A tribute to ‘inspiring, witty and pioneering’ John Fox


John Fox was a pioneer, chief, educator, serial entrepreneur.

He was additionally an advocate within the space of high-quality knowledge-based medical determination assist techniques (CDSS).

He constructed his profession at Most cancers Analysis UK and later Oxford College. He was additionally the founder and “driving power” of OpenClinical.

In late August this 12 months John died from most cancers, abandoning an unbelievable legacy that can proceed to have an effect in for years to come back.

John’s biggest fame comes from the PROforma formal laptop language for modelling medical choices and processes, which is rooted in cognitive principle and follows rigorous software program engineering practices.

He carried out and trialled greater than 15 CDSSs utilizing PROforma, offering protected and sound decision-support to completely different healthcare organisations in several international locations.

John additionally served our neighborhood as an editorial board member of the Journal of Biomedical Informatics for the previous eight years.

From his roots in psychology and cognition, he developed a strong formalism, PROforma, that displays our understanding of human determination making, and has clear and constant semantics.

John was an interdisciplinary researcher with theoretical pursuits in AI and laptop science and an utilized focus in medication and medical software program engineering.

After coaching in experimental psychology at Durham and Cambridge Universities within the UK, and post-doctoral fellowships at CMU (working with AI founders Herb Simon and Allen Newell) and Cornell within the USA, he joined the Medical Analysis Council in Sheffield UK to ascertain a programme of analysis in decision-making and medical determination assist.

In 1981 he arrange the Superior Computation Lab on the Imperial Most cancers Analysis Fund (now Most cancers Analysis UK) the place analysis targeted on functions of knowledge-based techniques in oncology and first care.

Nevertheless, the group was explicitly multidisciplinary and made contributions in fundamental laptop science, security vital techniques, AI and medical informatics, and developed quite a few applied sciences which have been commercialised.

In 1996, he and his group have been awarded the twentieth Anniversary Gold Medal of the European Federation of Medical Informatics for the event of PROforma, one of many first formal laptop languages for modelling medical choices and processes.

In 2007, John moved to the division of Engineering Science at Oxford College to arrange an interdisciplinary analysis collaboration with Edinburgh College and UCL, and a medical informatics incubator on the Royal Free Hospital in London.

The incubator ran quite a few profitable trials of AI applied sciences and spun out two corporations to take the applied sciences into medical use: OpenClinical CIC, and Deontics Ltd.

Standout contributions to analysis and well being

John developed and left for our neighborhood many achievements, together with symbolic reasoning and argumentation for determination assist.

John’s early contribution to symbolic DSS got here out of his time as a postdoctoral scholar with Simon and Newell, who established the paradigm as a manner of modelling cognition.

John had early and well-known clashes within the journals about whether or not cognition ought to be simulated symbolically or probabilistically.

This work developed right into a full mannequin of the cognitive processes surrounding the framing and making of selections, and planning and execution of motion in complicated and unsure domains resembling medication, which might come to underpin a lot of John’s work together with the PROforma language.

John additionally had a powerful curiosity in AI security. Even now, AI security stays an rising subject. Twenty-one years in the past, in 2000, John printed the ebook ‘Secure and Sound’ primarily based on analysis within the RED (rigorously engineered choices) undertaking carried out for the UK security vital techniques initiative.

Within the ebook he introduced an arguably extra refined remedy than something obtainable at the moment. Towards this objective, he formulated a stack of rules (The CREDO stack) that may systematically be used to make sure that CDSS functions are protected and sound.

John was additionally based OpenClinical a not-for-profit firm supported by Oxford College Innovation whose mission is to advertise the peer evaluate and dissemination of AI fashions of finest medical apply primarily based on a sound mannequin of the life course of small fragments of executable data John known as “publets”.

It features a repository of executable decision-support companies and express (normally declarative) data that may be shared for bettering affected person care by means of revolutionary AI and data engineering strategies, resembling PROforma.

A key goal is to empower and encourage healthcare professionals to writer, share, critique, trial and revise these executable fashions of finest apply in an moral, clear and reliable manner.

OpenClinical is an operational publishing platform that makes use of the PROforma language to seize human experience in decision-making, care planning and different cognitive expertise.

OpenClinical’s open-access, open-source repository carries over fifty numerous examples of computer-executable pointers and different artefacts.

PROforma – a technique and language for specifying medical pointers and protocols, rooted in strong cognitive principle and software program engineering is an executable course of modeling language used to construct and deploy determination assist techniques, medical protocols, pointers, and different medical functions in a machine-executable format.

