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Customer Name (MetaCondNormal-Roman 26pt/2
Managing clinical evidence at the speed of change
Based in Boston, Massachusetts, Partners HealthCare is an integrated health system
founded by Brigham and Women’s Hospital and Massachusetts General Hospital in 1994.
Partners HealthCare is one of the nation’s leading biomedical research organizations and
a principal teaching affiliate of Harvard Medical School.
In addition to two academic medical centers, the Partners HealthCare system includes
community hospitals, specialty hospitals, community health centers, a physician network,
home health and long-term care services, and other health-related entities.
support content that drivespatient safety, quality, utilizationmanagement, and clinical research
Evidence-based medical practice—the technique of using the best, most current scientific
evidence to make decisions about the care of individual patients—has become a
cornerstone of patient care for large, progressive medical facilities such as Partners
Healthcare. By definition, evidence-based practice demands quick, easy access tocomprehensive and current literature, data, and other information on specific medical
conditions and treatments. However, the sheer volume and complexity of this information
has placed a strain on physicians and other caregivers who are hard-pressed to keep up
with the latest findings. At the same time, insurance providers and the public are exerting
growing pressure on practitioners to improve their quality, efficiency, and performance.
and effectiveness of the clinicaldecision support update process
At Partners, these business drivers were causing administrators to take a comprehensivelook at existing computer-based clinical decision support systems to identify silos, gaps,and other inefficiencies. “Our overriding objective is to provide decision support thatimproves both the quality of care for patients and the performance of clinicians,” saidTonya Hongsermeier, Corporate Manager, Clinical Knowledge Management and DecisionSupport. “It was becoming more and more difficult to affordably develop, acquire, andmaintain the knowledge bases required to deliver meaningful decision support.”
More streamlined review and decision making
A specific area targeted for improvement was the process by which clinicians reviewedliterature and came to consensus on disease management approaches. The company’s
previous configuration for decision support did not provide adequate tools and personnelfor efficient vetting of information and updating of clinical decision support knowledge
bases. “There was a lack of transparency into the knowledge already in production, and
there were too many bottlenecks when it came time for people to agree on content,” said
Hongsermeier. “We wanted to provide better support for the content vetting process
without requiring our busy physicians to have to attend committee meetings.”
Improving organizational effectiveness
In evaluating potential solutions for a more comprehensive decision support system,Partners had several objectives. Most importantly, the new system would reduce the cost
and increase the speed in which clinical innovations and evidence could be translated into
clinical practice. “Through data-driven improvements in performance, we hoped toimprove Partners’ effectiveness as a learning organization,” said Hongsermeier. “And we
needed to bring our knowledge assets into better alignment with business, regulatory,
“Partners has a long and successful track record in applied clinical decision support; in
fact, we’ve created some of the best systems in production worldwide,” she said. “Now,
with the explosion in clinical information, it was time to go to the next level.”
EMC Documentum solution
Common repository for current
To meet these objectives, Partners Healthcare implemented an integrated knowledge
management system based on the EMC® Documentum® content management platform
and EMC Documentum eRoom® collaboration software. Documentum provides a
centralized repository for a library of clinical evidence that can be accessed across the
enterprise, and eRoom creates a collaborative workspace for clinicians to review literature
and make consensus-based decisions. Together, Documentum and eRoom create a
metadata environment for managing the lifecycle of content for the health system’s
when changes need to be madeto decision support content to
Global control over critical information
Within the Documentum repository, documentation on the design of the content is
organized and is made available to users via a searchable knowledge management portal.
Proprietary taxonomy and filters have been built so documents can be sorted by a varietyof perspectives, clinical disciplines, and other criteria such as application, site, venue,patient population, end user, and clinical care setting.
