KNOWLEDGE MANAGEMENT FOR CLINICAL DECISION SUPPORT Requirement Analysis of Collaboration Tools for...

Technical Report

DSG-TR-2004-23

KNOWLEDGE MANAGEMENT FOR CLINICAL DECISION SUPPORT

Requirement Analysis of Collaboration Tools for Content Management

Margarita Sordo, PhD, Decision Systems Group, Harvard Medical SchoolTonya Hongsermeier, MD, MBA, Partners Healthcare Robert A. Greenes, MD, PhD, Decision Systems Group, Harvard Medical School

Collaboration and Content Management Requirements AnalysisMargarita Sordo / October, 2004

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Contents

1 Introduction.........................................................................................................................32 Methodology .......................................................................................................................33 Business Requirements ......................................................................................................44 User requirements ..............................................................................................................6

4.1 Content Life Cycle.............................................................................................................84.2 Content Users and Roles...................................................................................................94.3 Summary of Interviews ....................................................................................................10

5 Functional Requirements ..................................................................................................306 Gathering and Organizing Current Content: Knowledge Management Portal .....................31

6.1 Users........................................................................................................................316.2 Functionality .............................................................................................................316.3 Signature Initiative-based Taxonomy ........................................................................326.4 Filters .......................................................................................................................33

7 Product review..................................................................................................................347.1 MS Share Portal Point Server 2003 / SharePoint Services ........................................357.2 Groove Workspace...................................................................................................377.3 Livelink .....................................................................................................................387.4 Interwoven 5 (Includes iManage Worksite)................................................................397.5 IBM Lotus QuickPlace ..............................................................................................407.6 Documentum............................................................................................................417.7 CommunityZero........................................................................................................427.8 InfoPath....................................................................................................................437.9 Wellogic....................................................................................................................447.10 Product Summary.....................................................................................................46

8 Quality Requirements........................................................................................................469 Recommendations ............................................................................................................5410 Pending Issues .................................................................................................................5411 References .......................................................................................................................55Appendix A. Evaluation tool for knowledge management of computerized rules ...............55


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1 IntroductionPartners Healthcare Systems is a heterogeneous integrated delivery system comprising numerous hospitals and thousands of physicians. The clinical information systems that support care across the enterprise are equally heterogeneous, hence, clinical decision support content is of varying composition and structure across Partners. Further, this content is not easily shared or updated. A quote from the Brigham and Women’s Knowledge Inventory1 is illustrative:

“Tight coupling of decision-support logic and application logic compromises development, update, and portability of the rules. The BICS system has a wonderful inventory of rules that can only be maintained by a MUMPS programmer and cannot be shared as a service to other applications and/or Partners entities… …Currently, there is no single formal clinical body that is responsible for the development and maintenance of these rules. The revision history of the rules is not available online”..

In light of these challenges and Partners’ strategic goal of becoming an effective learning organization, this research project was undertaken to evaluate the current state of knowledge management practices across Partners entities and identify to key requirements for tools and infrastructure that support collaboration and content management. This includes support for guideline definition and consensus development among leadership and subject matter experts, conversion of reference content into a form that approaches specifications for decision support content (rules, order sets, drug information, and the like), documentation of content provenance and history, tracking of responsible parties, workflow tools to enable timely review and updating of content, knowledge life-cycle management, and knowledge encoding.

To evaluate current state practices, we conducted a series of interviews with champions and multiple domain experts involved in knowledge engineering of key knowledge assets within the various clinical systems at Partners. The result was a list of business, technical and user requirements. In parallel, we identified possible collaboration tool vendors, and organized product presentations. The information gathered through the presentations plus the implementation of use cases, help us further refine our list of suitable vendors. We have piloted a collaboration and knowledge updating process with a product from a leading suitable vendor in order to further refine our requirements and understand to what extent Partners must modify and extend a commercially available system to meet the unique requirements of this enterprise.

2 MethodologyIn order to fulfil Partners’ strategic goal of becoming an effective learning organization, we need to structure current knowledge and enhance its usability and consistency across Partners institutions, Following this criteria we identified current state practices by examining audiences(champions, developers, users), current state of information, needs, assets and limitations, processes and available technology. On one hand, we identified who needs and uses information, how that information currently supports their needs, and how such information is created. On the other, we evaluated current commercial products that support content management, and identified potential vendors. The steps followed are listed below:

1. We identified current key domain experts and champions involved in the production of knowledge used from the following organizations and content areas within Partners clinical systems: BWH:


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o Patient Safety/P & T committee (Alerts and Notifications) - Tejal Ghandi MDo LMR Results Manager/Ambulatory Care - Eric Poon MDo Patient Safety/Medication Management (Alerts and Notification) - Jennifer Cina

PharmDo Patient Safety/Medication Management (Alerts and Notification) - Jon Silverman

Pharm D MGH:

o MGH POE/Clinical Pathways (Order Entry and Templates) - Andrew Karson MD o MGH POE (Order Entry and Templates) - Michelle Cullen RN

DFCI:o Chemo Order Entry - Sylvia Bartell Pharm D

Brigham Circle- Center for Clinical Excellence:o LMR All Content/Ambulatory Care - Thomas Sequist MD

Information Systems/Ambulatory Care:o LMR/Ambulatory Care - Mike Sperling

Clinical Informatics R & D:o Common Medication Services/Medication Management - Carol Shek Pharm D/

John Nolan Pharm D

2. Designed an evaluation tool for eliciting information from experts in a consistent manner , so we could identify identifying key issues across different environments.

