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Clinical Informatics

The Challenge of Knowledge Management at the Point of Care

Index:

  1. Introduction, Definitions and The Intricacies of knowledge Management at the Point of Care.

  2. The interplay between knowledge management, health informatics and evidence based medicine.

  3. The cost and benefits to the organisations and individuals involved.

  4. Conclusions

  5. References

Introduction

The practise of medicine is a knowledge intensive activity. Hence the management of knowledge is central to whether this endeavour succeeds or fails. Before even begriming to discuss about the intricacies of knowledge management, it was clear from the literature review that an attempt must be made at the onset to try to define the terms:

Definitions

Data can be defined as a set of discrete objective facts or value that does not have any attached meaning or context to it. By itself, data has little relevance or purpose. A good example would be the values on a spreadsheet.

Data that is organised to instruct or inform can then be defined as Information. It has added value that gives it meaning and purpose. It normally exists in the form of a message and has an intended recipient or audience (i.e. readers of a journal or letters).(1)

Defining " Knowledge" is not an easy task as it is a subject that has fascinated and eluded clear definition by philosophers, social scientists, historians, business consultants and academics alike.(2)

Oxford dictionary define it as " information and skills acquired through experience or education"; " the sum of what is known" or " awareness or familiarity gained by experience of a fact or a situation" (3)

Types of knowledge

There are further attempts to divide knowledge into three different categories i.e.

Explicit knowledge is defined as knowledge that can be easily codified and shared. In this aspect, it is equivalent to the characteristics of Information as discussed earlier.

Implicit knowledge can be best defined as knowledge that can be expressed explicitly but has not been expressed before. This is seen in the form of "the local way of doing things" in the business world.(4) As such, it can be seen as explicit knowledge that has not been vocalised or codified in any media form.

The idea of tacit knowledge was put forward by the philosopher of science, Polanyi, in 1958. He defined tacit knowledge as "acts of comprehension" and that "all knowledge consists of or is rooted in such acts of comprehension".(5) As such, tacit knowledge is intuitive, often subconscious and resists codification.

Often, it has been used when the term implicit knowledge would have been more accurate.

Knowledge is derived form information, and information is derived from data. Up to now, all these transformation has to be done by humans. Knowledge has to be delivered via structured media such as books and documents or person-to-person contacts, which may range form conversations to apprenticeships.(1)

The intricacies of knowledge management at the point of care

The medical profession is one that is knowledge intensive. It has been said that an experienced clinician would used up to 2 million pieces of information to manage a patient.(6, 7)

To-date, there are about 5,000 articles published every month in the biomedical journals. Even if only 6% of these were of high quality and relevant to everyday clinical practise, it would have meant reviewing 19 articles everyday throughout the year in order to keep up-to-date.

The doubling rate of the biomedical knowledge occurs about every 19 years.(6) This would mean that the amount of knowledge available would increase four fold in the professional lifetime of a physician.

Therefore, it would not be surprising that a study in 1989, commissioned by the publishers of the New England Journal of Medicine, found that two thirds of physicians felt that the body of knowledge available at that time was already " unmanageable".(8)

As the amount of information grows exponentially, it will get more and more difficult to find the information that we need as time goes by. This is a curious phenomenon; where a wealth of information leads to a poverty of attention, by consumption of all our attention. Our attention is a scarce resource and hence, the limiting factor in what has been described as the " Malthusian law of information".(9)

We also know that there are unacceptable delays in the implementation of important research findings, even if they have been repeatedly validated in multiple randomised control clinical trials and systematic reviews. However, this is not a new problem.

It took 264 years before the knowledge that lemon juice prevented scurvy was fully adopted in 1865.(11) More recent, it has been shown that there was a thirteen year delay in the advocacy of thrombolytic treatment of myocardial infarction from the demonstration of its efficacy in cumulative meta-analysis of randomised controlled clinical trials.(12)

The main consequence of such delays would be the sub-optimal care of patients in areas where the evidence would have been applicable.

 

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Page Updated: 17 May, 2017

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