Is Knowledge Management the Future of CME?

2. Is Knowledge Management the Future of CME? Nancy M. Lorenzi, Ph.D. Professor of Biomedical Informatics Assistant Vice Chancellor Vanderbilt University Medical Center

3. Is this a Typical 2002 Scenario? • Jefferson Smith graduated from medical school in 1979 at the age of 27. • After residency, he began practice with a primary care internal medicine group not connected to an academic medical center. • He has been quite successful and sees more than the average number of patients. • His original practice was integrated with another group practice.

4. Is this a Typical 2002 Scenario? • Dr. Smith attends periodic medical conferences. • He tries to read the New England Journal of Medicine and the Archives of Internal Medicine. • He wants to spend more time with his family. • He is feeling overwhelmed by both being 50 and coping with all the new treatments and techniques in medicine today.

5. Jefferson Smith’s Wish... • His wish is to simulate being up-to-date • Meaning, if there are 100 new concepts, he only wants to learn those that meet his needs! • Does knowledge management have anything to offer Jefferson Smith?

6. Objectives for Today • What is knowledge management? • What can CME do with respect to knowledge management? • What are the implementation challenges?.

7. What Is Knowledge Management?

8. T.S. Eliot “Where is the wisdom we have lost in knowledge? Where is the knowledge we have lost in information?”

9. What Knowledge Management is Not! • It does not open your head and pour in information. • It does not open up your head and steal all your thoughts.

10. What is Knowledge Management? • It has been predominantly used to describe what can happen within an organization to manage the data, information, or knowledge in multiple departments and from multiple people.

11. What is Knowledge Management? • Since the early 1980’s “knowledge management” has been used to mean many things: • the acquisition and transformation of organizational data into information; • the storage, retrieval and dissemination of relevant organizational information; • the determination of what is known and needs to be known in a decision making process.

12. What is Knowledge Management? • Knowledge Management caters to the critical issues of organizational adaption, survival and competence in the face of increasingly discontinuous environmental change.... • It embodies organizational processes that seek synergistic combination of data and information processing capacity of information technologies, and the creative and innovative capacity of human beings.

13. Knowledge Management Scope • Knowledge Strategies • Innovation and Knowledge Creation • Knowledge Processes • Performance Measurement • Building Knowledge Architectures

14. KM… • There is increasing “hype” about the wonders of knowledge management as the critical resource for business activity. • Knowledge management sounds daunting. • Let us also look at how some firms have applied knowledge management

15. Thomas Davenport • Thomas Davenport studied 31 knowledge projects in 22 different firms. • He found 18 as thriving, 5 as failing, and decided that it was too early to tell on the other 8. • A near-70% success rate for mature projects is higher than that reported for other recent implementations of high-change programs such as reengineering or TQM.

16. Four Types of KM • Type 1--Repository • 26 projects were some kind of repository. • The objective was to take some form of knowledge that had been extracted from human brains, and store it in a technical system for later access. • In some cases the knowledge was based in structured form, mostly documents. (Hewlett Packard and Sequent Computer store sales-oriented documents—white papers, presentations, marketing information for access by their field sales forces in selling computers.)

17. Four Types of KM • Type 1--Repository • Another repository type is less structured, consisting of the insights and observations of employees. They are “discussion databases” or “lessons-learned” systems. • The final type of repository holds not knowledge itself but pointers to those who have knowledge. • Microsoft uses Knowledge Inc for storing system development knowledge. • HP has expert repositories for researchers in its HP Laboratories and Corporate Education groups.

18. Four Types of KM • Type 2—Value Added • Several firms were beginning to try to measure the financial value of their repositories. • The two firms that primarily focused on value were • Skandia, the Swedish insurance company addressed the measurement of value. • Dow Chemical, focused more on the management of value by harvesting little-used patent and license assets.

