From extensive test results to exam notes to the very latest in medical research, modern health care professionals have become overloaded with data. As a result, it is now a critical mission for academic medical centers to translate this often-raw data into actionable knowledge used to deliver expert patient care, drive efficient clinical operations and promote discovery and education.
For an academic medical center like Vanderbilt University Medical Center, where clinicians, researchers and educators are creating and using data all the time, this kind of actionable knowledge is actually a tangible asset. Making the leap from raw data to actionable knowledge is, however, not a simple process.
It typically requires the thoughtful stewardship of knowledge management experts skilled in understanding how to capture, maintain, curate and, most importantly, share knowledge.
For organizations that want to establish themselves as pioneers within the changing landscape of health care, knowledge management expertise is essential. In this regard, the newly formed Center for Knowledge Management (CKM) helps to cement VUMC’s reputation as a leader in health care.
Led by Nunzia Bettinsoli Giuse, M.D., vice president for Knowledge Management and professor of Biomedical Informatics, the CKM was founded to create and share new knowledge by capturing, managing and transforming the myriad points of data that run through the Medical Center. The CKM focuses on how to take this newly created knowledge and make it useful and repurposable for a wide variety of clinical, research and educational purposes.
“One of the main scopes of CKM is to aid the Medical Center in the identification, use and reuse of knowledge embedded in both our systems and our experts,” said Giuse. The knowledge managed by the CKM falls into two types: “explicit”, referring to knowledge (such as facts in a textbook) that is readily understood with little interpretation; and “tacit,” meaning insights usually based on experience or expertise that must be provided with additional explanation or context.
“The CKM team has developed individual expertise, as well as methods and tools, that can help bring order and structure to a chaotic collection of data and information. The expertise of this team is analogous to systems engineers who review and revise workflows to achieve efficient operation flow, or user experience experts who design and refine systems to make them exponentially more usable,” said Neal Patel, M.D., MPH, professor of Clinical Pediatrics and chief health informatics officer for the Vanderbilt Health System.
CKM information scientists possess an in-depth understanding of sound practices in knowledge management, spanning a wide array of disciplines from knowledge mining and content filtering to information seeking and data organization. Their work can include such activity as interviewing VUMC personnel to uncover that aforementioned tacit knowledge or analyzing Medical Center software to curate explicit knowledge buried deep in the system. CKM staff then combine these two knowledge types to create new products and services that leverage applications for this newly married knowledge.
These new applications can include patient-focused tools such as conversion of dense medical terminology into more accessible language, or patient health portals that highlight findings of gene testing. In a clinical setting, CKM work around searching, analyzing, filtering and summarizing evidence from research literature can aid clinical decision making for inpatient and outpatient teams.
This research literature activity also facilitates development and revision of diagnosis and procedure-based order sets in use throughout VUMC. From a more academic perspective, CKM professionals train scientists and students how to search for and interpret the latest available genetic and biomolecular information.
On any given day, CKM team members can often be found throughout VUMC, rounding with clinical teams, analyzing patient records to ensure the proper tests are ordered for the diagnosis of rare diseases or leading a lecture at the School of Medicine. It is this kind of close collaboration with stakeholders all over the Medical Center that has heralded the success of the CKM, a partnership approach that is of particular benefit for the Epic Leap project
“The CKM has recently helped Health IT as we began to prepare for Epic Leap. Over the past 15 to 20 years our CPOE system (WizHEO) had accumulated thousands of clinical decision support tools, screens, and pop-ups to guide clinicians. Unfortunately, most of these were not well documented and their relationships and dependencies difficult to navigate,” said Patel.
“After a request from Health IT’s Asli Weikamp, the team from CKM was able to dive into the knowledge in our clinical applications and create a methodology and toolset that organized, documented, and identified the interrelationships of our complex clinical decision support assets in WizHEO. This collaborative effort between the CKM team and the Health IT team was essential, so that we could proactively manage the validation and transition of the knowledge VUMC has developed over the past two decades into the new EPIC system.”
The establishment and continued growth of the Center for Knowledge Management at VUMC will help the organization in a number of ways. Specifically, the CKM:
• Establishes and supports best-practices for extracting decision support content embedded into multiple clinical systems and structuring it for systematic update and re-use informed by timely evidence.
• Advances precision/personalized medicine initiatives by aiding the integration of molecular and genetic variation information into clinical processes and systems to improve decision-making and health outcomes.
• Allows patients to be stronger participants in the management of their own health by using proven communication techniques to provide timely, accurate and plain-language information.
• Better integrates research-based evidence into everyday clinical practice through knowledge management strategies including knowledge mining, content filtering and structuring knowledge for re-use.
• Develops knowledge management tools and platforms to facilitate the distribution and preservation of knowledge.
• Strengthens VUMC’s population health focus and promotes better community by providing current, vetted biomedical information to support and enrich VUMC’s holistic wellness portal, My Southern Health.
• Curates, licenses or maintains and provides access to critical evidence-based resources.
• Develops and supports a knowledge management workforce by promoting an internal environment of life-long learning.
