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The state of the art in clinical knowledge management: An inventory of tools and techniques
Open accessAbstract
Purpose To explore the need for, and use of, high-quality, collaborative, clinical knowledge management (CKM) tools and techniques to manage clinical decision support (CDS) content.Methods In order to better understand the current state of the art in CKM, we developed a survey of potential CKM tools and techniques. We conducted an exploratory study by querying a convenience sample of respondents about their use of specific practices in CKM.Results The following tools and techniques should be priorities in organizations interested in developing successful computer-based provider order entry (CPOE) and CDS implementations: (1) a multidisciplinary team responsible for creating and maintaining the clinical content; (2) an external organizational repository of clinical content with web-based viewer that allows anyone in the organization to review it; (3) an online, collaborative, interactive, Internet-based tool to facilitate content development; (4) an enterprise-wide tool to maintain the controlled clinical terminology concepts. Even organizations that have been successfully using computer-based provider order entry with advanced clinical decision support features for well over 15 years are not using all of the CKM tools or practices that we identified.Conclusions If we are to further stimulate progress in the area of clinical decision support, we must continue to develop and refine our understanding and use of advanced CKM capabilities.
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“A key challenge with clinical decision support is knowledge management as guidelines and best practices change over time,40–42 as well as governance.43–45”
From Clinician collaboration to improve clinical decision support: the Clickbusters initiative (2022) · cites this paper as [42]
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BackgroundFeasibility study on service-based data acquisition for human signal molecule profiling database
Zhao, X., & Dong, T. (2013) · IEEE International Conference on Bioinformatics and Bioengineering (BIBE) · doi:10.1109/bibe.2013.6701619 · Cited by 1
Improving Stock Management in Healthcares to Increase Efficiency
Çınar, O. (2012) · The journal of academic social science studies/The journal of academic social science · doi:10.9761/jasss_245 · Cited by 1
An Evidence-Based Health Care Knowledge Integration System: Assessment Protocol
Nabelsi, V., & Croteau, S. (2018) · JMIR Research Protocols · doi:10.2196/11754 · Cited by 1
“As such, several authors suggested exploring collaborative Web-based platforms to share, create, and update content of clinical decision-assistance systems [46,50-53].”
BackgroundOr, C. K., Liu, K., & Wang, H. (2018) · Advances in healthcare information systems and administration book series · doi:10.4018/978-1-5225-5460-8.ch018 · Cited by 1
CONCEPTUAL FOUNDATION OF SAFER GUIDES
Sittig, D. F., & Singh, H. (2015) · Apple Academic Press eBooks · doi:10.1201/b18371-5 · Cited by 1
Self-citationInformatics and Decision Support
Dexheimer, J. W., Johnson, L. H., Solti, I., Aronsky, D., & Pestian, J. P. (2012) · Translational bioinformatics · doi:10.1007/978-94-007-5149-1_11 · Cited by 1
Implementation of Laboratory Equipment Loan System in SiDal (BigData Laboratory System)
Asmoro, C. P., Susanti, H., & Maemunah, I. (2024) · EDULAB Majalah Ilmiah Laboratorium Pendidikan · doi:10.14421/edulab.2023.82.07 · Cited by 1
Proctor, S. N., & Desai, B. (2025) · Applied Clinical Informatics · doi:10.1055/a-2620-6221 · Cited by 1
Design Considerations of a Medical Expert System for Differential Diagnosis of Low Back Pain (ESLBP)
Santra, D., Mandal, J. K., Basu, S. K., & Goswami, S. (2020) · Advances in intelligent systems and computing · doi:10.1007/978-981-15-2188-1_34 · Cited by 1
Knowledge Integration and Use-Case Analysis for a Customized Drug-Drug Interaction CDS Service
Kam, H. J., Park, M. Y., Kim, W., Yoon, D. Y., Ahn, E. K., & Park, R. W. (2010) · Communications in computer and information science · doi:10.1007/978-3-642-16444-6_7 · Cited by 1
“Clinically inappropriate or excessive numbers of alerts can cause ‘alert fatigue’ for the clinician; this can render clinicians insensitive to alerts, and can degrade their confidence in the alerts, the alerting system and CDS as a whole [ 5 ].”
BackgroundOrlioglu, S., Boobalan, A. S., Abanyie, K., Boyce, R. D., Min, H., Gong, Y., Sittig, D. F., Biondich, P., Wright, A. T., Nøhr, C. G., et al. (2024) · medRxiv · doi:10.1101/2024.09.22.24314152 · Cited by 1
Self-citationKnowledge Delivery and Decision Support for Behavioral Healthcare Professionals
Kennedy, R. S., Weiss, L. G., Dewan, N. A., Luo, J. S., & Lorenzi, N. M. (2010) · Computers in health care · doi:10.1007/978-1-84996-344-2_4
Clinical Commissioning Groups in the UK
Baskaran, V., Johns, S. E., Bali, R. K., Naguib, R. N. G., & Wickramasinghe, N. S. (2011) · International Journal of Healthcare Delivery Reform Initiatives · doi:10.4018/jhdri.2011100104
An Inference Engine for Estimating Outside States of Clinical Test Items
Sakata, M., Yücel, Z., Shinozawa, K., Hagita, N., Imai, M., Furutani, M., & Matsuoka, R. (2013) · ACM Transactions on Management Information Systems · doi:10.1145/2517084
“Test Item Selection In content developments of clinical decision support systems, a large number of health care professionals and information scientists are involved such as pharmacists, clinical analysts, software developers, physicians and administrators [Sittig et al. 2010].”
