Knowledge management systems and unmet needs in healthcare

Managing Information Technology - Set of Four Reports

Knowledge Management in Health Care

Managing, organizing and making available to healthcare professionals the many types of content that comprise knowledge management systems require a flexible yet comprehensive content management framework as a foundation and process-based workflows at the user-level to stay continually relevant over time. Enterprise content management (ECM), and within that framework, Digital Asset Management (DAM), has lead to the development of medical knowledge management systems that deliver significant value over time. As this medical field specifically relies on both structured content in the from of patient records, and digital content in the form of x-rays, microphotography of their eye condition, and digital imagery of specific patient conditions, the need for a knowledge and content framework is clear.

In evaluating the growth knowledge management systems in healthcare it is critical to keep in mind the unmet needs these systems are designed to meet. Foremost in this list of unmet needs is the ability to manage both structured and highly textual content in conjunction with and often in the same database record as highly detailed, sophisticated graphical content that applies to each patient. The bottom line is that any research effort to discover, quantify and project how the advancements in IT will influence the healthcare field needs to start with central focus on the unmet needs of practitioners for the most up-date and relevant information. The intersection of healthcare's unmet needs in the form of processes relative to advances in IT, specifically in the areas of enterprise content management, digital asset management, security, collaboration and integration systems that were stand-alone before is addressed in this analysis.

Knowledge Management in Healthcare -- An Assessment of Unmet Needs

Healthcare's series of unmet needs are forming the foundation for a series of product and solution development strategies on the part of many software, hardware and services companies globally. What's so significant about the unmet needs of the medical practices globally is the direct effect the lack of fulfillment of these needs are having on the organizational goals of entire medical institutions including hospitals, clinics and individual practices. Reducing diagnosis errors, coordinating on treatment plans across patients with similar diseases and conditions, analyzing the extent of treatment plan effectiveness as delivered by clinicians (Ghosh, Judy E. Scott. 2009) and alleviating the need for clinicians to transcribe data from one computer system to another are all major unmet needs of the healthcare profession today. The U.S. And other nations have set four major objectives in the defining of knowledge management systems and these include the following: keeping clinicians informed as to new developments through a Web-based portal that is continually refreshed with new content; interconnecting clinicians so they can share best practices on advances in healthcare globally; personalizing and better analyzing patient care strategies; and improving broader population health by using IT from the content of websites for preventative health programs. These four broad goals are driven from the unmet needs of optometry clinicians and physicals.

The unmet needs of the healthcare community that are in turn driving the greater application and adoption of IT-based strategies for helping healthcare organizations meet their needs are as follows:

A major unmet need in delivering more timely and more accurate access to information including patient records, patient imagery, test results and treatment results. At present there are many manually-based processes, for example calling a local medical clinic and having to get a clerk on the phone to get a specific record. This is a major unmet need as it relates to responsiveness and speed of service to both the patient and the clinician delivering a diagnosis or treatment plan. The most pressing unmet need is to have these records online, integrated with many other systems including patient billing and accounting, patient history, and diagnosis analysis to accomplish the goal of delivering a 360 degree view of the patient on every inquiry.

Lack of consistency in existing manual processes aimed at the managing of chronic conditions. This unmet need emanates from the currently high levels of miscommunication medical clinicians, specialist MDs and patients with chronic conditions patients are experiencing. What exacerbates this lack of communication is that each treatment plan is slightly different treatment plans. The goal of many optometry clinics and practices is to create a self-management series of online tools where on the treatment side (clinicians, MDs) can have a 360 degree view of the treatment plan and with feedback from the patient, see if the treatments are making a positive impact on their eye-related conditions.

Greater levels of professional productivity through better collaboration, scheduling and coordination of medical clinicians and specialist MDs. This isn't simply about being able to see more patients or dispensing more prescriptions, it's about being able to have a more comprehensive view of the patient treatment plans for advanced diseases and conditions that a given medical discipline specializes in treating. This includes drug interactions that clinicians and specialist MDs both need to have instantly as they prescribe treatment plans for patients. Currently clinicians and specialist MDs have to look either through multiple systems or through a series of books to figure out what if any interactions there are to medications. Appling IT strategies to this unmet need would include integrating all databases internally to the practice in addition to subscribing to external information sources, all unified with a common search technology that would, from a single query, provide the medical professional with the information requested. Another aspect of this unmet need of increasing productivity is the scheduling of appointments between clinicians and specialist MDs in addition to those with patients. Moving away from manual systems in this area is also a critical step for higher levels of productivity for clinicians, specialist MDs and staff at clinics and hospitals alike.

