The Impact of Perioperative Data Science in Hospital Knowledge Management

Conservative practices, such as manual registry have limited scope regarding preoperative, intraoperative and postoperative decision making, knowledge discovery, analytical techniques and knowledge integration into patient care. To maximize quality and value, perioperative care is changing through new technological developments. In this context, knowledge management practices will enable future transformation and enhancements in healthcare services. By performing a data science and knowledge management research in the perioperative department at Hospital Dr. Nélio Mendonça between 2013 and 2015, this paper describes its principal results. This study showed perioperative decision-making improvement by integrating data science tools on the perioperative electronic system (PES). Before the PES implementation only 1,2% of the nurses registered the preoperative visit and after 87,6% registered it. Regarding the patient features it was possible to assess anxiety and pain levels. A future conceptual model for perioperative decision support systems grounded on data science should be considered as a knowledge management tool.

A Concept for a Data Dictionary System Supporting for Clinical Research

Clinical trials form the backbone of evidence-based medicine. They are indispensable tools that make it possible to compare medical interventions or test medical devices for their efficacy and safety. Each study design exactly defines which data is to be collected. Case report forms (CRFs) are used to document the collected data. Preparing CRFs is complicating, time consuming and requires extensive knowledge in the fields of medicine, data management and statistics. In addition, there are no global standards for CRF design, which means that each research institution produces CRF data definitions at its own discretion. This hampers the exchange of data definitions among different research groups and variants of CRFs might be created for a similar study design. To address these problems, we developed a concept for a freely accessible portal in the form of a web application in which definitions for CRFs, variables and tables can be created. The created data definitions can be exported from the portal to be transferred to common electronic data capture systems (EDC) that can then generate CRFs using the definition. The overall objective of the project is to develop a data dictionary system that is used during the entire workflow of a study and that enables sharing and re-use of metadata.

Enablers Supporting the Implementation of Knowledge Management in the Healthcare of Pakistan

Knowledge is considered to be an important resource; it is the source of competitive advantage. However, if knowledge is managed well with Knowledge Management (KM), then it becomes a source for sustainable competitive advantage for organizations. If KM is implemented in an organization, it would improve the organizational competitiveness, performance, and productivity, and facilitate the efficient use of resources. Due to intense competition in the global market, many organizations are moving towards the adoption of KM. The healthcare sectors of many developed countries have moved towards the implementation of KM because it can improve the procuring of knowledge from ongoing activities by the effective use of data repositories. Developing countries have now realized the potential and benefits of KM adoption. Pakistan is one of the developing countries that have recently shown an inclination towards the adoption of KM in its healthcare sector to improve performance of its healthcare. This study was composed of two main research phases. Firstly, the enablers of KM were reviewed from earlier studies. Secondly, interpretive structural modeling (ISM) and MICMAC (Cross-Impact Matrix Multiplication Applied to Classification) techniques were used to show the interrelationships between KM enablers and driving and dependence power of each enabler. The application of ISM and MICMAC technique shows that policy incentive, long-term strategic planning, Information Technology (IT), and alignment of KM efforts with business strategy are the main enablers of KM adoption in the healthcare of Pakistan. Focusing on the identified enablers will help in the implementation of KM. Policy incentives can work as a catalyst to promote KM adoption in the healthcare of Pakistan.

Leveraging Knowledge Representation to Maintain Immunization Clinical Decision Support

Immunizations are one of the most cost-effective interventions for preventing morbidity and mortality. As vaccines, related clinical knowledge and requirements change, clinical applications must be updated in a timely manner to avoid practicing outdated medicine. We use the Centers for Disease Control and Prevention (CDC) as a source for immunization knowledge for our Clinical Information Systems (CIS). After identifying knowledge management related gaps in the CDC's content and email notification service, we developed and adapted a knowledge management tool chain - called COMET - for facilitating automatic processing of the available immunization content to implement mature knowledge lifecycle management practices locally. The implemented features include error and change tracking, content discovery and analytics, and tracking of dependencies to dependent downstream CISs. We demonstrate the creation of a tool that enables content curators to visualize, track, and implement immunization changes.

