Knowledge Management and Translation in Health Systems Research

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Knowledge Management and Translation in Health
Systems Research

• Concepts of Knowledge in Healthcare
• Knowledge Management and Translation in
  Healthcare
• A KMT Framework in Health Systems Research
• Examples in HIS Evaluation, Terminology Standards
  and End-of-Life Care Surveillance
• Next Steps

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Concepts of Knowledge in Healthcare
Knowledge is a mix of experience, values,
expert insights and contextual info that provides
a framework for evaluating and incorporating new
information, experiences (Davenport Prusak 1998)
Explicit/Tacit Knowledge
A process that organizationally amplifies
knowledge created by individuals and crystallizes
it as part of knowledge system of an organization
(Nonaka et al. 1996)
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Knowledge Management and Translation in Healthcare

• Public Health Tobacco Control, Surveillance
• Acute/Tertiary/Continuing Care Patient Safety
• Primary Care Chronic Disease Management
• Care Continuity, Circle, Collaborative, Self
• Health Systems Complex, Interdependent,
  Dynamic, Feedback-loops

Research-based Knowledge
Knowledge Translation
Practice-based Knowledge
Knowledge Management
Large-scale Health Systems
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Knowledge Management and Translation in Healthcare
Social Context
(structures, values, preferences)
Production
Collection, Generation, Synthesis,
Identification Codification,
Storage Packaging,
Coordination
Integration, Evaluation,
Reflection, Sustainability
Explicit/Tacit Knowledge
Explicit/Tacit Knowledge
Use
Refinement
Distribution, Sharing, Application, Adaptation
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Knowledge Management and Translation in Healthcare
Ecological Context
(organizational, political, cultural, media)
Audience
Combination,
Articulation, Internalization, Socialization
Policy maker, Practitioner, Researcher,
the Public
Explicit/Tacit Knowledge
Motivations
Mechanisms
Decision, Education, Innovation, Advocacy
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Knowledge Management and Translationin Healthcare
EXPLICIT/TACIT KNOWLEDGE Evidence Policy Experien
ce Contact
KNOWLEDGE MANAGEMENT Production Use Refinement So
cial Context
KNOWLEDGE TRANSLATION Audience Motivations Mechan
isms Ecological Context
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Knowledge Management and Translationin Healthcare
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A Knowledge Management and TranslationFramework
in Health Systems Research
EXPLICIT/TACIT KNOWLEDGE Evidence Policy Experien
ce Contact
KNOWLEDGE MANAGEMENT Production Use Refinement So
cial Context
KNOWLEDGE TRANSLATION Audience Motivations Mechan
isms Ecological Context
OUTCOMES Evidence Base for Dissemination Knowledge
Base for Linking Science and Practice Implementat
ion Framework Interaction and Collaboration
Methodology
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KNOWLEDGE MANAGEMENT
EXPLICIT/TACIT KNOWLEDGE
KNOWLEDGE TRANSLATION
KMT STRATEGIES
4Ps
Purpose
People
Process
Product
STRATEGY MAPS
KMT Infrastructure
4P-KMT Infrastructure
4P-KMT
INFRASTRUCTURES
Organization, Information, Technology, Finance
OUTCOMES
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A Knowledge Management and TranslationFramework
in Health Systems Research
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A Knowledge Management and TranslationFramework
in Health Systems Research
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A Knowledge Management and Translation Framework
OUTCOMES
4P-KMT
KNOWLEDGE MANAGEMENT AND TRANSLATION
AUDIENCES Policy maker Practitioner
Researcher Public
MOTIVATIONS Decision Education
Innovation Advocacy
MECHANISMS Combination Articulation
Internalization Socialization
Purpose
Evidence Base
People
KNOWLEDGE MANAGEMENT
Science-Practice Linkage
PRODUCTION Creation
Collection Generation Synthesis
Identification Organization Codification
Storage Packaging Coordination
USE Distribution Sharing Application
Adaptation
REFINEMENT Integration Evaluation
Reflection Sustainability
Process
Implementation Framework
Product
Interaction Collaboration Methodology
INFRASTRUCTURES
Organization, Information, Technology, Finance
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Examples in HIS Evaluation,Terminology Stds, EOL
Care Surveillance

