Knowledge as a Service at the Point of Care

Abstract

An electronic health record (EHR) can assist the delivery of high-quality patient care, in part by providing the capability for a broad range of clinical decision support, including contextual references (e.g., Infobuttons), alerts and reminders, order sets, and dashboards. All of these decision support tools are based on clinical knowledge; unfortunately, the mechanisms for managing rules, order sets, Infobuttons, and dashboards are often unrelated, making it difficult to coordinate the application of clinical knowledge to various components of the clinical workflow. Additional complexity is encountered when updating enterprise-wide knowledge bases and delivering the content through multiple modalities to different consumers. We present the experience of Mayo Clinic as a case study to examine the requirements and implementation challenges related to knowledge management across a large, multi-site medical center. The lessons learned through the development of our knowledge management and delivery platform will help inform the future development of interoperable knowledge resources.

Figure 1.

Care Process Model (CPM) utilization in 2015

Figure 2.

Overview of knowledge generation, management, and delivery within Mayo Clinic

Figure 3.

Instances of the universal template: Concepts for the Topics “Condition” and “Procedure”

Figure 4.

Derived knowledge assets and the relationships between them

Figure 5.

Abstract representation of the KCMS architecture. The Sitecore system is used for authoring content, which is tagged with terms from the TopBraid Semantic Services Environment (SSE). Content is delivered to consuming systems, such as AskMayoExpert, through the content transformation layer.

Figure 6.

The knowledge lifecycle