Importance of knowledge management

Chapter 2

This chapter describes the concept and the importance of knowledge management for managing organizational knowledge. The concepts of knowledge is described and the types of knowledge that can be managed by technology are highlighted. Knowledge management systems, knowledge management processes and knowledge management cycle are described in this chapter.

Managing Knowledge

Knowledge Management


There are many definitions for knowledge management such as:

"Concerns the gathering, organization, refinement and distribution of knowledge".(Hussain & Raza, 2004), according to Alavi and Leidner knowledge management is "purported to increase innovativeness and responsiveness" (Alavi & Leidner, 2005), Rowley describes the term KM as follows: "Knowledge management is concerned with the exploitation and development of the knowledge assets of an organization with a view to furthering the organization's objectives. The knowledge to be managed includes both explicit, documented knowledge, and tacit, subjective knowledge. Management entails all of those processes associated with the identification, sharing, and creation of knowledge. This requires systems for the creation and maintenance of knowledge repositories, and to cultivate and facilitate the sharing of knowledge and organizational learning. Organizations that succeed in knowledge management are likely to view knowledge as an asset and to develop organizational norms and values, which support the creation, and sharing of knowledge" (Rowley, 2000)

Also knowledge management is "an emerging discipline with many ides yet to be tested, many issues yet to be resolved and much learning yet to be discovered."(Liebowitz, 1999)

In practice, knowledge management often encompasses identifying and mapping intellectual assets within the organization, generating new knowledge for competitive advantage within the organization, making vast amounts of corporate information accessible, sharing of best practices, and technology including groupware and intranets.(Barclay & Murray, 2000)

Therefore the main goals for using knowledge management in organizations to achieving organizational goals through the strategy-driven motivation and facilitation of (knowledge) workers to develop, enhance and use their capability to interpret data and information (by using available sources of information, experience, skills, culture, character, etc.) (Uit Beijerse, 1999)

From these definitions knowledge management can be defined "in order to increase innovativeness and responsiveness knowledge can be managed between both tacit and explicit in order to supports, capture, store and disseminate the information"

Why knowledge management is important

Knowledge management is important in any organizations because it's important in economics and business. Economics and business theorists have alluded to or identified knowledge as the ultimate competitive advantage for the modern firm. That is, it is a resource that is difficult to impossible to imitate or co-opt, giving its possessor a unique and inherently protected commodity. Therefore, any techniques or methods that sustain knowledge growth and distribution are key to the success of today's organizations.

Varieties of factors have contributed to the growth of and interest in KM. Robert E. Cole identifies seven of them:

  • Accelerating pace of change
  • Staff attrition (especially that resulting from years of downsizing and reengineering)
  • Growth in organizational scope
  • Geographic dispersion associated with globalization of markets
  • Global integration
  • Increase in networked organizations
  • Growing knowledge-intensity of goods and services
  • Revolution in information technology


Knowledge is distinct from data and information. Data are the collection of facts and information is the outcome of the data process. For example, a plan or a strategy for solving a medical problem could be considered as data, however, the way of solving that problem and the utensils used for solving the problem could be considered as information. Conversely, knowledge is the ability to manipulate information by adding elements of experience in a particular context.

Explicit knowledge

Explicit knowledge is knowledge that is articulated in formal language and easily transmitted among individuals both synchronously and asynchronously. Tacit knowledge, on the other hand, is personal knowledge embedded in individual experience and involving such intangible factors as personal belief, perspective, instinct, and values. Explicit knowledge is referred to as information in the context of our discussion. The challenge of explicit knowledge is one of handling the sheer volume of information that is available.

Tacit knowledge

Tacit knowledge potentially can represent great value to the organization, it is, by its very nature, far more difficult to capture and diffuse. The challenges represented by each type of knowledge at a very high level are the same - to build a bridge between seekers and providers of knowledge. Tacit knowledge depends on the experience the person encountered and this is not documented information.

