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EHR Corner

'Knowledgement' Defined

While writing about how clinicians are knowledge workers and have special requirements in using information technology (IT), a typo merged knowledge and management into knowledgement. This term truly reflects the core function of electronic health records (EHRs), and needs to be understood by all stakeholders. EHRs are not just about managing data or even turning data into useful information; EHRs must support the ability to apply clinician experience to information in support of enhanced knowledge.

The primary purpose of traditional medical records has generally been to serve as a means of communication among clinicians, and for clinicians across episodes of care. Paper records have not served this function very well. Thus most clinicians generally view medical records in terms of providing documentation. As such, they are seen as a necessary evil. But IT gives us the opportunity not only to improve upon the communication and documentation functions but to help manage health care knowledge.

Many talk about the level of change introduced by EHRs and the need for clinician stakeholder engagement. Few, however, acknowledge that not only must clinicians learn how to enter and retrieve data differently, but they must also understand how to best utilize its knowledgement functions. This aspect of EHR adoption requires a considerable level of trust in the system and its capability to truly support clinician use of information.

A non-linear process
Knowledge workers are best characterized as using a high level of heuristic thought. Unlike how IT was first used, knowledge workers do not process data linearly. So IT that requires a knowledge worker to find data by accessing a sequence of screens or recording data in a structured manner is outside the course of normal practice. They remember that what they want is "on the blue paper, three-quarters of the way through the chart." They want to be able to record a pertinent finding about one body system even though they may be examining another part of the body.

Knowledge workers often must act with incomplete data. Not only because the chart may be missing, but because the patient may be comatose and have no chart, or not know his/her family history. Most important, medicine is as much an art as a science. A drug that normally acts a certain way may suddenly act differently in a given patient for no apparent reason. Knowledge workers continuously refine their knowledge through new experiences with new data and information.

Given these characteristics and the black-and-white nature of IT, is it any wonder that trying to get knowledge workers to use IT is often frustrating? We should concentrate on the features of IT that work in favor of its adoption: If designed properly, IT can search huge volumes of data, perform many comparisons rapidly and accurately, and even "learn" how to process data heuristically.

The keys to such functions are correct programming, availability of data to be processed and sufficient capacity. Humans must do the programming correctly, enter or identify the data to be entered, and be willing to pay for the necessary capacity. Those functions require interaction of knowledge workers with IT developers. Such interaction develops trust between knowledge workers and the technology -- because the workers learn how the systems have been designed and grow to trust IT to support them.

Pursuing knowledgement should make systems more intuitive. In turn, organizations will establish the trust needed for clinical knowledge workers to believe that the system has been designed properly and can support the way they work. 

Margret Amatayakul ("Margret A") is president of Margret\A Consulting, LLC  and a principal in Health IT Certification, providing EHR and HIT training and consulting services. You can e-mail her at, or visit her Web site at

Mike Cohen is president of MRC Consulting Group, a Wheaton, Ill., firm dedicated to helping health care organizations make good decisions and get more value from their information systems investments. He is also a principal in Cardinal Consulting, Inc.   You can e-mail him at or visit his Web site at


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