3. Interviewed champions to identify current practices for sharing knowledge, current needs, assets and limitations.

4. Identified key issues and desired improvements.5. Identified kinds of tasks currently in use within content management.6. Modelled content life cycle based on findings.7. Based on our findings, we defined the business and user requirements requirements 8. Identified content management vendors and conducted a preliminary evaluation of product

features based on identified issues and needs.9. Set up product demonstrations with vendors that at first seem to satisfy our requirements.10. Implemented and evaluated use cases with available products.

Ongoing activities:11. Evaluate vendors and follow up those products that can improve our content management

requirements. 12. Evaluate integration costs – no product provides seamless integration.

3 Business RequirementsHigh level objectives of the organization requesting the system or product

Currently, each institution within Partners has its own systems, repositories, data formats. Further, the lack of disciplined and cohesive way to collect, manage and publish content amongst institutions precludes sharing any knowledge in a transparent way. Even within each institution there are no procedures in place for developing and maintaining the knowledge used in applications

The primary benefit of integrating collaboration and content management tools into end-to-end knowledge management process is to provide users with the means to aggregate and structure content that is currently widespread within various hospitals among Partners, and to make such knowledge accessible to authorised users within the organization. Another benefit will be to enable standardization of clinical best practices regarding clinical decision support and to acknowledge and maintain content differences where applicable. The collaborative process and content would be available for clinical experts to understand how content decisions were defined and updated. Other than typical content such as word/pdf documents, domain specific structured


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objects such as rules and order sets can also come within the purview of these collaboration processes

Given the difficulties in generating design requirements for a collaboration and content management system, our approach has been to undertake a series of carefully scoped interviews, with the aim of generating a set of correspondingly scoped and informed design requirements for a collaboration and content management system to support knowledge management activities. The tasks chosen are to some extent representative of the kinds of activities engaged in by a number of collaborators within the knowledge management context.

A clear aim of the current study is to investigate how tasks may be implemented –for those processes not yet in place- and enhanced when supported by a collaboration environment. We also aim to identify the requirements for such a collaborative framework to ensure an optimal and consistent experience for users of a collaborative environment. The following is a list of major limitations in the current state that were identified as a result of the conducted interviews:

1. Information is kept in “silos”, isolated repositories created by authors in isolation from other authors. Information is hence, missing, duplicated, inaccurate, re-created many times, not accessible to users, etc.

2. Information is organized, structured and displayed according to author’s own criteria.3. Lack of appropriate tools for creating, storing, organizing, retrieving, reusing documents.4. Lack of standard formats for structuring information.5. Poor communication within authors leading to inconsistencies, uncertainty in validity of

content6. Reduced awareness of information generated by other projects, tools, etc. leading to

inconsistencies, duplication, incompatible technology, etc.7. Lack of standardization and consistency of information created by multiple authors -

unaware of existing information- leading to confusion, and potentially incorrect data.8. Higher costs of content creation, management and delivery. Due to the lack of standard

procedures a piece of information is recreated, “massaged”, and stored many times, in multiple formats, in different places.

We believe that a unifying content strategy and process will be of benefit to the organization. Such strategy can help to avoid information ‘silos’, reduce costs of creating, managing, distributing and updating content information in a way that effectively supports the organization needs by increasing quality and consistency of information.

A unified content strategy should provide:

Unified processes to encourage authors to collaborate, resulting in processes that are repeatable and transparent across the organization, regardless of author or department.

A content management system to manage information in a definitive source Clear structure that separates content from format Reusable content objects that enable authors to write content once and use many times

To structure information effectively, it is necessary to:

Define standards that focus on content rather than format Create standards for each ‘chunk’ (element) of information, so consistency can be

maintained all across the organization Create either a common enterprise content standard or create a family of interlinked

cross-mapped enterprise standards. Define the content each element of information


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Provide a writing environment that enables authors to structure their content consistently, by providing tools or comprehensive models for them to follow

Define output ‘appearance’ of elements Define style sheets/templates to display information in a consistent format Provide writing guidelines to ensure content is written consistently for all environments:

same content, different uses. Standardize user requests and facilitate the incorporation of content

development/enhancements into the product management process.

The following business requirements describe the functionality a content management tool must provide to support authors (e.g. domain experts, knowledge engineers) involved in developing and maintaining knowledge used in applications across the organization:

BR-1. “Navigate” through a structured knowledge management process in a form thatfacilitates consensus development and maintenance.

BR-2. Create, access, store, print, organize, structure and reuse, and share knowledge at all stages of development and maintenance.

BR-3. Leverage and reuse existing data and knowledge by accessing document management functions and audit information for each piece of knowledge.

BR-4. Enable optimization of business and clinical care metrics such as: cost and time to create and update clinical content, improvement in quality of care, elimination of adverse events, etc.

BR-5. Search for specific pieces of knowledge/information. And display it in a consistent format (templates, etc).

BR-6. Communicate with other users, and provide/request feedback at all stages of knowledge development.

BR-7. Create and support multiple work/discussion groups.

BR-8. Store, access, convert knowledge in multiple document formats.

BR-9. “Translate” document formats into standard formats, e.g. XML

BR-10. Support structured content

BR-11. Access this application through a Web browser on the internet.

BR-12. Integrate and share knowledge with multiple applications/systems through standard data formats/models.

BR-13. Access/produce metadata.

BR-14. Support collaboration operations at the level of domain specific structured content as opposed to at the level of documents

4 User requirements Tasks that users must be able to accomplish with the product (captured in use cases or scenario descriptions)

Users: Physicians, nurses, knowledge editors, safety committee members, researchers in research groups, knowledge engineers, programmers, analysts.