Streamlining and making more efficient processes for patients to fill out their clinic paperwork, check on the status of their medications, and also provide feedback in the form of customer satisfaction surveys is a major unmet need is creating a full-cycle approach to patient care. One of the most glaringly obvious unmet needs in the entire medical profession is this specific area of streamlining what is called "on boarding" of new patients and measuring their satisfaction with the level of service delivered. The first series of processes, those of signing up new patients is fraught with inefficiencies and errors, and making this online, even for the medical clinics' staff is a potential major improvement. Capturing patient feedback on what is going well and what isn't is also a critical unmet need; only a very small percentage of medical clinicians and specialists get feedback on how their treatment programs are working, how their empathy skills are being perceived, and in short, how satisfied the patients. Clearly this link to customer satisfaction is a major unmet need in the medical practice area.

Lack of integration with health services providers, specifically those paying for the care of patients including HMOs, PPOs and health insurance organizations. This is perhaps one of the aggravating unmet needs in the medical profession and is exacerbated again in medical practices due to the fact that a person's sight is involved (Themistocleous, Mantzana, Morabito, 2009). The lack of IT systems-level integration between health services providers, HMOs, PPOs and health insurance organizations significantly slows down the time required to fulfill claims for patients, and in turn slows down the finances of clinics, physician offices, and hospitals. Clearly the need for greater levels of integration specifically in this area is critical, and as a major unmet need being addressed through IT strategies, this forms the basis for the framework emerging for comprehensive knowledge management systems that can integrate with these external providers and the many clinics and hospitals that rely on reimbursement to finance their daily operations.

Summary

The use of content management systems to create enterprise frameworks for the more efficient managing of knowledge management in healthcare has also led to the development of quality management benchmarks for performance that otherwise would not have been possible (Nembhard, 360, 361). This is due to the fact that more hospitals, medical centers and healthcare professionals have been able to manage their growing caseloads through the use of knowledge management systems that also have analytics and performance measurement included within them. The use of knowledge management systems to enable higher levels of collaboration between medical professionals and also nurture greater levels of process efficiencies is a key aspect of the medical profession being able to attain the highest levels of performance possible (Themistocleous, Mantzana, Morabito, 2009).

The Oracle Vision

Summary

The Internet's growth and adoption continues to completely transform business models and permanently change how both people and organizations communicate, transact, serve, and collaborate with one another. With this exponential growth of the Internet, there have been a multitude of approaches to enabling communication, collaboration, and transactions. All of these advances, both from an Internet standpoint but also from an applications one have significantly increased the simplest to the most complex transactions now completed over the Internet. Whenever a transaction is being completed however, even if only data is being traded, the security risks increase markedly. Transactions attract theft, fraud, and security breaches. This is especially true in the context of the Internet and its support of transactions of both data and funds between individuals and between companies.

As the Internet has now become a platform that enables electronic commerce, there has been an exponential rise in all forms of security breaches and theft of both data and funds over the Internet. There are six strategic pressures or concerns that are driving the need for Internet security today for every organization. The first three are trends occurring in the external marketplace, and the remainder is originating from within organizations. These three dominant external trends impacting all organizations are first the quick and agile access to information of all kinds, including transaction data to support global trade; the continual leakage of customer and confidential data; and third, the incidences of financial and operational losses as a result of compromised confidential data and the resulting disruption of business operations. The remaining three strategic pressures on organizations include the heightened regulatory oversight and increasingly automated regulatory audits; the risks that are inherent in defining strategies for privileged access to information; and third, the risk by internally-driven security attacks and attacks from hackers outside the company but based on compromised information. These six specific strategic pressures combine to put many organizations and the individuals they serve at a higher level of risk than has been the case in the past. Clearly the needs for greater levels of attack deterrence are needed.

