Advancing Healthcare through the Application of Predictive Knowledge Management

Authored by:
Kevin Fickenscher, MD, CPE, FACPE, FAAFP
Perot Systems Vice President of International Healthcare

Executive Summary

As a practicing physician, I often wished there was a way to look into a crystal ball and foresee the obstacles that would keep me from providing the best care for every patient.  Every day, providers are faced with situations that could have been predicted—the shortage of flu vaccine, adverse drug events that become clear when distributed data are pulled together following the widespread use of a medication, or predictable changes in surgical outcomes associated with the use of particular techniques in caring for trauma patients.  As the granularity of clinical information becomes more dominant in healthcare, we can anticipate that clinicians will need—and, in the future, demand—the use of predictive knowledge management as a tool for supporting the care process.

The purpose of this white paper is to provide a high-level overview and analysis of the evolving field of data warehousing, mining, and analytics known as Predictive Knowledge Management (PKM), which is an approach for proactively understanding the essentials of the care delivery process and its outcomes in order to improve care delivery.  

PKM provides value-added capability and service for clinicians as a resource for more effectively managing the process, safety, and outcomes of care.  It combines operational, business, and clinical data into a common platform so that healthcare organizations can more effectively manage a variety of processes and address critical issues that impinge on their ability to provide care and adjust to market challenges. 

The important point to understand is that PKM is not a quick-fix solution.  Rather, it is a strategic change in thinking and an approach to providing care within the healthcare industry.  It can be compared to an overweight, diabetic person making “life changes” versus going on a “diet.”  Life changes are long-term commitments to behavioral changes that not only affect our eating habits, but also fundamentally alter our living habits.  Companies who make the quantum leap into a PKM mindset or strategy must look at information as a corporate asset and not simply gather data that is pertinent to the accounting, basic reporting, or operational functions of the organization.

Beyond the four walls of any given organization, PKM takes information management a step further by providing reliable data and projections on the upstream and downstream effects of any given issue, trend, or strategy within the overall healthcare continuum.  PKM could be an important element in creating and maintaining directed and cogent thinking among the disparate healthcare ecosystem constituents (payers, CMS, providers, life sciences) within a given ecosystem creating a basis for consensus- driven benefit and cost balancing.  From the outputs of reliable PKM could eventually come documented plans that lend credibility and conviction as it relates to potential and actual investment in new reimbursement or care delivery programs.

On January, 31, 2007, in an interview with The Press-Enterprise, Kaiser Permanente’s chief medical information officer announced that “all of Kaiser’s 84 Southern California clinics will be able to check medical histories, lab results, progress notes, and order prescriptions for 2 million patients with the push of a button by the end of the year.”  The article also stated that Kaiser Permanente will, ultimately, spend about $3 billion to create its national medical records database and provide a significant foundation for future PKM efforts.  The Kaiser effort—like all true PKM efforts—is focused on integrating operational, financial, clinical, and community-based healthcare data to create a truly person-centric view of healthcare services ¹.

This is not the only example of massive investments with the intent of shifting information utilization toward a predictive understanding of the patient.  From a healthcare payer perspective, Harvard Pilgrim Health Care and Humana are also using data mining and medical informatics to identify early indicators of serious disease to help address patient healthcare needs before they become seriously ill ².

I anticipate that PKM will serve as a core differentiator for healthcare organizations in the not-too-distant future as they engage in work to enhance safety, drive efficiency, reduce cost, and effectively manage outcomes.  PKM will become, over the next decade, the requisite platform for healthcare organizations that are seriously pursuing an agenda to drive immediate value in the care delivery process and to focus future investments in healthcare.

This document provides:

• An assessment of the environment and market pressures that the healthcare industry faces today.
• An overview of the state of Predictive Knowledge Management solutions, as well as the technologies and processes that support this evolving tool.

My personal thanks are extended to the many Perot Systems associates and other professional colleagues who offered their comments, suggestions, and critiques by reviewing the white paper at various stages of its development.  I especially thank my non-Perot Systems colleagues – Tonya Hongsermeier, MD; David Ballard, MD; Carol Diamond, MD; Dale Prestipino; Daniel Foltz; and Vi Shaffer who have provided me with valuable insights and perspectives over the last several years as well as my Perot Systems colleagues – George Yurek; Matthew Kristin; Michael Bakerman, MD; Susan Noack; Joseph Blaha; Jack Richardson; Marina Mataraga; Dave Marchand; Mark Galea; Kathleen Catalano, RN, JD; Shawna Koch, RN; and Kristi Adams for their ongoing and diligent efforts in supporting the preparation of the white paper.  These colleagues, both individually and collectively, have contributed substantially to my personal education on the issues and implications of PKM, as well as assisted in framing the ideas embodied in this white paper.

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