Clinical knowledge management for healthcare
ABSTRACT A quiet transformation has taken place in health related research in the last twenty-five years. This transformation can be traced to the coming of age of new scientific domains like bioinformatics and cybernetics which have evolved thanks to trans-disciplinary research. The success of the human genome project is perhaps the most significant pointer of this silent transformation. We believe that in the future, as a result of synergistic interaction between bioinformatics and other paradigms, healthcare systems would have an increased interest in knowledge recycling of the collaborative learning process acquired from practices. In this context, the knowledge management (KM) paradigm could assist twenty-first century clinical practitioners to acquire proficiency in understanding and interpreting clinical information so as to attain knowledge and wisdom whilst dealing with large amounts of clinical data.
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ABSTRACT: In the last 10 years, the Information and Communication Technologies (ICTs) revolution has redefined the structure of the 21st century healthcare organization. It is clear that the 21st century healthcare organization will bring about new healthcare services and that traditional management and technological concepts would not be the appropriate conduit for disseminating these new healthcare services. The fundamental challenge faced by the 21st century clinical practitioner is to acquire proficiency in understanding and interpreting clinical information so as to attain knowledge and wisdom. An additional challenge that must be considered is that clinical practitioners make potentially life-saving decisions whilst attempting to deal with large amounts of clinical data. We focus on the emergence of telehealth as an alternative implementation for transfer of medical information using futuristic Information and Communication Technologies (ICT). We contend that current healthcare applications are being used in a static manner; futuristic applications will need to be dynamic in nature and would call for the transfer of context-based healthcare information. A Knowledge Management (KM) solution would allow healthcare institutions to give clinical data context, so as to allow knowledge derivation for more effective clinical diagnosis. It would also provide a mechanism for effective transfer of the acquired knowledge in order to aid healthcare workers as and when required Using data inputs from our collaborating organization, Applied Network Solutions (ANS), we argue that healthcare institutions that integrate KM and ICT into their main organizational processes are more likely to survive and prosper. These organizations would have a profound understanding of how to use clinical information for creating value in tangible and intangible terms.Electrical and Computer Engineering, 2002. IEEE CCECE 2002. Canadian Conference on; 02/2002
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ABSTRACT: Contemporary thinking amongst different healthcare stakeholders (HSs) indicates tremendous interest in new paradigms, concepts and frameworks like Clinical Governance (CG), Evidence Based Medicine (EBM), C ommunity Health Information Networks (CHIN), Knowledge Management (KM) and Integrated Care concepts like Integrated Health Care Delivery Systems (IHCDS), Integrated Quality Development, Integrated Patient Pathways (IPP). We explore the rationale behind these frameworks and analyse them based on their support for people, processes and technology. We conclude that KM is the only paradigm that holds potential in enabling HSs to realise the vision of a holistic and integrated healthcare management solution in the 21 st millennium.
Article: The era of knowledge in health care.Health care strategic management 03/2001; 19(2):12-3.
CLINICAL KNOWLEDGE MANAGEMENT
Ashish Dwivedi1, Rajeev K. Bali1, Raouf N G. Naguib1 and Nahy S. Nassar2
1BIOCORE, School of Mathematical and Information Sciences, Coventry University, UK
2Biotech Associates Ltd, Coventry, UK
Abstract - A quiet transformation has taken place in health
related research in the last twenty-five years. This
transformation can be traced to the coming of age of new
scientific domains like Bioinformatics and Cybernetics which
have evolved thanks to trans-disciplinary research. The
success of the Human Genome project is perhaps the most
significant pointer of this silent transformation. We believe
that in the future, as a result of synergistic interaction between
Bioinformatics and other paradigms, healthcare systems would
have an increased interest in knowledge recycling of the
collaborative learning process acquired from practices. In this
context, the Knowledge Management (KM) paradigm could
assist twenty-first century clinical practitioners to acquire
proficiency in understanding and interpreting clinical
information so as to attain knowledge and wisdom whilst
dealing with large amounts of clinical data.
Keywords - information technology, biomedical knowledge and
genetic engineering, pharmaceutical development.
The synergistic interaction between the Information
Technology (IT), Biomedical Knowledge and Genetic
Engineering revolutions has been responsible for creating
irrevocable changes in the very nature of healthcare
processes [1-3]. As a result of the above, healthcare
(regarded as one of the most complex sectors in our
economic structure with regard to information management
) has become even more intricate, particularly from an
II. CURRENT STATE OF BIOMEDICAL KNOWLEDGE.
Advances in biomedical sciences have unalterably
transformed the healthcare sector. Modern day healthcare
stakeholders (physicians, nurses, etc) require information
about “10,000 known diseases, 3,000 drugs, 1,100 lab tests,
300 radiology procedures…2,000
factors…with 1,000 new drugs and biotechnology
medicines in development” .
