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The authors are correct that there is a definite problem of lack of availability of clinical risk prediction models (CRPMs) and other clinical digital tools at the 'coalface'. However there may be many other potential solutions to solving this, using more orthodox methods than a novel blockchain-based deployment marketplace.
It is clear that academic, clinical, managerial , and industry incentives are misaligned and this is why CRPMs don't readily see deployment to places where clinical end-users can easily obtain and use them. But a blockchain-based solution is hard to envisage, when more ordinary deployment methods have not seemingly been tried with sufficient enthusiasm. The article suggests that blockchain 'might' be part of the solution but it would be a more convincing argument were this backed up by an open source proof of concept or a demonstration of such as system in action. It seems unlikely to me that EHR vendors will willingly integrate external features into their systems that are totally reliant on an unproven, fluid 'marketplace' of smart contract execution, with no guarantee of uptime, future cost, or long term reliability or even existence.
Additionally, widening the discussion of these deployment incentives to include AI-based clinical risk models blurs the picture because these two types of CRPM are very different. The level of clinical trust of such experimental AI models is low, and does not favourably...
Additionally, widening the discussion of these deployment incentives to include AI-based clinical risk models blurs the picture because these two types of CRPM are very different. The level of clinical trust of such experimental AI models is low, and does not favourably compare with the high level of clinical trust we place in traditional (non-AI) clinical risk models which are simple, statistics-based, deterministic, well understood, reproducible and evidence-based. AI-based models are almost always proprietary, resulting in a high risk of bias in their clinical evaluations, and a low level of clinical trust.
We don't need a blockchain marketplace - if existing incentives are insufficient for the incumbents in the marketplace then we as clinicians must intervene, we need to develop these CRPMs as open-source software, and deploy them commercially under the aegis of suitable clinically-trusted organisation, such as (but not limited to) the medical and surgical Royal Colleges. A real-life, working, replicable deployment model is that of the RCPCH Digital Growth Charts, which are open-source and deployed as a REST API in exactly this way, with a sustainable business model around them which ensures ongoing reliable presence in the market.
RCPCH Digital Growth Charts https://growth.rcpch.ac.uk/