Editorial - Knowledge Management Applications in Health Care

It is my great pleasure to welcome you to the September edition of Health Care and Informatics Review Online. This edition represents a new and exciting opportunity for Health Care and Informatics Review Online as we have the opportunity to present papers from participants in the health knowledge management course from the School of Population Health at Auckland University in New Zealand.

The health sector in New Zealand is highly technology enabled and integrated. The course aims to analyse and develop the concept of health knowledge management with a specific focus on the strategic application of healthcare software and networks to address identified healthcare goals and no doubt will serve to further advance New Zealand’s position internationally.

Depending on reader feedback on this edition, it may result that we include an edition comprising papers from the students of this course every year. Participants typically hold senior positions in the health service in New Zealand and have an active interest in innovative technology applications in health.

"Knowledge management applications in health care" begins with a guest editorial "Knowledge Management to Systemic Wisdom Development" from Dr Martin Orr, Principle Convenor of the course and Senior Lecturer in Health Knowledge Management, Section of Epidemiology & Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand.

Orr considers the features of an ideal health knowledge management system and highlights that each of the three papers presented in this edition seeks to advance one or some of these core features.

He goes on to discuss the complexity of implementing a "health knowledge management system" with its prerequisites of technology selection, context and needs analysis and changes in underlying processes. Sagaciously, he also highlights what may be the even more critical requirements of trust and the development of a culture that respects values and, in his words, "protects the acquisition, sharing, creation and utilisation of available knowledge in order to achieve better health outcomes for our communities".

In "Clinical Algorithms and Flow Charts as Representations of Guideline Knowledge", Rob Cook, Medical Advisor / Project Manager, New Zealand Guidelines Group, Auckland New Zealand, considers the question of whether graphical representation tools in clinical decision support are decision tools for topics of simple certainty or summaries in areas of complex ambiguity.

Cook presents the findings of an evaluation of a sample of New Zealand clinical practice guidelines against a checklist of quality domains for guideline algorithms. He highlights the variety of algorithm types and some key issues, including the use of ambiguous and undefined terms and a lack of explicit links to evidence. He goes on to make some valuable suggestions for the future that will assist to maximise the use of algorithms for knowledge management purposes. These include the requirement for a clearer purpose statement for each guideline from those commissioning its development, a clearer purpose statement for algorithms from guideline developers, and international standards for systematic assessment of algorithms.

In "Short Message Service as a support tool in medication adherence and chronic disease management", Yvette Hodgson, Analyst, Waitemata District Health Board, Auckland, New Zealand introduces a proposed project using text messaging to support patients with chronic disease or mental illness. Hodgson overviews the international evidence for successful use of text messages in the health sector and their application in enhancing patient care in areas of critical importance such as medication adherence.

Hodgson presents an overview of those factors which she sees as critical to the success of a text messaging project, highlighting the cognitive factors involved and the need for effective management of the considerable medicolegal issues which can arise.

In "Advancing Mental Health Pathways", Stuart Blomfield, Information Manager Waitemata District Health Board, Auckland, New Zealand, presents a project that uses an inexpensive but effective technology for integrating patient care in mental health.

The project responds to the a phenomenon that is recognised internationally: serious shortfalls in the procedures for accessing key clinical information contributing significantly to very high numbers of adverse health events. In a recent review The New Zealand Mental Health Commission highlighted that incomplete clinical information exchange processes and fragmented policies and information systems are risks to care continuity in mental health management in New Zealand.

The tool used in this project fills the important function of identifying key contacts for mental health patients, which becomes critical in an emergency situation. Emergency settings become a point of key clinical decision-making. Ready access to relevant caregivers can assist to avert the risk of variation in established pathways of care and subsequent exposure to interventions with adverse outcomes.

Feedback in the pilot stages of the tool’s use has been positive. The lessons from this project along with analysis of the information thus exchanged will provide a sound platform for the development of a singe regional clinical information system.

I would like to draw readers’ attention to a further addition to the journal this month. We are delighted to include in the December 2004 "Leadership in Health" edition the full text of the paper "Leadership and Learning: A Review of Leadership Themes in Health Informatics" from Ray Delany, Management Consultant, Auckland, New Zealand.

In this paper, Delany considers the argument that the leadership requirements of health care in general and informatics in particular are different.

Delany highlights that advocates of the view that any particular group requires a "special" form of leadership will quickly run up against the pragmatic experience of seasoned, professional leaders who are accustomed to providing differing leadership styles to suit the various circumstances they find themselves in. He notes that the characteristics of effective  leaders are consistent with the generic principles of ethics and good behaviour in society, and are transferable across many areas of human endeavour.