The project vita: A dynamic knowledge management tool

A project vita is a comprehensive index of factual information about a project's activities and achievements. Like an individual's professional curriculum vita or resume, it serves as evidence of past performance and capacity for future endeavors. This article situates the project vita as a knowledge management tool for use by large-scale research and development projects or coalitions. In such complex endeavors, the variety and scope of the knowledge generated can quickly outpace project staff attempts to collect, classify, disseminate, and support the effective use of the constant stream of information being produced. We describe how to develop a project vita and utilize it to support several essential project functions, including communication, evaluation, management, and as a portal to products.

Knowledge Management for Fostering Biostatistical Collaboration within a Research Network: The RTRN Case Study

Purpose: While the intellectual and scientific rationale for research collaboration has been articulated, a paucity of information is available on a strategic approach to facilitate the collaboration within a research network designed to reduce health disparities. This study aimed to (1) develop a conceptual model to facilitate collaboration among biostatisticians in a research network; (2) describe collaborative engagement performed by the Network’s Data Coordinating Center (DCC); and (3) discuss potential challenges and opportunities in engaging the collaboration. Methods: Key components of the strategic approach will be developed through a systematic literature review. The Network’s initiatives for the biostatistical collaboration will be described in the areas of infrastructure, expertise and knowledge management and experiential lessons will be discussed. Results: Components of the strategic approach model included three Ps (people, processes and programs) which were integrated into expert management, infrastructure management and knowledge management, respectively. Ongoing initiatives for collaboration with non-DCC biostatisticians included both web-based and face-to-face interaction approaches: Network’s biostatistical capacities and needs assessment, webinar statistical seminars, mobile statistical workshop and clinics, adjunct appointment program, one-on-one consulting, and on-site workshop. The outreach program, as a face-to-face interaction approach, especially resulted in a useful tool for expertise management and needs assessment as well as knowledge exchange. Conclusions: Although fostering a partnered research culture, sustaining senior management commitment and ongoing monitoring are a challenge for this collaborative engagement, the proposed strategies centrally performed by the DCC may be useful in accelerating the pace and enhancing the quality of the scientific outcomes within a multidisciplinary clinical and translational research network.

The relationship between knowledge management and creativity in bachelor degree compared to master degree nursing students

OBJECTIVES

To investigate the relationship between knowledge management and creativity in undergraduate compared with master degree nursing students.

METHODS

This cross-sectional study was conducted with nursing students of the faculty of nursing and midwifery in an urban area in the southeast of Iran from August 2017 to January 2018. In this study, 180 students were selected using a simple random sampling method (Bachelor degree=120 and Master degree=60). Data was collected using the Nonaka and Takeuchi̛s knowledge management and Randsip's Creativity questionnaires.

RESULTS

There was a direct and significant relationship between knowledge management and creativity in the students (r=0.47 in Bachelor degree and r=0.36 in Master degree). The mean scores of knowledge management dimensions and creativity were higher in the master degree students.

CONCLUSIONS

There was a relationship between knowledge management and creativity in the bachelor and master degree students. It is necessary to corroborate the Efforts for the implementation of strategies for the knowledge management in all its dimensions. Therefore, the education environment can help with the development of students' knowledge and skills.

[The paradigm shift for peptic ulcer disease]

Knowledge development and paradigm shift for peptic ulcer disease is described over a fifty-year period using four levels of knowledge that place demands on the healthcare organization. When medical knowledge reached a healing level, continuity became subordinate. However, accessibility to treatment became more important. An important task for future healthcare will be to define and create broader knowledge structures. Efficiency losses can occur when control instruments apply to medical problems at low levels of knowledge which are not mature for this.

Knowledge Management for Brazilian Cancer Care Services

Nowadays Brazil has a complex cancer care scenario. There are nearly 600.000 new cancer cases each year in Brazil, and the huge majority of patients have some contact with hospital services. However, long waiting queues for diagnostics and treatments have become common. One of the critical success factors in a cancer treatment is early diagnosis. The reduction of waiting time to start therapeutic procedures is one of the main issues for improvement of patient's quality of life and possibilities of cure. The objective of this work is to describe the development of a decision support system that improves the identification of access alternatives, appointment scheduling and employment of available resources. The Theory of Constraints was used to identify bottlenecks in patient treatment flow and a Discrete Events Simulation model was used to reduce patients' waiting time to start cancer treatment.

