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Knowledge management
Informatics
Knowledge management
Relationship between data, knowledge and wisdom
Paul Cooper
Data
Data
Data
Recognizing relations and context Information Understanding patterns
Abstract Extracting principles
Ethics Moral values Wisdom
Figure 1
Sources of knowledge and information
Keywords data; decision support; explicit knowledge; implicit knowledge
Much effort goes into ‘knowledge harvesting’, converting tacit knowledge (experience and intuition) into explicit knowledge, which, once organized and codified, can be used in producing guidelines and protocols. This process has several advantages: • best practice can be quickly passed round (people share ex periences and learn from each other) • poor or non-standard practice can be identified • experience can be made widely available. Sources of knowledge and information are also changing (Table 1). The burgeoning influence and accessibility of the Inter net has threatened traditional sources of information. The Inter net allows information and knowledge to be published cheaply and easily, bypassing traditional hierarchical routes. Some traditional publishers have made their materials avail able on the Internet (often adding interactive content) as free or paid services. However, there is a growing threat to these tradi tional sources of information, facilitated by the ease, cheapness and rapidity of publication on the Internet. Wikipedia (www.en.wikipedia.org), an online encyclopedia that can be edited and contributed to by users, allows access to more than 1.5 million articles covering a wide range of subjects. Despite the potential problems with such open access, Wikipedia seems to be no less of a source of information than the traditional sources. Other more specialized resources also exist (e.g. http:// www.ganfyd.org).1 Search engines (programmes that rapidly search and catego rize the web page content) have been shown to be useful in arriving at diagnoses.2 As ways of categorizing and labelling (meta-information: information about information) become more accurate and intuitive, specific information amongst the millions of likely targets may become more rapidly and easily found through the Internet compared with the traditional sources of information. It is not yet clear how traditional controllers and organizers of knowledge and information will respond to this new threat.
Data, information and knowledge (Figure 1) Data (or more correctly a datum) consist of a label and a value (e.g. systolic blood pressure (SBP) = 80 mm Hg or SBP= − 30 mm Hg). By itself data does not have meaning. Information is data together with a context, so that it gains meaning (e.g. SBP = −30 mm Hg if the transducer is incorrectly calibrated). SBP = 70 mm Hg has a different meaning, depend ing on whether the patient is a neonate or an adult. Information answers the ‘who’, ‘what’, ‘where’, and ‘when’ questions. Knowledge is the result of processing and collecting informa tion, sometimes from many sources. Knowledge can be gained by learning. Knowledge answers the ‘how’ questions. Understanding is the process by which one can synthesize new knowledge from previously held knowledge. Understanding answers the ‘why’ questions. Wisdom is an extrapolative process, which includes knowledge in an ethical or moral framework. Wisdom is the process by which we also discern between right and wrong, good and bad.
Paul Cooper, BSc (Hons), FRCA, is Consultant Anaesthetist at North Tyneside Hospital, North Shields. He qualified from Charing Cross Hospital, London, and trained in Canada, Sheffield and Newcastle. He is a member of the Society for Computing and Technology in Anaesthesia (SCATA), and is completing a degree in computer science at the Open University.
ANAESTHESIA AND INTENSIVE CARE MEDICINE 8:12
Evidence base Guidelines Protocols
Knowledge
The relationship between data, knowledge, wisdom and understanding is explained in this article. There is a need to convert implicit knowledge to explicit knowledge to support several projects within the NHS (and elsewhere), to disseminate good practice, and to provide a sound basis for the different levels of developing clinical decision support systems. Stimulated by increasing access to the Internet, there is a tension between traditional sources of knowledge (e.g. books, individuals recognized as experts), and many different and varied sources of information and knowledge (a wide range of online resources that often are freely available).
516
© 2007 Elsevier Ltd. All rights reserved.
Informatics
which can assist decision-making. Decision-support systems comprise a number of different component parts (e.g. user interface, database, decision-support algorithms and sources of information). Decision support can operate at many levels, from a system displaying warnings or advice to something that is much more prescriptive and can indicate courses of action (e.g. when to refer or which investigations to perform). There are various projects that attempt to codify knowledge and integrate it into clinical practice. The National Library of Health Clinical Knowledge Service (http://cks.library.nhs.uk/)3 focuses on primary care problems. The Map of Medicine (http:// www.mapofmedicine.com/)4 is a project in conjunction with Connecting For Health to codify and make available clinical information relating to a wide range of clinical conditions. One key feature is that the information can be configured locally, and combined with local directory information (e.g. referral paths).
