Dr. Tonya Hongsermeier, Corporate Director Clinical Knowledge Management, Partners HealthCare, presented a Seminar this week to us on Knowledge Management challenges in the healthcare delivery market. Dr. Hongsermeier described the many challenges facing Healthcare Delivery organisations with today's health information systems including limited implementation of structured, encoded clinical documentation and proprietary approaches to knowledge encoding. As a result knowledge assets are often not easily re-usable or sharable resulting in high maintenance costs and resource constraint bottlenecks for system improvement. Encumbered with this fragmented clinical systems environment, organisations are finding the improvement and development of their support systems for medical staff a difficult and daunting challenge.
Dr. Hongsermeier provides an overview of how Partners HealthCare is focusing its investments on next-generation clinical systems and knowledge asset management infrastructures to overcome these bottlenecks. She details their approach as guided by their Clinical Decision Support and Knowledge Discovery continuum model. In describing the principles of this approach, Dr. Hongsermeier explains:
Healthcare delivery is inherently complex and knowledge-dependent. To serve the needs of any clinical counter, relevant patient-centered knowledge must be accessible to the person supplying care at the “right time” in the workflow. Such knowledge can be delivered proactively before decisions are made, interactively as decisions are made, asynchronously such as via a pager, or passively as reference information that can be queried online. As biomedical research changes the standard of care at a rapid pace, the knowledge base required for safe care is growing exponentially. Knowledge Application is the science of leveraging knowledge at the right places in clinical workflow to support enhanced care-giver effectiveness, work-satisfaction, patient satisfaction and overall care quality. This view of Knowledge Application is broader and inclusive of the traditional definition of clinical decision support. Knowledge can be delivered through clinical applications in the form of templates for documentation, order sets for protocol-driven care management, dashboards and reports for feedback, and as alerts, reminders or suggestions. In a high-performance learning organization, process and outcomes data is captured as a by-product of workflow and rapidly analyzed to determine new models for process improvement. In essence, robust knowledge application evolves into and merges with knowledge discovery whereby the knowledge repository “learns” from the clinical outcomes in the patient database.
When I asked Dr. Hongsermeier how progress could be made in the critical bottleneck area of non-interoperable standards, she suggested that the government would have to step in to provide greater momentum. A similar question I posed to Dr. Jeff Spitzner, CSO, Recentris, earlier in the week on the similar standards problem faced in the life sciences area had evoked the suggestion that the pharmaceutical industry has to play a higher profile role in applying pressure to the market. It appears that both public and private initatives, public-private partnerships, cross-sector cooperation and vendor participation are all needed, to accelerate progress in this area, but the problem remains daunting.
Dr. Hongsermeier lamented the lack of aggressive vendor participation in health information standards initiatives. She pointed to the Federally-backed National Health Information Infrastructure as a good example of the way forward and hoped as a result that vendors would be encouraged to participate in creating common medical knowledge-sharing platforms. Even with progress in this area, she also pointed out that new tools need to be developed so that clinical decision and support systems could work better in anticipatory mode in clinical settings, thus ensuring that better quality healthcare was delivered to patients. She indicated that the pharmaceutical industry could play an increased role in this area. Also, work using a human readable specification approach for information entry into clinical systems was a critical area of development to enable and improve the collaborative sharing of clinical knowledge between medical practioners.
I had another conversation on the same day with Ben Toth, who is heading the new National electronic Library of Health (NeLH) in the UK, and has reported here on the Hub this week on the significant developments being made in their program on delivering more health information to more people in the UK. Although also emphasising the importance of standards, he admitted that he would still be writing the business case, if he had tried to achieve comprehensive interoperability and integration with the NeLH. He counselled a pragmatic approach and indeed the NeLH is making impressive strides forward with a combination of practicality, standards use and medical process modelling.
You can listen to the recorded talk at any time from the KM in Pharma & Life Science website at innovationwell.net.
Barry Hardy
www.douglasconnect.com
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