Guest Blogger Dr. Marvin BorenMarv Boren 1.jpg is a passionate knowledge management professional and forward thinker.​

Challenges

Picking up where I left off, I will discuss some of the challenges or barriers to HIT adoption.

It would be easy to compile a long list of challenges to the adoption of HIT. Nonetheless, I'll limit my discussion to a brief review of two general areas that I believe are of greatest importance: stakeholder attitude and technology challenges.

Stakeholder Attitude:

If the goals set forth by the HITECH Act are to be realized, healthcare providers must make the transformation from paper to digital records - no small feat. Thus far, the transformation has been met with considerable resistance. As reimbursement for services continues to decline along with increasing overhead expenses, efficiency and productivity must be maximized. Many stakeholders feel that the workflow changes needed in order to achieve Meaningful Use are burdensome and counter-productive. In addition, some question the value of the information gained from the Meaningful Use objectives. The consensus is that at the very least, the use of EHR is more time consuming than traditional charting methods. Statistics show that adoption of EHR and achievement of MU has grown substantially since the Program's inception in 2009 to date. Nonetheless, measurable achievement of the aforementioned goals arguably, has yet to be realized. Accordingly, there is no shortage of skepticism among stakeholders whether there is a direct correlation between achieving Meaningful Use and enhancing health care quality and efficiency. Additionally this attitude contributes to the perception that adopting CEHRT lacks value.

 In order to overcome these barriers, it is essential that organizations establish a culture of trust. I would expect that those organizations most successful transitioning to CEHRT had already established a culture of trust and encountered the least resistance to change. While I am not aware of any such studies substantiating my expectation, it may be an interesting study worth pursuing.

Technology:

"The HITECH Act seeks to improve patient care and make it patient-centric through the creation of a secure, interoperable nationwide health information network. A key premise is that information should follow the patient, and artificial obstacles -- technical, bureaucratic, or business related -- should not be a barrier to the seamless exchange of information. Therefore, secure information exchange needs to occur across institutional and business boundaries so that the appropriate information is available to improve coordination, efficiency, and quality of care." ("How does information exchange")

Although there has been a proliferation of local, regional and state Health Information Exchanges (HIE the noun) to facilitate information sharing, for the most part, data remains siloed in disparate EHR systems.

Most industry leaders would agree that in spite of a greater prevalence of structured data, primary obstacles include a lack of standardization and a lack of a nationwide interoperability infrastructure to facilitate Health Information Exchange (HIE the verb). Adding fuel to the fire so to speak, are accusations that information blocking has contributed to the challenge of establishing nationwide interoperability. The seriousness of these accusations prompted a request by Congress for the ONC to produce a report on the extent of health information blocking and a comprehensive strategy to address it.  It was also requested that "the report should cover the technical, operational and financial barriers to interoperability, the role of certification in advancing or hindering interoperability across various providers, as well as any other barriers identified by the Policy Committee."

According to the REPORT TO CONGRESS, APRIL 2015 - Report on Health  (ONC, 2015) (pp.15-16) as a result of current economic and business incentives, some stakeholders have knowingly and unreasonably interfered with the exchange of electronic health information by limiting its availability or use.  The Report goes on to say that "ONC's understanding of information blocking is informed in part by a substantial body of complaints and other anecdotal evidence. However, this evidence has significant limitations that prevent ONC from confirming individual cases of information blocking. Identifying and confirming specific instances of information blocking is a difficult and highly fact-specific task. Empirical data on information blocking is also limited at present. There is little quantitative data available with which to reliably identify and measure the extent of information blocking." Finally the report suggests that "successful strategies to prevent information blocking will likely require congressional intervention". ​​

Dr Marvin Boren is the Meaningful Use Program Coordinator at Akron Children's Hospital (Akron, OH) which has successfully attested for Stage 2 Meaningful Use. He formerly practiced podiatry in Canton, OH and has over five years of experience consulting in Electronic Health Records. He is currently working on a Master of Science degree in Health Informatics at Kent State University. He can be reached at marvboren at google.com


References

1. The Office of the National Coordinator for Health Information Technology (ONC) Department of Health and Human Services (April 10, 2015). Report to Congress on Health Information Blocking. Retrieved from https://www.healthit.gov/sites/default/files/reports/info_blocking_040915.pdf

2. EHR incentives & certification, How to attain Meaningful Use.  Retrieved from https://www.healthit.gov/providers-professionals/how-attain-meaningful-use

3. How does information exchange support the goals of the HITECH Act? Retrieved from http://www.healthit.gov/policy-researchers-implementers/faqs/how-does-information-exchange-support-goals-hitech-act

4. The Office of the National Coordinator for Health Information Technology (ONC) Office of the Secretary, United States Department of Health and Human Services (September 21, 2015). Federal Health IT Strategic Plan 2015-2020. Retrieved from: https://www.healthit.gov/sites/default/files/federal-healthIT-strategic-plan-2014.pdf​​​

 

By Guest Blogger: Lindsey Millan is an employee and graduate student at Kent State University. In her free time, she enjoys reading, roller skating, and spending time with her daughter. She is incredibly grateful for her husband Nate, who is supportive all of her endeavors.

