CLINICAL

KNOWLEDGE & Anisha Vadakkepatt

Amrita College of Nursing

DECISION MAKING
INTRODUCTION

Knowledge Management (KM) is viewed as a way to provide the

right information, to the right person, at the right time with the
potential to attain a greater competitive advantage.
DEFINITION OF KNOWLEDGE MANAGEMENT

Knowledge management is a “set of principles, tools, and practices

that enable people to create knowledge, and to share, translate and
apply what they know to create value and improve effectiveness.”
WHO, 2005
KEY CONCEPTS Systematic process
OF KNOWLEDGE
MANAGEMENT Explicit and implicit

Continuous process

Requires support to top

management
 INTEGRATED EFFECTIVE KM MODEL FOR
HEALTHCARE

Knowledge capture Knowledge storage Success Factors:

Key strategies:

KM Processes ❑ Organizationa
❑ Personalizatio
n strategy l factors
❑ Codification ❑ Technological
Knowledge factors
strategy Knowledge reuse
dissemination
COMPONENTS OF KM
• Attitudes
• Culture
• Capacity
People • Skills
Develops and • Motivation
nature a knowledge • vision
sharing culture

• Platforms
Technology Processes • Workflows
• Databases
• Best
• Websites Creates a Systematically practices
• Social unified captures and • Standards
media knowledge shares critical
• Procedures
• automation network knowledge
STAGES OF KM
Decision making

Synthesizing Knowledge
Analyzing

Information
Summarizing

Organizing
Data
Collecting
PROCESS OF KNOWLEDGE MANAGEMENT
Knowledge
acquisition

Reuse of
knowledge Knowledge
for a new creation
purpose

Applying
and or using
Packaging
existing
knowledge
ACTIVITIES OF HEALTH CARE KM

Capture, organize, and synthesize healthcare knowledge

Access, share, and disseminate knowledge

Operationalize and utilize healthcare knowledge

 Patient
knowledge
Measurement Practitioner
knowledge knowledge

Types of
Relationship Medical
knowledge health care knowledge
Knowledge

Organizational Resource
knowledge knowledge
Process
knowledge
 MODALITIES OF HEALTHCARE KNOWLEDGE
MANAGEMENT

Practitioner’s Collaborative
Tacit Explicit Operational
clinical problem
knowledge knowledge knowledge
experience solving

Formal
Educational Social Data-induced
decision
resources knowledge observations
support
 BENEFITS OF KNOWLEDGE MANAGEMENT IN
HEALTHCARE
Patient identification confidentiality
Medical errors reduction
Access to previous medical history
Helps with information updates
Helps digitalize healthcare documents
Enhances collaboration between medical professionals and patient
Encourages continuous learning environment
Improves decision making
 Rapid growth of
ROLE OF healthcare knowledge,
In the healthcare industry,
correct information on
KNOWLEDGE dispersed across time can save lives only if
different mediums, professionals can access it
MANAGEMENT needs to be effectively quickly, irrespective of
IN IMPROVING disseminated in current
clinical practice.
time and location.
DECISION
MAKING IN Healthcare knowledge is central
CLINICAL The source of accurate
to clinical decision-making
throughout the diagnostic and
CONTEXT information improves therapeutic cycle. Also, it allows
hospitals to standardize their
the clinician’s procedures completely and
confidence. provide easily accessible training
on these procedures.
 BARRIERS TO KNOWLEDGE MANAGEMENT
❑ Linguistic hurdles ❑ Infrastructure constraints
❑ Expensive initial ❑ User hostile system
investment ❑ Dissatisfying training
❑ Lack of senior Technological ❑ Poor acceptance by
management support Factors employers
❑ Lack of incentives
❑ Dissemination of ❑ Lack of awareness
knowledge ❑ Uncertainty
❑ Distrust
❑ The reluctance of
clinicians to use
Organizational information and
factors communication
technology tools
❑ Lack of motivation
‘7’ STEPS IN DECISION MAKING
Evaluate
the
information
 STANDARDIZED SOFTWARE
LANGUAGES/TERMINOLOGIES
USED IN HEALTH INFORMATICS
 INTRODUCTION

Standardized Terminology Also called “Controlled Terminology,” Structured

and controlled languages developed and approved by an authoritative body
Healthcare terminology standards are designed to enable and support
interoperability and information sharing Essential to the widespread
implementation of EHRs.
 To represent, communicate,
HEALTHCARE exchange, manage, and report
data information, and
TERMINOLOGY knowledge in healthcare
STANDARDS
Ensure accurate, valid data
collection among various
providers and care settings

Meaningful Use: exchange

clinical structured data wholly
and accurately to improve cost-
efficiency in client care
 TERMINOLOGY DEFINITIONS
• Concept: an expression with a single unambiguous meaning
• Code: letters/characters/both to represent a concept – Codified concepts
• Clinical terminology: describe health conditions and healthcare activities
• Ontology: concepts are organized by their meaning and describe a definitional
structure- relationship
• Reference Terminology: a set of concepts with definitional relationship – To retrieve
data across healthcare settings, domains, and specialties
• Point-of-care Terminology (interface terminology): reference terminology in familiar
terms to clinicians – to support the entry of patient-related information into a
computer program
TYPES OF HEALTHCARE TERMINOLOGIES
 Different terms indicate the same thing!

