As Vanderbilt University Medical Center’s (VUMC) hub for capturing, organizing, and preserving knowledge integral to institutional operations, the Center for Knowledge Management (CKM) creates, connects, and maintains rich, contextualized documentation of enterprise-wide initiatives.

To support process optimization and workflow best practices, CKM works with our collaborators to provide data-driven solutions.  CKM helps illuminate multiple potential paths and the costs and benefits of each, by combining internal data, expert content knowledge, and the best available evidence. We also help to identify priority efforts that are likely to give the highest return on investment, again via detailed and iterative analyses of supporting data and evidence.

Applying these skills to clinical decision support (CDS), CKM helps ensure the continuance and validity of local practice through the creation of format-agnostic metadata and application of the best current evidence. Prior to VUMC's 2017 implementation of eStar, the CKM team worked with HealthIT to understand, extract, and organize CDS content from the existing clinical systems for reuse within eStar and potential future clinical systems. 

This CDS data is represented as rich metadata within the CKM-created Clinical Support Knowledge Acquisition and Archival Tool (CS-KAAT).  Externalizing and translating CDS content into human-readable form, organized within a structured schema, enables the discovery of linkages among related CDS content and facilitates reuse external to the CDS native environment. CKM created this schema to represent critical concepts in logic and data flow, content lifecycle, and relationship to underlying evidence. Knowledge is represented in a format-agnostic, descriptive format to simplify analysis by many parties including content developers and clinician-users. 

Leveraging CKM’s expertise and experience in evidence provision, CKM information scientists use CS-KAAT to document the relationship of each concept within the CDS rules (medication dosing, drug-drug/drug-genome interaction checking, homeostatic ranges, etc.) to the evidence. The evidence-based concepts that unite this embedded CDS content allow CKM to discover and relate key ideas independent of the executable format it currently takes.  Within CS-KAAT, these evidence-based concepts consist of a synthesis of relevant published literature, select filtered references and expertly-formulated search statements enabling dynamic updates on the topic.

Building upon the existing schema created for the VGRs and Indicators and the expertise developed through years of providing evidence to support VUMC order set creation, CKM has next prioritized another part of the institution’s CDS portfolio - inpatient and outpatient order sets -for capture and preservation within CS-KAAT.   Likewise, these externalized records are presented in a human-readable format and explicitly linked to evidence-based concepts. Their residence alongside other extracted content enables sharing of evidence and other linkages among various CDS types and allows for a broader visualization of the practices surrounding specific orderables, workflows, and patient types throughout the clinical enterprise.

CS-KAAT’s underlying evidence architecture also supports the development of new knowledge products in the VUMC Lab Tests Expert Guide & Data Repository.