Tacit versa explicit

Knowledge could also be transferred and transformed from tacit to explicit knowledge and vice versa using Nonaka's Knowledge Model (Marwick, 2001). Following are elaborations of such transformation of knowledge:

Socialization (tacit to tacit):

Sharing of information within the health industry is monumental. These include the shared formation and communication of tacit knowledge between people by the act of socialization, interaction, and engagement and discussion among the health professionals. For example, when a new medical problem appear in a particular heart disease case, the professionals attending the case would meet to discuss the case amicably which may produce new tacit knowledge.

Externalization (tacit to explicit):

Tacit knowledge can also be transformed to become an explicit knowledge. For example, when attending a particular case, many questions and answers must be attended to. Every professionals involved will participate accordingly, and subsequently such discussion will produce new explicit knowledge. In this scenario, tacit knowledge has been transformed to explicit knowledge.

Combination: (explicit to explicit):

Sharing of knowledge and information is important. This can be done in many ways and avenues. For example, explicit knowledge can be shared in meetings, via documents and e-mails. Such practices will help the team members of a particular case to share the same explicit knowledge together and subsequently take appropriate actions.

Internalization (explicit to tacit):

In order to act on information, individuals have to understand and internalize the information. This involves creating personal tacit knowledge, and this can be achieved by efforts through research, and reading. It is through such efforts that the medical professional will develop and enhance his or her tacit (Marwick, 2001).

Technologies for knowledge management

The effects of technology on our daily life cannot be refuted. It is impacting on every facet of human activities, and knowledge management in the health industry is no exception. Explicit knowledge needs to be shared within professionals in organizations. With the assistance of technology, it is not necessary for the professionals to meet face-to-face during the working hours. Discussions, meetings are now made possible through on-line discussion, teleconference and emails, and this has significantly changed how organizations work and function. (Marwick, 2001).

In particular, software like Lotus Note groupware's is an innovative technology that facilitates the sharing of documents and discussions. It allows users to have asynchronous discussions. Such software which is known as groupware helps individuals to work together in groups or teams. Groupware can to some extent support all four facets of Nonaka's knowledge transformation model.

The babble system is another type of knowledge sharing, but much more like conversation. With this system, tacit knowledge could be formed and made explicit. Nevertheless, not all on line meeting systems have the properties of face to face meeting. For example, the videoconferencing system was more like a video telephone rather than a face to face meeting.

Online discussion database is another tool that has the potential to capture tacit knowledge. For example, newsgroups and similar forums are accessible to all, unlike the typical team discussion. Newsgroup browsing application illustrates how user friendly it is to engage in an open discussion to discuss a particular issue or in response to a request for help or question. The readers or participants of the forum will read and discuss the issue or problem and will advance those ideas in writing. Such responses produces explicit knowledge which can be of value and beneficial to many. When the knowledge is made explicit, persons with similar problems can find the solution by consulting or referring the archive of discussions made.

The accessibility of such discussion can be made to all if not many professionals and workers in the organization. This example is one of many other evidence to show how document management system technology, through the ubiquitous use of word processing able to generate electronic documents make it easy for us to share information and knowledge via web, email.

Nevertheless, the popularity of online data and search engines too has negative effect effects. One in particular, information overloaded is a reality face by many of us. These of course make it more challenging to find what most reliable and valid knowledge is.

Knowledge management system

Knowledge management system is a system for managing knowledge in organizations. Such system supports, capture, store and disseminate the information. It can be part of a Knowledge Management initiative in organization. KM system is important because it could share valuable organizational information; avoid re-inventing; reducing redundant work and may reduce training time for new employees, and helps retention of intellectual property in situations where employee leaves. This could be made possible if such knowledge can be codified.(Kucza, 2001)

Knowledge management process

The main idea of a KM system is to enable employees to have access to the organizations based documented of facts, sources of information, and solutions sharing this information organization can lead to more effective engine design. It could also lead to ideas for new or improved equipments. For example, a typical claim justifying the creation of a KM system might run something like this: An engineer might know the metallurgical composition of an alloy that reduces sound in gear systems. Sharing this information, the organization can lead to more effective engine design. This could also lead to ideas for new or improved healthcare equipment which in turned may provide better health services and treatments to patients. This can be further viewed in Figure 2.

