Assignment: Ethical and Societal Issues
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Assignment: Ethical and Societal Issues
Providing Knowledge to Physicians Just in Time
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 founded by Brigham and Women’s Hospital and Massachusetts General Hospital. The system includes primary care and specialty physicians, community hospitals, academic medical centers, and other health-related entities.
Assignment: Ethical and Societal Issues
Assignment: Ethical and Societal Issues
For years, Partners has invested heavily in medical knowledge management systems that provide physicians with information about the latest drugs and treatments for illnesses 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 genebased 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 system. 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 management (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 content management platform accessed through eRoom collaboration 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 medical documents in folders on file systems. The location of the file and its name provided all the hierarchical and organizational information 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, knowledge is stored in a database. All interaction with the data is tracked and archived. For example, if a pharmacist reads about new findings 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 system 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 management system affect a community?
2. How might the Partners Healthcare knowledge management system be expanded to benefit medical organizations nationwide or even worldwide in developing countries?
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