Overture Article: "Information Rich, Knowledge Poor"

Trailing all the way back to the Wise Old Doctor Who Made House Calls (anyone remember that?), we have come to think of healthcare as the most knowledge-specific of professions. Practitioners of the medical arts are trained for years, decades actually, to recall and apply information that no layperson need ever understand. Doctors are information junkies, and the rest of us take it on faith more or less that our health is in good, well-informed and reliable hands.

But increasingly, healthcare, the noble art, is groaning under the weight of healthcare, the modern business. Paperwork has erased the Country Doctor and replaced him with an information network.

In an article called “Managing Your Organization’s Key Assets: Knowledge,” J. Fitchett wrote that the healthcare industry is essentially knowledge based. “The quality and efficiency of work performed in healthcare institutes depends on their ability to both manage internally created knowledge about patients, i.e. healing practices, and available experiences as well as to enrich and integrate it with relevant external knowledge created worldwide by related institutes.”

Get that? The quality of the healthcare you get depends directly upon your caregiver’s ability to “manage” internal knowledge about the patient and “enrich and integrate” it with external knowledge from some network of expertise. Your health depends upon knowledge management. When you put it that way, I bet you take it a little more seriously.

My key resource in preparing for this White Paper was another white paper, one written by Xiaoyan Hao, University of Technology, Sydney Faculty of Business, Sydney, Australia. I owe much to this document.

In it, Xiaoyan notes: “Healthcare enterprises can be regarded as data-rich since they generate massive amounts of electronic medical records, clinical trial data, hospitals records, administrative reports, benchmarking findings and so on.... It is not only the basic and specialized medical knowledge a general practitioner is expected to know, but also ‘the content of various governmental guidelines, circulars, warnings of adverse effect of drugs the latest scientific findings in medicine and so on’ (Smith 1996). It is reasonable to say that a doctor suffers from information overload.

“Furthermore, most of the information doctors use when seeing patients is kept unrecorded in their heads and unfortunately some of this information is out of date or wrong. ‘New information may not have penetrated and the information may not be there to deal with patients with uncommon problems.’

“These problems have become more serious as the rate of change in medical knowledge has accelerated. There are new scientific findings everyday, and at the moment the amount of medical knowledge is estimated to increase fourfold during a professional lifetime (Healthfield and Louw 1999), which inevitably means that ‘doctors cannot practice high-quality medicine without constantly updating their knowledge and finding information to help them with particular patients' (Smith 1996).”

The inescapable conclusion is that the healthcare industry—really a conglomerate of enterprises that produces and manipulates a vast spectrum of knowledge from mainly discrete and disconnected sources—is awash in information, and challenged badly to leverage it into useful, actionable knowledge. It is information rich but knowledge poor.

Worse Than Knowledge: Bureaucracy

And it’s not simply medical knowledge and procedural expertise that is challenging healthcare. It’s the damn paperwork.

In 1996, the U.S. Department of Health and Human Services enacted the “Health Insurance Portability & Accountability Act,” known to us all as HIPPA.

HIPPA includes provisions for healthcare organizations to implement electronic transactions as well as new safeguards to protect the security and confidentiality of sensitive patient information.

On the upside, HIPPA encourages healthcare companies to eliminate paper records altogether, increasing the potential for cost savings and enhanced operational efficiency. On the large downside, however, the resource and efforts to comply with HIPPA will make Y2K preparation seem like a walk in the park. In fact, the cost to implement HIPPA is projected to end up being between two and four times what it cost the same participating organizations to get ready for Year 2000 only a few years ago.

But the prime intent of HIPPA is to protect the privacy of the patient; cost savings are simply a lucky byproduct.

Lurking just inside the dark corners of HIPPA, however, is the scariest threat of all: Business executives are now personally liable for any misuse of “personally identifiable, non-public information.” Given that a healthcare organization’s “non-public information assets” range from X-rays and MRI charts to lab results, prescriptions and even videos of consultations, the stewardship of that information is vitally important.

Luckily, there is help. In this White Paper you’ll learn of solutions and best practices that help the healthcare information professional accept that stewardship. Solving the HIPPA challenge is a biggie, no doubt, but that is merely one of uncountable opportunities in healthcare to either accomplish great goals or flub up royally. It is our hope that this particular “information asset” can be turned into constructive knowledge for you and your organizations.

And if it doesn’t, take two aspirin and e-mail me in the morning.

Xiaoyan Hao, University of Technology, Sydney Faculty of Business, November 16, 2001, "Knowledge Management in the Healthcare Industry"

H. Healthfield and G. Louw 1999, “New Challenges for Clinical Informatics: Knowledge Management Tools,” Health Informatics Journal

R. Smith 1996, “What Clinical Information Do Doctors Need?” British Medical Journal, Oct. No. 313

J. Fitchett 1998, “Managing Your Organization’s Key Assets: Knowledge,” http://www.healthforum.com/hfpubs/as

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