Functionality: By interacting with the system, users should be able to:


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UR-1. Follow from end-to-end knowledge in the system from the moment it is first created until it is released into production, by navigating through a graphic user interface displaying the workflow, status, stage, etc.

UR-2. Clinical and non-clinical users can participate and interact with the system, and have different roles.

UR-3. At any time, and for any piece of stored knowledge, users may identify sources of provenance/ownership, evidence for/against represented knowledge, stage in development process, status (deployed/in development, etc), versioning, etc, by accessing the properties of a piece of knowledge

UR-4. Create work/discussion groups so all/selected members can be notified/contacted.

UR-5. Automatically notify involved parties of changes/additions/updates in both existing and newly added knowledge.

UR-6. Automatically notify involved parties of newly discovered inconsistencies and conflicts

UR-7. Join work/discussion groups by selecting from a listUR-8. Discuss ‘evolution’ of knowledge with involved parties, and follow discussions

without need of active participation if desired (asynchronous communication in virtual spaces or workgroups)

UR-9. Access/Search for indexed information/knowledge in a repository in a variety of approaches.

UR-10. Handle/access knowledge/content in multiple document formats, e.g. Microsoft Office products, PDF files, image files.

UR-11. Reuse existing content.UR-12. Use tools/templates/guidelines to write content in a consistent way, focussing on

meaning rather than format.UR-13. Use tools/templates/guidelines to modify/reuse existing content.UR-14. Automatically tag knowledge/content explicitly available in a document.UR-15. Manually tag non-explicit knowledge/content embedded in a document, e.g.

screenshot. UR-16. Define user roles and set up privileges for handling content accordingly (e.g.

“view only”, “read-write”, “create”, etc)UR-17. Check-in /out of the system.UR-18. The ability to perform content management tasks and collaborate seamlessly in

the context of a clinical workflow without significant overheadUR-19. Ease of use and human factors requirements…

Figure 1 depicts the envisioned collaboration and content management environment where clinical and non-clinical users under different roles may collaborate among themselves to access, create, publish, and deploy content in multiple formats. A Web-based interface may provide searching, indexing capabilities to ease access to content.

The following section describes the content life cycle at different stages, and how multiple collaboration tool features may ease the process.


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Clinical

Users

Role

CollaborationTools

Accessform

Content

Non Clinical

Admin

ParticipantViewer

format

PDF.DOCPPT

HTMLVBFCSV

XMLImage

Browser

VPN

Search/Tagging/Indexing

Web /Meeting

BlogVote

email w/links

collaborate using

is-ais-a

is-a

is-ais-a

is-a

is-a

is-part-of

is-part-of

is-part-of

is-a

is-ais-a

has

access

via

have

Save (WIP)Pre-Prod

Publish/Prod

WebServerDBs

UsageTrendsAccess

publish

deploy

report /review

using

using

Prod DocIndex Cont

ContentManagement

support

using

supp

ort

uses

supportaccess

uses

Model for Collaboration /Content Management

Figure 1: Collaboration / Content Management Model. From Judith Colecchi and Kathy Ann Harris.

4.1 Content Life CycleContent can be monitored through various phases of development from creation, review, management, delivery and maintenance.


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The content creation phase can include planning, design, authoring and revision. Planning activities such as analysis, collaboration and decision-making, are frequently

not controlled by a content management system. Planning involves identifying the need for new content and determining what kind and type of information will most effectively satisfy such need. Hence, a good planning strategy that supports the appropriate, predefined standards ensures quality repeatable processes, and consistency of information – solid foundation for reusability.

Design involves two aspects: Visual design and content/structural design. The former deals with the physical appearance of information, e.g. templates. The latter involves identifying people involved in content development processes, standards already in place, limitations, and needs.

Authoring means creating new content or accessing existing content in the form of text, graphics, and/or media. Authoring of domain specific content such as structured templates for authoring rules should also be supported. It is essential to identify and fully understand all authoring processes; identify who creates/reviews content and their role(s) in the process; identify similarities in processes so they can be standardised and replicated.

Revision may involve one or many reviewers. It may be carried out in single/multiple stages of refinement until it is ready for delivery. It is important to identify the tasks involved in the revision process: people responsible of reviewing content, the roles they play, and who gives the final approval.

Content Management involves several processes necessary to keep track of content at all stages of development.

Version control ensures that each time content is saved, it is versioned. Changes can be tracked and comparisons amongst versions can be performed. It is important to have the proper versioning criteria in place, e.g. whole document v. content-within-document versioning, product version, author, date, etc. The ability to “roll back” to a prior version will be necessary in certain circumstances.

Authoring access controls keep track of who/when access content. Document lifecycle management is also important to capture (a spectrum from read to read/write capabilities (based on role of user), as well as read only access upon content publication.

Version control should also be cognizant of the structure of the content, for instance, the ability to version the antecedent of a rule as opposed to the whole rule, rule version, author, date, etc. The ability to roll back rules also involves deleting the instances of the rule being executed in the current production systems, and compensating for any of it’s effects

Publication and delivery can be provided to users through Web, data repositories, paper-based documents, etc. It is important to have clear publication and delivery procedures in place. Such procedures must specify valid content formats, location of repositories, access requirements based on user roles/privileges, user interfaces, notification methods –if any-, etc.

4.2 Content Users and RolesDeveloping content involves not only multiple stages, but many users with different skills and roles, which participate in many steps of content development. Since each user brings their expertise into the process, it is important to identify them and interview them to learn from their different perspectives.