  

Over the past 10 years or so, higher education systems have seen a demand for more online courses and programs of study. This demand has forced institutions to think about course development and the overall learning community in a different way. We often refer to the "traditional" student in higher education: the recent high school graduate who lives on campus and is working on their degree full-time.  However, student demographics are changing, and the "traditional" student is becoming less of a reality at many institutions. A growing number of students fall into the "non-traditional" category: working professionals who have more pressing demands outside of the classroom. These students need more flexible course schedules and different types of learning tools in order to succeed in their academic pursuits.

So, how does knowledge management fit into these scenarios?  Well, how can we provide students with the tools they need to be successful?  What can we do to meet students where they are and on their timeframe? How can we help non-traditional and online students connect with their peers and other resources?

Utilizing an online community of practice (CoP) can help us solve some of the issues presented by the shift to more non-traditional learning methods. Communities of practice can help us move from the teacher to student learning model to learning as more a social and collaborative experience (Smith, 2003, 2009).   So far in this blog, we have thought about communities of practice in the context of the workplace or a professional group.  Creating communities of practice in both traditional and non-traditional settings could help students make connections in their fields of study that could eventually translate to personal or professional connections.

A community of practice is a group of people that come together over a common interest or subject (Smith, 2003, 2009). The members of the group learn together over time and create a collective memory of experiences and ideas (Smith, 2003, 2009). In a university setting, we could create communities of practice for each class, program of study, and area of interest. We could also give students the tools to create their own communities of practice, enabling them to learn in innovative and creative ways. Those tools could be blogs, wikis, discussion boards, and instant messaging and videoconferencing software (Becerra-Fernandez & Sabherwal, 2015).

When people first become involved in a CoP, their participation is usually less significant than that of more experienced members (Smith, 2003, 2009). The community helps them learn the vocabulary and processes of the group.  They also learn how to interact with others in the group and what is important to the community as a whole (Smith, 2003, 2009). As they learn, they contribute more frequently and provide more pertinent information to the group (Smith, 2003, 2009).

This pipeline diagram is my vision for moving students through via a community of practice model.  A type of pipeline is created as students move through their studies and enhance their knowledge.  As students move through each of the various groups, they develop more complex skills and more specific relationships that will help them continue to grow and ultimately make connections with employers.  Once students graduate, they can still contribute to some of the communities and help others broaden their own knowledge.  This would help graduates stay connected to their alma mater and also foster the idea of lifelong learning.

As students' progress through the pipeline, they will be able to see how the connections they are making will help them in their future careers and be able to apply that to their courses and programs of study.  The students may decide through the help of the communities that they want to go in another direction.  These CoPs would help the university community become more innovative and creative and break out of the traditional mold (Smith, 2003, 2009).

Today's students can become easily frustrated by the slow-moving traditional structure of most universities (Smith, 2003, 2009). Look at how fast everything else in the world moves!  Using CoPs can help us transition to a fast-paced organizational model that supports online learners (Smith, 2003, 2009). They can also help all stakeholders become more informed participants in their own careers or areas of focus.

Ultimately, CoPs, along with other online learning tools, could create a more collaborative, community-focused environment for all students, no matter where they fall on the spectrum of student types. The communities can help students be better prepared for the workforce when they graduate, while fostering connections and mentors that can help them in academics and beyond.

By Guest Blogger

Lindsey Millan is an employee and graduate student at Kent State University. In her free time, she enjoys reading, roller skating, and spending time with her daughter. She is incredibly grateful for her husband Nate, who is supportive all of her endeavors.   

 

References

1. Smith, M.K. (2003, 2009). Jean Lave, Etienne Wenger and communities of practice. The encyclopedia of informal education. Retrieved from http://infed.org/mobi/jean-lave-etienne-wenger-and-communities-of-practice/

2. Becerra-Fernandez, I., & Sabherwal, J. (2015). Knowledge management: Systems and Processes(2nd Ed). New York, NY: Routledge Publishing Company

3. Millan, L. [Community of practice pipeline for universities]. Created March 2016.

Edwin K. Morris ​

Pioneer Knowledge Services

Contact@pioneer-ks.org

Knowledge management is a contemporary business practice and organizational capacity builder that is recognized Army Def.pngand used by governments, military systems, industries, corporations, foundations, and academia.

The World Health Organization considers "KM to be the dual challenge of, first, managing information and processes and, second, managing people and their environment so that knowledge is created, shared and applied more systematically and effectively." (World Health Organization, 2005, p. 8)

Effective knowledge management economizes and creates opportunities for learning across at an enterprise level. This effort enables better and faster decision-making and reduces resource mismanagement by creating a learning and knowing culture. A culture that shares and provides the opportunity for reflection then learning becomes foundational in the organizational culture. The result is an organization that gains strength and agility as the system continually builds and leverages the deliberately designed institutional wisdom. The ingredients in this KM Recipe is People, Processes, Tools equate and include in the equation the Organization.