From the diagram in Figure 2, the main processes are well distributed in a systematic cycle which consists of the following:

  1. Identification of need:
  2. Identifies a need for knowledge and determines it.

  3. Sharing:
  4. Sharing is initiated to find out whether existing knowledge can be used, and this process is pursued by those who needs the information and knowledge (knowledge pull) and the feeding of knowledge to the recipients who need those knowledge (knowledge Push).

  5. Creation:
  6. If the needed knowledge is not available, creation of new knowledge is initiated.

  7. Collection and Storage:
  8. The new knowledge (the result) has to be collected. This is done in a process known as "knowledge Collection and Storage".

  9. Update:
  10. When there is new change on the old knowledge, the knowledge is revised and updated.(Kucza, 2001)

Knowledge management cycle

Knowledge management system follows a six steps process in a cycle as shown in (Figure 3). The reason the system is cyclical is that knowledge is dynamically refined over time. The knowledge in a good KM system is never finished because over time, the environment changes and the knowledge must be updated to reflect the changes. Today's knowledge may become obsolete if the organization fails to update the knowledge. The cycle works as follows:

  • Create knowledge: Knowledge is created as people determine new ways of doing things or develop the 'know-how'. Sometimes external knowledge is introduced. For example, using the old tacit knowledge cases in order to solve new cases by comparing the cases that they have with the old cases in order to make the right diagnose of a particular patient.
  • Capture knowledge: New knowledge must be valued and represented in a reasonable way. For example, when a medical professional i.e doctors, sergeants, nurses, etc. solves a new medical case, so he/she has captured new knowledge. Therefore, when the professional wants to represents the solution of that diseases, the newly found knowledge should be presented in a reasonable way to ease understanding among the audience or related professionals.
  • Refine knowledge: New knowledge must be placed in proper context so that appropriate actions can be made. This is where human insights (tacit qualities) must be captured along with explicit facts. For example, when someone has new knowledge to present, the presentation should depend on explicit facts or knowledge available.
  • Store knowledge: Useful knowledge must then be stored in a reasonable format in a knowledge repository so that others in the organization can access it. For example, storing the knowledge in electronic medical records will help other medical professionals to access that information at any time.
  • Manage knowledge: Like a library, the knowledge must be kept current. It must be reviewed to verify that it is relevant and accurate. When a nurse create knowledge, that knowledge must be reasonable and not reflecting other irrelevant facts.
  • Disseminate knowledge: Knowledge must be made available in a useful format to anyone in the organization who needs it, anywhere and anytime. For example, when a nurse introduces new knowledge, it should be clear and easy to understand for others to view and use it accordingly.

In summation, knowledge management is useful and can be employed in almost all facets of human's life. The following section will show how knowledge management and technology can be used in hospitals in general and in nursing in particular.


Two hundred years ago, at the beginning of the 19th century, society was still largely rural and agrarian. Medical theory had begun to advance during the Renaissance, but practical medicine was still primal and largely the domain of homeopaths, herbalists, midwives, barbers and home remedies.

In that time medicine was not regulated and any one can become a doctor. Its not surprisingly some times the cures will be not that good, and sometimes it can be worse than home cures, many were considered quacks and the profession itself was poorly regarded. Therefore, because of the Industrial Revolution the need for modern healthcare become needed, this is because it urbanized the population, narrowed its skills, and put people to work away from home. This had several affects. Denser populations concentrated healthcare needs.("Healthcare History and Issues," 2004)

In addition, specialization increased the dependence on others for services; working away from home reduced the ability of the family to provide home care; and industrial accidents and illnesses increased the demand for healthcare services.

During the first half of the century, doctors were viewed with suspicion and disdain. There were few hospitals, and these had been started as the healthcare component of the poorhouse and the people they treated were indigent, old, and disenfranchised("Healthcare History and Issues," 2004)

Perhaps the most important medical development of the 19th century was the understanding of the nature and cause of infection, As the results of medical treatment improved, the fear of medical care began to subside, patent cures and other non-science based medicine began to wane, and respect for the profession increased.