ACCESS climate data management

Building on achievements and experience gained through the EU project DAMOCLES and international data management during the International Polar Year, ACCESS, data management was implemented using the same platform as used for DAMOCLES. A metadata-driven approach through which all datasets are properly described with discovery and use metadata was chosen in order to simplify data management and data usage. The system provides automated submission and checking of datasets, search and download as well as visualisation and transformation on user demand and metadata export. Long-term management of ACCESS climate datasets is done within the context of the Arctic Data Centre. This ensures visibility of ACCESS datasets in the context of WMO and GEOSS catalogues. Challenges with ACCESS data management have mainly been cultural with the consequence that the system has been underutilised within the duration of the project duration.

Knowledge Representation and Management, It's Time to Integrate!

Objectives: To select, present, and summarize the best papers published in 2016 in the field of Knowledge Representation and Management (KRM). Methods: A comprehensive and standardized review of the medical informatics literature was performed based on a PubMed query. Results: Among the 1,421 retrieved papers, the review process resulted in the selection of four best papers focused on the integration of heterogeneous data via the development and the alignment of terminological resources. In the first article, the authors provide a curated and standardized version of the publicly available US FDA Adverse Event Reporting System. Such a resource will improve the quality of the underlying data, and enable standardized analyses using common vocabularies. The second article describes a project developed in order to facilitate heterogeneous data integration in the i2b2 framework. The originality is to allow users integrate the data described in different terminologies and to build a new repository, with a unique model able to support the representation of the various data. The third paper is dedicated to model the association between multiple phenotypic traits described within the Human Phenotype Ontology (HPO) and the corresponding genotype in the specific context of rare diseases (rare variants). Finally, the fourth paper presents solutions to annotation-ontology mapping in genome-scale data. Of particular interest in this work is the Experimental Factor Ontology (EFO) and its generic association model, the Ontology of Biomedical AssociatioN (OBAN). Conclusion: Ontologies have started to show their efficiency to integrate medical data for various tasks in medical informatics: electronic health records data management, clinical research, and knowledge-based systems development.

Knowledge Management Implementation and the Tools Utilized in Healthcare for Evidence-Based Decision Making: A Systematic Review

BACKGROUND

Healthcare is a knowledge driven process and thus knowledge management and the tools to manage knowledge in healthcare sector are gaining attention. The aim of this systematic review is to investigate knowledge management implementation and knowledge management tools used in healthcare for informed decision making.

METHODS

Three databases, two journals websites and Google Scholar were used as sources for the review. The key terms used to search relevant articles include: "Healthcare and Knowledge Management"; "Knowledge Management Tools in Healthcare" and "Community of Practices in healthcare".

RESULTS

It was found that utilization of knowledge management in healthcare is encouraging. There exist numbers of opportunities for knowledge management implementation, though there are some barriers as well. Some of the opportunities that can transform healthcare are advances in health information and communication technology, clinical decision support systems, electronic health record systems, communities of practice and advanced care planning.

CONCLUSION

Providing the right knowledge at the right time, i.e., at the point of decision making by implementing knowledge management in healthcare is paramount. To do so, it is very important to use appropriate tools for knowledge management and user-friendly system because it can significantly improve the quality and safety of care provided for patients both at hospital and home settings.

Leveraging medical taxonomies to improve knowledge management within online communities of practice: The knowledge maps system

BACKGROUND AND OBJECTIVE

Online communities of practice contain a wealth of information, stored in the free text of shared communications between community members. The Knowledge Maps (KMaps) system is designed to facilitate Knowledge Translation in online communities through multi-level analyses of the shared messages of these communications.

