Posted by: Richard Chennault | October 20, 2005

Knowledge Management

Knowledge Management In Health Care


Knowledge Management (KM) is the aggregated body of work dealing with the creation, dissemination, socialization and utilization of knowledge. Knowledge management is about people and organizations leveraging collective experience and know-how for the delivery of healthier outcomes.
Knowledge can be categorized in two major domains; tacit and explicit. Tacit is knowledge implicit and that which is resident in the individual. Explicit knowledge is structured and expressed in an externally consumable form. Knowledge management is often structure as a cyclical process of (list phases here). Each phase is an important aspect of the human cognitive process that ascribes value to knowledge.
The most important aspect however of knowledge is its use by the individual. Knowledge stored in a great repository is nothing more than information. Information has little value until the knowledge is assimilated and internalized by the individual. What good is the library to the day worker when the library is open only during the hours to which the laborer is at his task? What good is a data warehouse when the information contained there in is accessible only to highly trained technocrats? Knowledge must be accessible and used to have value. No, accessible and used does not necessarily always translate to business value. Systems that support knowledge by necessity must not require the user to be schooled in complex methods of interaction in order to utilize the knowledge. This basic tenant however is often contrary to a modern cultural drive towards more and more complex methods of knowledge distribution and assimilation.
Knowledge and its use have greater impact to the organization and its consumers, partners and providers than any other single product, initiative or financial asset. This axiom is true from the small entrepreneur to the mega conglomerate.



      The first principle of knowledge management is that knowledge must be freely accessible and usable by the broadest set of individuals. Therefore solutions must not by design institute barriers to access. Thusly KM solutions must not impose complex systems either technical or methodological that interfere with knowledge access.


      Proposed knowledge management solutions to the enterprise must first be compared against the existing cultural knowledge process. These solutions either technical or methodological must not perturb greatly outside of the current process until the culture has had a chance to naturally absorb the change and began to assimilate the change into the existing knowledge culture. This principle therefore proscribes a rapid and aggressive transition from one knowledge process state to another. Instead a transition process is prescribed in order to facilitate greater utilization and value of knowledge to constituents of the knowledge management system.


      Knowledge is the product of a cognitive process that has internalized external content. Knowledge therefore has no value outside of self and organization. A person or an organization can not point to a central repository or individual and declare here resides knowledge. Instead the enterprise must adopt an active policy of managing content and information repositories that contain fresh and actively used content. Through measurement and metrics can an enterprise evaluate the utilization of knowledge and then obtain value from that information and content. Therefore knowledge management solutions must have methods and tools in place to measure and update existing content and information in order ensure continued value and utilization.


      It is often stated that knowledge is power. We are taught from the earliest that knowledge is the key to unlocking more knowledge. We hold in high esteem those who have knowledge and what may be a shameful practice deride those who do not have knowledge. Knowledge is more than facts and figures but it is an understanding of how things are done, why they are done and what impact those things will have on others. This is why throughout the millennium those who have knowledge have typically also had power. This is as simple as knowing where a good fishing hole is located or as complex as international espionage. However in the clinical domain holding knowledge close to the breast is antithetical to medical ethics. Therefore knowledge that is bottled up and locked away is as destructive as cancer is to the body. It is therefore important that an organization create and support a knowledge distribution and support mechanisms.
      These mechanisms exist today in most organizations but are pursued in an ad-hoc fashion across business units and department. Health communities offer internal and external course on CPR, Parenting, diabetes control and etc. Some organizations develop online training centers, create training teams and may even offer a library of resources for general consumption. Yet still others have disaster preparedness teams, weight control support groups and technical review boards. All of these things have a common thread running through the core of each solution, knowledge. Yet how many of these organizations have created an enterprise wide initiative to support and distribute knowledge created at the micro levels? Where is the Chief Knowledge Officer? Often the duty of knowledge distribution and support falls to the CIO who is poorly equipped to meet the needs and demands of knowledge that are produced outside the traditional role of the CIO and the information technology department.
      Knowledge must be an enterprise wide solution that is led by all levels of the organizations and is regarded as one of the most valued assets of the organization. An organization that views knowledge and its assistant knowledge management as the purview and domain of lines of business or even worse as sub-specialization of technology are poised to repeat mistakes and spend capital on duplicative efforts.