Need a standardized nursing language to

describe care across clinical settings and
TERMINOLOGY specialists.
AND NURSING
How to document nursing problems,
interventions, and outcomes

To support interoperability, sharing

comparable data with other healthcare
organizations.
 LANGUAGES AND CLASSIFICATIONS
• Billing Codes:
– Mandated by Health Insurance Portability and Accountability Act
(HIPAA)
– International Classification of Disease (ICD) by World Health
Organization (WHO): for diagnosis reimbursement
– Current Procedural Terminology (CPT) American Medical
Association(AMA): for billing and reimbursement of outpatient
procedures and interventions
ICD EXAMPLES
CPT EXAMPLES
LANGUAGES AND CLASSIFICATIONS
• Clinical Terminologies:
– Unified Medical Language Systems (UMLS) by the National Library of
Medicines (NLM), recognized by the American Nurses Association (ANA)
– Systematized Nomenclature of Human and Veterinary Medicine Clinical
Terms (SNOMED-CT)
– Logical Observation Identifiers, Name, and Codes (LOINC)
 SNOMED-CT

Globally recognized terminology (concepts,

descriptions, and relationships) Recognized by ANA
Promotes evidence-based practice Undergoes review
process to keep up to date SNOMED-CT consists of 19
top-level hierarchies, Using parent-child relationships
to build vertical hierarchies.
 LOINC

“Logical Observation Identifiers, Names,

and Codes” Terminologies for
laboratory and clinical observations For
recording a single observation,
measurement, test result.
 Nursing Terminologies:
LANGUAGES AND Clinical Care Classification (CCC)
CLASSIFICATIONS
International Classification of Nursing Practice (ICN)
North American Nursing Diagnosis Association
International (NANDA-I)
Nursing Intervention Classification (NIC)

Nursing Outcome Classification (NOC)

Omaha System

Perioperative Nursing Data Set (PNDS)

 CLINICAL CARE
CLASSIFICATION (CCC) SYSTEM
• To facilitate patient care documentation at the
point of care
• CCC of nursing diagnosis and outcome:
-182 diagnosis concepts in categories and sub-
categories, 3 outcome qualifiers.
• CCC for nursing intervention:
-198 concepts in categories and sub-categories
to represent interventions, procedures,
treatments, and activities.
 INTERNATIONAL CLASSIFICATION OF
NURSING PRACTICE
(ICNP)
• For point-of-care and reference terminology
• Contains diagnoses, actions, and outcomes in 7axes
(dimensions)
ICNP EXAMPLES
NANDA-I

• North American Nursing Diagnosis International

• Each nursing diagnosis actual or potential health problem has
description, definition, defining characteristics (manifestations,
signs, symptoms)
• 13 domains , 7 axes(dimensions)
NANDA DOMAINS
 NURSING INTERVENTIONS
CLASSIFICATION (NIC)
• Describe interventions used in nursing care
• 30 classes, 7 domains, and 542 interventions
NIC DOMAINS
NURSING
Describe outcomes related to
OUTCOMES nursing interventions
CLASSIFICATION
(NOC)
31 classes and 7 domains of
outcomes

Each outcome has a definition,

measurement scale, associated
indicators, supporting references
NOC DOMAINS
OMAHA SYSTEM

• Research-based taxonomy for integrating and sharing clinical data

• Assessment component Problem Classification Scheme
• Intervention component Intervention Scheme
• Outcomes component Problem Rating Scale for Outcomes
OMAHA SYSTEM
 PERIOPERATIVE NURSING DATA (PNDS)
SET
• Provide wording and definitions for nursing diagnoses, interventions,
and outcomes.
• Allow collection of data in a uniform way for analyses.
• 4 components, 75 diagnoses, 135 interventions, and 27 nurse-
sensitive patient care outcomes
PNDS EXAMPLE
 Client-specific benefits

BENEFITS OF Decreased costs

IMPLEMENTATION

Increased quality

Improved outcomes

Improved safety
 Provider/Nursing Complete access
Benefits to data

BENEFITS OF
IMPLEMENTATION
Increased Increased
efficiency accuracy

Increased Improvement in
effectiveness client care
 Organizational Benefits
BENEFITS OF Decreased costs
IMPLEMENTATION

Decision support

Outcome measurement

Data mining
 Integrate systems with locally defined
concepts, not using standard terminology
ISSUES AND
CONCERNS
Select which terminology(ies) to use

Point-of-care terms and synonyms for clinical

tasks must be locally developed potential
problems for other local systems
THANK YOU