A series of interviews were carried out. A questionnaire was implemented and used in the interviews (Appendix A). Typical users were identified:

Content users Content authors


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Reviewers Designers Publication staff IT staff

Common issues among users were identified: Lack of proper procedures/support for content development Lack of consistency, e.g. same content represented in multiple forms Unable to find content, e.g. content stored in personal directories, paper binders, etc. Different granularity in information detail No standard procedures for communicating/sharing content No clear time constraints for development Long ‘waiting time’ from request until publication of content Multiple “authoring tools”, e.g. Word, Excel, text files, PPT screen shots No versioning, audit mechanisms to keep track of changes Hard –almost impossible- to reuse content Ongoing change of content after publication Incompatible formats Not all potential content reviewers all clearly identified Different content development ‘processes’. Basically, each person has their own. Heavy duplication of efforts. Content is redone mostly from scratch each time Lack of proper reviewing processes ‘Informal’ review. The reviewing task is not recognized as part of their job. Lack of means to verify changes. Not possible to compare versions of the same

document Reformatting to fit media Bottle neck at coding/publication stage. IT people have multiple tasks. Long backlog??

4.3 Summary of Interviews

User Tejal GandhiInstitution BWHPosition Co-lead drug-safety committeeRole Review order sets, rules, drug informationParticipation in processes Order sets, guideline definition, review drugs, DDIs, remindersSends content to Research groupIssues identified There are no personal order sets

Order sets reviewed every 1-2 years by pharmacy Requests for new templates need approval from drug safety

committee Templates kept as screen shots in binders (Deb Thomas) Reminders:

o Reminders: BICS list created in the 90s in Access DB. Last reviewed in 2002. Ideally info should be evaluated by a clinical body. Right now it is done by particular clinicians IF reviewed.

o Results Manager. Research group and lab work on that

o Prescribing alerts. Incorporating alerts into medication: drug-lab, drug-disease, drug-pregnancy, duplicate therapy, drug-allergy, DDI, Nephros, Gerios. All these sent to key reviewers. Nobody complained.


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From all the above: There is no formal process to get knowledge approved/validated

For alerts, there is a predefined list of possible actions. No evaluation processes in place. Some it’s done for

research purposes, but not for maintenance Information kept in excel, and access files No way to track information, ownership, changes in BICS A lot of engineering dependency. Takes ages to

update/create/validate information and get it into the system (Deb Thomas programmer)

Takes lengthy time period for content updates, creation and validation process to get approved by BISP and into the application (may take years)

Desired improvements/tools/aids

Predefined, realistic workflow, with clear measurable goals. Audit trail, notification of updates, versioning Automatic notification of requests Consensus groups, collaboration approach Central repository with browsing/searching capabilities Email communication Predefined templates User profiles Project scope, milestones and task list, status reports

capabilities


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Start

Request from"owner" (chief of

division) fortemplates

Template needsapproval from DrugSafety Committee

Tejal, as part ofcommittee reviews

it for drug safety

BISP approveswhat goes into

BICS

Approved?

Templates go toDeb Thomas

Programmerimplements them

and gets them intothe system

end

Yes

No

Yes

No

BWH Approval of Order SetsBy Drug Safety Committee

Tejal Gandhi

Figure 2: Flow Diagram for BWH Approval of Order Sets by Drug Safety Committee / Tejal Gandhi

User Andrew CarlsonInstitution MGHPositionRole Liaison/mediation. Gets requirements from clinical performance

management and passes them to the appropriate committees. Once approved, sends them to Michele Cullen

Participation in processes Order sets, templatesSends content to Review committees, final version to Michele CullenIssues identified No current procedures/processes for updating information

Over 200 templates. No tracking infrastructure. Some templates have been there for years. No way to clean them out.

No alignment in the organization Every template get approved by clinical teams for each area,

e.g. cardiology, ICU. They may be run by pharmacy without Andrew seeing them

Andrew mostly checks templates for lab, rad, blood bank, pharmacy.

Templates are hard coded. Needs an editor (Michele Cullen, who keeps screenshots of templates)

For every template, a chair person signs it. Every 3 years is


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reviewed by owner or otherwise is taken off No organization or infrastructure for handling guidelines No templates, no style guide, no consistency for proper

guideline encoding. Just informal request No evaluation processes Final templates (screenshots in PPT files) kept by Michele

Cullen in binders No way to keep track of changes. Final version is live in the

systemDesired improvements/tools/aids

Clear. Predefined procedures, formats/templates for requesting, developing, tracking information

Consistent, traceable workflow Structured communication by asynchronous means, e.g.

email, weblog Predefined style guides Audit capabilities: who, when, why owns templates. Who

sponsors (clinical body, person) the item, how they come to that, when went live, who reviewed, authorized changes, when it needs to be reviewed again.

Automatic notification of changes, reminders for due reviews, alerts for reviewing data that may get affected by changes.

Central, structured repository Easy access to information. Browsing/searching capabilities. Information independent from look/format Ability to reuse information and share template building best

practices with new staff Automatic notification of requests, changes Automatic versioning User profiles Project scope, milestones, task lists, status reports

capabilities Who/how/where owns knowledge including links to external

sources e.g., dose calculators supported by other institutions that interact with the system, e.g., POE

New processes that will facilitate the addition/approval of new content and reduce unnecessary obstacles.


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Start

Receives requestsfor templates

Checks templatesfor Lab, rad, bloodbank, pharmacy

Until approvedby Clinical Perf.

Management

Andrew is theliason/mediatorwith committees

Back to Michelefor development

end

No

Yes

90% ofthe time

MGH / Requests forOrder Sets

Andrew Carlson

Figure 3: Flow Diagram for MGH Requests for Order Sets / Andrew Carlson

User Michele CullenInstitution MGHPosition Knowledge editorRole Implement order sets, templates for cliniciansParticipation in processes Design or order sets, templatesSends content to Final version of template to clinician for approval

Then sends it to analyst for review Issues identified Predefined processes with clear measurable goals.