In 1900, there were only a few hundred hospitals in the United States. By the year 1930 there become 7,000 hospital in United state. We can see that there become huge revolutions in healthcare in a short period. This dramatic increase was due to the development of new techniques such as X-rays that could only be delivered in an institutional setting. Another factor helped enhancing healthcare in that time is the rise of the nursing profession that improved hygiene and the quality of care.("Healthcare History and Issues," 2004)

In order to provide a good healthcare we must not ignore these Reasons:

The substantial progress in health over recent decades has been deeply unequal, with convergence towards improved health in a large part of the world, but at the same time, with a considerable number of countries increasingly lagging behind or losing ground. Furthermore, the nature of health problems is changing in ways that were only partially anticipated, and at a rate that was wholly unexpected.(Tim Evans, 2008)

Until the early part of twentieth century, very little could actually be done in hospital to improve the health of patients. Quite often, the rich can afford better health services than the poor ones. Today, patients want to have good and fast care by nurses. This depends largely on how nurses assess, plans, implements, evaluates and diagnose the patient in a short.(Hsia et al., 2006)

Today, healthcare has become the first aim for any country; this is because countries must provide a good healthcare service in order to avoid there people the sickness and it reflects on there behavior, so these countries will think how they can development there healthcare in rural and urban areas.

In addition, many healthcare services are now delivered in outpatient settings, where patients receive the required care, and then allowed to leave. During such care, patients assume significant responsibility for monitoring their own health status, managing their recovery, and communicating with clinicians from home. This increasingly distributed system of specialized outpatient health care places new demands on patients.(Pratt, Unruh, Civan, & Skeels, 2006)

It is important to realize that healthcare system has three primary goals: the provision of high-quality care, ready access to the system, and affordable costs. The practical problem in health care policy is that the pursuit of any two of these goals aggravates the third. Thus, a more accessible system of high-quality care will tend to lead to higher costs, while a low-cost system available to everyone is likely to be achieved at the price of diminishing quality. In order to have a good healthcare service, healthcare providers must work as a group , they have to share all their experiences to solve any problems faced by them. Therefore, it is imperative for the healthcare providers to work together.

Healthcare process

According to dictionary, a process is "a system of operations in producing something series of actions, changes, or functions that achieve an end result". Thus, healthcare process can be defines as a set of activities, methods, practices to provide healthcare service, and maintain the environment that support the service provider.

As healthcare processes are characterized by the fact that several organizational units can be involved in the treatment process of patients and that these organizational units often have their own specific IT applications, it becomes clear that getting data, which is related to healthcare processes, is not an easy task for example diagnostic tests, medical treatments, and laboratory examinations protect and restore health and save lives .(Mans, Schonenberg, Song, van der Aalst, & Bakker, ; Marrow, 2005)

Nursing process

In 1980, The American Nurses' Association defined nursing as "The diagnosis and treatment of human responses to actual or potential health problems." The practices (steps) of the nursing process including assessment, diagnosis, plan, implementation, and evaluation are cyclic, overlapping and interrelated.

  • Step 1, assessment, is the most critical step and answers the questions: "What is happening (i.e., actual problem)?", or "What could happen (i.e., potential problem)?" This step involves collecting, organizing, and analyzing information/data about the patient. That is two parts: data collection and data analysis. In general, the data collection is a holistic approach and the methods of data collection can be observation, interview, and examination. The data types include subjective and objective data. The former can be "symptoms" that the patient describes; e.g. "I can't do anything for myself." The later can be "signs" that can be observed, measured, and verified; e.g., swollen joints.
  • Step 2, diagnosis, is a statement that describes a specific human response to an actual or potential health problem that requires nursing intervention.
  • Step 3, plan, provides consistent, continuous care that will meet the patient's unique needs, includes patient goals and nursing orders. The patient goals are directly related to the patient's problem as stated in the diagnosis, which describe the desired result of nursing care and the nursing order describes what the nurse will do to help the patient achieve the goals.
  • Step 4, implementation, involves applying the skills needed to implement the nursing order. The major tasks include reassessing the patient, validating that the care plan is accurate, carrying out nurses' orders, documenting on patient's chart and so forth.
  • Step 5, evaluation, compare the patient's current status with the stated patient goals and has three different operations or purposes: evaluation of the quality of the written care plan, evaluation of the client's progress, and evaluation of the status/currency of the care plan.(Hsia et al., 2006)

