Decision Support versus Decision Making
Types of Shared Knowledge
Other than the patient information shared between clinical platforms, what are the general types of information needed by the platform to fulfill its purpose?
Reference Terminologies – These are the fundamental building blocks of information the platform uses in its model to represent, reason over and process information. This could include standard, commercial, platform specific or local terminologies.
Master Data – This is information, built from the reference terminologies, that describes the structure, constraints and general information the platform requires to supports its core functionality.
Facts – This information includes generally undisputed and well defined rules which describe how items in the reference terminologies relate to one another. These facts allow the clinical platform to have a fundamental understanding of medicine that can be leveraged during the decision support process. This type of information may grow or get refined over time, but should not change in a fundamental way. Facts do not have a stated outcome, they are just facts.
Beliefs – This information includes evidence or experience-based assertions that are intended to drive or avoid a particular outcome. These ‘beliefs’ are different from ‘facts’ in that they may be disputed or may not be universally applicable. This is the difference between ‘knowing’ something is right and ‘thinking’ something is right. Beliefs should have an intended outcome. If following the belief does not result in the stated outcome the belief should be re-evaluated.
Policies – This information includes rules intended to assist the provider in complying with regulatory, corporate or local policies and procedures. Like beliefs that might have intended outcomes, the outcome of policies are likely to be administrative in nature, not clinical.
These facts, beliefs and policies are involved in medical decision making today. It just happens that the clinical platform that is leveraging them is the provider’s brain.
Some might argue that the conceptual differences between facts, beliefs and policies are negligible and they could be fundamentally modelled and used in a universal way. While this might be technically correct, I would argue that universal patterns by their very nature introduce compromise. I don’t think knowledge is an area where we should compromise. These types of knowledge are separate because each has a distinct function, likely source and unique implementation patterns. Even if we store them in a generic structure we need to acknowledge their differences so that we can manage and leverage them appropriately.
What Is the Source of Shared Knowledge?
Where shared knowledge comes from often depends on the type of knowledge. Typically the basic building blocks a system needs to function, like reference terminologies and master data should be provided by the platform vendor or created and managed locally. Curated facts, beliefs and policies could be provided by the platform vendor, purchased from a commercial content publisher, created locally, created in a community, or some combination of any of these. Considering the possibilities, the real question is, what should be the source of shared facts, beliefs and policies?
We should be able to select the knowledge we want from the sources we feel are the best with regards to the needed subject. We should be able to acquire the knowledge in manageable chunks and should be able to adjust it to best meet our needs without breaking the update mechanism.
In the next post we will talk about what these characteristics are and why they are crucial if we want the platform to play a meaningful role in the care process.
Please share any thoughts or comments you might have.