Program Session

3 - Applying Knowledge Management Best Practices to Capture, Support, and Archive Systems-Embedded Clinical Decision Support Evidence

Monday, May 29
1:35 PM - 1:50 PM
Room: 611

Objectives: To highlight the methods used by information scientists at a large academic medical center to successfully capture the processes around providing relevant and most current evidence to clinical decision support systems, and to explore the best practices for capturing and archiving changes in evidence over time and substantiating and documenting instances in which local practice decisions override published evidence.

Methods: Capitalizing on this team’s history of clinical evidence provision, and prompted by the medical center’s need to extract and organize clinical decision support (CDS) content from existing systems, leadership approached the team to lend its expertise to discovering/archiving evidentiary support for existing CDS. The urgency of this request comes in light of preparation for migration to a new clinical system. In conjunction with a project externalizing CDS rules in human-readable format, information scientists examine and evaluate all CDS content to discover existing embedded evidence, ascertain newer evidence or differing viewpoints, and document/preserve decisions driving local practice. The team will review literature on institutional experiences reconciling differences between local practice and published evidence. Preserving institutional knowledge, through documentation of situations in which published literature and local practice do not coincide, is a unique opportunity for information scientists to interject their expertise.

Results: The CKM team developed a robust, extensible knowledge acquisition and archival tool, CS-KAAT (Clinical Support Knowledge Acquisition and Archival Tool). As part of an integrated process, CKM Information Scientists analyzed and categorized over 8,000 CDS rules into evidentiary concepts, identified related evidence, and flagged for further review CDS rules which seemingly conflict with published evidence.  To date, CKM has defined 755 evidence concepts supported by over 1600 citations scheduled for iterative review. As part of the process, 24 evidence flags were raised – 6 of which were escalated to clinician experts for resolution and the resulting decision is documented within CS-KAAT.

Conclusion: Decision support logic rules embedded in the physician order entry system, ordersets used to guide care for specific clinical conditions, and at-a-glance visual indicators of a patient’s status within the EHR all rely on up-to-date evidence to improve patient care. As clinical information systems and decision support rules continually evolve, the need to provide ongoing organizational and evidentiary support for the health information infrastructure is critical, thus presenting our profession with a significant, novel opportunity to integrate our skills and expertise within clinical and health information technology teams.

Keywords: Knowledge Management, Clinical Decision Support, Best-Practices, Archiving, Evidence



Program Session

Elizabeth Frakes

Information Scientist
Vanderbilt University Medical Center
Nashville, TN

Elizabeth Frakes, MSIS, is an Information Scientist with the newly established Center fo Knowledge Management (CKM) at Vanderbilt University Medical Center. She received her MSIS from the University of Tennessee, Knoxville in 2014. She completed Eskind Biomedical Library's formal, internship program and completed a practicum with the Preston Medical Library at the University of Tennessee Medical Center. She graduated from Saint Louis University with a Bachelor's in Biology and a minor in Spanish. During her tenure at CKM, Elizabeth has developed expertise in areas of technology, including social media, evidence provision, and knowledge management principles. As a member of CKM she collaborates on projects with a focus on supporting clinical decision support with high-quality, vetted evidence.

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Zachary Fox

Information Scientist
Center for Knowledge Management
Vanderbilt University Medical Center
Nashville, TN

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Jing Su

Information Scientist
Center for Knowledge Management
Nashville, Tennessee

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Mallory Blasingame

Information Scientist
Center for Knowledge Management
Nashville, Tennessee

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Marcia Epelbaum

Senior Information Scientist
Center for Knowledge Management
Nashville, Tennessee

Marcia Epelbaum, M.A., is the Associate Director for Patron Education and Training, Eskind Biomedical Library/Knowledge Management. Vanderbilt. University Medical Center. Nashville, TN.

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Spencer DesAutels

Information Scientist
Center for Knowledge Management
Nashville, Tennessee

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Qinghua Kou

Health Systems Analyst Programmer III
Center for Knowledge Management
Nashville, Tennessee

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Annette Williams

Senior Information Scientist
Center for Knowledge Management
Vanderbilt University Medical Center
Nashville, Tennessee

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Nunzia B. Giuse

Vice President for Knowledge Management / Professor, Biomedical Informatics
Center for Knowledge Management
Nashville, Tennessee

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