• eHealth Observatory to Monitor Effects of HIS
  Deployment in Canada
• Adoption, Use and Impact of Terminology Standard
  in Palliative Care
• End-of-life Care Surveillance Team Network
  Development

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Examples in HIS Evaluation,Terminology Stds, EOL
Care Surveillance
eHealth Observatory to Monitor Effects of HIS
Deployment in Canada
HIS Users
Early Adopters
Late Adopters
Advanced-users
Intermediate-users
Basic-users
Non-users
HIS Lifecycle
Requirements Deployment
Use
Adaptation
Telescopic Views
Wide-angle
Fixed-anchor
In-motion
Close-up
Meta-analysis And Review
HIS Effects
Impact Evaluation
Usability Engineering
Process Evaluation
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Examples in HIS Evaluation,Terminology Stds, EOL
Care Surveillance
PharmaNet-MedRec Study Phases 6 months each
Baseline
Implementation-1
Implementation-2
Followup-1
Followup-2
No PharmaNet
PharmaNet1
PharmaNet2
PharmaNet1/2
Site-3
Site-2
Time series cohort design
Site-1
No MedRec Control Group
MedRec Intervention Group
Admission
Discharge
Usability engineering
?
MedRec-1
MedRec-2
(Un)/Intentional Discrepancies
?
Case finding
Expert consensus
Potential Adverse Drug Events
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Examples in HIS Evaluation,Terminology Stds, EOL
Care Surveillance
Terminology Systematized Nomenclature of
Medicine Clinical Terms (SNOMED CT)
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211334007Abrasion, ankle 399963005Abrasion 
    363698007Finding site67269001Skin
structure of ankle 64572001Disease     1166
76008Associated morphology400061001Abrasion,
     363698007Finding site67269001Skin
structure of ankle 243796009Situation with
explicit context     246090004Associated
finding(          64572001Disease          
     116676008Associated morphology400061001Ab
rasion,               363698007Finding
site67269001Skin structure of
ankle     ),     408729009Finding
context410515003Known present,     408731000
Temporal context410512000Current or
specified,     408732007Subject relationship
context410604004Subject of record
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Examples in HIS Evaluation,Terminology Stds, EOL
Care Surveillance
An Interactive EOL Care Surveillance System
Data Sources
Information Products
CIHI/BC EOL datasets
Common Data Definitions
Administrative Databases
Web assessment tool Scannable paper
Teleform? MS-Access assessment tool ISAAC tool
for ESAS/PPS
EOL Epidemiologic Profiles
Web Interface Module
RAI/MDS Databases
EOL 1-year Survival Profiles
Epidemiologic Profile Module
Survival Analysis Module
Clinical Quality Module
VIHA MDS-HC/RC datasets
EOL Resource Use Profiles
Scenario Modeling Module
Meta-analysis Module
Assessment/ Prognostic Databases
Resource Use Module
VH/Edm Prognostic datasets
EOL Clinical Quality Profiles
Data Translation Module
SNOMED CT Terminology Server
Common EOL Metadata Dictionary
Common EOL Database Repository
Regional/ Provincial Databases
Published Secondary Sources
Meta-analysis Published EOL Studies
EOL Care Scenarios
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Data Sources
Extracted Datasets
Additional Datasets
Consolidated Datasets
EOL Care Surveillance Framework, Methods, Data
Sources
Administrative Data Vital Statistics Discharge
Abstracts Pharmacy Prescriptions Palliative
Benefits Plan Medical Service Plans Home/Community
Care
Western EOL dataset BC Branch EOL dataset
Updated BC EOL dataset
RAI/MDS Data MDS-Home Care MDS-Residential
Care Client Grouping/CHESS
Vancouver Island HA MDS datasets
BC EOL dataset BC MDS BC palliative
resource BC program BC known cancer VH
prognostic AB EOL dataset Edm prognostic AB