Email communication with clinicians works fine No clear, pre-defined process in place Process can take from 2 weeks to 2 months Templates developed using a VB tool Final product can be seen only when it goes live Information kept in personal folders. These may not always

be the most up to date (as the complete binder is 1999). Updates completed by other staff may not be represented in a central location.

Physician personal templates cannot be reviewed by OE staff as the staff does not have access to these personal templates. Therefore, it cannot be ensured that there is consistency with approved templates.

Screenshots stored in PPT files, printed and archived in binders

No inventory mechanisms in place for versioning, changes, requests, etc.

Current staff often tries to avoid number of review cycles and reduce need to go to POE. Present processes are viewed as a bottleneck with no clear standards/review process or outcome.


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Automatic mechanisms to track changes, link requests to final files, notification of changes, requests for reviewing content, ownership, content in templates

Email history per process, subject, requester, etc Central repository with searching capabilities Browsing capabilities by keyword, topic, etc Reusability of components User profiles Project scope, milestones, status reports (not plan view)

Start

Clinician requestsnew/update order

sets via email

Until OK

Michele reviewsrequest

Michele checksstandards

Committeesreview knowledge

in OS(Lab, Med, Rad...)

Andrew Carlson here forMGH. He is the liaisonbetween Michele and

committees

Tejal Gandhi here asmemeber of committees (for

BWH)

Approved?

OK

Implementscreenshots with

VB tool

Yes

Michele sends toanalyst

OK?

No

No

Until cliniciangives OK

Michele sends OSto clinician for

review

Michele makesnecessarychanges

Upload finaltemplate

Screenshots inPPT stored in

personal files andbinders

end

OK

Implementation of OrderSets TemplatesMichele Cullen

Figure 4: Flow Diagram for MGH Implementation of Order Sets / Michele Cullen


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User Thomas SequistInstitution BWHPositionRole Maintains LMR reminders, Patient gateway, updates clinical

practice changes, and handles physician complaints/requests. Participation in processes Guideline specification for encodingSends content to ProgrammerIssues identified LMR tables las updated in 2002

Guideline implementation based on grant applications. No follow up in place once project ends.

Timelines based on grant timelines He keeps track of all reminders No mechanisms for human-readable inventory of content. Standard way to keep track of changes not used. Read-only access to information Information kept in a DB Lack of easy search/access to drug dictionaries e.g. ACE

Inhibitors family Will become more difficult to maintain current processes as

more content is developed for LMR and as more clinical reviewers are included.

Reminders based on grants. Once studies conclude, it is difficult to undo randomization

No knowledge-coding functionality Monthly release of changes/enhancements. Automatic

notification of changesDesired improvements/tools/aids

Annual review of reminders and links Predefined procedures Enhanced query capabilities for patient data, medication

dictionaries, institution Links to ease access to information Reminders should be coded independent of application (they

should be written in a way easy to update changes without reprogramming)

Easier methods for reviewing current/proposed content and to compare “old” v “new” changes, focusing on highlighting changes.

Automatic version control of changes Central repository better organized/structured (right now is

done in Access) User profiles, specially for viewing/changing information Project scoping, milestones, task lists, status reports Reminders directed to patients besides to clinicians Integration to knowledge sources (med dictionaries, patient

gateway) Data synchronization same rule applied in different

environments Customized/personalized advise for patients Risk assessment tools


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Guidelinegrant project

Based on needs ofgrant

Tom writesremiders

Programmerreviews reminders

RemindersOK?

No

LMR Outpatient RemindersGuideline Specification for

EncodingThomas Sequist

Start

end

Put into "dummy"LMR to check

them

OK?

Put reminders intolive LMR systemand check links

Yes

No

Yes

Figure 5: Flow Diagram for LMR Outpatient Reminders Guideline Specification for Encoding / Thomas Sequist

User Carol Shek / John NolanInstitution PartnersPositionRole Carol: Manages medical dictionary for DDIs, medication-related

allergies, dose-frequency, BICS dictionary for BWH (adults and NICU), calculatorsJohn: Updates DDI with info from First databank, med dictionaries

Participation in processes Carol: DDI dictionary. BICS dictionary for BWH (adults and NICU only) and Partners (MGH adult, paediatrics, NICU), calculatorsJohn: DDI dictionary. BICS dictionary for BWH (adults and NICU only) and Partners (MGH adult, paediatrics, NICU), calculators.

Monthly updates for FirstData Bank. New drugs on request basis from analysts/users, especially for outpatients.

Sends content toIssues identified Ill-specified requests. No format available.

o From MGH requests in spreadsheetso From BWH, requests via email, paper-based and

databases No clear instructions as to what is required Time constraints based on urgency of request Manual maintenance of audit trails/changes for personal use No explicit, predefined evaluation process. No means to

detect errors. Extensive checking of chemo functionality for daily/weekly


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dosage Limitations of DDI: New drug in the drug dictionary does not

link dynamically to the DDI Manual check of DDI for drug interactions. Drug families

present in BICS/Partners are not dynamically linked No consistent mechanisms for rendering information in

different systems. It has to be done manually. Different medications for each site (Partners/BICS) and each

subsystem (adult, NICU, chemo) and subsubsystem (Nephros, Gerios) ← BICS only

Updating –if any- drug-allergies is done by hand by picking the numberID (from an almost meaningless list) of the drug into the allergies DB, going from Drugingredientallergy group.

