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Exchanging clinical knowledge via Internet
International Journal of Medical Informatics 47 (1997) 39 – 41
Exchanging clinical knowledge via Internet I.E. Buchan *, R. Hanka Medical Informatics Unit, Uni6ersity of Cambridge, Cambridge CB2 2SR, UK
Abstract The need for effective and efficient exchange of clinical knowledge is increasing. Paper based methods for managing clinical knowledge are not meeting the demand for knowledge and this has undoubtedly contributed to the widely reported failures of clinical guidelines. Internet affords both opportunities and dangers for clinical knowledge. Systems such as Wax have demonstrated the importance of intuitive structure in the management of knowledge. We report on a new initiative for the global management of clinical knowledge. © 1997 Elsevier Science B.V. Keywords: Knowledge; Knowledge representation; Clinical decision support; Internet
1. Introduction Increasing demand for health services and the growth of health knowledge continuously increase the rate of exchange of knowledge within this ‘super-family’ of domains. Demand for clinical knowledge already outstrips supply and the consequences of this inequity are beginning to be reported [1]. The paucity of success with paper based guidelines, despite large investment in this area, suggests that the healthcare professions are
* Corresponding author. E-mail: ieb21.cam.ac.uk
no longer able to manage paper based knowledge effectively. The advent of affordable on-line information services bears opportunities and dangers for clinical knowledge exchange. The transcription of unstructured, ‘over diluted’ knowledge from paper into electronic media is one danger that has already been realised in much of the content of health related sites on the World Wide Web. Some initiatives to structure clinical knowledge exchange via electronic media have been successful. The Path Finder project demonstrated benefits to General Practitioners in the UK of an architecture, known as Wax,
1386-5056/97/$17.00 © 1997 Elsevier Science B.V. All rights reserved. PII S 1 3 8 6 - 5 0 5 6 ( 9 7 ) 0 0 0 8 4 - 1
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I.E. Buchan, R. Hanka / International Journal of Medical Informatics 47 (1997) 39–41
for the management of district level clinical knowledge services [2]. The current challenge is to meet both local and global needs for structured clinical knowledge exchange. For this purpose, we are developing a new knowledge management architecture for the Clinical Immediate Knowledge Project (CLINIK) which is based in the Universities of Cambridge and Oxford and is supported by the Research and Development Directorate of the UK National Health Service. Here we outline the objectives and methods of this new architecture and discuss the need for such work.
2. Objectives Our broad objective is to improve the exchange of clinical knowledge by providing methods and knowledge templates which can be used to build specific, inter-operable applications. Specific objectives are: to develop and maintain templates of valid, globally relevant key clinical knowledge to support local applications; optimal methods for accessing clinical knowledge in different situations; methods for the effective integration of locally relevant procedural information and key clinical knowledge; methods to help authors understand when, why and where their communications are used; fertile communication between knowledge providers and users methods for easy extraction of research data from the navigation of knowledge in routine clinical practice methods for integrating different knowledge resources to make them easy to main-
tain via Internet and easy to navigate in both networked and stand-alone operations.
3. Methods
3.1. Knowledge acquisition Healthcare requires knowledge from a large number of agencies. Our knowledge management strategy encompasses both local and global structures for knowledge acquisition. At the local level we apply the Wax architecture based around a district level clinical hypertext library. This library is operated by one full time information manager who coordinates the maintenance of hypertext ‘books’ and facilitates communication between local knowledge providers and users. An example of this is the first PathFinder library which was established to meet the knowledge needs of General Practitioners in Wirral, UK. This serves a district with a population of 360 000 and one major provider of secondary level hospital services. The library is located at the largest local hospital site to ensure maximum contact with local knowledge providers. PathFinder has been evaluated as highly useful by General Practitioners using the system in routine clinical practice for more than 18 months [2]. Much clinical knowledge is globally relevant. We aim to provide a library of ‘template books’ to prime local initiatives world wide. Localisation and concentration are essential steps toward making clinical knowledge relevant and useful enough to be used. By connecting local clinical hypertext libraries, systematic review sources, experts and literature services our knowledge management system will reduce repetition of effort in identifying and concentrating knowledge for target audiences.