The PROforma formalism and methodology for modelling medical data is predicated on the domino mannequin, a generalised mannequin of medical determination making and protocol administration.

PROforma is a first-order logic formalism prolonged to assist determination making and plan execution. It incorporates non-classical logics (e.g., modal logic, temporal logic, deontic logic), LA, logic of argument and LOT (logic of obligation and time) to assist determination making and motion management.

Work resulting in the introduction of PROforma began within the late Nineteen Eighties with funding from European businesses. PROforma improvement was additionally supported by Most cancers Analysis UK with the aim of constructing determination assist and clever brokers to enhance most cancers care.

PROforma contains a proper specification language, a data illustration language and a collection of authoring instruments and execution software program for constructing functions. It kinds the data illustration layer within the CREDO data stack. CREDO is a framework for understanding human experience and for designing and deploying techniques that assist cognitive duties resembling scenario and threat evaluation, decision-making, remedy planning and workflow administration.

The Tallis know-how stack was developed by John’s group at Most cancers Analysis UK to assist the authoring and execution of PROforma functions.

PROforma has been validated in a variety of functions in numerous medical settings and specialties, with trials of those printed in excessive influence peer-reviewed journals. Trials have studied affected person workup and threat evaluation; determination assist (e.g., prognosis, take a look at and remedy choice, prescribing); adaptive care pathways and care planning.

Greater than 15 medical functions have been constructed utilizing PROforma know-how, together with:

  • ORAMA (Optimum Renal Anaemia Administration Evaluation)
  • Retrogram HIV remedy
  • MACRO as a web-based medical trial administration system)
  • ARNO for most cancers ache management
  • Proof with out Effort Medical determination assist
  • RAGs for genetic threat administration
  • ERA for early referral for suspected most cancers
  • CAPSULE as a choice assist for prescribing in main care
  • e-Asma as a choice assist for bronchial asthma administration
  • HOMEY for the event of pure language and speech interfaces for affected person dwelling monitoring and medical companies
  • LISA a choice assist for collaborative care in childhood acute lymphoblastic leukemia
  • CREDO, a medical trial of decision-making and workflow administration within the care of ladies susceptible to or with a confirmed prognosis of breast most cancers
  • And a computer-interpretable model of the AACE, AME, ETA medical pointers for medical apply for the prognosis and administration of thyroid nodules

In 2020, PROforma and OpenClinical have been used to create a knowledge mannequin for care of Covid-19 sufferers along with executable fashions of guidelines, choices and plans that interpret affected person information and provides personalised care recommendation. This undertaking demonstrated a novel and promising method to the fast translation of medical pointers into point-of-care companies, and a basis for fast studying techniques in lots of areas of healthcare.

John additionally co-founded two corporations that develop instruments supporting medical decision-support system implementations primarily based on PROforma.

The primary PROforma-based know-how for authoring and executing medical pointers was Arezzo. This software program was designed and constructed by Most cancers Analysis UK and InferMed to develop enactable medical pointers.

Deontics, of which John was a founder and a director, is a spinout firm from Oxford College, College Faculty London Enterprise and Most cancers Analysis UK.

It produces a mobile-friendly CDS utility supporting medical and operational pathway administration and remedy determination making, together with analytics instruments for working PROforma pointers towards longitudinal retrospective affected person information, and a PROforma guideline authoring system.

A witty and humorous household man

Away from work, John was a a lot liked household man and pal.

Over dinners and household visits, and when chatting earlier than Skype/Zoom calls, John shared his manner of seeing the world by means of his wit and humour, which is what all of us keep in mind.

John cared about what’s essential – household, schooling, ethics, healthcare and different societal challenges.

He not solely cared, however did one thing about these challenges inside his grasp, particularly the place he felt determination making might be improved.

John was a deeply principled and good man, and was completely captivated with his work and seeing his informatics analysis translate and contact the lives of actual individuals by means of improved healthcare.

He was inspiring, targeted, stuffed with power and had a lot ardour for analysis, and was a mentor to many college students and younger researchers. He was an excellent speaker and generously shared his data and expertise with others, coaching many PhD college students, a few of whom are actually leaders in our subject.

He was an moral man and a person of sturdy rules. We are going to miss John, his sense of humour and his considerate insights, questions and feedback.

He was a beautiful mentor and an inspirational particular person in our lives.

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