Hello there. I have a rather broad question I would like to pose.

I am in the medical field and wondering if there is a place for an open sharing of programming and structural issues for medicine in some sort of forum. What I have observed is that in communities where there is a free flow of ideas, much faster progress is possible. Medical computing is very complex at the very least, nearly impossible at its worst. But what I am observing is if there are 50 companies out there trying to build something for a clinic, hospital, or doctor’s office, there are 50 different implementations and business logic sets which don’t communicate with each other or have any knowledge of each other. The real losersonName>ersersonName> in that scenario are the clients because they need to communicate with one another.

What would be nice is a library for IT people developing for medicine of structural standards including field names, data types, and data within the field, as well as business logic having to do with those fields. Quite a number of medical academic institutions have their own programmersonName>ersersonName> who might be willing to share their expertise and develop a sort of open source community specifically for medical applications. I realize there are numerous commercial enterprises who guard this type information closely. There are huge meetings and a couple hundred organizations collaborating to standardize medical information, but I am seeing slow forward progress. This type forum wouldn’t be for everyone, but perhaps some would like to participate. I am thinking that the way to make progress is to start somewhere and have open, data-level discussions.

My specific area of interest is oncology (cancer) and an example of what I am talking about might be cancer staging. Every doctor who deals with cancer patients reports staging information to a hospital tumor registry and they in turn report that to government and other national agencies. That’s how we know, for instance, that there were over 180,000 cases of breast cancer diagnosed in the United States last year. Staging is different for every type tumor and growing more complex. For breast cancer alone, there is a two or three page form of tiny print to fill out on every patient. This is often inaccurate because doctors may not take the time to read all that print carefully. But it lends itself very well to automation.

Here, for example, is the logic behind breast cancer staging:

Private Sub PathSizeInvTum_AfterUpdate()

Dim f As Form

Set f = Me.SubForm.Form

'check to see if this is a malignant lesion

    If Me.MB = 1 Then 

        If [PathSizeInvTum] > 0.02 And [PathSizeInvTum] <= 2 Then

                f!PathT = 1

            ElseIf [PathSizeInvTum] > 2# And [PathSizeInvTum] <= 5 Then

                f!PathT = 2

            ElseIf [PathSizeInvTum] > 5# Then

                f!PathT = 3

        End If

    End If

    f![PathM] = 0

    If f![PosNode] = 0 Then

            f![PathN] = 0

            Else: f![PathN] = 1

    End If

Select Case f![PathT]

    Case "is"     'in-situ cancer

        f![PathStage] = 0

    Case 1

        If f![PathN] = 0 Then f![PathStage] = 1

        If f![PathN] = 1 Then f![PathStage] = "2a"

    Case 2

        If f![PathN] = 0 Then f![PathStage] = "2a"

        If f![PathN] = 1 Then f![PathStage] = "2b"

    Case 3

        If f![PathN] = 0 Then f![PathStage] = "2b"

        If f![PathN] = 1 Then f![PathStage] = "3a"

    Case 4

        f![PathStage] = "3b"

End Select

    If [ExtraNodExt] = 1 Then [PathNSub] = "b iii"

    If [ExtraNodExt] = 0 Then

        If [SizeMaxNode] <= 0.2 And [SizeMaxNode] > 0 Then [PathNSub] = "a"

 If ([SizeMaxNode] > 0.2 And [SizeMaxNode] <= 2) And ([PosNode] > 0 And [PosNode] <4) Then

[PathNSub] = "b i"

        If ([SizeMaxNode] > 0.2 And [SizeMaxNode] <= 2) And ([PosNode] > 4) Then [PathNSub] = "b ii"

        If [SizeMaxNode] > 2 Then [PathNSub] = "b iv"

    End If

End Sub

This is written in VBA, but any programmer can follow the logic and write it in whatever programming language being used. Don’t use this, by the way, because the staging system has recently changed and I haven’t incorporated those changes yet. But I place it here as an example of what might be useful. The table structure behind this logic could be displayed and discussed as well as the business logic.

Being written by an IT amateur, I am sure the above could be prettied up and commented better. But the question is whether having such a library available to those developing in the medical arena is possible or potentially useful. I’ve checked several medical informatics sites and no one seems to be at this level of discussion. I get the impression that the behind-the-scenes logic and structure is beyond the scope of what most these sites are about. They are discussing how to get doctors interested, how to roll out big systems, etc. but no one is addressing what to me are the REAL issues, such as how do you structure this type data, how do you analyze this type data, etc. To me, until that is right, we are going to continue to have some of the nightmares that have plagued the automation of medicine over the past 10 years. That was undersonName>ersersonName>cored in my own thinking when I recently acquired a flat file of data that I now get to upload into a real database. I am seeing first hand how difficult that is.

As IT people, you shouldn’t have to spend your time trying to get this logic which can only come from doctors or other health providersonName>ersersonName> (mostly docs for this type thing). Most doctors could not give it to you in this form. The above logic requires that the physician supply only about 4 or 5 pieces of information. Then he doesn’t have to read all that tiny print or memorize anything.

Thanks for any input for this concept.

I realize this may or may not be the right forum to post this in. (But give me a break: I’m a rookie)J

SMK