Clinic process

Health care practices are characterized by complex clinical processes in which high risk and high cost activities take place. A clinical process can be view as particular workflow where medical (e.g. treatment, drug administration, guideline execution and medical) and non-medical (e.g. patient enrollment, medical records instantiation) activities and events occur.(Massimo Ruffolo, Marco Manna, Vittoria Cozza, & Ursino, 2007)

Semantic information extraction, the clinical process to obtain information from unstructured sources, and stored in the structure of machine-readable form. This large amount of data can be in the data mining technology can detect patterns of adverse events, errors and cost dynamics, hidden in the structure of clinical trials, the risk of his career and poor performance.

The maintaining of patient records requires a lot of time and effort, even in the cases that is well documented. Furthermore, patient records usually do not capture information from communication sessions (e.g. face-to-face communication) between physicians. Nevertheless, Investment in new medical equipment and the training of doctors is very cost-intensive, can hardly proper management of the clinical process to wake up. Consequently, we draw on PROGEMM (PRocess-Oriented GEneric Management of Medical Knowledge ) in order to support the specification, maintenance, and execution of clinical processes(Maximini & Schaaf, 2003)

Information communication technology in healthcare

Healthcare information technology

In general, IT allows health care providers to collect, store, retrieve, and transfer information electronically. However, more specific discussion of IT in health care is challenging due to the lack of precise definitions, the volume of applications, and a rapid pace of change in technology.

Information technology (IT) has the potential to improve the quality, safety, and efficiency of health care. The volume of application, and a rapid of change in technology. Drivers of investment in IT include the promise of quality and efficiency gains. Barriers include the cost and complexity of IT implementation, which often necessitates significant work process and cultural changes. (Glenn M. Hackbarth, D. Reischaver, & E. Miller, 2004)

Information technology software's used in healthcare

There are several software technologies and terms are used in healthcare in order to improve healthcare quality and services such as:

  • Electronic health record (EHR):
  • EHRs were originally envisioned as an electronic file cabinet for patient data from various sources (eventually integrating text, voice, images, handwritten notes, etc.). Now they are generally viewed as part of an automated order-entry and patient-tracking system providing real-time access to patient data, as well as a continuous longitudinal record of their care.(Baron, Fabens, Schiffman, & Wolf, 2005)

  • Computerized provider order entry (CPOE):
  • CPOE in its basic form is typically a medication ordering and fulfillment system. More advanced CPOE will also include lab orders, radiology studies, procedures, discharges, transfers, and referrals.(Campbell, Sittig, Ash, Guappone, & Dykstra, 2006)

  • Clinical decision support system (CDSS):
  • CDSS provides physicians and nurses with real-time diagnostic and treatment recommendations. The term covers a variety of technologies ranging from simple alerts and prescription drug interaction warnings to full clinical pathways and protocols. CDSS may be used as part of CPOE and EHR.(Kawamoto, Houlihan, Balas, & Lobach, 2005)

  • Picture archiving and communications system (PACS):
  • This technology captures and integrates diagnostic and radiological images from various devices (e.g., x-ray, MRI, computed tomography scan), stores them, and disseminates them to a medical record, a clinical data repository, or other points of care.

  • Bar coding:
  • Bar coding in a health care environment is similar to bar-code scanning in other environments: An optical scanner is used to electronically capture information encoded on a product. Initially, it will be used for medication (for example, matching drugs to patients by using bar codes on both the medications and patients' arm bracelets), but other applications may be pursued, such as medical devices, lab, and radiology.

