Knowledge Artifacts as Bridges between Theory and Practice: The Clinical Pathway Case

Abstract

This paper discusses how Clinical Pathways (CPs) are defined, used and maintained in two hospital settings. A literature review and observational study are combined to illustrate the composite nature of CPs and the different roles they play in different phases of their life-cycle, with respect to the theme of bridging medical knowledge with the related practices by which physicians deal with a specific care problem. We take the case of the CP as a paradigmatic case to stress the urgent need for an integrated approach with the computer-based support of information and knowledge management in rapidly evolving cooperative work settings.

Ontology modeling for generation of clinical pathways

“…It is proven that their implementation reduces the variability in clinical practice and improves outcomes (Cabitza et al, 2008).…”

Active artifacts as bridges between context and community knowledge sources

“…This definition of Knowledge Artifact enhances alternative formulations [26,40] that take the notion of KA as a mere intuitive and decontextualized juxtaposition of the concepts of knowledge and artifact and that therefore disregard its role of community collective memory [15].…”

“…The study helped shed light on the double nature of the artifacts compounding an IS: these artifacts can be characterized not only in terms of the conceptual categories of the IS research [17], but also from a KM perspective. In fact, users of an organizational IS see its artifacts also as Knowledge Artifacts (KA), that is, as artifacts that reify or evoke some organizational and/or domain-dependent knowledge [15], either in its design, in its use or in regards to both. Therefore, our point is that designers must conceive and treat these artifacts as such.…”

“…These process maps can be seen as the instantiation of the local combination and harmonization of heterogeneous and general guidelines to provide a visual representation of the course of action that clinicians agreed to comply with, when managing a specific disease. Clinicians maintain and refer to this kind of knowledge for a selection of diseases that the community considers as worthy of the related effort of modeling: typically, these diseases are either frequently recurring situations that have to be managed in a uniform way or highly critical diseases for which any mismatch in coordination can imply serious consequences in safety and effectiveness [15]. We described an example of convention that leverages clinical pathways, and therefore an externalized model of work flow, in [10], where we illustrated the case of the nurses of the emergency department that are pre-alerted in order to schedule with proper advance the transfer of a patient to the Stroke Unit as soon as the triage doctors have requested a chest-ray exam for that patient within the pathway of suspect stroke.…”

“…In the last years, we accomplished an empirical study in two wards of an important hospital in Northern Italy [12,16,15]: a Neonatal Intensive care Unit (NICU) and an Internal Medicine (IM) ward. These wards were significantly different not only with respect to the medical specialty, but also as regards their communities of professionals and the nature of the work being done therein.…”