The Knowledge Egg Stanford

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Presentation at Stanford Center for Biomedical Informatics Research, Stanford University School of Medicine, 4th of February 2010.

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  • ENTUSIASME.
  • ENTUSIASME. SHOW.
  • The Knowledge Egg Stanford

    1. 1. The Knowledge Egg Øystein Eiring, Geir Kristian Lund, Endre Aas. Innovation group and project management, EviCare, Norway. 1. The problem 2. Making a solution 3. The Egg
    2. 2. The problem 02/15/10
    3. 3. Clinicians need knowledge from research, but: <ul><li>Problem 1: Most research findings are not reliable </li></ul><ul><li>2: Most research is not readable at point-of-care </li></ul><ul><li>Problem 3: Most reseach is not relevant </li></ul>02/15/10
    4. 4. Evidence-based practice the heroic way
    5. 5. Evidence-based practice the heroic way 02/15/10
    6. 6. Evidence-based practice the heroic way
    7. 7. Are there short-cuts to evidence-based practice?
    8. 8. Building a solution 02/15/10
    9. 9. Shortcut # 1: Pre-appraised single studies <ul><li>Knowledge refinery: </li></ul><ul><ul><li>Reading the 130 best journals </li></ul></ul><ul><ul><li>Throwing 90 percent + </li></ul></ul><ul><ul><li>7000 clinicians asked for relevance </li></ul></ul><ul><li>23 000 pre-appraised studies: MacPLUS </li></ul>February 15, 2010
    10. 10. Shortcut # 1: Pre-appraised single studies <ul><li>Knowledge refinery: </li></ul><ul><ul><li>Reading the 130 best journals </li></ul></ul><ul><ul><li>Throwing 90 percent + </li></ul></ul><ul><ul><li>7000 clinicians asked for relevance </li></ul></ul><ul><li>23 000 pre-appraised studies: MacPLUS </li></ul>February 15, 2010 Problem: will miss other studies about the same topic
    11. 11. Shortcut # 2: systematic reviews <ul><li>Identifies all research about an intervention </li></ul><ul><li>Assesses quality of research and throws most </li></ul><ul><li>Summarizes the rest </li></ul><ul><li>Systematic reviews are more reliable than single studies </li></ul>
    12. 12. Shortcut # 2: systematic reviews <ul><li>Identifies all research about an intervention </li></ul><ul><li>Assesses quality of research and throws most </li></ul><ul><li>Summarizes the rest </li></ul><ul><li>Systematic reviews are more reliable than single studies </li></ul>Problem: covers few topics and most often not conclusive
    13. 13. Shortcut # 3: clinical guidelines <ul><li>Research only describes what is </li></ul><ul><li>Guidelines describe what should be done </li></ul>
    14. 14. Shortcut # 3: clinical guidelines <ul><li>Research only describes what is </li></ul><ul><li>Guidelines describe what should be done </li></ul><ul><ul><li>take into account values, resources, politics, patients opinions, expert opinion </li></ul></ul><ul><li>Need quality assessment </li></ul>Problem: too lenghty to be useful at point of care
    15. 15. Shortcut # 3: clinical guidelines <ul><li>Research only describes what is </li></ul><ul><li>Guidelines describe what should be done </li></ul><ul><ul><li>take into account values, resources, politics, patients opinions, expert opinion </li></ul></ul><ul><li>Need quality assessment </li></ul>
    16. 16. Shortcut # 4: evidence-based textbooks
    17. 17. Shortcut # 4: evidence-based textbooks Problem: lack local adaptation and ownership
    18. 18. Shortcut # 5: Evidence-based procedures <ul><li>… care pathways </li></ul><ul><li>… care plans </li></ul><ul><li>… order sets </li></ul>
    19. 19. Building a solution What if we combined all the short-cuts in a hierarchy? (some are better than others)
    20. 20. The 6S Model Quality-assessed single studies Systematic reviews Quality-assessed systematic reviews Single studies that need quality assessment Guidelines and evidence-based textbooks Local protocols, pathways in CDSS
    21. 21. Seek answers as close to the top as possible Quality-assessed single studies Systematic reviews Quality-assessed systematic reviews Single studies that need quality assessment Guidelines and evidence-based textbooks Local protocols, pathways in CDSS More reliable, relevant and readable
    22. 22. Building a solution: full-text access 02/15/10
    23. 23. Norwegian Health Library: core features <ul><li>Publicly funded </li></ul><ul><li>Access for the whole population preferred </li></ul><ul><li>Quality assessments of knowledge -AGREE </li></ul><ul><li>6S increasingly used as fundamental knowledge model </li></ul>02/15/10
    24. 24. Scientific journals Bibliographic databases Evidence-bases textbooks Clinical guidelines Systematic reviews
    25. 25. What if we merged the hierarchy with full-text local, national and international knowledge resources?
    26. 26. The Knowledge Egg
    27. 27. The Knowledge Egg Evidence-based local procedures/pathways Evidence-based textbooks Guidelines Systematic reviews Quality-assessed studies Other studies
    28. 28. One search into all resources Instruction
    29. 29. Usage: by the individual clinician at point-of-care 02/15/10 Here is the answer -in the top of the egg!
    30. 30. Usage: by those making procedures and pathways
    31. 31. Benefits: – everything in your hand <ul><li>Common interface for local, international and national knowledge </li></ul><ul><li>Continuous updating </li></ul><ul><li>Underlying machinery not visible </li></ul><ul><li>Decision support – not dictatorship </li></ul>
    32. 32. Benefits: – everything in your hand <ul><li>EBM despite low information literacy among health personnel </li></ul><ul><li>Shared knowledge between clinicians and patients </li></ul>
    33. 33. Norwegian Electronic Health Library Øystein Eiring, Geir Kristian Lund, Endre Aas. Innovation group and project management, EviCare, Norway.

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