Creating and Using the Knowledge Archive in the Internet Medical Consultant for Decision Support at the Point of Care

Introduction

With the emergence of the Internet and fast improvement of the ICT technologies, the demand for knowledge by the physicians greatly moves towards the cyberspace. Access to their knowledge is often done by consultations. It is common for a hospital to provide a way to ask its experts for a consultation. At present, hospitals are more concentrated in providing on-line services to potential patients and referring physicians, repositioning expert knowledge-sharing in the lower priority on-line services, if implemented at all (http://www.doctorinternet.co.uk). These services are commonly charged and they do not have searchable knowledge archive.

The Internet Medical Consultant – IMC system (Nakic & Loskovska, 2009) tends to overcome these problems. Its functional and logical organisation is presented in Figure 1.

Figure 1.

Logical and functional diagram of the IMC system

This paper is concentrated on the asynchronous knowledge sharing in the system and exploiting the knowledge archive as a decision support tool at the point of care in clinical conditions. In the following sections we represent the related work, briefly describe the IMC system, present the process of knowledge utilisation at the point of care by elaborating how the knowledge archive is created. Firstly we represent the model of communication between the physicians and then the way the knowledge is captured as a product of that process. Afterwards we discuss the process of searching the archive in details, going through four modifications of an algorithm used for that purpose. In the end, a conclusion is made.

Related Work

A number of systems that try to improve the knowledge – based decision making in clinical conditions exist. SANDS is distributed architecture for clinical decision support which is mainly concerned with medical information exchange (Wright & Sitting, 2008). It involves drug interaction checking, syndrome surveillance, diagnostic decision support, information at the point of care and a simple personal health record. However, it lacks a possibility for direct human consultation and knowledge generation. MDConsult (http://www.mdconsult.com) is a web-application that relies on bibliographical data and images when it comes to providing knowledge and has a mobile application for at point of care knowledge referencing, but lacks the possibility of knowledge generation trough consultations. A system that is very similar to ours is TeleDICOM (Kosiedowski, Mazurek, Stroinski, & Weglarz, 2009). It provides hierarchical consultations with attached files, searchable archive and intensive collaboration features. On the other hand, it has time constraints when the consultations can be made, it is a local system, and is not designed to be a decision support tool at point of care, thus lacks mobile application module.