The Catalyst of Security Business Models for Security

Whenever a computer system or network is capable of being infiltrated and comprised, it is considered vulnerable. It has been argued by many systems and Internet engineers that the majority of systems on the Internet today have a high level of vulnerability despite the many security measures in place by both individuals and organizations. When a system or network has the characteristic of vulnerability, more aggressive strategies must be undertaken to minimize the risk of data and funds being compromised.

In minimizing system and network vulnerability from outside the organization break-ins through remote access facilities and from the Internet need to be minimized through a layered approach to security. In order to prevent these break-ins from damaging the computer and network resources, networks can employ firewall solutions to block unsafe services and sources. In addition, detection techniques and vulnerability testing can be used to identify and block intrusion attempts on a 24/7 basis. Firewalls are both hardware and software-based, and increasingly are used for blocking hacker, virus and all other forms of attacks. Many organizations also choose to work with system security consultants to continually test and refine their systems' levels of security.

In addressing security concerns either on a system or network it's critical to realize that no security measures or products will completely secure a network and alleviate the risks of vulnerability. What both individuals and organizations must do is balance the need for security and minimizing vulnerabilities on the one hand while ensuring a high level of system performance on the other. Too much of a focus on security and alleviating vulnerabilities in systems leads to difficult-to-use interfaces, an over-abundance of passwords, and sluggish system and network performance due to the many security controls in place. At much higher levels of security there is an accompanying higher level of inconvenience for users, further reducing job satisfaction and productivity. When there are too many system security measures in place often users look to circumvent them, making both systems and networks even more vulnerable. What needs to specifically be accomplished is a balance between high levels of security on the one hand, and enough flexibility to allow users to complete tasks on their systems and the network on the other.

Hackers: Who They Are and Why the Do It

The common perception of hackers are that they are intent on causing harm to all computer systems, looking to obtain confidential data or even gain access to secured accounts. In fact the hacker communities are a series of programmers who see the challenge of learning about how to complete complex programming tasks as worthy accomplishments. In the hacker community the crackers, as they are called, are those that seek to break into systems and cause harm by either disrupting systems, processes or deleting files to cause harm to others. There is a major segmentation of the hacker community as well, with those that seek to test, refine and perfect as close as possible security algorithms as "white hats" while those hackers (or crackers) who seek to disrupt and destroy systems as being "black hats." In studying the overall hacker community it is clear that the differences in values between these two groups are dramatically different, with entirely different values and skill sets. What does unify these two groups however is a respect for programming prowess and a willingness to share information across their global networks.

Analysis of Security Concerns

The following is an analysis of the key security concerns that both individuals and organizations need to address on their securities strategies. Each of these security concerns have a different origination point yet all share the common attribute of having potentially disastrous impacts on both individuals and organizations.

Phishing -- This term makes analogous reference to how online criminals use e-mail bait to fish for passwords and financial data from the global population of Internet users. .This specific form of fraud has had exponential growth as the sophistication of the last three years. Phishing is used for unlawfully obtaining ATM pass codes, account numbers, account passwords, credit card numbers, mother's maiden names, and social security numbers according to Phishing (2007). This is a particularly difficult security threat to stop as virus firewalls and other forms of security do not detect and stop phishing attempts as they appear to these security layers as legitimate e-mails and communications, Phishing (2007). At the center of phishing fraud is an attempt to gain personal data so identity theft can be accomplished. Too often unsuspecting individuals click on the e-mail and then provide the confidential information, and their accounts and identity are compromised.

Viruses -- A virus is a computer program that infects other programs via replication. It clones itself from disk to disk or from one system to the next over computer networks. A virus executes and accomplishes it damage when the host program executes. Computer viruses are called viruses because they share some of the traits of biological viruses. A computer virus passes from computer to computer like a biological virus passes from person to person. A computer virus must piggyback on top of some other program or document in order to get executed. Once it is running, it is then able to infect other programs or documents. In today's environment, a virus can destroy an individual's credit record, bankrupt a company, and destroy a wealth of information. There are a number of virus classifications set forth by the CERT Coordination Center (CCC) according to (CERT, 2007) and the Computer Security Institute (CSI).