Potential chance of error if medication is entered before the allergy is added

Not clear which medications do not have links to allergies Not clear which drugs are missing in the DDI They add a drug to the dictionary and then ask Bob McCully

to put it in the DDI editor. There’s no support for drug families. If entering a drug that does not have a HIC number, they

need to remember to keep checking until the drug gets a HIC number.

Carol/John keep data/changes in an excel file


Clear procedures, formats in place for requests Web interface/templates/portal for requests Tracking, audits of requests, maintenance, update History of changes: who, how, when requests/validates what. Clearer way to identify drugs and interactions e.g., drug

names instead of numbers Link code# with ingredients Central, structured repository for data A more clearly structured user interface that more clearly

states its functionality Consistent user interface for tools that support enterprise

wide functionality (and consistent functionality/data integrity standards, conflict resolution, and updating drug family/inherit rule updates.


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Start

Get request forDDIs from MGH

and BWH

Add drug todictionary

Ask Bob McCullyto add drug to the

DDI editor

1 2

Procedure foradding a new drugbased on known

ingredient

Procedure foradding a brand

new drug

Figure 6: Flow Diagram for Requests for DDIs from MGH and BWH (1) / Carol Shek, John Nolan


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Procedure foradding a new drugbased on known

ingredient

DDI committeeapproves

Don't know whathappens if

committee doesnot approve

PartnersDictionary

1

BICSDictionary

Yes

No

Med part offamily?

?

Look at all DDIsfor similar drugs(here families doNOT exist) and

add them allmanually

Link it to the HIC.It comes up ineditor tool as aseparate roll-up

Bob McCully addsthe link.

Link does not hetpick up

Does not link byingredient

Yes

NoPick all familyinformation if itwas added to a

family byingredient

Procedure foradding a brand

new drug

DDI committeeapproves

Don't know whathappens if

committee doesnot approve

PartnersDictionary

2

BICSDictionary

Yes

No

Manually add newDDIs between new

drug and eachmedication of thefamilies affected

No way to add anew drug to a

family

Bob McCully addsnew drug

andcreates new rec #

Picks familyinformation

end

Figure 7: Flow Diagram (cont.) for Requests for DDIs from MGH and BWH / Carol Shek and John Nolan

User Eric PoonInstitution Partners/BWHPositionRole Clinical consultant for results manager and product manager. Participation in processes Selects and translates knowledge into semi-automatic

presentation


21

Sends content to Clinical Data Repository (CDR) team for hardcoding and testingIssues identified Knowledge extracted from literature and clinical experts

No evaluation process in place – back-and-forth until right Bottleneck at CDR No pre-defined testing procedures in place. Sometimes Eric

participates in them No feedback mechanisms from LMR users Knowledge is research-driven rather than user-driven No formats/templates for capturing knowledge – but there’s

some influence by Gil’s rule editor All information is kept in his laptop in Word documents No way to track changes


Structured central repository for knowledge Searching/browsing capabilities Separate knowledge from application will help to solve the

bottleneck. Formats/templates/rule editor – rules need to have structure Audit, versioning capabilities Email as a conversation tool


22

Eric Reviewsand gathers

information from

UserRequests

Med literaturePublishedguidelines

Clinical experts

Primary careresearch agenda

(Bates, Poon,Gandhi...)

Eric keeps "secret" inventoryof new rules

(TSH, CFTs, PSA,OB/Gyn...)

Prioritization

Translates intosemantically

meaninful rules

CDR teamreviews

Resourceprioritization /IT endoding

Validate feasibilityof rules

Implement Test rules

Test cases

OK?No

Deploy rules

Yes

Get feedbackto analyst

LMR userfeedback button

LMR users group

Direct email

back to Eric

LMR rulesEric Poon

Figure 8: Flow Diagram for LMR rule creation / Eric Poon


23

User Jennifer CinaInstitution BWHPosition Drug safety committee PharmacyRole Review contents of alerts (ADEs)Participation in processes ADESends content toIssues identified This was ‘yet another project’ that does not fully integrate with

other available systems There’s a separate DB to record patient information for

adverse drug reactionsDesired improvements/tools/aids

Tools for log/conversation only if can be done automatically –they don’t need any extra work!

Templates/display hits of the day instead of printouts Automatic intervention management with portable devices Monitoring/audit capabilities to improve management of

knowledge – what alerts are working or not. What fires, when, how, why.

Improved reporting capabilities, viewing each system as independent

Improve documentation Mode differentiated rules Centralized, structured repository Proper knowledge management so knowledge ‘percolates’

with context specific alerts at each layer/level (Knowledge Management Issue)

Access to external sources/procedures/calls/rules by creating an action call (Knowledge Management Issue)

Pick up collisions among rules (Knowledge Management Issue)

Audit capabilities Surveillance v. interaction modes (Knowledge Management

Issue)


24

If Positivepredictive value

< 10%

Rate itDo not review alltriggers becauseof human factors

New ideas foralerts

Go to Tejal Gandhiet.al (Pharmacy/drug committee/subcommittee for

review

Yes No

Yes

No

Pharmacy / BWH / ADESurveillance rules updating

Jennifer Cina

Start

end

Figure 9: Flow Diagram for BWH Pharmacy ADE Surveillance Rules Updating / Jennifer Cina

User Jon SilvermanInstitution BWHPosition PharmacyRoleParticipation in processes Order SetsSends content toIssues identified Order sets records kept in screen shots in binders. Not sure

they have the latest version No proper, structured communication procedures in place.