Traditional and new sources of knowledge and information Traditional source of knowledge
Comments
Books
• Expensive production and distribution costs • 12–18 months in production • Sometimes peer-reviewed • Expensive production and distribution costs • Often peer-reviewed • Cheap and easy source • Recognized (local) authority • Time-consuming, may necessitate travel
Journals
Asking colleagues Lectures New sources of knowledge
Comments
Web pages
• Easy to access • Often not quality-assured • Author may not be readily identified • May be difficult to find relevant information • Quick and easy • Not limited by geography or time zones • May not be applicable for distributing images • Issues over authenticity • Often unmoderated • Time-consuming (some lists can generate hundreds of emails/day) • Often not moderated • The most prominent opinion may not necessarily be the most informed • CDs containing images, speech and text may be expensive to produce but cheap to distribute • Allow personal use, not dependent on a connection to Internet
Email
Mailing lists
Discussion forums
Distributed multimedia
Further information For more information, Wikipedia has an article on clinical deci sion support systems (http://en.wikipedia.org/wiki/Clinical_ decision_support_system) compiled over approximately 2 years by 16 authors identified by a username and 9 identified only by an IP address (i.e. an internet address for a computer). Clicking on the ‘history’ tab gives a list of changes and allows you to compare versions and changes. You have to use your judgement as to the veracity of the information contained in the Wikipedia article.
The future Developments in categorizing Web-based content (e.g. OWL, Web Ontology Language; and XML, Extensible Markup Lan guage) are likely to make searching Web content more intuitive and relevant, whilst perhaps not quite achieving the ‘Semantic Web’ vision of Tim Berners-Lee (the inventor of the Internet). Web technologies have enabled greater participation in knowledge and information systems. There are likely to be on going tensions between the traditional keepers and maintainers of knowledge and those who are enthusiastic to challenge the hierarchical structures where they exist. ◆
References 1 http://www.ganfyd.org/ (accessed 1 September 2007). 2 Tang H, Hwee Kwoon Ng J. Googling for a diagnosis—use of Google as a diagnostic aid: internet based study. Br Med J 2006; 333: 1143–5. 3 National Library for Health. Clinical knowledge summaries. http://cks.library.nhs.uk/ (accessed 1 September 2007). 4 Map of medicine. http://www.mapofmedicine.com/ (accessed 1 September 2007).
Table 1
The Internet technologies are increasingly finding local appli cation, and many organizations have local networks (Intranets) of resources available.
Decision-support software In the clinical setting decision-support software is an application of knowledge management. This is any method that takes input information about a clinical situation and produces inferences,
ANAESTHESIA AND INTENSIVE CARE MEDICINE 8:12
Further reading W3C (Worldwide Web Consortium) frequently asked questions. http://www.w3.org/2001/sw/SW-FAQ (accessed 20 August 2007).
517
© 2007 Elsevier Ltd. All rights reserved.
Knowledge management
Relationship between data, knowledge and wisdom
Paul Cooper
Data
Data
Data
Recognizing relations and context Information Understanding patterns
Abstract Extracting principles
Ethics Moral values Wisdom
Figure 1
Sources of knowledge and information
Keywords data; decision support; explicit knowledge; implicit knowledge
Much effort goes into ‘knowledge harvesting’, converting tacit knowledge (experience and intuition) into explicit knowledge, which, once organized and codified, can be used in producing guidelines and protocols. This process has several advantages: • best practice can be quickly passed round (people share ex periences and learn from each other) • poor or non-standard practice can be identified • experience can be made widely available. Sources of knowledge and information are also changing (Table 1). The burgeoning influence and accessibility of the Inter net has threatened traditional sources of information. The Inter net allows information and knowledge to be published cheaply and easily, bypassing traditional hierarchical routes. Some traditional publishers have made their materials avail able on the Internet (often adding interactive content) as free or paid services. However, there is a growing threat to these tradi tional sources of information, facilitated by the ease, cheapness and rapidity of publication on the Internet. Wikipedia (www.en.wikipedia.org), an online encyclopedia that can be edited and contributed to by users, allows access to more than 1.5 million articles covering a wide range of subjects. Despite the potential problems with such open access, Wikipedia seems to be no less of a source of information than the traditional sources. Other more specialized resources also exist (e.g. http:// www.ganfyd.org).1 Search engines (programmes that rapidly search and catego rize the web page content) have been shown to be useful in arriving at diagnoses.2 As ways of categorizing and labelling (meta-information: information about information) become more accurate and intuitive, specific information amongst the millions of likely targets may become more rapidly and easily found through the Internet compared with the traditional sources of information. It is not yet clear how traditional controllers and organizers of knowledge and information will respond to this new threat.
Data, information and knowledge (Figure 1) Data (or more correctly a datum) consist of a label and a value (e.g. systolic blood pressure (SBP) = 80 mm Hg or SBP= − 30 mm Hg). By itself data does not have meaning. Information is data together with a context, so that it gains meaning (e.g. SBP = −30 mm Hg if the transducer is incorrectly calibrated). SBP = 70 mm Hg has a different meaning, depend ing on whether the patient is a neonate or an adult. Information answers the ‘who’, ‘what’, ‘where’, and ‘when’ questions. Knowledge is the result of processing and collecting informa tion, sometimes from many sources. Knowledge can be gained by learning. Knowledge answers the ‘how’ questions. Understanding is the process by which one can synthesize new knowledge from previously held knowledge. Understanding answers the ‘why’ questions. Wisdom is an extrapolative process, which includes knowledge in an ethical or moral framework. Wisdom is the process by which we also discern between right and wrong, good and bad.