METHODS

Using state-of-the-art semantic mapping technologies (Metamap) the contents of the messages shared within an online community are mapped to terms from the MeSH medical lexicon, providing a multi-level topic-specific summary of the knowledge being shared within the community. Using the inherent hierarchical structure of the lexicon important insights can be found within the community.

RESULTS

The KMaps system was applied to two medical mailing lists, the PPML (archives from 2009-02 to 2013-02) and SURGINET (archives from 2012-01 to 2013-04), identifying 27,924 and 50,597 medical terms respectively. KMaps identified content areas where both communities found interest, specifically around Diseases, 22% and 24% of the total terms, while also identifying field-specific areas that were more popular: SURGINET expressed an interest in Anatomy (14% vs 4%) while the PPML was more interested in Drugs (19% vs 9%). At the level of the individual KMaps identified 6 PPML users and 9 SURGINET users that had noticeably more contributions to the community than their peers, and investigated their personal areas of interest.

CONCLUSION

The KMaps system provides valuable insights into the structure of both communities, identifying topics of interest/shared content areas and defining content-profiles for individual community members. The system provides a valuable addition to the online KT process.

Knowledge as a Service at the Point of Care

An electronic health record (EHR) can assist the delivery of high-quality patient care, in part by providing the capability for a broad range of clinical decision support, including contextual references (e.g., Infobuttons), alerts and reminders, order sets, and dashboards. All of these decision support tools are based on clinical knowledge; unfortunately, the mechanisms for managing rules, order sets, Infobuttons, and dashboards are often unrelated, making it difficult to coordinate the application of clinical knowledge to various components of the clinical workflow. Additional complexity is encountered when updating enterprise-wide knowledge bases and delivering the content through multiple modalities to different consumers. We present the experience of Mayo Clinic as a case study to examine the requirements and implementation challenges related to knowledge management across a large, multi-site medical center. The lessons learned through the development of our knowledge management and delivery platform will help inform the future development of interoperable knowledge resources.

Critical Issues in Radiation Protection Knowledge Management for Preserving Radiation Protection Research and Development Capabilities

As a hub of domestic radiation protection capabilities, Oak Ridge National Laboratory's Center for Radiation Protection Knowledge has a mandate to develop and actuate a formal knowledge management (KM) effort. This KM approach exceeds recruitment and training efforts but focuses on formalized strategies for knowledge transfer from outgoing subject matter experts in radiation protection to incoming generations. It is envisioned that such an effort will provide one avenue for preserving domestic capabilities to support stakeholder needs in the federal government and the nuclear industry while continuing to lead and innovate in research and development on a global scale. However, in the absence of broader coordination within the United States, preservation of radiation protection knowledge continues to be in jeopardy in the absence of a dedicated KM effort.

A Digital Framework to Support Providers and Patients in Diabetes Related Behavior Modification

We present Diabetes Web-Centric Information and Support Environment (D-WISE) that features: (a) Decision support tool to assist family physicians to administer Behavior Modification (BM) strategies to patients; and (b) Patient BM application that offers BM strategies and motivational interventions to engage patients. We take a knowledge management approach, using semantic web technologies, to model the social cognition theory constructs, Canadian diabetes guidelines and BM protocols used locally, in terms of a BM ontology that drives the BM decision support to physicians and BM strategy adherence monitoring and messaging to patients. We present the qualitative analysis of D-WISE usability by both physicians and patients.

From a Content Delivery Portal to a Knowledge Management System for Standardized Cancer Documentation

Heterogeneous tumor documentation and its challenges of interpretation of medical terms lead to problems in analyses of data from clinical and epidemiological cancer registries. The objective of this project was to design, implement and improve a national content delivery portal for oncological terms. Data elements of existing handbooks and documentation sources were analyzed, combined and summarized by medical experts of different comprehensive cancer centers. Informatics experts created a generic data model based on an existing metadata repository. In order to establish a national knowledge management system for standardized cancer documentation, a prototypical tumor wiki was designed and implemented. Requirements engineering techniques were applied to optimize this platform. It is targeted to user groups such as documentation officers, physicians and patients. The linkage to other information sources like PubMed and MeSH was realized.

