Knowledge as a Service at the Point of Care

An electronic health record (EHR) can assist the delivery of high-quality patient care, in part by providing the capability for a broad range of clinical decision support, including contextual references (e.g., Infobuttons), alerts and reminders, order sets, and dashboards. All of these decision support tools are based on clinical knowledge; unfortunately, the mechanisms for managing rules, order sets, Infobuttons, and dashboards are often unrelated, making it difficult to coordinate the application of clinical knowledge to various components of the clinical workflow. Additional complexity is encountered when updating enterprise-wide knowledge bases and delivering the content through multiple modalities to different consumers. We present the experience of Mayo Clinic as a case study to examine the requirements and implementation challenges related to knowledge management across a large, multi-site medical center. The lessons learned through the development of our knowledge management and delivery platform will help inform the future development of interoperable knowledge resources.

Critical Issues in Radiation Protection Knowledge Management for Preserving Radiation Protection Research and Development Capabilities

As a hub of domestic radiation protection capabilities, Oak Ridge National Laboratory's Center for Radiation Protection Knowledge has a mandate to develop and actuate a formal knowledge management (KM) effort. This KM approach exceeds recruitment and training efforts but focuses on formalized strategies for knowledge transfer from outgoing subject matter experts in radiation protection to incoming generations. It is envisioned that such an effort will provide one avenue for preserving domestic capabilities to support stakeholder needs in the federal government and the nuclear industry while continuing to lead and innovate in research and development on a global scale. However, in the absence of broader coordination within the United States, preservation of radiation protection knowledge continues to be in jeopardy in the absence of a dedicated KM effort.

A Digital Framework to Support Providers and Patients in Diabetes Related Behavior Modification

We present Diabetes Web-Centric Information and Support Environment (D-WISE) that features: (a) Decision support tool to assist family physicians to administer Behavior Modification (BM) strategies to patients; and (b) Patient BM application that offers BM strategies and motivational interventions to engage patients. We take a knowledge management approach, using semantic web technologies, to model the social cognition theory constructs, Canadian diabetes guidelines and BM protocols used locally, in terms of a BM ontology that drives the BM decision support to physicians and BM strategy adherence monitoring and messaging to patients. We present the qualitative analysis of D-WISE usability by both physicians and patients.

From a Content Delivery Portal to a Knowledge Management System for Standardized Cancer Documentation

Heterogeneous tumor documentation and its challenges of interpretation of medical terms lead to problems in analyses of data from clinical and epidemiological cancer registries. The objective of this project was to design, implement and improve a national content delivery portal for oncological terms. Data elements of existing handbooks and documentation sources were analyzed, combined and summarized by medical experts of different comprehensive cancer centers. Informatics experts created a generic data model based on an existing metadata repository. In order to establish a national knowledge management system for standardized cancer documentation, a prototypical tumor wiki was designed and implemented. Requirements engineering techniques were applied to optimize this platform. It is targeted to user groups such as documentation officers, physicians and patients. The linkage to other information sources like PubMed and MeSH was realized.

Knowledge Management in Health Technology SMEs

The purpose of this study was to examine knowledge management's (KM) role in small and medium-sized (SMEs) health technology enterprises, which employ fewer than 250 employees. In this study, KM is understood as the ability to achieve competitive advantage by utilizing management knowledge and making it profitable. The health technology enterprises use modern technology to resolve health-related issues. The research data was acquired from Finnish health technology SMEs. The questionnaire was sent to 140 enterprises, generating 25 responses, or a 17.9% response rate. According to the results, health technology enterprises have not adopted KM concepts, nor do they have the necessary resources to do so. SMEs' KM use is informal: information is transferred informally through human interaction, rather than through information systems. In the SMEs, KM is not perceived as important, although it is seen as associated with the enterprise's financial performance through the potential in making the knowledge profitable.

Integrating Science and Engineering to Implement Evidence-Based Practices in Health Care Settings

Integrating two distinct and complementary paradigms, science and engineering, may produce more effective outcomes for the implementation of evidence-based practices in health care settings. Science formalizes and tests innovations, whereas engineering customizes and optimizes how the innovation is applied tailoring to accommodate local conditions. Together they may accelerate the creation of an evidence-based healthcare system that works effectively in specific health care settings. We give examples of applying engineering methods for better quality, more efficient, and safer implementation of clinical practices, medical devices, and health services systems. A specific example was applying systems engineering design that orchestrated people, process, data, decision-making, and communication through a technology application to implement evidence-based depression care among low-income patients with diabetes. We recommend that leading journals recognize the fundamental role of engineering in implementation research, to improve understanding of design elements that create a better fit between program elements and local context.