Paul Cooper, BSc (Hons), FRCA, is Consultant Anaesthetist at North Tyneside Hospital, North Shields. He qualified from Charing Cross Hospital, London, and trained in Canada, Sheffield and Newcastle. He is a member of the Society for Computing and Technology in Anaesthesia (SCATA), and is completing a degree in computer science at the Open University.
ANAESTHESIA AND INTENSIVE CARE MEDICINE 8:12
Evidence base Guidelines Protocols
Knowledge
The relationship between data, knowledge, wisdom and understanding is explained in this article. There is a need to convert implicit knowledge to explicit knowledge to support several projects within the NHS (and elsewhere), to disseminate good practice, and to provide a sound basis for the different levels of developing clinical decision support systems. Stimulated by increasing access to the Internet, there is a tension between traditional sources of knowledge (e.g. books, individuals recognized as experts), and many different and varied sources of information and knowledge (a wide range of online resources that often are freely available).
516
© 2007 Elsevier Ltd. All rights reserved.
Informatics
which can assist decision-making. Decision-support systems comprise a number of different component parts (e.g. user interface, database, decision-support algorithms and sources of information). Decision support can operate at many levels, from a system displaying warnings or advice to something that is much more prescriptive and can indicate courses of action (e.g. when to refer or which investigations to perform). There are various projects that attempt to codify knowledge and integrate it into clinical practice. The National Library of Health Clinical Knowledge Service (http://cks.library.nhs.uk/)3 focuses on primary care problems. The Map of Medicine (http:// www.mapofmedicine.com/)4 is a project in conjunction with Connecting For Health to codify and make available clinical information relating to a wide range of clinical conditions. One key feature is that the information can be configured locally, and combined with local directory information (e.g. referral paths).
Traditional and new sources of knowledge and information Traditional source of knowledge
Comments
Books
• Expensive production and distribution costs • 12–18 months in production • Sometimes peer-reviewed • Expensive production and distribution costs • Often peer-reviewed • Cheap and easy source • Recognized (local) authority • Time-consuming, may necessitate travel
Journals
Asking colleagues Lectures New sources of knowledge
Comments
Web pages
• Easy to access • Often not quality-assured • Author may not be readily identified • May be difficult to find relevant information • Quick and easy • Not limited by geography or time zones • May not be applicable for distributing images • Issues over authenticity • Often unmoderated • Time-consuming (some lists can generate hundreds of emails/day) • Often not moderated • The most prominent opinion may not necessarily be the most informed • CDs containing images, speech and text may be expensive to produce but cheap to distribute • Allow personal use, not dependent on a connection to Internet
Mailing lists
Discussion forums
Distributed multimedia
Further information For more information, Wikipedia has an article on clinical deci sion support systems (http://en.wikipedia.org/wiki/Clinical_ decision_support_system) compiled over approximately 2 years by 16 authors identified by a username and 9 identified only by an IP address (i.e. an internet address for a computer). Clicking on the ‘history’ tab gives a list of changes and allows you to compare versions and changes. You have to use your judgement as to the veracity of the information contained in the Wikipedia article.
The future Developments in categorizing Web-based content (e.g. OWL, Web Ontology Language; and XML, Extensible Markup Lan guage) are likely to make searching Web content more intuitive and relevant, whilst perhaps not quite achieving the ‘Semantic Web’ vision of Tim Berners-Lee (the inventor of the Internet). Web technologies have enabled greater participation in knowledge and information systems. There are likely to be on going tensions between the traditional keepers and maintainers of knowledge and those who are enthusiastic to challenge the hierarchical structures where they exist. ◆
References 1 http://www.ganfyd.org/ (accessed 1 September 2007). 2 Tang H, Hwee Kwoon Ng J. Googling for a diagnosis—use of Google as a diagnostic aid: internet based study. Br Med J 2006; 333: 1143–5. 3 National Library for Health. Clinical knowledge summaries. http://cks.library.nhs.uk/ (accessed 1 September 2007). 4 Map of medicine. http://www.mapofmedicine.com/ (accessed 1 September 2007).
Table 1
The Internet technologies are increasingly finding local appli cation, and many organizations have local networks (Intranets) of resources available.
Decision-support software In the clinical setting decision-support software is an application of knowledge management. This is any method that takes input information about a clinical situation and produces inferences,
ANAESTHESIA AND INTENSIVE CARE MEDICINE 8:12
Further reading W3C (Worldwide Web Consortium) frequently asked questions. http://www.w3.org/2001/sw/SW-FAQ (accessed 20 August 2007).
517
© 2007 Elsevier Ltd. All rights reserved.