| > With properly structured data, machines should be able to interpret the guidelines. Charting systems could automatically suggesting diagnostic tests for a patient. Alarm bells and "Are you sure?" modals could pop up when a course of treatment diverges from the guidelines. And when a doctor needs to review the guidelines, there should be a much faster and more natural way than finding PDFs I have implemented this computerized process twice at two different startups over the past decade. I would not want the NCCN to do it. The NCCN guidelines are not stuck in PDFs, they are stuck in the heads of doctors. Once the NCCN guidelines get put into computerized rules, they start to be guided by those computerized rules, a second influence that takes them away from the fundamental science. So while I totally agree that there should be systemtticization of the rules, it should be entirely secondary and subservient to the best frontier knowledge about cancer, which changes extremely frequently. Annually after every ASCO (major pan-cancer conference) and every disease specific conference (e.g. the San Antonio breast cancer conference), and occasionally during the year when landmark clinical trials are published the doctors need to update their knowledge from the latest trials and their continuing medical education, which is entire body of knowledge that is complementary to the edges of what the NCCN publishes. Having spanned both computer science and medicine for my entire career, I trust doctors to be able to update their rules far faster than the programmers and databases. Please do not get the NCCN guidelines stuck in spaghetti code that a few programmers understand, rather than open in PDFs with lots of links that anybody can go and chase after. Edit: though give me a week digesting this article and I may change my mind. Maybe the NCCN should be standardizing clinical variables enough such that the rules can trivially be turned into rules. That would require that the hypotheses that a clinical trial fits into those rules however, and that's why I need a week of digestion to see if it may even be possible... |