Knowledge Management in Health Technology SMEs

The purpose of this study was to examine knowledge management's (KM) role in small and medium-sized (SMEs) health technology enterprises, which employ fewer than 250 employees. In this study, KM is understood as the ability to achieve competitive advantage by utilizing management knowledge and making it profitable. The health technology enterprises use modern technology to resolve health-related issues. The research data was acquired from Finnish health technology SMEs. The questionnaire was sent to 140 enterprises, generating 25 responses, or a 17.9% response rate. According to the results, health technology enterprises have not adopted KM concepts, nor do they have the necessary resources to do so. SMEs' KM use is informal: information is transferred informally through human interaction, rather than through information systems. In the SMEs, KM is not perceived as important, although it is seen as associated with the enterprise's financial performance through the potential in making the knowledge profitable.

Integrating Science and Engineering to Implement Evidence-Based Practices in Health Care Settings

Integrating two distinct and complementary paradigms, science and engineering, may produce more effective outcomes for the implementation of evidence-based practices in health care settings. Science formalizes and tests innovations, whereas engineering customizes and optimizes how the innovation is applied tailoring to accommodate local conditions. Together they may accelerate the creation of an evidence-based healthcare system that works effectively in specific health care settings. We give examples of applying engineering methods for better quality, more efficient, and safer implementation of clinical practices, medical devices, and health services systems. A specific example was applying systems engineering design that orchestrated people, process, data, decision-making, and communication through a technology application to implement evidence-based depression care among low-income patients with diabetes. We recommend that leading journals recognize the fundamental role of engineering in implementation research, to improve understanding of design elements that create a better fit between program elements and local context.

Contextualizing learning to improve care using collaborative communities of practices

BACKGROUND

The use of interorganizational, collaborative approaches to build capacity in quality improvement (QI) in health care is showing promise as a useful model for scaling up and accelerating the implementation of interventions that bridge the "know-do" gap to improve clinical care and provider outcomes. Fundamental to a collaborative approach is interorganizational learning whereby organizations acquire, share, and combine knowledge with other organizations and have the opportunity to learn from their respective successes and challenges in improvement areas. This learning approach aims to create the conditions for collaborative, reflective, and innovative experiential systems that enable collective discussions regarding daily practice issues and finding solutions for improvement.

METHODS

The concepts associated with interorganizational learning and deliberate learning activities within a collaborative 'Communities-of-practice'(CoP) approach formed the foundation of the of an interactive QI knowledge translation initiative entitled PERFORM KT. Nine teams participated including seven teams from two acute care hospitals, one from a long term care center, and one from a mental health sciences center. Six monthly CoP learning sessions were held and teams, with the support of an assigned mentor, implemented a QI project and monitored their results which were presented at an end of project symposium. 47 individuals participated in either a focus group or a personal interview. Interviews were transcribed and analyzed using an iterative content analysis.

RESULTS

Four key themes emerged from the narrative dataset around experiences and perceptions associated with the PERFORM KT initiative: 1) being successful and taking it to other levels by being systematic, structured, and mentored; 2) taking it outside the comfort zone by being exposed to new concepts and learning together; 3) hearing feedback, exchanging stories, and getting new ideas; and 4) having a pragmatic and accommodating approach to apply new learnings in local contexts.

CONCLUSIONS

Study findings offer insights into collaborative, inter-organizational CoP learning approaches to build QI capabilities amongst clinicians, staff, and managers. In particular, our study delineates the need to contextualize QI learning by using deliberate learning activities to balance systematic and structured approaches alongside pragmatic and accommodating approaches with expert mentors.

Knowledge management in a waste based biorefinery in the QbD paradigm

Shifting resource base from fossil feedstock to renewable raw materials for production of chemical products has opened up an area of novel applications of industrial biotechnology-based process tools. This review aims to provide a concise and focused discussion on recent advances in knowledge management to facilitate efficient and optimal operation of a biorefinery. Application of quality by design (QbD) and process analytical technology (PAT) as tools for knowledge creation and management at different levels has been highlighted. Role of process integration, government policies, knowledge exchange through collaboration, and use of databases and computational tools have also been touched upon.