1. Computerized Medical Systems HCSS/HCES Workshop November 16, 2004

2. Issues Today A. We have a product built using non-formal methods that has vast amounts of knowledge in it but which doesn’t lend itself to enhancements using formal methods. We need a tool that will work backwards – take the code we have today and from that create math models. B. While the world has the CMM and now CMMI, there are still many companies which have not implemented such models or who have not advanced to the higher levels of the models. Help is needed in implementing such models in existing development organizations, and there is very little public data, which is current, that shows the benefits of moving to higher levels of maturity within the models (last report in 1994 admitted it was incomplete. In business we need proof that things work and ways of moving existing complex organizations and systems of software to new and better ideas. We need NSF to fund a) completion of the studies and b) marketing of the gains companies have seen from implementing processes.

3. Issue To Be Worked In The Next 5 Years Eliminate data Silo-ization –System A -> System B -> System C without data manipulation or problems –Need to be able to mine data to support biological modeling IHE Initiative for standards-based data sharing methods is too small Need finer grain, more lightweight data models We need vendors to: mine the data they have today provide it to an impartial user/vendor body create data models. This would give users more benefit from the data.

4. Issues 10 Years From Now Information and models of therapy delivery being used by RTP systems have become more complex. The user is less able to judge the output intuitively. Soon the data output will be unintelligible by users. We will need to present information so that the user can understand what the system is telling them –Apple PCs graphing output of Cray supercomputers –possibly involving use of haptic devices

5. Issues 20 Years From Now 1895 – diagnostic X Ray developed 1970 – first computerized RTP system developed; UNIX developed 1972 – first commercial CT scanners 1990 – first “3D RTP” system developed 2000 – Inverse planning, IMRT introduced 2005 – Image Guided Radiotherapy introduced 2025 - treatment planning done by an array of machines making all the decisions because no human could do them in a reasonable time or understand the output. “Human race drifts into a position of dependence and must accept their (the computers’) decisions. Eventually keeping the systems running will itself be so complex that humans cannot make them and machines will make themselves. Software development will be done by machines and not human activity since it will be required so quickly and be so complex that human’s can’t perform adequately.” (Bill Joy – “Why the future doesn’t need us”) (This is not necessarily the opinion of my employer!)

6. Bio Mike Parsons is the Director of Quality Assurance and Regulatory Affairs at Computerized Medical Systems (CMS), a position he has held since 1993. CMS is a developer of software for use in radiation treatment planning. Prior to CMS, Parsons worked five years for a start-up diagnostic ultrasound company in a similar capacity. He has held several positions in Engineering, Manufacturing, and Quality Assurance with various other commercial and aerospace companies.