Knowledge is the base for reasoning, a cause-action-based and purpose-driven process of thinking about problems in a logical way.
In clinical work, knowledge management is the process of creating, sharing, storing, using, and managing relevant knowledge and information.
Clinical knowledge consists of a myriad of facts distributed through the universe of the biomedical literature, clinical trial protocols, and intellectual concepts that only exist within abstract constructs, perceived as thoughts or intuition of a physician.
Clinical reasoning is a complex cognitive process that uses formal and informal thinking strategies to gather and analyze clinical information, evaluate the significance of the information, and weigh alternative actions (Simons et al). Decision making is the final step in the cognitive process of clinical reasoning.
In modern clinical practice, it is ever more important for practicing clinicians to have reliable technical support when choosing the best treatment options.
At Wemedoo, we believe in a solution in the form of a single framework, created for conceptualization, representation, distribution, and evaluation of clinical knowledge.
Levels of Clinical Knowledge
Level one – Clinical questions that are self-explanatory, a matter of common sense, or basic medical education usually taken as a ground basis or golden standard for clinical situations. At this level, knowledge management should serve as an educational tool.
Level two – Clinical questions that require a certain level of expertise, formal education, or some years of practice.
For example, if there are various treatment options with similar efficiency and toxicity profile, the expert needs a helping hand to select one that suits best in the current clinical situation. In other words, specialists must think outside a clinical-trial-established environment and choose a more efficient option for the current situation. In this particular case, knowledge management is presented in the form of sharing knowledge.
Level three, the hard one – a clinician is confronted with a clinical situation where extraordinarily little information exists, uncertainty is high and there is no sufficient level of evidence. This is often the case with rare diseases and rare interventions in highly specialized centers. In these situations, the operating system must act intelligently, suggest referral to the competence center, or inclusion in a clinical trial.
In this case, knowledge management is perceived as an integration process in the large knowledge network.
Sometimes, the only option is to act upon the physician’s best judgment. Although not based on a high level of evidence in the classical sense, it is no less worthy. A doctor’s decision is a precious exhibition of knowledge and the system must capture it within a context of systematic evaluation and adapt it for knowledge transfer.
How can the digital environment support healthcare workers and how we can learn from the daily routine?
The classical way to disseminate best practice and evidence-based medicine is through clinical guidelines, and the best way to capture information about clinical decisions is thorough clinical documentation.
Ideally, the system should consider a multifactorial environment and predefined constraints (e.g. need for prior authorization, availability of equivalent generic or less costly option) to provide help.
Tailor Your System to Manage Your Staff’s Knowledge
- Define & Design – Design the best clinical practice suitable for your environment. This is applicable to large university hospitals, local community clinical centers, or even small practices.
- Implement – Take the pathway of implementation and introduce the best practice into the department. Educate your workers, and make them familiar with the tools.
- Document – Document your daily practice, disease response, patient satisfaction, record other important inputs.
- Evaluate – Compare your practice with historical or prospective cohorts. Assess the performance of your department, appraise the work of teams or individual clinicians.
- Adjust and extend – Keep up with the clinical development and adjust your practice as to optimally serve your patients.
Clinical Knowledge and Cancer Care
The complexity of cancer care increases each year with new therapeutic options, drug regimens, and advancements in tumor genomics.
This tide is accompanied by a deluge in biomedical literature with more than 1 million papers indexed in the PubMed each year and a rising trend of 9% annually. The problem is that practicing medical workers are confronted with a vast volume of evidence of uncertain value.
Between this myriad of information, a physician must carefully choose the finest. Therefore, critically evaluated and condensed scientific evidence has become fundamental to patient-oriented clinical practice.
Condensed Clinical Knowledge
Condensed clinical knowledge is an invaluable tool for practicing clinicians in community hospitals as well for clinical researchers at university settings. It accents the importance of the highly specialized topic and provides optimally guided solutions.
This knowledge appears in several forms, such as systematic reviews, consensus statements, clinical guidelines, checklists, and clinical pathways. The later ones are of special importance, considering ever-rising healthcare costs associated with expensive therapies. Although already in digital form, very few of these assets are available in a suitable format for clinical use.
We at Wemedoo understand the value of accessible clinical knowledge and is basis for providing actionable insights and point to the area where the potential for adjustment is eventually needed. Condensed knowledge in the form of clinical pathways can be seamlessly connected with other sources of clinical knowledge, such as biomedical databases and clinical guidelines. They can be integrated within existing hospital infrastructure or act as stand-alone applications, which serve as the documentation and data exchange tool.