I.E. Buchan, R. Hanka / International Journal of Medical Informatics 47 (1997) 39–41
3.2. Interface design Good interfaces are essential to successful knowledge systems. This is obvious from the point of view of the user but the needs of knowledge providers are often overlooked. We will offer knowledge structures with outline content and software tools to help optimise communication between clinical knowledge providers and users. We arrange knowledge into a familiar hierarchical structure of pages of books on shelves in a library. The Wax software used in the PathFinder project is being developed further for local applications of our new knowledge management system. Wax-II software provides browsing and authoring of hypertext books which have been optimised for clinical use on Microsoft Windows compatible platforms. Wax facilities include feedback mechanisms, navigation logs and performance features which are not achievable using HTML and standard web browsers. Wax books will be able to import and export HTML documents and are designed to be browsed from a local storage medium. Internet software options will be provided for the synchronisation of book updates between district level libraries and endusers. The Wax-II software tools can be downloaded from http:// www.medinfo.cam.ac.uk/wax/. Our current software developments will enable Wax type books to be created from HTML pages and to be browsed with standard web browsers using a knowledge management apples set; this is due for release in the third quarter of 1997. Wax provides easy authoring of book centred content which can be exported in HTML format. The knowledge management applets will combine the .
41
clinical benefits of a Wax browser with all of the functions and cross-platform operation of standard web browsers.
4. Conclusions The history of clinical decision support systems and latterly knowledge systems is awash with reports of problems in providing diagnostic support. Studies have shown, however, that the focus for clinical decision support should be placed upon management rather than diagnosis [3]. Recent initiatives, such as Wax, have successfully implemented knowledge systems built around identified clinical needs [2]. Our new knowledge management architecture extends to the global support of knowledge systems with methods and templates to prime locally managed clinical knowledge services. Many of today’s healthcare problems are global. Rising expectations, new technologies and population ageing are increasing the demand for healthcare at a rate which can not be met in the long term by any developed country. The demand for knowledge, however, should be met by well managed, intuitively structured and accessible clinical knowledge systems.
References [1] J. Wyatt, Hospital information management: the need for clinical leadership, Br. Med. J. 311 (1995) 175 – 178. [2] I.E. Buchan, H.A. Heathfield, et al., Decision support for Primary Care using the PathFinder System, Br. J. Healthcare Comput. 13 (6) (1996) 20 – 22. [3] H.A. Heathfield, J. Wyatt, Philosophies for the design and development of clinical decision support systems, Methods Inform. Med. 32 (1993) 1 – 8.
Exchanging clinical knowledge via Internet I.E. Buchan *, R. Hanka Medical Informatics Unit, Uni6ersity of Cambridge, Cambridge CB2 2SR, UK
Abstract The need for effective and efficient exchange of clinical knowledge is increasing. Paper based methods for managing clinical knowledge are not meeting the demand for knowledge and this has undoubtedly contributed to the widely reported failures of clinical guidelines. Internet affords both opportunities and dangers for clinical knowledge. Systems such as Wax have demonstrated the importance of intuitive structure in the management of knowledge. We report on a new initiative for the global management of clinical knowledge. © 1997 Elsevier Science B.V. Keywords: Knowledge; Knowledge representation; Clinical decision support; Internet
1. Introduction Increasing demand for health services and the growth of health knowledge continuously increase the rate of exchange of knowledge within this ‘super-family’ of domains. Demand for clinical knowledge already outstrips supply and the consequences of this inequity are beginning to be reported [1]. The paucity of success with paper based guidelines, despite large investment in this area, suggests that the healthcare professions are
* Corresponding author. E-mail: ieb21.cam.ac.uk
no longer able to manage paper based knowledge effectively. The advent of affordable on-line information services bears opportunities and dangers for clinical knowledge exchange. The transcription of unstructured, ‘over diluted’ knowledge from paper into electronic media is one danger that has already been realised in much of the content of health related sites on the World Wide Web. Some initiatives to structure clinical knowledge exchange via electronic media have been successful. The Path Finder project demonstrated benefits to General Practitioners in the UK of an architecture, known as Wax,
1386-5056/97/$17.00 © 1997 Elsevier Science B.V. All rights reserved. PII S 1 3 8 6 - 5 0 5 6 ( 9 7 ) 0 0 0 8 4 - 1
40
I.E. Buchan, R. Hanka / International Journal of Medical Informatics 47 (1997) 39–41
for the management of district level clinical knowledge services [2]. The current challenge is to meet both local and global needs for structured clinical knowledge exchange. For this purpose, we are developing a new knowledge management architecture for the Clinical Immediate Knowledge Project (CLINIK) which is based in the Universities of Cambridge and Oxford and is supported by the Research and Development Directorate of the UK National Health Service. Here we outline the objectives and methods of this new architecture and discuss the need for such work.
