The Computerworld Honors Program
Honoring those who use Information Technology to benefit society
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Partners Healthcare

Managing clinical evidence at the speed of change

Introductory Overview
Physicians and other caregivers are hard-pressed to keep up with the sheer volume and complexity of information on the treatment of specific medical conditions.

When physicians create electronic prescriptions, for example, they would like to know that they are drawing on the very latest knowledge with regard to dosage and drug selection that accounts for patient age, preconditions and interaction with other drugs. This means that electronic prescribing systems must contain vast amounts of current knowledge to provide reliable and efficient guidance. Further, when they receive guidance, it is essential that the knowledge be evidence-based and up to date. .

In the early 1990s, Partners HealthCare began grappling with the explosion in medical information by making a huge investment in clinical decision support content development. But by 2003 they realized that they had thousands upon thousands of rows of content in production but did not have the processes, policies and tools in place to insure that they were kept up to date.

Getting busy clinicians together initially to create content is a difficult, time-consuming process. Finding an effective way to keep that content updated is even harder. Files and spreadsheets have to be routed to different reviewers, comments have to be collated and hours are spent in meetings. Even then, changes can take months, with the backlog of needed updates far outpacing maintenance efforts.

Partners also realized that if the decision support content was currently inadequate, how would clinicians possibly be in a position to practice personalized gene-based medicine in the not-too-distant future, which would require daily changes to clinical knowledge content?

These challenges led the organization to invest in the development of a knowledge management team, starting with just one person in 2003 and growing over five years to include more than 50 people, including analysts, project managers, knowledge engineers and developers.

The team worked intensively to develop the groundwork policies and processes for maintaining clinical knowledge content. But to speed up the review process and make it more time-efficient for clinicians to participate, effective content management and collaboration tools were essential. Contributors needed to "meet" and comment on guidelines in a very detailed manner, without actually having to attend meetings or participate in conference calls.

EMC's® Documentum® content management platform provided the team with a central repository that could contain complete data on the content, and Documentum eRoom® collaboration software gave content developers a means of collaborating without scheduled meetings or conference calls or having to share files and spreadsheets by email.

The result was a robust, Web-based content management infrastructure that would meet the organization's needs now and in the future, allowing much faster changes to treatment guidelines, reducing the time spent by clinicians in reviewing those changes and building trust among caregivers in the quality of the decision support content available to them.