An indicator of the enormity of the exponential increase
in biomedical knowledge is witnessed by the growth in the
National Library of Medicine's Medline database (4500
journals in thirty languages, dating from 1996) of published
literature in health-related sciences. In 2002, Medline
contained 11.7 million citations and, on average, about
400,000 new entries year were being added per year .
Observations evidence the impact of these exponential
advances on individual stakeholders . Even if a typical
modern day healthcare stakeholder were to read two articles
a day, it would take him/her 550 years to get updated with
the new literature added every year (ignoring the existing
literature level of 11.7 million). If we assume that about 1
percent of the new literature added every year is of
relevance to a healthcare stakeholder, it would take a
stakeholder five years (reading an average of two articles a
day) to be updated with the healthcare advances of one year.
It would appear that contemporary healthcare stakeholders
are always behind the current state of knowledge .
III. CURRENT STATE OF GENETIC ENGINEERING.
Advances in modern day genetic sciences have
augmented the number of potential drug compositions from
a meagre 400 to over 4,000 in a very short timespan .
These advances are acting as a key driving force behind the
development of pharmaceutical drugs. In the immediate
future, the application of the Human Genome project will
result in the discovery of new treatments based on new
pharmaceutical compounds . Previous studies  have
estimated that, in the near future, new pharmaceutical
compounds could “replace 50% of today's in-patient
services". Most dramatic of all is the statistic that the
majority of physicians practicing in US community
hospitals are unable to understand the impact of
biomolecular sciences as they have been “trained in the
germ theory of disease, not molecular medicine… and that
in a recent nationwide survey, it was found that of all the
incidents of advice on genetics given by primary care
physicians, the advice was wrong 85 % of the time” .
IV. PHARMACEUTICAL DEVELOPEMENT
The process of creating new drugs has been
conventionally divided into two main phases: (1) Discovery
and (2) Clinical development. In clinical development, one
of the main challenges is to gather sufficient evidence that
validates the use of the drug, both from safety and efficacy
issues. The logistics and costs of clinical development trials
as seen below can be overwhelming.
A clinical development trial for a recently approved drug
by the US based Federal Drug Administration’s (FDA)
Cardiovascular and Renal Drugs Advisory Committee
“involved 11000 patients in 27 countries and 700 treatment
centers” . On average, pharmaceutical companies spend
about US $350 million over a period of 8 to 12 years to
bring an archetypal new drug to the consumers and the
average submission “reports on 60 clinical trials and the
report typically runs into thousands of pages” .
V. CURRENT STATE OF INFORMATION MANGAMENT IN
A study by the Institute of Medicine (IOM) in 1999
estimated that up to 98000 patients die every year as a result
of preventable medical errors . They further estimated
that the financial cost of these preventable medical errors
cost from “US $37.6 billion to $50 billion” and, in
numerical terms, account for more deaths than from “car
accidents, breast cancer or AIDS” . A study  has
pointed out adverse drug reactions result in more than
770000 injuries and deaths each year.
Another study reported in the Harvard Business Review
 noted that, as early as 1995, there were indications that
“more than 5% of patients had adverse reactions to drugs
while under medical care; 43% of those inpatient reactions
were serious, life threatening, or fatal”. They also noted that
other studies carried out at the Special Services Department
at Brigham and Women's Hospital in Boston indicated that
“out of the six most common laboratory tests ordered by
physicians in Brigham and Women's surgical intensive care
unit found that almost half of the tests ordered were
clinically unnecessary…other studies found that more than
half of the prescriptions for a particular heart medicine were
One of the main reasons for this is that, despite the
existence of best practices, most of them are, and continue
to be, inadequately expressed and are not disseminated
effectively to other Healthcare Institutions (HIs). A large
number of HIs contain several examples of first-rate
performance that have improved the quality of patient care.
The challenge from a healthcare perspective is “to identify,
describe, and learn from these examples and to use the
learning to construct systems of improved performance”
The following indicators  illustrate how healthcare
information needs are growing at an exponential rate. An
average physician spends about 25 percent of his/her time
managing information and has to learn 2 million clinical
specifics. This is further compounded by the fact that
biomedical literature is doubling every 19 years. In the UK,
each physician receives about 15 kg of clinical guidelines
per annum .
A survey  on the amount of information present in
an average General Practice found that practices generally
had “855 different guidelines - a pile 68 cm high weighing
28 kg”. Advances in hardware technologies are further
accentuating this information overload in healthcare. For
example, “Organ and tissue scanning speed is doubling
every 26 months, making tests both faster and
months…the increase in computer power (four-fold over the
next 20 years) and the availability of inexpensive
This combination has had a momentous impact on
healthcare and in particular has rendered extraneous the
concept of a healthcare expert. As shown above, it is no
longer possible for healthcare stakeholders to possess all the
pertinent knowledge in their domain of specialty [4,16].
