Abstract
This chapter introduces strategies to meet knowledge transfer needs. The clinical knowledge repository infrastructure and tools developed at Intermountain Healthcare are described. The knowledge repository (KR) is a database with services housing knowledge assets. The electronic tools are used to access and manipulate the assets. The tools include (1) the Knowledge Repository Online, used to load, view, and review knowledge assets stored in the KR, (2) the Knowledge Authoring Tool, used to compose knowledge assets using schema-based XML templates, (3) the viewer, used for easy and rapid access to a predetermined collection of knowledge assets, and (4) KR Reports, used to mine monitoring data about KR tool usage and the user experience. The process for knowledge asset development is described, and four project-specific case studies are presented describing asset development incorporating the infrastructure and tools. The value added by knowledge engineers to the knowledge transfer process is discussed.
TopIntermountain Healthcare Clinical Strategy
Intermountain Healthcare (Intermountain) is a nonprofit, multi-state network of hospitals, clinics, surgery centers, and an insurance plan. The primary clinical initiative of Intermountain is to “deliver the best clinical practice in a consistent and integrated way … at the lowest appropriate cost to the population served” (About Intermountain Healthcare, 2007) regardless of facility size or location, demonstrate improvement in measureable outcomes, and secure interactions by all levels of clinical users in the development and use of the centralized clinical content (Commitment to Quality, 2007). The literature reports goal attainment is dependent upon the availability of pertinent knowledge at the moment the knowledge is needed (Davis et al., 2003; Guptill, 2005). Users benefit from the consolidation of multiple knowledge elements into a succinct, usable arrangement. The degree of detail in the knowledge presented to the user is dependent upon the user’s current knowledge level of the task at hand (Santesso et al., 2006). The user’s learning process must not be hindered while attempting to access knowledge content (Roberts, Patel, & Bakken, 2004). Users of clinical knowledge should have access to pertinent knowledge expressed in a comprehensible approach (e.g., language, reading level, font size, paper vs. electronic access). Therefore, usable knowledge should (1) be available or instantiated at the appropriate moment of need in the workflow process, (2) be the appropriate level of detail for the task, and (3) be displayed in a user-friendly format.
Guptill (2005) supports the recognition that knowledge management incorporates knowledge sharing between individuals working toward a common goal with the end result being a desirable modification in behavior. Studies show collegial communications for knowledge exchange is more commonly used than searching literature (Gerrish & Clayton, 2004; Thompson et al., 2001). This type of communication, known as knowledge transfer, is the act of engineering implicit and explicit knowledge into an understandable, recognizable, and accessible format, and passing that body of knowledge between the knowledge holder and the intended knowledge users. The knowledge user is an active participant in completing the communication loop by transferring enhancement suggestions back to the knowledge holder (Aita, Richer, & Héon, 2007; as cited in Graham et al., 2006; Greenhalgh, Robert, Macfarlane, Bate, & Kyriakidou, 2004).
Greenhalgh et al. (2004) suggests that systematically organizing knowledge according to the manner in which the knowledge is expected to be used will enhance the transfer and incorporation of that knowledge into practice. Health care institutions must be able to readily comply with the mutability of regulatory and policy revisions (Gerrish & Clayton, 2004). Informed decision-making for users of healthcare knowledge may directly affect patient safety and outcomes.
To accomplish the initiative reported above, Intermountain implemented a number of processes to improve quality outcomes for patients and influence accessibility to quality personal care information for the community (Roemer et al., 2006). These methods emphasize equal access to knowledge assets (assets) by those who need the access (Hougaard, 2004). A “knowledge asset” is a single file or document (instance) containing knowledge of value to a knowledge user. Knowledge transfer is enhanced by ready access to a network of assets by the intended knowledge users.
TopKnowledge Repository Infrastructure
The Knowledge Repository (KR) infrastructure and four interoperable tools provide maximum ownership of the knowledge management life cycle to knowledge authors, and encourage the development and use of high quality, evidence-based assets. The tools provide a consistent method for knowledge authors to develop electronic assets and to give voice to knowledge users when the need for changes to current practice is identified.
Key Terms in this Chapter
Knowledge Asset: A knowledge asset is a single file or document (instance) containing knowledge of value to a knowledge user.
Knowledge Repository Online: The Knowledge Repository Online is a collaborative web-based application utilizing the KR services and database, providing knowledge users a rapid and convenient electronic means of submitting a KR asset review. Also known as KRO.
Knowledge Authoring Tool: The Knowledge Authoring Tool is a web-based text processor enabling knowledge authors to compose XML assets using schema-based XML templates through a third-party ActiveX plug-in rendered in an HTML page. Also known as KAT.
Monitoring Infrastructure: Monitoring infrastructure is a Java service that logs and time stamps (1) sessions for an application, (2) the events performed against the system or asset, and (3) database performance statistics.
Knowledge Engineer: A knowledge engineer is responsible for the analysis, documentation, development, implementation, validation, and maintenance of interdisciplinary knowledge bases and tools providing clinical decision support capabilities for internally developed or vendor supplied applications.
Intermountain Healthcare: Intermountain Healthcare is a nonprofit, multi-state network of acute care hospitals, clinics, surgery centers, and an insurance plan.
KR Reports Tool: The KR Reports tool is a flexible monitoring infrastructure providing the ability to mine and report data about access to KR assets and the user experience for any date range.
Knowledge Transfer: The act of engineering implicit and explicit knowledge into an understandable, recognizable, and accessible format, and passing that body of knowledge between the knowledge holder and the intended knowledge users.
Collaborative Practice Guideline Viewer: The Collaborative Practice Guideline (CPG) Viewer is a web-based tool designed to efficiently search and display a selection of CPG asset titles based upon clinician defined search criteria. Also known as CPG Viewer.
Knowledge Repository Infrastructure: Knowledge Repository Infrastructure consists of a database, set of services (e.g., monitor, redirect, search, retrieve, display, change ownership), and interoperative tools providing maximum ownership of the knowledge management life cycle to knowledge authors, encouraging the development and use of high quality, evidence-based knowledge assets. The tools provide a consistent method for knowledge authors to develop electronic assets and to give voice to knowledge users when the need for changes to current practice is identified.