Contextualizing learning to improve care using collaborative communities of practices

BACKGROUND

The use of interorganizational, collaborative approaches to build capacity in quality improvement (QI) in health care is showing promise as a useful model for scaling up and accelerating the implementation of interventions that bridge the "know-do" gap to improve clinical care and provider outcomes. Fundamental to a collaborative approach is interorganizational learning whereby organizations acquire, share, and combine knowledge with other organizations and have the opportunity to learn from their respective successes and challenges in improvement areas. This learning approach aims to create the conditions for collaborative, reflective, and innovative experiential systems that enable collective discussions regarding daily practice issues and finding solutions for improvement.

METHODS

The concepts associated with interorganizational learning and deliberate learning activities within a collaborative 'Communities-of-practice'(CoP) approach formed the foundation of the of an interactive QI knowledge translation initiative entitled PERFORM KT. Nine teams participated including seven teams from two acute care hospitals, one from a long term care center, and one from a mental health sciences center. Six monthly CoP learning sessions were held and teams, with the support of an assigned mentor, implemented a QI project and monitored their results which were presented at an end of project symposium. 47 individuals participated in either a focus group or a personal interview. Interviews were transcribed and analyzed using an iterative content analysis.

RESULTS

Four key themes emerged from the narrative dataset around experiences and perceptions associated with the PERFORM KT initiative: 1) being successful and taking it to other levels by being systematic, structured, and mentored; 2) taking it outside the comfort zone by being exposed to new concepts and learning together; 3) hearing feedback, exchanging stories, and getting new ideas; and 4) having a pragmatic and accommodating approach to apply new learnings in local contexts.

CONCLUSIONS

Study findings offer insights into collaborative, inter-organizational CoP learning approaches to build QI capabilities amongst clinicians, staff, and managers. In particular, our study delineates the need to contextualize QI learning by using deliberate learning activities to balance systematic and structured approaches alongside pragmatic and accommodating approaches with expert mentors.

Knowledge management in a waste based biorefinery in the QbD paradigm

Shifting resource base from fossil feedstock to renewable raw materials for production of chemical products has opened up an area of novel applications of industrial biotechnology-based process tools. This review aims to provide a concise and focused discussion on recent advances in knowledge management to facilitate efficient and optimal operation of a biorefinery. Application of quality by design (QbD) and process analytical technology (PAT) as tools for knowledge creation and management at different levels has been highlighted. Role of process integration, government policies, knowledge exchange through collaboration, and use of databases and computational tools have also been touched upon.

The role of innovative global institutions in linking knowledge and action

It is becoming increasingly recognized that our collective ability to tackle complex problems will require the development of new, adaptive, and innovative institutional arrangements that can deal with rapidly changing knowledge and have effective learning capabilities. In this paper, we applied a knowledge-systems perspective to examine how institutional innovations can affect the generation, sharing, and application of scientific and technical knowledge. We report on a case study that examined the effects that one large innovative organization, The Global Fund to Fight AIDS, Tuberculosis, and Malaria, is having on the knowledge dimensions of decision-making in global health. The case study shows that the organization created demand for new knowledge from a range of actors, but it did not incorporate strategies for meeting this demand into their own rules, incentives, or procedures. This made it difficult for some applicants to meet the organization's dual aims of scientific soundness and national ownership of projects. It also highlighted that scientific knowledge needed to be integrated with managerial and situational knowledge for success. More generally, the study illustrates that institutional change targeting implementation can also significantly affect the dynamics of knowledge creation (learning), access, distribution, and use. Recognizing how action-oriented institutions can affect these dynamics across their knowledge system can help institutional designers build more efficient and effective institutions for sustainable development.

The Role of Diverse Strategies in Sustainable Knowledge Production

Online communities are becoming increasingly important as platforms for large-scale human cooperation. These communities allow users seeking and sharing professional skills to solve problems collaboratively. To investigate how users cooperate to complete a large number of knowledge-producing tasks, we analyze Stack Exchange, one of the largest question and answer systems in the world. We construct attention networks to model the growth of 110 communities in the Stack Exchange system and quantify individual answering strategies using the linking dynamics on attention networks. We identify two answering strategies. Strategy A aims at performing maintenance by doing simple tasks, whereas strategy B aims at investing time in doing challenging tasks. Both strategies are important: empirical evidence shows that strategy A decreases the median waiting time for answers and strategy B increases the acceptance rate of answers. In investigating the strategic persistence of users, we find that users tends to stick on the same strategy over time in a community, but switch from one strategy to the other across communities. This finding reveals the different sets of knowledge and skills between users. A balance between the population of users taking A and B strategies that approximates 2:1, is found to be optimal to the sustainable growth of communities.