2. Objectives Our broad objective is to improve the exchange of clinical knowledge by providing methods and knowledge templates which can be used to build specific, inter-operable applications. Specific objectives are: to develop and maintain templates of valid, globally relevant key clinical knowledge to support local applications; optimal methods for accessing clinical knowledge in different situations; methods for the effective integration of locally relevant procedural information and key clinical knowledge; methods to help authors understand when, why and where their communications are used; fertile communication between knowledge providers and users methods for easy extraction of research data from the navigation of knowledge in routine clinical practice methods for integrating different knowledge resources to make them easy to main-
tain via Internet and easy to navigate in both networked and stand-alone operations.
3. Methods
3.1. Knowledge acquisition Healthcare requires knowledge from a large number of agencies. Our knowledge management strategy encompasses both local and global structures for knowledge acquisition. At the local level we apply the Wax architecture based around a district level clinical hypertext library. This library is operated by one full time information manager who coordinates the maintenance of hypertext ‘books’ and facilitates communication between local knowledge providers and users. An example of this is the first PathFinder library which was established to meet the knowledge needs of General Practitioners in Wirral, UK. This serves a district with a population of 360 000 and one major provider of secondary level hospital services. The library is located at the largest local hospital site to ensure maximum contact with local knowledge providers. PathFinder has been evaluated as highly useful by General Practitioners using the system in routine clinical practice for more than 18 months [2]. Much clinical knowledge is globally relevant. We aim to provide a library of ‘template books’ to prime local initiatives world wide. Localisation and concentration are essential steps toward making clinical knowledge relevant and useful enough to be used. By connecting local clinical hypertext libraries, systematic review sources, experts and literature services our knowledge management system will reduce repetition of effort in identifying and concentrating knowledge for target audiences.
I.E. Buchan, R. Hanka / International Journal of Medical Informatics 47 (1997) 39–41
3.2. Interface design Good interfaces are essential to successful knowledge systems. This is obvious from the point of view of the user but the needs of knowledge providers are often overlooked. We will offer knowledge structures with outline content and software tools to help optimise communication between clinical knowledge providers and users. We arrange knowledge into a familiar hierarchical structure of pages of books on shelves in a library. The Wax software used in the PathFinder project is being developed further for local applications of our new knowledge management system. Wax-II software provides browsing and authoring of hypertext books which have been optimised for clinical use on Microsoft Windows compatible platforms. Wax facilities include feedback mechanisms, navigation logs and performance features which are not achievable using HTML and standard web browsers. Wax books will be able to import and export HTML documents and are designed to be browsed from a local storage medium. Internet software options will be provided for the synchronisation of book updates between district level libraries and endusers. The Wax-II software tools can be downloaded from http:// www.medinfo.cam.ac.uk/wax/. Our current software developments will enable Wax type books to be created from HTML pages and to be browsed with standard web browsers using a knowledge management apples set; this is due for release in the third quarter of 1997. Wax provides easy authoring of book centred content which can be exported in HTML format. The knowledge management applets will combine the .
41
clinical benefits of a Wax browser with all of the functions and cross-platform operation of standard web browsers.
4. Conclusions The history of clinical decision support systems and latterly knowledge systems is awash with reports of problems in providing diagnostic support. Studies have shown, however, that the focus for clinical decision support should be placed upon management rather than diagnosis [3]. Recent initiatives, such as Wax, have successfully implemented knowledge systems built around identified clinical needs [2]. Our new knowledge management architecture extends to the global support of knowledge systems with methods and templates to prime locally managed clinical knowledge services. Many of today’s healthcare problems are global. Rising expectations, new technologies and population ageing are increasing the demand for healthcare at a rate which can not be met in the long term by any developed country. The demand for knowledge, however, should be met by well managed, intuitively structured and accessible clinical knowledge systems.
References [1] J. Wyatt, Hospital information management: the need for clinical leadership, Br. Med. J. 311 (1995) 175 – 178. [2] I.E. Buchan, H.A. Heathfield, et al., Decision support for Primary Care using the PathFinder System, Br. J. Healthcare Comput. 13 (6) (1996) 20 – 22. [3] H.A. Heathfield, J. Wyatt, Philosophies for the design and development of clinical decision support systems, Methods Inform. Med. 32 (1993) 1 – 8.