Worms -- Like a virus, a worm infects a computer and is specifically designed to replicate itself to both significantly degrade the performance of the system and network, and eventually destroy it. A worm is also designed to install itself, then alter and ultimately destroy files and programs. A virus does not need a file or even an e-mail attachment to begin infiltrating a system. Worms spread through chat rooms and through backdoor viruses that act as the delivery mechanism for certain worms. These are the most difficult of virus variants to remove and often require entire networks to rebuilt.

Pop-ups -- These are advertisements that are very obtrusive and annoying, and appear when a web browser is open. Pop-ups are typically advertisements that companies pay websites to host and deliver based on the cookies, or personalization settings within a browser. These pop-up advertisements rob literally thousands of hours of productivity from millions of people every year. Ad-Aware is an application specifically developed to provide relief from the annoyance of these ads.

Drive-by downloads -- These are applications that download themselves onto your computer without your consent or knowledge, and often are delivered through websites or through e-mail messages. Drive-by downloads are used in conjunction with worms as a delivery mechanism and also are used for placing small applets that look for open ports on systems so hackers can gain access over the Internet.

Malware -- This type of small application is intentionally designed to harm the system BIOS and therefore make the hardware, software, or firmware of the system inoperable. In addition, 2007 has seen this specific form of Internet-based attack rise in complexity, according to industry experts, MalWare (2007)

Trojan viruses -- This is a type of program that presents itself as a useful function yet contains destructive components that seeks out critical operating system files and destroys them. Often these types of viruses are installed while a user leaves a system turned on, unattended while connected to the Internet without a firewall. Hackers have even created shareware programs that claim to rid your system of this specific type of virus and instead introduce them.

Identify theft- This threat has many different schemes associated with it, including phishing, social security number theft, and the large scale theft of customer files from mortgage and insurance companies. Criminals use a variety of approaches to accomplishing identity theft, with a combination of methods being used by the most technologically advanced crime syndicates who often resell social security numbers globally.

Credit card security -- A pervasive problem that has only partially been resolved, this is another area of online and electronic theft where hackers have created program to both capture the credit cards numbers through phishing sites that present themselves as legitimate. The large scale theft of credit card information is also a global problem, as VISA and MasterCard databases have been hacked, later finding their databases sold on the black market. To counter this level of theft and also protect its customers from credit card fraud and theft, both VISA and MasterCard have partnered to create a security standard, which was released in 2006. This standard has enforced tighter audits of small businesses who match profiles of those who have fraudulently used or been caught reselling credit card numbers. The pervasiveness of credit card security has led to an entirely new level of security technologies and studies, including 256-bit encryption technologies previously used only by the U.S. government to protect government websites.

What a Wonderful Technological World

Summary

Debating the inherent value of technology and innovation relative to its detraction of emotion and insight is misguided, because only through innovation can these debates be heard by a larger audience. Innovation is as engrained in the human experience is as breathing; to debate its moralistic value is to completely miss the point. Instead what needs to be embraced is an appreciation of how technologies, both oriented towards personal needs, and commercial, oriented to enterprise-wide needs, can be more effectively harnessed to get people and organizations to their goals. Studies regarding the ability of firms to create and nurture innovation show that smaller, more agile firms are inherently more effective at seeing creative, often less-costly approaches to solving problems than their larger counterparts (Plehn-Dujowich, 2009). These smaller firms are also more adept at creating innovation from the study of data and digital content, information workflows and the patterns by which people collaborate with one another, including the need for searching vast amounts of content quickly (Wang, 2009). As a result, the development of the world's most dominant search engine technologies from Google, Microsoft and Yahoo have all been formed through the actions of smaller companies who saw this initial need. There are also the highly collaborative social networking applications including Facebook, Twitter and MySpace all started at smaller companies who were able to capitalize on the need people have for connecting with one another and sharing insights, lessons learned and knowledge. All of these technological innovations are creating entirely new platforms for communicating and also for completing transactions, both from a B2B and B2C standpoint.