Physicians, clinicians, quality improvement personnel, and knowledge engineeringteams can browse the portal by topic and access all pertinent documents in a specificcategory such as coronary artery disease management. The documents contain thedesign specifications and all the relevant information about that particular contentartifact including author, business owner, date of last update, and others. According toa set schedule, documents are periodically posted to eRoom so that Partners clinicianscan review them and determine whether the content needs to be updated in the decisionsupport system. “A large driver for this new system was our ability to manage changesand updates to knowledge,” said Hongsermeier. “Once the decision has been madefor knowledge to change, it needs to happen rapidly and it requires the ability tochange rules, order sets, templates, and reports quickly and accurately. Documentumprovides the industrial-strength content management functionality to ensure effectivechange management.”
“The EMC Documentum solutions are playing a key role in our ability to continue
enhancing and improving the quality of our clinical decision support knowledgeso that we can offer superior quality of care to patients and excellent ‘quality oflife’ for our clinicians and other employees.”
Tonya Hongsermeier, MD, MBA, Corporate Manager,
Clinical Knowledge Management and Decision Support
Shortening and streamlining review and change
Documentum eRoom has dramatically improved the processes by which reviewing clinicians collaborate and make decisions for standard dosage guidelines and othertreatment procedures. Before Documentum and eRoom, documents were maintainedin folders on file systems and were related by title and common location only. “It wasdifficult to know what information had changed from one version to the next or why,and when people moved on to new jobs, folders would get lost,” said Cathyann Harris,Project Manager, Clinical Knowledge Management and Decision Support. “Since documents are now posted to eRooms by Documentum, we’re able to maintain muchmore extensive ‘metaknowledge’ on each—the who, what, when, where, and why ofeach piece of information.”
In one example, Partners has created an eRoom to support a database for medicationdosing of geriatric patients. The clinicians responsible for reviewing these dosingguidelines according to the latest medical information and literature are able to“meet” in the eRoom, hold on-line discussions, and reach consensus via the eRoom pollingfunctionality. In a typical scenario, a pharmacist proposes changing the frequency ofan ibuprofen dosage based on recommendations in updated literature. Once the clinicianshave agreed on the new dosage, the pharmacist can post supporting documentationto the eRoom and the system keeps an audit trail of each member’s statements andactions. “eRoom has played a large role in helping us reduce the cost and increase thespeed of knowledge acquisition for our decision support systems,” said Harris. “Thesystem has greatly shortened the cycle for making decisions and implementingchanges by enabling people to reach agreement online, rather than spending monthsparticipating in committees and attending meetings.”
At Partners Healthcare, the EMC Documentum content management platform and EMC
Documentum eRoom have brought new efficiencies to decision support processes and
greatly enhanced clinicians’ ability to make evidence-based decisions on patient care.
The Documentum repository has brought new levels of control and streamlined access
to critical information, and eRoom has greatly enhanced clinicians’ ability to propose,
discuss, and make decisions on changes to treatment guidelines. “The Documentum
solutions are playing a key role in our ability to continue enhancing and improving the
quality of our clinical decision support knowledge so that we can offer superior quality
of care to patients and excellent ‘quality of life’ to our clinicians and other employees,”
EMC Corporation (NYSE:EMC) is the world leader in products, services, and solutions for
information storage and management. Through information lifecycle management (ILM)
strategies, EMC helps enterprises of all sizes manage their growing volumes of
information—from creation to disposal—according to its changing value. EMC information
infrastructure solutions are at the heart of this mission, helping organizations manage,
use, protect, and share their information assets more efficiently and cost-effectively. The
result? Information with greater business value and at lower management cost.
1-508-435-1000In North America 1-866-464-7381
EMC2, EMC, Documentum, eRoom, and whereinformation lives are registered trademarks ofEMC Corporation. All other trademarks used herein are the property of their respective owners.
Copyright 2007 EMC Corporation. All rights reserved. Published in the USA. 6/07
Mark D. Reid, James Montgomery, Mindika PremachandraAbstract — In order to relate machine learning problems we argue that we need tobe able to articulate what is meant by a single machine learning problem. Byattempting to name the various aspects of a learning problem we hope to clarifyways in which learning problems might be related to each other. We tentatively putforward a proposal for a
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