Establishing an Evidence Based Knowledge Platform for Norwegian Healthcare

Introduction

In Norwegian healthcare, there is a call for evidence-based knowledge to support clinical decision-making. Today healthcare workers have to access knowledge through external publishing channels, which makes the process complex and time-consuming [1]. The existent knowledge bases do not compare or select the information for a specific patient, and the healthcare professional must contextualize the information to a specific purpose. In addition, the portfolio of Electronic Patient Records (EPRs) represented in Norway today, uses mainly free-text to record clinical information, which make it difficult to enable advanced clinical process- and decision support where recommendations from evidence-based knowledge combine patient specific clinical information. Consequently, this leads to diverging practices and a risk for compromising "best practice" of treatment and care. Therefore, a national initiative has started to explore how to establish a standardized knowledge platform where the overall goal is to enable high quality knowledge support “for the right healthcare personnel, in the right situation at the right time.” We raise the following question: How to organize and govern a national platform for evidence based knowledge?

Methods

The study applies a qualitative interpretive approach including a literature review related to the objectives, as well as semi-structured interviews with EPR vendors, knowledge-base providers, and healthcare personnel/managers in hospitals [2[LS1] ].

Theory

A national platform for evidence-based knowledge can be conceptualized as an Information Infrastructure (II), in which it will span organizational boundaries to serve multiple purposes. The notion of II describes and conceptualizes how technology, like the knowledge platform, is intertwined with users, different work practices, procedures and organizational structures [3].

Results

• To realize the goal of evidence-based knowledge support “for the right healthcare personnel, in the right situation at the right time” the knowledge platform have to be integrated with Clinical Decision Support functionalities within an EPR system.
• A national platform of evidence-based knowledge need to be integrated with various EPR systems, tailored to different clinical practices and organizational structures to be an II supporting multiple purposes.
• To use the most advanced form of knowledge support requires structured patient data in the EPR system.
• To succeed with a national platform of evidence-based knowledge there is a need for defining mandatory standards, in terms of codes, terminologies and information models.
• Different EPR systems with different standards for recording clinical information compromise the quality of CDS and complicates the development of an II.
• For healthcare personnel to find the knowledge support trustworthy, it is important to adjust and govern it in relation to the different organization’s needs.
• Healthcare personnel needs to be included in the development and governance of the knowledge platform, which also includes guidelines, procedures and decision support tools.
• There is a need for establishing extensive governance organizations on national, regional and local levels to provide an updated evidence-based knowledge platform.

References

[1] National ICT. 2013. Evidence-based Patient Planning. Action 50.

[2] Klein and Myers. 1999. A Set of Principles for Conducting and Evaluating Interpretive Field Studies in Information Systems. MIS Q. 23(1), p. 67-93.

[3] Hanseth and Monteiro. 1998. Understanding Information Infrastructures.