The whole thing takes 10-40 emails over 3-4 weeks. No defined guidelines/procedures for order sets If requester is present with the programmer, thing may go

faster. Backlog of order sets No personal order sets. They removed them because there

was conflict between personal and departmental order sets Once the order sets get into the system, the only way to keep

track is by keeping screenshots Some audit information e.g. who, when, requested what OS

is kept in an Access DB. Emails with requests are kept in folders Don’t know who does therapeutic interventions


Proper, predefined procedures for requests Proper, predefined templates/guidelines for OS Audit capabilities e.g., when updated, who did it, how, who

authorized, status, etc.


25

Collaboration environment to keep track of development e.g., OS presented to committee, make sure it matches guidelines, get agreement, check specification, get it into production.

Centralized, structured repository with search/browsing capabilities so they can see OS at all times along the process

User profiles Sign in/out Project scope, milestones, task list, status reports capabilities Automatic request for reviews/ notification of changes Automatic notification of possible conflicts/inconsistencies in

information when parts of the dictionaries are updated e.g. medications, drug safety changes

Until OK

Physicianasks nurse

Draft on paperDirectly to IS for

drug safety

Drug safety subcommittee (Jen)

reviews

Representatives: Physician,nurse, pharmacy

meets monthly to revieworder sets

meets monthly to revieworder sets

Order sets go intoproduction

Order set go intothe system

Jen et.al takescreenshots oforder sets andstore them in

binders

OK

Pharmacy / BWH / Order SetsJon Silverman / Jennifer Cina

Start

end

Figure 10: Flow Diagram for BWH Pharmacy Order Sets / Jon Silverman & Jennifer Cina

User Silvia BartelInstitution Dana Faber Cancer InstitutePosition Director of PharmacyRole Review order sets, rules, drug information, dosage in protocols

for chemotherapyParticipation in processes Order sets, guideline definition, review drugs, DDIs, dosage in

protocols for chemotherapySends content to Research groupIssues identified There are two systems: VB and BICS

Treatment protocols and guideline procedures in VB are reviewed by a review committee

Four requirements need to be included and reviewed in all protocols

o Hydration


26

o Chemoo Antimedico Criteria to continue treatment

There are 1200 investigation sets and 300 non-investigation sets approximately

All protocols are in paper. Only the final version is electronic Protocols can be reviewed in a ‘patient-specific’ form only. There is the need for consulting protocols in the system

without looking at a patient Non-research regiments are reviewed once/twice a year. A

printout of the regiment is given to the disease leader to review.

Requests for new templates need approval from the review committee.

Document protocols are implemented by builders (Caren, Deb Ellen) using a ‘builder tool’

Document protocol is reviewed by a builder, a nurse, pharmacist (one in the IRB) and PI of the protocol

Changes are paper-based. A protocol tracking system (POST) for oncology is being

implemented ‘COST’ (Chemo order set track) for dose changes will be in

place. o Protocol buildero IRBo Who signed offo Comments from reviewers

But NOT:o Elements of protocol

Dose changes go to Silvia Bartel and PNT. Track of this is kept in excel files.

An interface between VBCOE and COST is required. Chemo protocols are in BICS. These contain outpatient

research protocols for bone marrow transplant and high complexity leukaemia.

Chemo protocols are duplicated because BWH wanted to keep them in BICS instead of moving into VBCOE.

No way to know if the are conflicts in duplicates From all the above research/non-research protocols: There

are no formal processes to get knowledge approved/validated No evaluation processes in place. Some it’s done for

research purposes, but not for maintenance Information kept in excel No reliable, automated way to track information, ownership,

changes in BICS and VB A lot files hanging around. No way to aggregate requests,

approvals, dosages, sources, comments for each protocol. No electronic standard templates for requests. All done in

paper. COST (Chemo order set track) will provide support for dose

changes, user will be able to:o See protocol buildero IRBo Who signed off


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o Statuso Comments from reviewers

However, the approach is of ‘one tool’ for handling some features without fostering real integration of required tools/aids.

You cannot see order sets from inside COST Desired improvements/tools/aids

Predefined workflow, with clear measurable goals for each type of protocol.

Audit trail, notification of updates, versioning Automatic notification of requests Consensus groups, collaboration approach Central repository with browsing/searching capabilities for

protocols and order sets –and all knowledge embedded in them

Email communication Predefined templates User profiles Project scope, milestones and task list, status reports

capabilities All these features integrated in one single tool.


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Builders (Karen,Deb and Ellen)start building

protocol

PI sends treatmentprotocol document

for review

Committee reviewstreatment protocol

committee checksrequested

medications

Committee checksprotocol meetsrequirements for :- Hydration- Chemo- Antimedic- Criteria for continuingtreatment

Pharmacyst OKsfor activation

Builders finish

No

Chemotherapy Research ProtocolsSilvia Bartel / DFCIFor a new Chemo

VB treatment

3 people fromthe IRB, and

nurse, PI, builderand pharmacyst

OK?

yes

IRB approves,activates andemails people

?

end

start

Figure 11: Chemotherapy Research Protocol/ Silvia Bartel


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Disease groupmeet to review

regiments

Disease leadersigns

Builders makeschanges

Chemotherapy Non- Research ProtocolsSilvia Bartel / DFCI

Disease grouprequests regiment

by filling form

end

start

new regiment?new drug in the

market?

report forexceptionorders?

Yes Yes Yes

form is a Word documentform has drug route, hydration

dose, and modifications

send form to disease leader

regimentreview?

Yes

Once/twice a yearSilvia prints out

regiments

Silvia sendsregiments to

disease leader

Builder getsrecommendations

Figure 12: Chemotherapy Non-Research Protocol /Silvia Bartel


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5 Functional RequirementsSoftware functionality: the product allows users to accomplish their tasks, thereby satisfying the business requirements. A feature is a set of logically related functional requirements that provides a capability to the user and enables the satisfaction of a business requirement.