  • Radio frequency identification (RFID):
  • This technology tracks patients throughout the hospital, and links lab and medication tracking through a wireless communications system. It is neither mature nor widely available, but may be an alternative to bar coding.(Sarma, Brock, & Engels, 2001)

  • Electronic materials management (EMM):
  • Health care organizations use EMM to track and manage inventory of medical supplies, pharmaceuticals, and other materials. This technology is similar to enterprise resource planning systems used outside of health care.(Glenn M. Hackbarth et al., 2004)

Information technology hardware's used in healthcare

Hardware can be divided in three parts which healthcare providers can use in there work. The three parts are:

  • Large hardware

    • Magnetic resonance imaging:
    • Is primarily a medical imaging technique most commonly used in radiology to visualize the structure and function of the body. It provides detailed images of the body in any plane. MRI provides much greater contrast between the different soft tissues of the body than computed tomography (CT) does, making it especially useful in neurological (brain), musculoskeletal, cardiovascular, and cancer imaging. ("magnetic resonance imaging," 2006)

  • Big hardware

    • X-ray machine:
    • An X-ray imaging system consists of a X-ray source or generator (X-ray tube), and an image detection system which can either be comprised of film (analog technology) or a digital capture system.

  • Small hardware:
  • These small hardware can be used by physicians and nurses it depends on what they want to use it for, we will review three devices that physicians and nurses can use in there work such as:

    • Tablet PC
    • Tablet PCs are full-featured computers designed in a portable size with a special tablet version of the operating system installed; they are smaller than laptops and come with a writing stick (pen) that replaces the keyboard and mouse. Rather than replace software, they make any software such as word processors, Acrobat, or Markin, "writable" so that the instructor is using a familiar tool to produce familiar results for the student.

      Tablet PC Advantages

      • Editing is performed directly on student's word-processed paper with no extra software required.
      • Instructors mark the document using the same method used in standard paper marking— write on it directly (in black or colors).
      • Students see marks where they need to edit.
      • Preserves complex formatting, fonts, and graphics exactly as the student created the document.
      • Marked documents are returned to the student in the same document type as submitted with no conversions or readers needed.
      • Portable (grade it in the car, on a plane, or in the office as usual).

      Tablet PC Disadvantages

      • Expense—because the machine is a complete computer, it costs around $2000 plus the standard software that must be installed.
      • While the results look like the original document, in the original format, the file is actually a graphic and cannot be edited by the student (also an advantage) although the instructor can edit the file.
      • Hand writing recognition (Jennings & McCuller, 2004)

    • Pocket PC
    • Handheld device that enables users to store and retrieve e-mail, contacts, appointments, tasks, play multimedia files, games, exchange text messages with Windows Live Messenger (formerly known as MSN Messenger), browse the Web, and more

    • Personal Digital Assistant (PDA)
    • Is a handheld computer, also known as a palmtop computer. Newer PDAs also have both color screens and audio capabilities, enabling them to be used as mobile phones, (smartphones), web browsers, or portable media players. Many PDAs can access the Internet, intranets or extranets via Wi-Fi, or Wireless Wide-Area Networks (WWANs). Many PDAs employ touch screen technology.

Handheld devices come in two types of operating systems, Palm OS and Windows CE (Pocket PC). While Palm OS PDAs are recommended for their lower cost, broad variety of software, and better reliability, students can use Pocket PC PDAs if they choose to do so. Much more medical software is available for Palm than Pocket PC. The comparative difference is the operating system (Palm OS vs. Window CE). If you are more familiar with the Windows interface and interested in the multimedia features, then a Pocket PC PDA might appeal to you. Otherwise, we suggest the Palm PDA. Pocket PC is strongly not recommend for users that own Apple computers. If you prefer to buy a Pocket PC, however, we would suggest you consider the following models.("Medical Patient Encounter Application," 2005)

Technology in healthcare

Technology has many impacts on healthcare. For example if the doctors or nurses or other care givers want to monitor the status of their patients, they can use the wireless sensor network which enables them to know the status of their patient by receiving all changes or data of the patient on the Personal Digital Assistant (PDA) anywhere they may be at the hospital(Ashraf, H?rk?nen, H?m?l?inen, & Riekki, 2007).

In clinics, we can see that technology has a direct impact to assist in executing the clinical process by providing intelligence functionalities based on workflow mining techniques, and in monitoring process during their execution. The doctor can know all the information about his or her patient, and the doctors could monitor the patient while he is in his room(Curia, Gallucci, & Ruffolo, 2005).