        Knowledge management may be implemented using several approaches. Each approach has merits based on the enterprise maturity level and business objectives. The approaches described below are not meant to be exhaustive but illustrative of the means to which Knowledge Management and the sub-domain of content management can be viewed. The spectrum of approaches is as multi-faceted as the consumer of the knowledge. Described briefly therefore is a broad generalization of the approaches. Furthermore the approaches denoted are not meant to be architectural recommendations but instead architectural frameworks of which an enterprise may choose to follow.


        A technology driven knowledge management system is a set of solutions built around the perception that the use of technology will increase the distribution and utilization of knowledge. Technology has become ingrained in western cultures as having inherent benefit. This tenant often drives organizations to adopt an aggressive adoption rate of technology as a means to achieve the value perceived that technology brings.
        A technology driven organization will often times overlook or discount the human cognitive process of knowledge management. Instead the organization assumes that the enhanced capabilities and automation gained through technology adaptation to human process outweigh the anachronistic methods of obsolescent or pre-technology based processes. This view of technology as a means to the ends transforms the enterprise around the limits and capabilities that are inherent to the particular technology being applied.
        Once technology is accepted as the solution de jour of the enterprise, selection and control of technology is granted to the technologist. Technologists then decompose the space of knowledge management by applying technical functionality into discreet problem domains. Once the domains are classified around functional capabilities (i.e. web, office, sales) systems are selected based on their capabilities to meet the requirements created around the functional areas. Systems are then implemented and individuals are re-trained to perform previous task based on the constraints and liberations enabled by the systems.
        While the technical functional decomposition is a useful construct for which to select and apply technology it often comes at the expense of understanding the actual value of knowledge. Instead entire systems and people are put to the task of creating content without full realization of the value of knowledge. This can be seen in enterprises that produced content based on an ascribed value the content had in a knowledge process. However often times the process has changed or has become obsolescent. Change and obsolescence is often the result of the adoption of technology to which the original knowledge was meant to benefit.
        For example a technology company developing a highly anticipated new version of a product wishes to capture customer driven requirements in digital form. Pervious iterations of product requirements were captured through a laborious paper based document process where requirements were gathered and managed on paper. The company felt if they could capture and manage the requirements in digital form they could better manage product timelines and features by capturing and maintaining the history of the requirements and therefore having a living history of their product. The technologist chose the most feature rich and technically advanced requirements management software solution. The software requirements system came with a legacy feature which was able to print requirements to paper form for offline review. The feature was poorly implemented due to the base assumption that the requirements management system would be the online means of managing and reviewing requirements. However the technologist failed to understand the culture of requirements and management of requirement knowledge in the enterprise. Management insisted that they review a paper version of the requirements prior to approval. This lack of understanding and failure to address how the organization utilizes knowledge led to a replacement system that was poorer in quality than the one to which it replaced.
        Lastly technology driven knowledge management system often disenfranchise large segments of the target population to which they are targeted to assist. This is especially true in organizations where technology is not the main product of the company. Such is the case in health care where technology often frustrates and constrains the provider in the pursuit of healthier outcomes. The care communities (providers are receivers) are often required to obtain specialized technical knowledge in order to access and utilize even the most basic medical information. This is exemplified by mass conversion of medical content to digital form and then not providing the necessary training and equipment to access and utilize the information. What value is digitized medical content to the tenant laborer in the Sacramento valley which struggles to provide the basic necessity of life? What happens to the quality of care and diagnostic detail the nurse provides through the cognitive process of hand scribing patient condition when the charting process is digitized and the nurses cognitive process is reoriented towards scripting based on pick list of codified medical terms? Technology driven knowledge management is a framework that may have deleterious impact to the enterprise and the individuals of the enterprise serves. Good lecture above.


