Information Technology Reference
In-Depth Information
ETHICAL AND
SOCIETAL ISSUES
Few professions are more complex and continuously changing
and expanding than medicine. The quality of healthcare provided to
a community depends on physicians being equipped with the latest
medical knowledge on wide-ranging ailments and treatments.
Information systems that feed this knowledge to physicians are the
foundation on which life-and-death decisions are based. The
responsibility of acquiring and managing the knowledge of the
most up-to-date discoveries by the greatest minds in medicine is a
daunting task, one that Partners Healthcare takes very seriously.
Partners HealthCare is an integrated healthcare system found-
ed by Brigham and Women's Hospital and Massachusetts General
Hospital. The system includes primary care and specialty physi-
cians, community hospitals, academic medical centers, and other
health-related entities. For years, Partners has invested heavily in
medical knowledge management systems that provide physicians
with information about the latest drugs and treatments for illness-
es and diseases. In recent years, the amount of knowledge needed
to make healthcare decisions has become so immense and
changes so frequently that it has become unmanageable through
traditional systems that rely on committee meetings and e-mail. In
the near future, as physicians begin to practice personalized gene-
based medicine, the amount of information to manage will explode
in size.
Partners HealthCare's main objective is to maintain the quality
of knowledge and information in medical systems. Partners
involves hundreds of physicians in the process of storing and
checking information in its medical knowledge management sys-
tem. Gathering physicians together to build a knowledge base is
difficult enough. Establishing a way to keep the content updated is
even more challenging. Rather than focusing on the knowledge,
Partners Healthcare began focusing on improving the efficiency of
acquiring and maintaining the knowledge.
Starting with one person, Partners built a knowledge manage-
ment (KM) team that has grown to more than 50 people in the last
five years. Those involved include analysts, project managers,
knowledge engineers, and software developers. The goal was to
develop policies and processes for maintaining clinical knowledge
content. The team focused on building a collaborative system that
allowed domain knowledge experts to communicate without
attending meetings or conference calls.
The team created a central repository for knowledge based on
a product from EMC called Documentum. Documentum is a con-
tent management platform accessed through eRoom collabora-
tion software. Together these products provide physicians with a
robust, Web-based content management infrastructure that is
flexible and scalable.
Prior to the Documentum system, physicians organized medi-
cal documents in folders on file systems. The location of the file
and its name provided all the hierarchical and organizational infor-
mation for storing and retrieving the file. Files were often updated
and over time the organization of the system degraded. Files were
also lost and mismanaged. With the Documentum system, knowl-
edge is stored in a database. All interaction with the data is tracked
and archived. For example, if a pharmacist reads about new find-
ings related to dosages of ibuprofen for geriatric patients, she can
share that article with colleagues, making it available through the
database management system. Colleagues can then comment on
the article and work to a consensus decision on what dosage is
best for patients. The article, the discussion, and the vote are all
catalogued in the database and can be referenced in a few years if
someone wants to re-evaluate the dosage.
The Documentum and eRoom system has substantially
reduced the cost of maintaining the knowledge management sys-
tem and increased the speed at which Partners Healthcare can
acquire knowledge. Physicians have more confidence in the
information provided by the system. Rather than attending monthly
meetings, clinicians are spending time poring over the information
provided by the knowledge management system. To maintain the
quality of data, participants log on to the system at the end of the
day to comment on or approve new guidelines. Allowing physicians
to work at their convenience saves everyone time and makes an
unmanageable amount of information manageable.
Discussion Questions
1.
What was the main challenge facing Partners Healthcare
for managing clinical knowledge and information?
2.
What functionality does Documentum and eRoom provide
that was missing in Partners Healthcare's previous
system?
Critical Thinking Questions
1.
How does the quality of a medical knowledge manage-
ment system affect a community?
2.
How might the Partners Healthcare knowledge manage-
ment system be expanded to benefit medical organiza-
tions nationwide or even worldwide in developing
countries?
SOURCES
: Computerworld Staff, “Managing clinical evidence at the speed
of change,” Computerworld—Honors Program, 2008,
www.cwhonors.org/
viewCaseStudy2008.asp?NominationID=365;
Partners Healthcare Web site,
www.partners.org
accessed July 4, 2008; EMC Web site,
www.emc.com,
accessed July 4, 2008.
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