Technology can also help people with chronic conditions. By providing continuous home monitoring service, this will reduce the hospital operating costs. Therefore, this will increased efficacy of health care service delivery of patients who suffer form chronic diseases such as weakness of the heart muscle, chronic obstructive pulmonary disease and diabetes, and others (Prentza et al., 2006).

During a patient's life time, he or she will receive treatment form many different healthcare providers and each of these healthcare will store information of the person's medical history. Having such information available in away that it could be easily retrieved is important not only for the patient but also for healthcare providers. For this reason we want to have a standard for data integration and knowledge sharing in healthcare using resource description framework (RDF) in order to have the history of the patient in less time and less effort (Nardon, de Assis Moura Jr, & de Faria Leao, 2004).

Constantly patients want emergency rooms and clinics for treatment, and they seldom saw the same doctor once or twice. Therefore the new doctor will start form the beginning with them to diagnose there situation, that will cost them money and they will lose time. In addition, photo ID card with patient data on magnetic strip is now made possible and integrated. Thus, if a new doctor wants to diagnose on a patient, he or she can know all his medical history by accessing to the system and typing the patient's ID. As a result, patient will have a fast and good treatment even if the doctor or nurse at that time diagnoses the patient for the first time (Larsen & Pedersen, 2001).

PDA is one tool that can used to provide a good healthcare assistant. Via knowledge management techniques on PAD systems, such technology can provide an effective healthcare service to the needy ones.

With PDA technology, there are many tasks that nurses can do for example:

  • Nurses assess patient health status quite often through the patients' file, but this takes time and effort. With PDA such information can be stored in the pc and the the nurse involved can access from her PDA to the patient file and take the data that she needs (Rodriguez et al., 2003).
  • Evaluate the patient's response to the care provided. The nurse can use the PDA to evaluate the patient's responses and actions. This is much better that conventional practices where the nurse evaluate and check the patient's response manually by writing every thing in the papers (Berglund, Nilsson, Révay, Petersson, & Nilsson, 2007).
  • The nurse can give health teaching and continuously educate the patient and the family using PDA. The nurse will use the PDA as a reference and a backup data. Therefore, there will be no worries to forget any instructions or giving wrong information and advice to the patients and families (White et al., 2005).
  • Discharging of the patient and all the relevant discharge processes can be assisted by the PDA. The nurse can receive on her PDA a message that a new patient has just been registered in the hospital, and all information about that patient. Like wise, when the patient is discharged, the nurse can send SMS to the reception so they can prepare all the relevant documents (White et al., 2005).
  • Administration of oxygen therapy can also be made using the PDA.
  • Check blood pressure can also be assisted using the PDA.
  • The nurse can also calculate the percentage of the fluid intake and output with the PDA.
  • Hand over shift report and a summary of the patients' condition can also be made available to the next shift, through data transfer from the PDA to the next nurse on shift so the nurse will know all the information that she needs about the patient(s).

The above evidently shows the potential of PDA technology in the health industry. PDA has a direct impact in hospitals in providing a better healthcare to patients. We can use technology for knowledge sharing in healthcare by using a semantic web standard and concepts. By using a good electronic health record (GEHR) will give us the opportunity to exchange data among different healthcare areas, sections and professionals., With proper guidelines, users will be able to find the right information when needed (Nardon et al., 2004)

PDA in Education

The powerful and the small size of PDA's can provide much for education. It can encourage students to learn by providing both individualized and collaborative learning activities, and to eliminating the physical constraints of the classroom setting. The use of non-traditional settings can result in more effective/meaningful learning in real situations or contexts.

PDA's also can be a range of information processing devices and media-orientated gadgets that play video and MP3 music files. All these devices share the key characteristic of mobility and, to varying degrees, they can process digital data and digital media. Moreover, ever greater numbers of these devices are becoming Internet-enabled.(Anderson & Blackwood, 2004)

PDA in Medical Education

the PDA has become an extremely valuable tool for the medical student attempting to master an immense body of knowledge in the setting of a hectic clinic or ward. It also can be useful in medical education and clinical practice, particularly to access net-based information as needed and takes up questions regarding how the medical students, dispersed in a variety of local patient care sites, use the Internet to access and apply relevant knowledge and information for their training practice with patients. It also explores how the participating medical students make use of mobile communication and the Internet to keep and build collaborative support structures with their fellow students.(Sm?rdal et al., 2002)

PDA's are used in medical schools centers around a variety of medical and drug references, clinical prediction applications and data/charge collection tools. These applications are viewed by all as effective tools to save time, improve accuracy of data collection, reduce medication errors, improve management and recording of patient information and facilitate accurate documentation of care provided thus increasing charge capture.