known cancer? AB palliative resource? Yukon,
Ottawa datasets
BC MDS datasets
Assessment/Prognostic Data Demographics,
PPS ESAS/MMSE/PNHA/PPS PaP/PPI/ECOG/KPS/PPS
Victoria Hospice (VH) prognostic
dataset Edmonton (Edm) prognostic datasets
Updated VH and Edm prognostic datasets
Regional/Provincial Data BC Cancer Agency Info
System VH Palliative Program Regional Information
Systems
BC known cancer dataset VH Program dataset BC
Palliative resource datasets
Meta-analysis datasets
Published Secondary Source (e.g. EOL
epidemiology, clinical quality, resource use,
burden of dying)
Meta-analysis datasets
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Sample EOL epidemiologic profiles
Example - EOL Epidemiologic Profiles
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Sample EOL 1-year survival profiles
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Sample EOL 1-year survival profiles
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Sample EOL clinical quality profiles
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Better Understanding Of EOL Care
Surveillance Strategy
Learning Strategy
Health System Perspective
Improve Data Quality
Improve Data Use
Build Analytic Capacity
Engage in KT
Enhance EOL Care
Patient/Family Perspective
Epidemiologic Profiles
1-yr Survival Profiles
Resource Use Profiles
Clinical Quality Profiles
Team Network Perspective
Meta-analysis EOL Studies
Common Data Definitions
EOL Care Scenarios
Startup
Consolidation
Enhancement
Integration Planning
Construct platform Obtain data access Refine data
definitions Assemble datasets Conduct
meta-analysis 1 Publish 1st info
products Conduct KT workshop 1 Write progress
report 1
Consolidate datasets Conduct meta-analysis
2 Publish 2nd info products Conduct KT workshop
2 Plan yr-2 data extraction Write progress
report 2
Enhance datasets Conduct meta-analysis 3 Publish
3rd info products Conduct KT workshop 3 Write
progress report 3
Expand datasets Conduct meta-analysis 4 Publish
4th info products Discuss integration
plans Conduct KT workshop 4 Conduct impact
evaluation Write renewal plan
Learning/Growth Perspective
Technology A Web based Interactive EOL Care
Surveillance System Platform
Information Data Sources ? Extracted Datasets ?
Additional Datasets ? Consolidated Datasets
People Project Team, Steering Committee,
Executive Co-Sponsors, CPAC Network Secretariat
Organizations Team, Partners, Collaborators,
CPAC Surveillance, Other Networks
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Next Steps

• Applying the KMT Framework for Health Systems
  Research
• eHealth Observatory for HIS Evaluation
• Models, methods and metrics Evidence and better
  practices KT and capacity building eLearning
  resources/tools, eHealth community
• Adoption/Use/Impact of SNOMED CT Terminology
  Standard
• Encoding methodology Encoding/mapping rules
  Encoded terms/maps Terminology assets Prototype
  for trial use Lessons for KT
• Interactive EOL Care Surveillance System and Team
  Network
• Knowledge based info products Community of
  practice KT and capacity building KMT
  strategy/process/infrastructure

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Knowledge Management and Translation in Health
Systems Research

• Questions, Comments, Feedback?
• Acknowledgments
• Canadian Institutes for Health Research STIHR
  and NET
• CIHR Institute of Health Services and Policy
  Research
• Canada Health Infoway
• College of Pharmacists of BC
• BC Ministry of Health, Pharmaceutical Services
  Division
• Canadian Partnership Against Cancer and Partner
  Organizations
• Canadian Institute for Health Information
• HINF, UVic, colleagues
• Staff, trainees, collaborators .
• Contact Francis Lau fylau_at_uvic.ca