19. Four Types of KM • Type 3—Project Oriented Knowledge Transfer • BP Exploration built a desktop video conferencing system to enable workers at remote exploration sites to exchange their knowledge with each other. • Sematech, the semiconductor research firm used both technical and human means to transfer the knowledge gained in research to its sponsors. • These transfer-oriented projects were found in firms that believed the most important knowledge in the organization to be tacit.

20. Four Types of KM • Type 4—Knowledge Cultural Environment • This type of knowledge project did not address any specific knowledge domain, but rather tried to improve the overall knowledge environment. • One direct marketing knowledge manager was trying to improve the appreciation for knowledge and the culture of sharing. • Others were focusing on the reward systems for evaluating knowledge generation, sharing, or use. • These projects were more difficult to measure than others.

21. Jeremy Wyatt • Knowledge Management Centre, University College of London and also leading a Knowledge Management program in Amsterdam. • Studied 22 randomized controlled trials including over 41,000 patients regarding the use of “reminders” as a method to enhance learning.

22. How Does the Preceding Material Relate to CME?

23. Potential... • Knowledge Management has two potential ways to apply to CME. • Internal to your operation • The traditional or evolutionary approach of knowledge management • External to your operation and focused on the needs of your constituency • The non-traditional or revolutionary approach of knowledge management • Star Trek--To go where no man (or woman) has gone before!

24. Evolutionary or Revolutionary? • Evolutionary • Inside your offices to assist you, your staff and your involved committees with all of your multiple CME responsibilities? • Through one of the four typical (traditional) types of knowledge management. • Revolutionary • To your CME efforts for practicing physicians? • A non-traditional approach to knowledge management

25. CME Application • For healthcare the playing field is changing faster than our (CME) ability to respond to the needs of physicians using traditional methods. • Is it time for adding knowledge management to the CME mix? • If yes, are you thinking about knowledge management in an evolutionary or revolutionary way?

26. The Reality • Most, if not all, CME operations are not of a size or complexity to warrant an internal knowledge management thrust. • You might just need better traditional processes and systems as well as improved staff communication! • The major opportunity lies in a truly uncharted area—the development of knowledge management tools for your physician constituency.

27. Slight Diversion… • What Dr. Jefferson Smith wants is not new. • In July 1945 Vannevar Bush published “As We May Think” in The Atlantic Monthly.

28. As We May Think • Dr. Bush’s future device, targeted individual use, is a mechanized private file and library that he called, “memex”. • “A “memex” is a device in which an individual stores all his books, records, and communications, and which is mechanized so that it may be consulted with exceeding speed and flexibility to supplement to his memory.” • “It consists of a desk at which he works. On the top are slanting translucent screens, on which material can be projected for convenient, reading. There is a keyboard, and sets of buttons and levers.”

29. As We May Think • Any given book of his library can thus be called up and consulted with far greater facility than if it were taken from a shelf. • Items can be instantly recalled by tapping a button below the corresponding code space. • Wholly new forms of encyclopedias will appear, ready-made with a mesh of associative trails running through them, ready to be dropped into the memex and there amplified.

30. As We May Think • Most of the memex contents are purchased on microfilm ready for insertion. • On the top of the memex is a transparent platen for direct entry. On this are placed longhand notes, photographs, memoranda, all sort of things. • There is an indexing scheme and if the user wishes to consult a certain book, he taps its code on the keyboard, and the title page of the book promptly appears before him, projected onto one of his viewing positions.

31. End Diversion… • Dr. Jefferson Smith’s wish is very similar to Vannevar Bush’s vision of “memex”.

32. Key Point • While Jefferson Smith’s wish is similar to the vision, he does not have time to create his personalized “memex” system. • He would like you to help him learn what he needs to know as efficiently and effectively as possible.

33. Key Point • As CME leaders you face an analysis/synthesis dilemma about the concept of knowledge management. • By looking at the problem not as the sum of its parts but as a system of interdependent parts, the “solutions” to effectively using knowledge management in CME will rest not in changing any one of the parts of what you do, but in changing the way the various components interact • ... a classic example of systems thinking.

