A knowledge-management model for clinical practice.

Healthcare professionals face information overload and they come across paradoxical information. They are overwhelmed by information but cannot find a particular piece of information when and where they need it.1 This paper describes a model for knowledge-management (KM) specifically designed for use by healthcare professionals. Technologies have increased the dissemination of information, but worsened the problem of unwanted information. Freely available search engines such as PubMed, MEDLINE and other such searches within bmj.com, allow rapid access to a growing body of knowledge as never before.2,3 The skill required by the practitioner is to know how to sift and find information, rather than how to remember facts. In an attempt to control the volume of information and to ensure its relevance to the end-user, sites like the Primary Care National Electronic Library for Health (NeLHPC) have been created.4 It is designed to meet the needs of its target group. Instead of getting tens of thousands of hits, as would happen if a search term for a common condition is placed in MEDLINE, NeLH-PC is designed to take the user to a smaller number of more relevant hits. It is an example of how to access the information appropriately. However, access to the information by itself will not result in its use or raise the quality of service. The knowledge-management model outlined in this paper goes beyond the need to manage information-overload. It sets out to ensure that learning about the best practice actually takes place and as a result, quality standards are actually implemented. However, this implementation is a complex process as real patients often do not fit neatly into simple evidencebased categories. The proposed model differs from much of the existing knowledge-management literature in that it reconciles a fundamental challenge in medicine: The duty of clinical governance which requires clinicians to implement evidence-based practice across populations5 whilst personalising the way they consult with individuals to meet their ideas, concerns and expectations.6 There is consensus among a number of knowledgemanagement authors, drawn from both the commercial and health sector, that for a knowledge-management strategy to be successful, it must adopt either a “codification” or “personalisation” strategy.7,8,9,10 Codification means that the work can be reduced to frequently performed routine tasks – for which computerised decision-support can then be deployed. Personalisation is the production of customised solutions for an individual case. In clinical practice, an approach to knowledgemanagement that uses either personalisation or codification alone will prove inadequate. Even in the most scientific clinical setting, human interaction will affect the acceptance of therapeutic interventions. Medicine remains a human science, with a strong scientific basis; its consultations have such high levels of complexity that probably they can never be computerised and automated. This knowledge-management model suggests needs of clinicians that are within both the codification and personalisation domains and is therefore unique. The knowledge-management model, presented in this paper, is derived from three sources of information: Firstly, a review of literature knowledge managment from both the medical and commercial contexts and secondly the learning from two programs of developmental work the authors have been involved in. The two sources of experiential learning are: the development of applications that provide easy access to evidence at the consulting room desk, the “Doctor’s Desk”11 and the “NeLH-PC”, 12 and the design and development of educational programs to improve data quality and clinical care, the “Primary Care Data Quality (PCDQ) Program”.13