As KM, has evolved so has the meaning and definition of knowledge management. To this end in 2015 Girard & Girard authored a research paper to distill and find the essence of the various definitions of knowledge management. From 100 definitions, they analyzed the words and distilled the essence of them to state KM is, "Knowledge Management is the process of creating, sharing, using and managing the knowledge and information of an organization." (Girard & Girard, 2015, p. 14) They concluded the following describing the trek of KM and its definition.

From a humble beginning about three decades ago, knowledge management has developed from a premature concept into a mainstream organizational necessity. Over the course of time the exact nature of the term has evolved. In the past decade the responsibility for establishing a precise applied meaning of the domain has passed from academics to practitioners. The latter have massaged the early academic definitions to meet the wants and needs of their particular constituents. This project is an early attempt to record the applied definitions that have progressed to ensure they are available to academics and practitioners alike. (Girard & Girard, 2015)

Just as knowledge management is used in business and industry as a key ingredient for innovation, sustainment, and growth, it can serve the same purpose for regions, communities and society.

For example, the World Bank produced a Knowledge Economy Index that represents a country's overall preparedness to compete in a knowledge economy. In a knowledge economy, "…knowledge assets are deliberately accorded more importance than capital and labor assets, and where the quantity and sophistication pervading economic and societal activities reaches very high levels." (Institute, 2007, p. 13) In the World Bank's 2012 index, the U.S. ranked in 12th place. This was a drop by 8 since the year 2000. Sweden is in first place and regarded as the most advanced knowledge economy. The relevance and importance of developing knowledge resources is highlighted further below:

…whatever their level of development, countries should consider embarking on a knowledge- and innovation-based development process. In these times of accelerated globalization, "grey matter" is a country's main durable resource. Its exploitation for economic and social well-being is increasingly at the center of development strategies. (Institute, 2007, p. xiii)While the vision promoted by The World Bank is much larger in scope and depth than what this pilot could possibly aim to accomplish, we can point to incremental steps under way in our state government that are necessary to enable the prioritization and development of a true knowledge economy. For example, Denise Bedford reflects that, "The nature of the shift from an industrial to a knowledge economy – in organizational culture, in collaboration, in technologies and simple operations – is a radical transformation." (Bedford, 2012)

An indication of knowledge importance in society is exampled by searching the New York State Assembly Bill Search. Searching the keyword "data" produces 125 bills. A search of the keyword "database" results in 38 and the term "knowledge" produces 13 bills. (State, 2016)

Given the magnitude of activity at the public policy level, we suggest also that paying attention to the data policy agenda must also be a priority.

Consider the realm of leadership and how it effects the organization culture. APQC in 2013 conducted a survey that produced the below infographic. They polled 547 respondents from various industries. They were asked about leadership in their organizations. Listed as the top leadership deficiencies knowledge sharing is number three. (APQC, n.d.)

So where are we know? KM as an organizational asset continues to grow in every domain of business. In my judgement the need for 21st century digital skills in people is the same in what is expected in organizations. How well they adapt and adopt addresses the question to how successful the culture integrates into the knowledge ecosystem. The Knowledge Management era will innovate how work gets done.

References

APQC. (n.d.). The Leadership Deficit: Survey Results Report. Retrieved Feb 9, 2016, from APQC: https://www.apqc.org/knowledge-base/documents/leadership-deficit-survey-results-report

Bedford, D. (2012, December). The Role Of Knowledge Management In Creating Transformational Organizations And Transformational Leaders. Journal of Knowledge Management Practice, Vol. 13, none. Retrieved Feb 2016, from http://www.tlainc.com/articl320.htm

Girard, J., & Girard, J. (2015). Defining knowledge management: Toward an applied compendium . Online Journal of Applied Knowledge Management, 3(1), 15. Retrieved Feb 8, 2016, from http://www.iiakm.org/ojakm/articles/2015/volume3_1/OJAKM_Volume3_1pp1-20.pdf

Institute, T. W. (2007). Building Knowledge Economies: Advanced Strategies for Development. Washington: The International Bank for Reconstruction and Development. Retrieved Feb 2016, from http://siteresources.worldbank.org/KFDLP/Resources/461197-1199907090464/BuildingKEbook.pdf

Sabherwal, R., & Becerra-Fernandez, I. (2015). Knowledge management : systems and processes . New York: Routledge.

State, N. Y. (2016, Feb 8). New York State Bill Search. Retrieved from The New York State Assembly: http://assembly.state.ny.us/leg/?

World Health Organization. (2005). Knowledge Management Strategy. Geneva: World Health Organization.