Ergonomics for the inclusion of older workers in the knowledge workforce and a guidance tool for designers

The ageing of the population and the inverted population pyramid is bringing important changes to society as a whole. These changes are associated with the inclusion of an older workforce in knowledge work and the challenge they represent in adapting the work environment accordingly. In order to approach a more universal design of the work environment, industrial designers need support from user-sensitive inclusive design studies. While there are plenty of guidelines and tools containing relevant information, there is a need to develop more appropriate tools for Industrial Designers that cover the initial phase of the design process. This study provides a review of the available tools and guidelines and proposes a theoretical framework intended for developing a design guidance tool for inclusive workstation design.

Brokering the Research-Practice Gap: A typology

Despite widespread recognition of a research-practice gap in multiple service sectors, less is known about how pre-existing communication channels facilitate the flow of information between researchers and practitioners. In the current study, we applied an existing typology of brokerage developed by Gould and Fernandez (Sociol Methodol 19:89-126, 1989) to examine what types of brokerage facilitate information spread between researchers and educational practitioners. Specifically, we conducted semi-structured interviews with 19 school administrators and staff in two public school districts regarding their experiences searching for information about instructional, health, and social skills programs. Using deductive content analysis, we found evidence of all five types of brokerage identified by Gould and Fernandez (1989). However, only three types of brokerage-gatekeepers, representatives, and liaisons-were involved in the flow of information between school administrators and researchers. Moreover, information transfer often occurred in longer chains that involved multiple, distinct types of brokerage. We conclude with the broad implications of our findings for narrowing the research-practice gap by improving researchers' dissemination efforts and practitioners' search for information.

Towards a better management of complex emergencies through crisis management meta-modelling

Managing complex emergency situations is a challenging task, mainly due to the heterogeneity of the partners involved and the critical nature of such events. Whatever approach is adopted to support this objective, one unavoidable issue is knowledge management. In the context of our research project, gathering, formalising and exploiting all the knowledge and information about a given crisis situation is a critical requirement. This paper presents some research results concerning this specific topic: from a theoretical point of view, the generic dimensions of crisis characterisation are defined, while from a technical point of view, we describe a software solution able to collect that knowledge (based on meta-models and ontologies). This is used to confront the characteristics of the situation (context) with characteristics of the resources (relief system) in order to design a suitable response. Finally, an illustrative example concerning a crash between a tanker truck and a train is described.

The effectiveness of toolkits as knowledge translation strategies for integrating evidence into clinical care: a systematic review

OBJECTIVES

The aim of this systematic review was to evaluate the effectiveness of toolkits as a knowledge translation (KT) strategy for facilitating the implementation of evidence into clinical care. Toolkits include multiple resources for educating and/or facilitating behaviour change.

DESIGN

Systematic review of the literature on toolkits.

METHODS

A search was conducted on MEDLINE, EMBASE, PsycINFO and CINAHL. Studies were included if they evaluated the effectiveness of a toolkit to support the integration of evidence into clinical care, and if the KT goal(s) of the study were to inform, share knowledge, build awareness, change practice, change behaviour, and/or clinical outcomes in healthcare settings, inform policy, or to commercialise an innovation. Screening of studies, assessment of methodological quality and data extraction for the included studies were conducted by at least two reviewers.

RESULTS

39 relevant studies were included for full review; 8 were rated as moderate to strong methodologically with clinical outcomes that could be somewhat attributed to the toolkit. Three of the eight studies evaluated the toolkit as a single KT intervention, while five embedded the toolkit into a multistrategy intervention. Six of the eight toolkits were partially or mostly effective in changing clinical outcomes and six studies reported on implementation outcomes. The types of resources embedded within toolkits varied but included predominantly educational materials.

CONCLUSIONS

Future toolkits should be informed by high-quality evidence and theory, and should be evaluated using rigorous study designs to explain the factors underlying their effectiveness and successful implementation.

The Self-Assessment Process and Impacts on the Health Information Management Program Performance: A Case Study

This study examined how health information management (HIM) educational programs can use the Malcolm Baldrige National Quality Award Model (MBNQAM) educational criteria to meet the self-assessment requirement for Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM) accreditation. An existing instrument, Quantum Performance Group's Organizational Assessment Survey authored by Dr. Mark Blazey, was used in this study. The instrument was designed to self-assess the entire organization. Results of the study demonstrate how the MBNQAM can be used to successfully self-assess HIM programs. This research adds to the body of literature surrounding the application of the MBNQAM for HIM programs and provides new information to deans, administrators, and educators that may be useful, as an added component, when self-assessing HIM programs. The results of this study will help to establish a foundation for HIM programs to strengthen the self-assessment process, providing a strong starting point for strategic planning prioritization for HIM program improvement initiatives. The improved process will help in maturing the HIM program while fulfilling accreditation requirements for self-assessment. As additional HIM programs formalize the self-assessment process, benchmarking opportunities with other HIM programs will be created.

