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employing downstream solutions such as clinical guidelines for screening and
treatment of colon cancer as well as public health interventions to promote early
diagnosis of the disease, the solution to the increased incidence of colon adeno-
carcinoma takes on a systems-level confi guration (as opposed to interventions
limited to the aforementioned silos).
Unfortunately, as promising as the scenario described above appears, it is the
exception rather than the norm relative to current approaches to healthcare delivery,
research and policy formulation. The reasons for such challenges are at a high level
a function of traditional reductionist thinking paradigms coupled with social, regu-
latory and technical barriers, and are further explored in Sect.
2.3
of this chapter.
2.3
Implications of This Prototype for Knowledge-Driven
Healthcare
As noted in Sect.
2.2
, while the ideal and prototypical scenario of using TI to over-
come a higher-than-average incidence of colon cancer is highly desirable, it is also
extremely uncommon given the current state-of-the-art in healthcare delivery,
research and associated policymaking. This of course raises the question of why
such a model is not widely seen in the “real world”. Broadly speaking, there are a
number of organizational, social, regulatory and technical barriers that serve to
defi ne this space, and that can be attributed to traditional and reductionist view-
points. The major and contributing areas that make up current “silos” in the health-
care domain are illustrated in Fig.
2.2
and described below:
At the core of the current healthcare paradigm is a
unidirectional care delivery
model
in which clinicians diagnose and/or treat patients in episodic encounters,
which are increasingly codifi ed and recorded using Electronic Health Record
(EHR) systems. In this approach, the patient is usually a passive recipient of
care, and does not necessarily contribute substantive data or information to the
decision making process that occurs during clinical encounters;
Clinicians who engage in clinical care utilize a variety of knowledge sources
that are delivered to them in a similar unidirectional manner to them with
variable time-frames for the delivery of that knowledge
. For example, health-
care educators train clinicians in terms of prevailing basic and clinical science.
Such training is usually augmented and informed over time by new evidence that
is generated by a variety of researchers. Finally, policy makers at the local,
regional, national and international levels may generate guidelines or other poli-
cies corresponding to clinical best practices and reimbursement that serve to
infl uence or constrain the decision making of a clinician. Of note, all of the
aforementioned relationships to the clinician tend to be unidirectional and the
generators of such knowledge or policies are rarely the recipients of data, infor-
mation or knowledge “feedback” from the point-of-care unless they are engaged
in highly targeted and formalized research programs.
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