A large-scale knowledge management method based on the analysis of the use of online knowledge resources

Online health knowledge resources can be integrated into electronic health record systems using decision support tools known as "infobuttons." In this study we describe a knowledge management method based on the analysis of knowledge resource use via infobuttons in multiple institutions.

METHODS

We conducted a two-phase analysis of laboratory test infobutton sessions at three healthcare institutions accessing two knowledge resources. The primary study measure was session coverage, i.e. the rate of infobutton sessions in which resources retrieved relevant content.

RESULTS

In Phase One, resources covered 78.5% of the study sessions. In addition, a subset of 38 noncovered tests that most frequently raised questions was identified. In Phase Two, content development guided by the outcomes of Phase One resulted in a 4% average coverage increase.

CONCLUSION

The described method is a valuable approach to large-scale knowledge management in rapidly changing domains.

Activist trust: the diffusion of green expertise in a Brazilian landscape

MST (Movimento Sem Terra/Landless People's Movement) is the largest rural movement of Latin America. Since the late 1990s, it has taken part in the diffusion of expertise about biodiversity conservation. Using an ethnographic approach, this paper investigates sources and roles of trust within this process. How does trust work when experts and laypeople belong to the same movement? The paper uses and critically discusses the works of Brian Wynne and the Actor Network Theory. It describes the particular ways in which the building of trust takes place within the intimate networks of MST. As ecological expertise becomes a central element within MST's project of liberation, the sources of trust are both affective and effective. Interests, social recognition and identity are intertwined. In the conclusion, I propose the concept of activist trust.

Identifying best practices for clinical decision support and knowledge management in the field

To investigate best practices for implementing and managing clinical decision support (CDS) in community hospitals and ambulatory settings, we carried out a series of ethnographic studies to gather information from nine diverse organizations. Using the Rapid Assessment Process methodology, we conducted surveys, interviews, and observations over a period of two years in eight different geographic regions of the U.S.A. We first utilized a template organizing method for an expedited analysis of the data, followed by a deeper and more time consuming interpretive approach. We identified five major categories of best practices that require careful consideration while carrying out the planning, implementation, and knowledge management processes related to CDS. As more health care organizations implement clinical systems such as computerized provider order entry with CDS, descriptions of lessons learned by CDS pioneers can provide valuable guidance so that CDS can have optimal impact on health care quality.

The trajectory of scientific discovery: concept co-occurrence and converging semantic distance

The paradigm of literature-based knowledge discovery originated by Swanson involves finding meaningful associations between terms or concepts that have not occurred together in any previously published document. While several automated approaches have been applied to this problem, these generally evaluate the literature at a point in time, and do not evaluate the role of change over time in distributional statistics as an indicator of meaningful implicit associations. To address this issue, we develop and evaluate Symmetric Random Indexing (SRI), a novel variant of the Random Indexing (RI) approach that is able to measure implicit association over time. SRI is found to compare favorably to existing RI variants in the prediction of future direct co-occurrence. Summary statistics over several experiments suggest a trend of converging semantic distance prior to the co-occurrence of key terms for two seminal historical literature-based discoveries.

A systematic approach: optimization of healthcare operations with knowledge management

Effective decision making is vital in all healthcare activities. While this decision making is typically complex and unstructured, it requires the decision maker to gather multispectral data and information in order to make an effective choice when faced with numerous options. Unstructured decision making in dynamic and complex environments is challenging and in almost every situation the decision maker is undoubtedly faced with information inferiority. The need for germane knowledge, pertinent information and relevant data are critical and hence the value of harnessing knowledge and embracing the tools, techniques, technologies and tactics of knowledge management are essential to ensuring efficiency and efficacy in the decision making process. The systematic approach and application of knowledge management (KM) principles and tools can provide the necessary foundation for improving the decision making processes in healthcare. A combination of Boyd's OODA Loop (Observe, Orient, Decide, Act) and the Intelligence Continuum provide an integrated, systematic and dynamic model for ensuring that the healthcare decision maker is always provided with the appropriate and necessary knowledge elements that will help to ensure that healthcare decision making process outcomes are optimized for maximal patient benefit. The example of orthopaedic operating room processes will illustrate the application of the integrated model to support effective decision making in the clinical environment.

Knowledge representation and management: towards interoperable medical terminologies

OBJECTIVES

To summarize current outstanding research in the field of knowledge representation and management.

METHOD

Synopsis of the articles selected for the IMIA Yearbook 2009.

RESULTS

Four excellent papers have been selected for the section knowledge representation and management. All these papers are concerned with terminological systems whether it is to detect equivalent concept definitions, to structure narratives, to compare existing lay and professional terms or to reformulate the SNOMED's logical formalism towards a more expressive language.

CONCLUSIONS

The ability of one computer system to access and use the resources of another system becomes crucial in a world where the amount of electronically stored data increases continuously. The selected papers for the section knowledge representation and management corroborate that interoperable medical terminologies play a growing and strategic role in Electronic Health Record (EHR) systems. Indeed, they allow data in clinical systems to be defined in a more uniform and granular manner, thus leading to flexible, semantically interoperable and trust-worthy health information systems.

E-health versus KM-based health: a dilemma in researchers' minds

Over the past several years, there have been intensive discussions about the importance of Knowledge Management (KM) within our society. As we are moving into an era of "knowledge capitalism", the management of knowledge is promoted as an important and necessary factor for organisational survival and maintenance of competitive strength. During the last 15 years, KM has changed from one generation to the next through constant improvements and new perspectives. Many researchers have presented methodologies, frameworks, technologies and have discussed various KM theoretical and practical issues in several sectors, including healthcare. E-health and KM-based health are still in an early state of evolution, and it is only recently that researchers decided to intensify their efforts in these fields. In this context, this paper aims to review the current status quo, analyse key issues to which researchers should pay attention and contribute to researchers' dilemma solving about where future research should be focused.

A knowledge management framework to morph clinical cases with clinical practice guidelines

In this paper we present a knowledge management framework that allows the automatic linking/mapping of contextually and functionally similar medical knowledge that may originate from different sources and be represented in diverse modalities. Our tacit-explicit knowledge morphing framework supports the extraction of tacit knowledge from past cases stored in a case-base and maps it to corresponding explicit knowledge stored in clinical practice guidelines. The novelty of our approach is inherent in the fact that it allows practitioners to simultaneously refer to explicit knowledge-i.e. clinical practice guidelines-and experiential knowledge-i.e. past clinical cases. Here we present the system design and intended functionality of our knowledge morphing framework.

Clinical knowledge management: an overview of current understanding

This chapter outlines contributions to a workshop for ICMCC 2005. We details some of the central issues surrounding the incorporation of the Knowledge Management (KM) paradigm for the healthcare and clinical sectors. The complex nature of KM is discussed, together with some essential theories and some contemporary applications of the tools and techniques are presented.

Health information management: what business are we in?

Developments in information technology will drive the change in records management; however, it should be the health information managers who drive the information management change. The role of health information management will be challenged to use information technology to broker a range of requests for information from a variety of users, including health consumers. The purposes of this paper are to conceptualise the role of health information management in the context of a technologically driven and managed health care environment, and to demonstrate how this framework has been used to review and develop the undergraduate program in health information management at the Queensland University of Technology.