This notion is confirmed by another author  who notes
that “against a background of an explosively growing body
of knowledge in the health sciences current models of
clinical decision making by autonomous practitioners,
relying upon their memory and personal experience, will be
inadequate for effective twenty-first-century health care
is doubling every 12
VI. APPLICABILITY OF THE KNOWLEDGE MANAGEMENT (KM)
PARADIGM IN HEALTHCARE.
The failure of existing healthcare management concepts
to tackle the information overload in healthcare  has
advocated the incorporation of the KM paradigm in
healthcare [18-19]. The need for integration of KM in
healthcare has been supported by authors  who say that
that “information explosion in biomedical domains requires
systematic knowledge management, ie. support for
evolution of knowledge in its many forms”.
It has been argued  that future healthcare
stakeholders would need to “combine management skills
with clinical knowledge”. The way forward for HIs is to
“integrate clinical knowledge bases at the point of care…-
thereby rendering it more accessible”  which would call
for streamlining clinical knowledge into the workflow of
KM has been defined as “a multi-disciplinary paradigm,
which uses technology to support the acquisition,
generation, codification and transfer of knowledge in the
context of specific organisational process”  (see Fig.1).
Explicit knowledge typically takes the form of company
documents and is easily available whilst Tacit knowledge is
subjective and cognitive and as such requires interpretation.
Explicit knowledge can be easily documented and is
generally found in the form of written manuals, reports or in
electronic databases. It is easily accessible and, in many
cases, available on an organization’s intranet .
organization, usage, and
Figure 1 The KM Cycle  Modified from 
The cornerstone of any KM project is to transform tacit
knowledge to explicit knowledge so as to allow its effective
dissemination . The de-facto knowledge categorisation
approach of classifying knowledge as being either explicit
or tacit has led to the emergence of two types of KM
strategies: (1) codification strategy and (2) personalisation
strategy . The personalisation strategy emphasizes the
tacit knowledge that resides in an organization whilst
codification strategy emphasises
processes and focuses on using technological infrastructure
to provide support for enabling knowledge identification,
storage, and transfer.
The very nature of healthcare processes calls for
physicians to use both KM strategies . The codification
strategy could be very effective for repetitive healthcare
processes for routine medical conditions (eg. influenza)
whilst the personalization strategy could be more suitable
for variations of routine medical conditions and non-routine
medical conditions (eg. Meningitis).
In the UK, the National Health Service (NHS) emphasis
has concentrated on KM strategies supporting codification
to standardize treatment of routine cases. The aim of the
NHS is to create “a standard approach…for dissemination
based on best NHS practice…to raise performance to that
of the best units”.
A. KM Success Stories
A study by International Data Corporation (IDC) 
reported that Fortune 500 companies wasted $12 billion by
duplicating knowledge work and that companies that
adopted KM practices were able to enjoy tremendous cost-
B. KM Healthcare Success Stories - Hoffmann-LaRoche
Hoffmann-LaRoche investigated new ways of reducing
the time taken to launch a new product on the market and
commenced a KM program. The results were astonishing.
Before the introduction of the KM programme, an average
drug used to cost $250 million and used to take five to eight
years to develop. Now, the savings of the KM programme
are estimated at $90 million. Even more remarkable was the
result achieved in getting US FDA approval for the
distribution of pharmaceutical
introduction of the KM programme, the time taken for US
FDA approval fell from three years to nine months .
products. After the
The existing information management crisis in
healthcare is likely to be aggravated due to the completion
of the Human Genome project . Our own perception of
the information available and possible for one human being
to acquire will undergo a drastic change. It would be
prudent to hypothesize that the existing information
management crisis is likely to emerge as the biggest
stumbling block preventing healthcare evolution in the 21st
Clinical data in the 21st century will be dynamic in
nature and would call for the ability to interpret context-
based healthcare information. This challenge cannot be met
by an IT led solution. The solution needs to come from a
domain that supports all three integral healthcare system
components, ie. people, processes and technology, of the
future. KM is one such domain which we believe holds the
solution to the existing information management crisis in
KM, and in particular the codification KM strategy, has
attracted the attention of HIs and is viewed as a potential
solution to the information management woes in healthcare.
The emphasis on codified knowledge ie. to discover new
ways of effectively representing healthcare related
information has its own drawbacks.
However, currently there are very few research
projects examining how tacit clinical knowledge can be
managed in healthcare . Clearly if KM is to fulfill its
potential, there is a need to further develop models that
support the adoption of personalization-based KM
strategies in healthcare.
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