BackgroundConstruction of a Drug Safety Assurance Information System Based on Clinical Genotyping
Springer, J. A., Iannotti, N. V., Sprague, J. E., & Kane, M. D. (2011) · ISRN Bioinformatics · doi:10.5402/2012/982737
Carney, T. J. (2013) · IUScholarWorks (Indiana University) · doi:10.7912/c2/939
Lin, C. H., Yang, A. W. H., Pittayachawan, S., & Wickramasinghe, N. S. (2016) · Healthcare delivery in the information age · doi:10.1007/978-3-319-25973-4_11
Virtual Communities of Practice in Immersive Virtual Worlds
Majewski, G., & Usoro, A. (2012) · IGI Global eBooks · doi:10.4018/978-1-4666-0312-7.ch019
Kramer, H. S. (2014) · J. Willard Marriott Library · doi:10.26053/0h-wwe2-h7g0
Using Performance Measurement in Healthcare Analytics
Nammour, F. L., Mansour, N., & Danas, K. (2016) · World Congress on Medical Physics and Biomedical Engineering, September 7 - 12, 2009, Munich, Germany · doi:10.1007/978-3-319-32703-7_162
Creating an immunization content database for knowledge management across clinical systems
Wen, H., Mathe, J. L., Weinberg, S. T., Weitkamp, A. O., & Nelson, S. D. (2019) · American Journal of Health-System Pharmacy · doi:10.1093/ajhp/zxz134
Governance for Clinical Decision Support
Wright, A. T., Sittig, D. F., Ash, J. S., Bates, D. W., Feblowitz, J. C., Fraser, G., Maviglia, S. M., McMullen, C. K., Nichol, W. P., Pang, J. E., et al. (2013) · Apple Academic Press eBooks · doi:10.1201/b16306-17
Self-citationA Systematic Review of Ontologies applied in Clinical Decision Support System Rules (Preprint)Preprint
Jing, X., Min, H., Gong, Y., Biondich, P., Robinson, D., Law, T., Nøhr, C. G., Faxvaag, A., Rennert, L., Hubig, N., et al. (2022) · doi:10.2196/preprints.43053
Sagala, S., Prilandita, N., Pranindita, N., Gracia, E., Ikhsanul, M. N., Seba, R. R., Zahra, T. A., & Sitanggang, C. M. (2024) · AIP conference proceedings · doi:10.1063/5.0238339
van Brummelen, N., Leopold, J. H., & Medlock, S. K. (2025) · Journal of Medical Systems · doi:10.1007/s10916-025-02293-x
“Sittig et al., 2010 surveyed six sites in the United States of America (USA), which used five different tools to facilitate con - tent development.”
Campion, T. R., Tran, T. V., Cheriff, A. D., Gossey, J. T., & Cole, C. L. (2026) · Applied Clinical Informatics · doi:10.1055/a-2880-6252
Historia clínica electrónica de atención primaria de salud: Valoración de las enfermeras
Masclans, J. G. (2014) · LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas)
Metadata
- Authors
- Sittig, D. F., Wright, A., Simonaitis, L., Carpenter, J. D., Allen, G. O., Doebbeling, B. N., Sirajuddin, A. M., Ash, J. S., & Middleton, B.
- Affiliations
- Memorial Hermann (US)
- Regenstrief Institute (US)
- Health Services Research & Development (US)
- Oregon Health & Science University (US)
- Corresponding author
- Sittig, Dean F.
- Venue
- International Journal of Medical Informatics
- Publisher
- Elsevier BV
- Published
- 2010-01
- Volume
- 79
- Issue
- 1
- Pages
- 44-57
- ISSN
- 1386-5056 (ISSN-L)
- PMC
- PMC2895508
- OpenAlex
- W1982907589
- Cited by
- 101
- References
- 39
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 5 · 2022: 5 · 2021: 1 · 2020: 3 · 2019: 3 · 2018: 4 · 2017: 6 · 2016: 10 · 2015: 5 · 2014: 9 · 2013: 13 · 2012: 14
- FWCI
- 21.16
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- International Journal of Medical Informatics (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Purdue University Indianapolis (Indiana University) (submittedVersion)
- Funders
- Agency for Healthcare Research and Quality
- U.S. National Library of Medicine (R01LM006942, R56LM006942)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
- Social Sciences › Decision Sciences › Information Systems and Management › Knowledge Management and Technology
- Keywords
- clinical knowledge management, clinical decision support, collaborative content development
- MeSH terms
- Hospital Information Systems, Humans, Terminology as Topic, Patient Care Team, Software, United States, User-Computer Interface, Information Storage and Retrieval, Medical Records Systems, Computerized, Vocabulary, Controlled, Health Care Surveys, Decision Support Systems, Clinical, Internet, Interdisciplinary Communication
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