Why Technology Enables Progress

The proliferation of inventions has saved mankind countless hours of distraction, manual drudgery and unnecessary costs. The entire concept of a "lean" manufacturing where the most unnecessary and least critical steps of the manufacturing process are gradually done away with, leaving only the most essential product processes and steps is one example of how technology has benefited both consumers and manufacturers (Riezebos, Klingenberg, Hicks, 2009). Lean manufacturing has been responsible for the continual development of entirely new approaches to producing everything from automobiles to the production of new from of fabric, to the building and construction techniques of homes and buildings. The innovations inherent in lean manufacturing and lean production therefore have been one of the greatest contributors to middle class and lower middle class consumers being able to afford higher quality homes, better automobiles and more economically priced products. For businesses, lean manufacturing has translated into entirely new levels of production efficiency and a focus more on providing high-value jobs that have inherent within them more learning and innate intelligence. The win/win of lean manufacturing between consumers and businesses is just one example of how innovation brought about through exceptional uses of technology is revolutionizing the world for the better.

In addition to the examples of lean manufacturing, the far reaching implications of the Internet and its complete re-ordering of content, data and information, in addition to the development of entirely new forms of banking are a case in point (Kim, Shin, Lee, 2009). The progression of online banking from being purely managed through dial-up connections via modem access in the 1980s before the en masse adoption of the Internet to the use of an Internet browser from any device, from a PC to a Personal Digital Assistant (PDA) continues to show triple-digit compound annual growth rates over time. This is primarily because consumers and businesses both have learned how to trust this new technology and over time it has saved literally millions of hours of waiting in line at banks, as was done prior to the Internet's pervasive support of ATM machines and websites for example. All of these innovations have made online banking more secure and also over time, more trusted than has ever been the case in the past.

As trust has evolved in online banking and financial transactions, there has been more freedom than ever to travel, be more mobile, and less concerned about getting to a bank branch to get money out before they close for example. In this respect the innovation of the Internet, combined with trust in online banking, has created an entirely new approach to managing one's finances online. The combined effects of trust in the Internet and higher levels of security in online banking applications is resulting in a higher level of adoption of these applications globally, both for consumers and businesses. Safeguards and security always are a concern especially with regard to online banking security (Orr, 55, 56) yet the continued growth of encryption algorithms has been successful in fighting off even the most complex and convincing phishing or identity theft attacks. The continual growth of security technologies is also significantly changing how financial institutions verify the identity of their customers as well. In terms of how this makes for a wonderful technological world is appreciated when one considers that their identity and online reputation is by far the most important asset they have. The continual improvement on online security technologies is serving to continually increase the level of trust that consumers have in these online banking and financial services Web-based applications as well. By increasing the level of sophistication and security with these applications, even more functionality is included within them, thereby further enriching those actively using them. This further adds to their time savings and further frees those using online banking and financial services applications to spend their time as they choose. The automating and creation of online Web-based applications is one of many, many examples of how technology has enriched and made more efficient the lives of literally millions of people globally. Combined with the fact that with greater process efficiency on the part of banks and financial institutions they can provide more cost-effective service, and the value chain of these enterprises begins to emerge (Melao, 2009). The Internet is as a result revolutionizing the entire banking industry today and making it more customer-centric and driven first by customer value less by outmoded processes that have ceased to be relevant to 21st century consumers.

For many, the invention and widespread availability of the cell phone has forever changed their lives, giving them increased freedom and mobility than ever had been possible before. For many members of the 21- to 30-year-old age group, the cell phone is their only telephone; they no longer have a landline or location-dependent telephone number to speak of (Kristensson, Johansson, Matthing, 2008). The use of Internet-based applications Skype, which enables telephone calls over the Internet for free to other Skype members, has given small businesses that want to expand globally exceptional ability to seek out new customers on other continents. There are also the many advances made in the convergence of telephone technologies, specifically in the area of how telephone now include video cameras, GPS location tracking, texting and MP3 music as well (Chen, Ross, Huang, 2008). The Apple iPhone now has many of these functions and advanced models from Nokia today have all of these functions including full motion video. What these innovations translate into is remarkable levels of freedom and creativity in how they are used. When the wonderful world of technology is considered, it is clear that the advances in banking and cellular telephones provide a powerful case in point.

Conclusion

Technology is the foundation of innovation, and inherent in its use is the ability to create entirely new processes and approaches to getting work accomplished while also significantly streamlining daily life. The many challenges of modern life and the dramatic reduction in time is also forcing technology into entirely new uses to capture all available efficiencies and enable people and companies to get more done in the time available. Never before has time been so critical of a resource. The wonderful technological world we live in is made even more valuable in the amount of process efficiencies these technologies bring.