34. Key Point • As CME leaders you face an analysis/synthesis dilemma about the concept of knowledge management. • Are you looking at knowledge management as a new umbrella to assist you in doing what CME has traditionally offered? (analysis) • Are your looking at what appears to be an overwhelming problem by viewing your “product” in a new way? • Improving today’s efforts is more on the analysis frame of reference.

35. Key Point • Many of you maybe wishing for wonderful new knowledge management accomplishments with CME for practicing physicians, while your offices are suffering from a paper explosion. • Where will you place your CME knowledge management efforts?

36. Catering to the Revolutionaries among you… • What is Vannevar Bush’s “memex” for physicians?

37. MedexCME • MedexCME—Creating Knowledge for Physicians

38. MedexCME(a draft CME-Knowledge Management model) • What are the Appropriate CME Questions • What does a physician need to be an effective performer-practitioner today and for the next 5 years? • What is the knowledge available? • What are the knowledge gaps of physicians? • What are the clinical information interactions that occur now? • Where do physicians get their clinical information today and from/to whom?

39. MedexCME(a draft CME-Knowledge Management model) • Organizing the Knowledge • Target one area of need and clearly identify what is needed to be the most effective performing practitioner (practice guidelines, etc.) • Design strategies for research, analysis and synthesis to fulfill the content for the need, e.g. work in collaboration with others, e.g. the Library, medical informatics, quality professionals, etc, • Investigate and create how to organize the knowledge, e.g. create a knowledge map by mapping all the new concepts.

40. MedexCME(a draft CME-Knowledge Management model) • Organizing the Knowledge • Create the package of knowledge (MedexCME) from multiple sources • Design the CME knowledge management distribution architecture. • Designate someone the knowledge manager for a specific content area and respond to specific questions.

41. MedexCME(a draft CME-Knowledge Management model) • Applying the Knowledge • Genomic transplant??? • Determine how to most effectively use information technology to distribute knowledge to physicians. (e.g. Internet, CD ROM, video-conferencing) • Establish how CME organizations will collaborate to broker the knowledge.

42. MedexCME(a draft CME-Knowledge Management model) • Your thoughts on MedexCME?

43. What Are the Implementation Challenges?

44. Implementation Challenges • The most difficult barriers in knowledge management implementation include: • Establishing wide ownership • Establishing clear objectives and language • Establishing communities of practice • Changing the culture

45. Establishing wide ownership • In organizations where there is a single “true believer” in knowledge management, but no one else buys in, it is doubtful if the project will continue if the “true-believer” is not available. • Senior management support helps in all cases and is absolutely critical to transformation or survival-oriented projects.

46. Establishing Clear Objectives • It’s far easier to manage knowledge if you know what it is and if you know what you want to do with it. • General Clausewitz (famous German General of the 19th century) “No one starts a war—or rather, no in his senses ought to do so—without first being clear in his mind what he intends to achieve by that war and how he intends to conduct it.” (Objectives and a Plan!)

47. Establishing Communities of Practice • We still have people working in stovepipes (or isolation), not as communities. • While we know we have many informal networks, our challenge is to find them and support them. • This will also be true for the physician population • What are the implications for CME?

48. Changing the Culture • Crucial to the success of a knowledge management effort is the role of culture. Too often someone will attempt to implement a KM strategy by imposing it with little or no regard for existing networks, beliefs or working systems. • People that successfully implement knowledge management do not try to change their culture to fit their knowledge management approach. They build their knowledge management approach to fit their culture. • There is not one right way to get people to share, but many different ways depending on the values and style of your organization (or the people you are working with. • What are the implications for CME?

49. Need for Collaboration • MedexCME or even its individual components will require massive efforts and investments. • The project will be far too large for any one CME operation to bring to reality. • This means that there will need to be large collaborations and a strong central organization to spearhead and oversee such a development.

50. Summary