be achieved if two main conditions can be met:
- An open knowledge community can be established which can operate sustainably as an independent sector (e.g., by servicing a market which does not depend exclusively on commercial players);
- The development and acceptance of business models in which publicly-shared knowledge can be licensed for commercial use (such as the selling of applications which add value to open content).
The panel discussed many of the technical tasks which need to be accomplished to enable knowledge to be shared in a form which computers can interpret and used in practical clinical tasks such as decision support and care planning. The development of standardized platforms for deploying scalable knowledge-based services of these kinds would include a set of requirements to ensure, for example, that:
- Services are as far as possible mutually compatible and interoperable and free of institution-specific details;
- Content and service components are reusable;
- Quality and safety can be assured by automated cross-verification.
But the panel felt that the vision of sharing executable clinical knowledge will not be achieved without strong co-operation between groups of people, communities of practice, able and willing to share, maintain, update, and improve content, in a manner analogous to the publicly-minded communities of programmers who develop and maintain open source software.