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KNOWLEDGE MANAGEMENT STRATEGY IN HEALTHCARE
Ministry of Health Republic of Croatia
CROINFO 2003 May 8 - 10, 2003
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• Sinia Varga
• Deputy Minister

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Characteristics

• Ongoing proliferation of data and information
  technology
• Need for knowledge
• We are drowning in information and starving for
  knowledge - John Naisbitt, Megatrends

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Knowledge management is

• The systematic process of identifying, capturing,
  and transferring information and knowledge people
  can use to create, compete, and improve.
• American Productivity and Quality Center

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Components of KM
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Physician/patient relationships
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Information economy

• The information age is dead and gone, replaced by
  the information economy
• In the information economy, intellectual capital,
  not physical assets, drives everything
• The 500 Year Delta What Happens after What
  Comes Next by Jim Taylor and Watts Wacker with
  Howard Means

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Why manage knowledge?

• Ease of partnering
• Managing expertise turnover
• Decentralizing decision-making
• Knowledge can and should be evaluated by the
  decisions or actions to which it leads - Thomas
  Davenport

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Diagnosis of knowledge management status in
healthcare
Knowledge Management is the most neglected aspect
of management in health care

• Recognized problems
• Failure to get new knowledge quickly and
  consistently into practice
• Wide variation in the knowledge available to key
  professionals
• Poor control on the knowledge brought into health
  care organisations
• Lack of control of knowledge flow within
  organisations
• Haphazard and low quality control over the
  knowledge produced by health care organisations,
  for example, knowledge for patients
• Poor co-ordination of knowledge sources

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Recognizing the need
Quote Even with the limited knowledge that it
retains, a doctor's unaided mind cannot reliably
integrate that knowledge with the infinite
variety of data about patients in order to
identify and systematically assess all diagnostic
or treatment options based on each patient's
unique characteristics and needs. In short,
medicine lacks a modern information
infrastructure that rigorously and efficiently
connects all those who produce and archive
medical knowledge to all those who need the
proper application of that knowledge. Weed,
L. L. (1997) New connections between medical
knowledge and patient care, British Medical
Journal, No. 315, p. 231-235
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Knowledge management objectives

• Ensure that required knowledge is produced
• Identify knowledge needs of professionals,
  patients and organisations
• Deliver knowledge when and where it is needed
• Convert tacit knowledge into explicit forms
• Provide answers to questions
• Develop Knowledge Management skills
• Develop necessary culture, systems and structure
  within organisations
• Manage documents effectively and efficiently
• Create opportunities for learning

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Two opposed knowledge management strategies
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Two opposed knowledge management strategies
Codify
Connect
Product
Process
Content
Context
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Infosmog
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• The condition of having too much information to
  be able to take an efective action or make an
  informed decision.

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Implementing KM will provide

• Measureable efficiencies in development and
  provision of health services
• Improved decision-making
• Better ability to quickly introduce new staff to
  SOPs
• Improved morale because employees are making more
  effective decisions
• Increasing patient loyalty due to better trust in
  your health professionals' expertise

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Better!
Good!
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Recommended assumptions for building knowledge
management

• Assume that patients are competent and
  responsible.
• Integrate every type of document to provide a
  single query
• Deliver knowledge when and where is needed.
• Knowledge management will drive quality
  improvement.
• Allow changes in policy to be immediately
  communicated and implemented.
• KM can be integrated with the electronic patient
  record.
• KM supports clinical decision making and
  development.
• Offers research opportunities to clinicians and
  patients.
• Facilitates systems and networks.

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Informatization strategy for the national
healthcare system
Informatization ( internetization ) of the
national healthcare system is one of the primary
objectives of key government initiatives that
will also enable knowledge management projects in
healthcare
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ICT Objectives

• To create such ICT system in Health sector that
  will ensure
• Business intelligence
• Public Health intelligence
• Health Care intelligence
• Equity for citizens (insurees)
• Connectivity between health providers
• ... and everything transparent and measurable, of
  course!

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National Healthcare Knowledge Management System
INTERNET
LAN
WAN
WLAN
KNOWLEDGE MANAGEMENT PORTAL
Thick Client Applications
Thin Client Applications
WEB Applications
INTEGRATION LAYER
Server KM Application UNIX
Server KM Applications Windows
Server KM Applications OS
DATA INTEGRATION LAYER
HIS Central System
Virtual Libraries
Knowledge Bases
Experts Database
MASTER FILE
EXPERT REGISTRY
LIS
KM DB
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Interplay of knowledge management system elements
Source
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E-Learning Projects
Healthcare informatization project will create
environment that will enable e-learning

• Integration of healthcare information systems
• Transforming medical libraries into centers for
  the lifelong learning
• Promotion of e-learning projects for the
  continuous education of medical professionals
• Electronic books, virtual libraries, multimedia
  content
• On-line self-exams, surveys, guides
• On-line pharmacological databases with updated
  information on drugs

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Virtual Polyclinic Telemedicine
Internetization project coupled with Adriatic
islands telemedicine project proved that
knowledge sharing can save lives

• Virtual Polyclinic specialist counselling
  service for the islands
• Virtual Polyclinic on the Cres-Loinj Archipelago
• Island Telemedicine Project of the Croatian
  Academy of Medical Sciences
• Developing insular and counselling networks
• Guidelines for diagnostic safety and
  cost-effectiveness of
• Tele-medical systems in the outpatient medical
  care

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Contribution of IT to an improved healthcare
system

• Access to the medical knowledge-base
• Computer-aided decision support systems
• Collection and sharing of clinical information
• Reduction in errors
• Enhanced patient and clinicial communication

Commitee on the Quality of Health Care in
America, Workshop, September 1999
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Research activity
Systematic reviews of research findings
Development of evidence-based clinical guidelines
Continuing medical education programmes
Adaptation of clinical guidelines and use as
local standards for practice and
audit. Understanding critical appraisal techniques
Audit cycle
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FIRST PATIENT - PHYSICIAN ENCOUNTER
Data collection
Diagnostic decision
Is the diagnosis accurate?
No
Yes
Therapy decision
Therapy follow-up
END
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Physicians who rationalized drugs prescribing
received up to 15.000 kn bonus
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Summary Conclusion

• The amount of information that medical
  professionals need at the time of making critical
  decisions affecting peoples lives is growing
  exponentially
• Knowledge management has become one of the most
  important issues in healthcare
• Staying current becomes impossible without the
  use of modern technology.
• Informatization and institutionalization of
  knowledge management systems in healthcare
  presents one of the major objectives and
  challenges in a national healthcare system.

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Further reading

• Working Kowledge by Thomas H. Davenport and
  Laurence Prusak
• Intellectual Capital by Thomas A. Stewart
• The Knowledge-Creating Company by Ikujiro Nonaka
  and Hirotaka Takeuchi
• Managing Knowledge A practical Web-Based
  Approach by Wayne Applehans, Alden Globe and Greg
  Laugero

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Knowledge is power. Francis Bacon
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Thank you for your attention!
Imagination is more important than
knowledge. Albert Einstein
sinisa.varga_at_miz.hr