Managing OMICS-Data: Considerations for the Design of a Clinical Research IT-Infrastructure

Biomarker-based translational research enables deep insight into cellular processes and human diseases. As a result, high-throughput technologies promulgating a fast and cost-effective generation of data are widely used to advance our understanding in the molecular background of individuals. However, the increasing volume and complexity of data increases the need for sustainable infrastructures and state-of-the-art tools allowing management, analysis, and integration of OMICS data. To address these challenges, we have performed site visits of core facilities with a focus on high-throughput technologies to explore their (IT) infrastructure, organizational aspects, and data management strategies. Different stakeholders were interviewed regarding requirements and needs for dealing with high-throughput data. We have identified four different fields of action: (1) the interface from biorepositories to service providers of high-throughput technologies, (2) aspects within services providers, (3) the interface from service providers to bioinformatical analysis, and (4) organizational and other aspects. For each field, recommendations and strategies were developed for implementation of a seamless pipeline from biorepositories to highly specialized high-throughput laboratories including the sustainable management and integration of OMICS data.

Clinical Decision Support Knowledge Management: Strategies for Success

Clinical Decision Support Systems have been shown to increase quality of care, patient safety, improve adherence to guidelines for prevention and treatment, and avoid medication errors. Such systems depend mainly on two types of content; the clinical information related to patients and the medical knowledge related to the specialty that informs the system rules and alerts. At King Faisal Specialist Hospital and Research Center, Saudi Arabia, the Health Information Technology Affairs worked on identifying best strategies and recommendations for successful CDSS knowledge management. A review of literature was conducted to identify main areas of challenges and factors of success. A qualitative survey was used over six months' duration to collect opinions, experiences and suggestions from both IT and healthcare professionals. Recommendations were categorized into ten main topics that should be addressed during the development and implementation of CDSS knowledge management tools in the hospital.

Knowledge Management within the Medical University

The aim of the work is studying the possibilities of ontological engineering in managing of medical knowledge. And also practical implementation of knowledge management system (KMS) in medical university. The educational process model is established that allows analyzing learning results within time scale. Glossary sub-system has been developed; ontologies of educational disciplines are constructed; environment for setup and solution of situational cases is established; ontological approach to assess competencies is developed. The possibilities of the system for solving situation tasks have been described. The approach to the evaluation of competence has been developed.

A Decision Fusion Framework for Treatment Recommendation Systems

Treatment recommendation is a nontrivial task--it requires not only domain knowledge from evidence-based medicine, but also data insights from descriptive, predictive and prescriptive analysis. A single treatment recommendation system is usually trained or modeled with a limited (size or quality) source. This paper proposes a decision fusion framework, combining both knowledge-driven and data-driven decision engines for treatment recommendation. End users (e.g. using the clinician workstation or mobile apps) could have a comprehensive view of various engines' opinions, as well as the final decision after fusion. For implementation, we leverage several well-known fusion algorithms, such as decision templates and meta classifiers (of logistic and SVM, etc.). Using an outcome-driven evaluation metric, we compare the fusion engine with base engines, and our experimental results show that decision fusion is a promising way towards a more valuable treatment recommendation.

Evaluation of need for ontologies to manage domain content for the Reportable Conditions Knowledge Management System

The Reportable Condition Knowledge Management System (RCKMS) is envisioned to be a single, comprehensive, authoritative, real-time portal to author, view and access computable information about reportable conditions. The system is designed for use by hospitals, laboratories, health information exchanges, and providers to meet public health reporting requirements. The RCKMS Knowledge Representation Workgroup was tasked to explore the need for ontologies to support RCKMS functionality. The workgroup reviewed relevant projects and defined criteria to evaluate candidate knowledge domain areas for ontology development. The use of ontologies is justified for this project to unify the semantics used to describe similar reportable events and concepts between different jurisdictions and over time, to aid data integration, and to manage large, unwieldy datasets that evolve, and are sometimes externally managed.

Managing free text for secondary use of health data

OBJECTIVE

To summarize the best papers in the field of Knowledge Representation and Management (KRM).

METHODS

A comprehensive review of medical informatics literature was performed to select some of the most interesting papers of KRM and natural language processing (NLP) published in 2013.

RESULTS

Four articles were selected, one focuses on Electronic Health Record (EHR) interoperability for clinical pathway personalization based on structured data. The other three focus on NLP (corpus creation, de-identification, and co-reference resolution) and highlight the increase in NLP tools performances.

CONCLUSION

NLP tools are close to being seriously concurrent to humans in some annotation tasks. Their use could increase drastically the amount of data usable for meaningful use of EHR.