In anaesthesia there is little doubt that better monitoring improves patient care. There is a gamut of new technology being used for cardiac output monitoring and integrating current monitors at the anaesthetic workstation. However, the cost of these new systems are relatively high, no doubt due to the extensive research and complexity of the newer devices.
The pulse oximeter has become so vital to patient care worldwide that Lifebox has come to be. For those who may not know Lifebox is an organization that is promoting safer surgery/anaesthesia and offering a low-cost, high-value pulse oximeter, other vital equipment and training to developing countries. I am very happy about this.
In the UK, the National Institute for Clinical Excellence makes recommendations based on current evidence to guide the best practice within the medical specialties. Is there need for a body that supports the development of technology that is low cost but high quality once shown that it is likely to be of benefit to the majority? Would clinicians/researchers be interested in an open-source community that puts the benefits of new technology above its costs?
Of course clinicians will be interested in open source communities helping them exchange very specific applications and integrate them in the backbone EHR system.
Software vendors and eHEALTH systems must provide the software for keeping our records up to date and exchange information. We will rely much more on computerized decision support, but the knowledge behind should not be maintained and updated by big IT companies or vendors. That should be done by reliable independent knowledge providers (or WIKI like open communities).
Also clinicians can now create very specific applications, extremely tailored to their needs and have these quite rapidly developed for their own need, as younger clinicians often harness the technology to develop quickly and efficiently new applications. Then they should be helped to standardize, codify and implement these local applications in a wider open source platform.
In other areas of research that overlap with medicine, but are not solely medicine, there are extensive examples of effective open source communities. The best example is in statistical software. R is an open sources software package where users can write their own code and share it. It is so effective that R has become the most diverse statistical package for analysis of health and epidemiological data. I think this demonstrates how much professionals like open source and how sustainable it is. However, there is no regulatory body to make sure the codes in R are correct, and this is something that would have to be monitored in healthcare, which would incur cost.
"Is there need for a body that supports the development of technology that is low cost but high quality once shown that it is likely to be of benefit to the majority?"
This is putting the cart before the horse. The horse is always a stakeholder that sees the community benefit and is prepared to underwrite the costs initially and act as the sustainer. Notice also "open source" is a misnomer, what you are talking about is community developed resources, which typically will have an open source and open license aspect. 80% of the task is hence coordination, cooperation, politics, and funding the last 20% is building the actual technology. Therefore there really is no one "body" that can do this. A set of guidelines and principles known to foster good outcomes - that would be helpful for those wishing to undertake such journeys.
Worked with UCSD cardiologists we had developed an inexpensive monitoring system, DynaPulse, which measures cardiac output and other hemodynamic parameters while using the traditional cuff during a routine blood pressure monitor. However, the medical community is not applying the technology in clinics due to lack of reimbursement. Only few doctors with visions and research mind are using DynaPulse for improving patient care and to advance the management and treatment of hypertension and CVDs.
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