          A line of business categorization of knowledge management is aligning KM with business goals. Business driven knowledge management is founded on the construct that knowledge and content are best understood through the focal lens of business deliverables. Knowledge is created, developed and utilized for the sole purpose of achieving a specific business goal. This construct is best suited for businesses that are single product focused or has set the construct as an enterprise principle.
          At first this categorization may seem an appropriate application however, without broad dissemination and liberalization of knowledge the knowledge management system becomes subservient to the business product or goal. Therefore knowledge management becomes an artifact of the solution delivering only limited value based on the direct goal of the line of business. Additionally it leads to isolated islands of knowledge buried in line of business solutions. This subservience of knowledge to product shares many of the challenges of a technology driven knowledge management solution. Finally this leads to barriers in knowledge sharing and utilization across business lines.
          For example a medical center for a large healthcare company in California has developed a web based dermatology consulting application. The application enables providers to obtain consultation from colleagues via the presentation of jpeg images of patients. The application is well liked by the physicians and is replicated in other regions. However this content oriented knowledge management system is isolated from other clinical applications, it does not capture meta information about the image, the images are not of diagnostic quality, the system does not provide a workflow, it is line of business specific and there exist potential security concerns. All of which add up to barriers and process constraints on the potential knowledge value stored within the system.
          Examples of line of business knowledge management applications are many and varied and extend the gambit from purchased solutions to custom build applications (as it the case in our example). While each application may meet the functional needs of a particular business (i.e. dermatology consulting) they fail to deliver extended knowledge value as they are not extendable across department, group or business boundaries. This lack of a cohesive knowledge management solution decreases quality of care across the organization while conversely increasing the cost of care.

            FEDERATED KM

            Federated knowledge management is a hybrid approach which attempts to understand the challenges of other approaches while at the same time offering the advantages. Federated systems are built on the premise that integration is the primary design principle of the knowledge management. Integration happens at all levels of the system from the cognitive process to technical systems. Federated systems allow business to pursue solutions that align with goals and allows technologist to apply modern technology.
            However the federated system is not without cost. By necessity design of independent knowledge systems must be developed with interfaces that enable knowledge sharing and utilization metrics within and across knowledge processes and systems. Integration require organizations to govern all proposed knowledge management solutions centrally in order to ensure minimum integration constraints are met.
            The complexity of the federated knowledge management will increase time of delivery for solutions as organization struggle to balance the needs of lines of business units with the near and long term knowledge sharing initiatives, deal with technology architecture mismatches and cultural resistance to change.

              APPROACH SUMMARY

              The approaches annotated above are meant to serve as a architectural sketch to which a more detailed architecture may be constructed. There are certainly other approach descriptions that could be described however, the section of knowledge management approaches is an abstraction of many approaches and serves to elucidate the reader to positives and negatives of approaches at the gross level. It is presumed that most organizations will attempt a mix of approaches in the attempt to capitalize on the value of knowledge.
              Knowledge management is a broad and complex topic and this paper attempts to lay only the basic groundwork. It is meant to provide the reader with a brief introduction to the domain of knowledge management The next section will begin to articulate the focus of this paper which is enterprise content management.


                • SAFE AND EFFECTIVE

                Content utilized for the delivery of care should help members and not harm them and interventions should be based on the latest evidence.


                Content should be created and delivered to assist the health care community in seeking to prevent ill health and promote good health.


                Content is part of a holistic care must be based on organizational and community social and emotional needs as well as their physical and medical. Content utilized by one individual should be understood as linked to the needs of many (i.e. other providers, family members, etc.)


                Members and providers should be presented with quality information in order to enable equal partners in health decisions.

                • TIMELY AND CONVENIENT

                Content should be timely, relevant and delivered in a convenient manner in order to facilitate healthier outcomes.

                • OUTCOME BASED MEDICINE

                Content should be generated and disseminated through the practice of evidence based medicine.


                1. Great blog I hope we can work to build a better health care system. Health insurance is a major aspect to many.–>

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