PDA can be used as a direct reference materials. For example, many student and resident lab coat pockets are heavy with pocket manuals in order to use it as a reference. Most of the popular texts such as the Washington Manual of Medical Therapeutics, Ferri Practical Guide to the Care of the Medical Patient and Griffith's 5 Minute Clinical Consult are available as programs for Palm OS based computers. Thus, having the information available at the point-of-care, whether it be at the bedside or in the clinic, helps residents to make better decisions and outline better, more thorough courses of treatment for our patients.(Young, 2009)

In some instances, using these devise could be a good business. For example, the Visiting Nurses Association (VNA) Home Health Systems, in Santa Ana, Calif. — began using PDA's as an employee retention tool. In 2000, VNA was one of the first home healthcare organizations in the nation to develop PDA software for nursing staff that would improve accuracy, save time and update paperwork. PDA can help in search for the data and informations and it can help in collecting data. Therefore, Incorporate new knowledge into clinical practice will help the medical communities.(Ulfelder, 12/23/2002)

Knowledge management in healthcare

Healthcare management is a hidden career. When we think of a hospital or a clinic, we tend to think of physicians, nurses, and other caregivers. The myriad of people who work in the organizations that support health services delivery organizations, like insurance and managed care companies and government policy-making and regulatory agencies, are even more invisible and are not who we think of when we hear the phrase "health services." However, they play very important roles in making health services available and accessible.

Healthcare in Rural area

In order to provide a good healthcare for the whole country, we must not forget to provide a good care for people who live in the rural areas as they may be the group of patients that are in need due to their economy status and background. Such areas are distinct from the more intensively settled urban and suburban areas, and from unsettled lands such as the outback or wilderness. The lifestyle in rural areas are different from those in urban areas depending on the area, mainly because the limited public service. Therefore, in order to provide a good healthcare service in rural areas we must start thinking how we could help to improve the health service in these areas. Evidently, there are many obstacles faced by clinic in a rural area for example:

  1. Travel
  2. Peripheral leads to increased travel by both health professionals and patients. Nurses have reported that they see a lower number of patients in a day than their urban counterparts because of the travel distances involved.

  3. Staff recruitment and retention
  4. In remote rural communities staffing levels of health, services tend to be static with a low turnover. However, because there is a need for more senior, experienced staff who can work autonomously in a range of roles, salary bills is often high.

  5. Access to continuing professional development
  6. Health practitioners frequently find it difficult to access continuing professional education (CPD), because of the distance involved in traveling to higher education facilities , and lone workers and single handed GP services finding it difficult to obtain locum cover. Furthermore CPD may not necessarily focus on rural issues mean that practitioners are not appropriately updated on those issues important for working in rural areas.

  7. Equipment and resources
  8. For allied health professionals it can be difficult to obtain and transport equipment for use in out-lying areas. This can result in practitioners having to use their own cars for transportation limiting the amount of equipment delivered. Additionally, demand often outweighs supply and patients often have to wait a long time for certain equipment.

  9. Delivering care at a distance
  10. Emergency services have difficulties meeting response times in rural areas and this can have serious health consequences, for example delays in administering thrombolysis, defibrillation and treating abdominal aortic aneurysm. Consequently, prognosis can be poor, resulting in mortality or poor health outcomes.(Dower, 2008)

    These include access to physicians, dentists, nurses, and mental health services; the financial circumstances of the rural hospitals; federal rules concerning Medicare reimbursement rates, and the impact on rural hospitals and healthcare professionals; and the consequences of all of these on the health of rural people in general. (Strong, Trickett, Titulaer, & Bhatia, 1998)

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