The Pragmatic Patterns for Clinical Knowledge Management research program's goal to come closer to the goal of health information systems (HIS) with better support for (evidence-based medicine) EBM. The research program is based on the following:
- Computer support should be based on the practical use of knowledge, with the knowledge process context in focus. It’s clear that HIS must be designed to support the users’ knowledge management tasks in different situations. This should provide tools with better potential for integration in clinical practice and therefore with greater possibilities for long-term use and increased patient benefit.
- The developed models for clinical decision making and knowledge creation and dissemination should be generalizable so that reusable patterns of knowledge management can be identified, which can be turned into improved strategies for evidence-based health care.
- Standards for the Semantic and Pragmatic Web should be used to ease reuse and use of external information sources. By modeling clinical knowledge in accordance with proposed standards, the possibility of information exchange between HIS and use of third party applications is increased. A net-based knowledge management infrastructure is favorable since it provides geographically dispersed clinicians and health care providers with the possibility to cooperate.
- To increase user acceptance, methods and computer support should be user-centered and user-controllable. Tools for computer support should be simple and adaptable to the individual user’s preferences and context.
- Iterative testing and validation of the computer support in daily clinical work. Development in collaboration between user and developer, where prototypes and applications are tested in daily clinical activities, has been identified as a key success factor in the development and adoption of HIS
Aims and Research Questions
The overall goal of the project is to obtain further knowledge of how pragmatic patterns for clinical knowledge management that support evidence-based health care should be modeled, implemented and introduced into clinical practice. More specifically, the project addresses the question of how to design clinical computer-supported tools in which the use of information and the context of knowledge processes are in focus, while a solid foundation in formal knowledge representation and reasoning is maintained. In this, we seek to answer the following:
- What patterns for knowledge management can be identified in clinical decision-making and knowledge sharing and dissemination and how can these patterns be modeled and put to practical use?
- How should clinical knowledge processes be modeled and computer support be designed so that the knowledge’s use and the processes’ context is in focus while maintaining the foundations in formal knowledge representation and reasoning?
- How should computer support for clinical knowledge management be designed to be in alignment with existing clinical health care processes?
The hypothesis is that use of suggested standards and methods in Semantic Web, Pragmatic Web and computer-supported co-operative work (CSCW) are advantageous in answering these questions. In the project, oral medicine will serve as an example discipline from which more general results will be extracted.
Foundations and Objectives
MedView and SOMWeb are two information systems in oral medicine that already provide the foundation of the research program, in the form of an elaborated content when it comes to formalized clinical knowledge, web-based tools for the entering and analysis of clinical data, an online community for clinicians, and an established user base. With MedView and SOMWeb as starting points, the above hypotheses are investigated by setting up the following objectives:
- Formalizing clinical examination data: Using the current formalization of clinical examination data in SOMWeb, initiatives for standardization of electronic health records and of Web-based knowledge representation should be applied to get a more standardized knowledge model.
- Formalizing the context of clinical knowledge processes: Based on results from previous steps, the context of a typical clinical decision process and a typical knowledge sharing process should be described at a suitable level of abstraction.
- Support for net-based knowledge sharing and dissemination: Based on the results of previous steps, SOMWeb’s net-based tool for communication and collaboration should be made more context-aware, to better support the knowledge sharing processes within the community.
- Decision-support: Based on the results of previous steps, a context-aware decision-support system for oral medicine should be developed.
- Pragmatic patterns for clinical knowledge management: From the results of previous steps, generic, reusable patterns for clinical knowledge management should be identified and described at a suitable level of abstraction.
Expected results include improved strategies for evidence-based health care in oral medicine, the identification and implementation of generic patterns for knowledge management, more specifically, knowledge sharing and dissemination and decision-making, and contributions to open standards for representing patient data and to the Pragmatic Web.
The above objectives are met through the parallel development of a tool for web-based knowledge sharing and dissemination and a clinical decision-support system for use in oral medicine.
The complete research proposal to VINNOVA is available in Swedish.