Sonny Saggar has posted No One Can Own the Language of Medicine: The Legal and Economic Case for an Open, AI-native Standard for Coding Medical Interventions on SSRN. Here is the abstract:
In America, the language of medicine is leased back to the people who speak it. Every billable act has to be named in a code that a private trade association owns and rents back. The American Medical Association holds the copyright to Current Procedural Terminology (CPT), the federal government has mandated its use since the 1980s, and the licensing revenue runs into the hundreds of millions of dollars a year. This paper argues that the arrangement is difficult to justify on legal, economic, or clinical grounds, and that a credible open alternative is now technically straightforward and politically possible.
The legal terrain is more contested than is usually assumed. The case that shields the CPT copyright also found the AMA misused it, the modern authority on standards incorporated into law favors public access, and the federal government can open the field by rulemaking without a single new statute. The technical objection that an open standard is hard to build does not survive contact with the facts: the composable, machine-readable model is already standardized by the World Health Organization’s International Classification of Health Interventions (ICHI) and by SNOMED CT. The missing piece is governance, not computer science. This paper sets out that governance model under the working name OMNI, for Open Medical Nomenclature and Interventions, and maps a realistic adoption path through the interoperability machinery the United States already built under the 21st Century Cures Act. Administrative activity consumed an estimated 34 percent of US health spending in 2017, roughly 812 billion dollars; a licensed bottleneck on the basic vocabulary of care is a small but symbolic piece of that, and a fixable one.