The following are the capabilities that a given product must posses for the user to carry out the daily tasks.

Any given user must be able to: Log in to the system using their current userID and password Identify content owners, authors, participants. Create new content Access/reuse existing content Create/view content structure Set up email for automatic notification of changes/additions/updates to a given group of

users Send email to other users inviting them to review a particular piece of knowledge Send template-based emails for communication/notification/requests Invite other users to Blog for conversations Check audit features: ownership, modification dates Check-in/out Have access to all features available for his/her user role Customize the collaboration environment to suit his/her preferences Create user groups based on interests Invite users to enrol in groups Review schedules, state of production for content

Besides all the features required by a user, the following administrative features must be supported:

Add/delete users to the system Set up/block roles/privileges for users Check log files to review activity, profiles, information accessed, audit trails Create/delete user groups based on interests

Hence, the system must support: Validate users ID and password by accessing current authentication procedures Allow users to login to the system using their current userID and password Scheduling/planning, so content production can be monitored at all stages of content

creation (workflow). Templates for specific communications/notifications Email for automatic notification of changes/additions/updates Display alerts –tiny icon flags next to filenames- to members (users) when some

document has been changed/updated. Blog environment for conversations Multiple user groups based on roles, interests, topics Provide audit capabilities: trail, ownership, modification dates Check-in /out Handle user privileges according to role Support multiple database formats.


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Support multiple document formats “Translate” document formats into standard, e.g. XML Interface with existing/new systems via communication standards/formats Support semantic tagging to provide metadata Support user environment customization Support Browsing/Navigation capabilities Backup capabilities, so if the system crashes it can be restarted at its latest state.

6 Gathering and Organizing Current Content: Knowledge Management Portal

A step towards a unified approach to knowledge management is a Knowledge Management Portal for publishing content. The development of this portal is the first implementation of the functional requirements described above. The KM Portal deserves a fully detailed description, not included in this document; hence we refer the reader to [1]. This section is informative and serves the purpose of highlighting key functional aspects of this ‘first generation’ KM Portal.

6.1 Users Identified users of the KM Portal are:

o Physicianso Nurseso Healthcare providerso Knowledge engineers

6.2 Functionality Search for information by:

o Signature initiative domain (see taxonomy below)o Name of documento Title of documento Keywordso Filters

Entity Venue Patient age group User role Application Content type

o Categories/taxonomy (see below) Validate information by reviewing documents retrieved from search/browse Identify ownership – who, when wrote the document Contact the ‘owner’ of the knowledge – by email. Review content

o Embedded in applications: Annotated screenshots, images, with owner, content description, keywords (for filters), nodes in taxonomy tags.

o Explicitly available. Information about ownership, content description, keywords available from content (text document) and node in taxonomy.


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6.3 Signature Initiative-based Taxonomy

Uniform Quality

SIGNATURE

DOMAIN

TAXONOMY

Medical Discipline

SurgicalDiscipline

- Behavioural Health- Cardiac (Medical)- Emergency Medicine- Endocrinology- Gastroenterology- General Medicine- Hematology- Infectious Disease- Obstetrics- Oncology- Nephrology- Neurology- Newborn/Neonatology- Respiratory/Pulmonary- Rheumatology/Immunology

- Anesthesiology/Perioperative- Cardiac (Surgical)- Cardiac (Interventional)- Emergency Medicine- Gastroenterology- General Surgery- Gynecology- Neurosurgery- Obstetrics- Orthopedic- Pediatric Surgery- Thoracic Surgery- Transplant- Trauma- Urology/Renal- Vascular Surgery

Patient Safety

MedicationManagement

Lab ResultNotification

- Results Manager Content- Panic Lab Notification- Drug-Lab Interaction Notification

- Antibiotic Restriction Management- Anticoagulation Management- Consequent Order Display- Consequent Lab Display- Drug-Drug Interaction (DDI) Checking- Drug-Disease Interaction Checking- Drug-Labs Interaction Checking- Drug-Pregnancy Interaction Checking- Food-Drug Interactions- Geriatric Drug Dosing (Gerios)- Infusion Guidelines- Interactive Decision Suppot- Neonate/Pediatric Drug Dosing- Renal Drug Dosing (includes BWH Nephros)- Order Sentences- Surveillance- Therapeutic Duplication

+ ADE reporting+ Drug-Lab Interaction Notification

Diabetes

Lipid Management

Coronary ArteryDisease

DiseaseManagement

HealthMaintenance

Other Safety

- Decubitus ulcer preventions- Restrain Management

TrendManagement

FormularyGuidelines

Figure 13: Signature Initiative Domain Taxonomy


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6.4 FiltersUsers can narrow down the search for information by selecting one or more items from the following filters. All filters are set to ‘All’.

Entity (linear filter)o All (default option)o BWHo MGHo Faulknero Newton Wellesleyo NSMCo SRHo DFCIo PCHI

Venue (linear filter)o All (default option)o Ambulatory careo Acute careo Emergency departmento Perioperativeo Intensive careo Pediatrics

Patient age groupo All (default option)o Pediatrico Neonateo Adulto Geriatric

User role (under revision)o All (default option)o RNo MDo Pharm

Applicationo All (default option)o MGH-Order Entry (POE)o Chemo-Order Entry (COE)o BICS Event Monitoro BWH-NICU-Order Entryo BWH-ED-Order Entryo BICS-Order Entryo LMR – All Contento LMR – Results Managero Meditech

Context Typeo All (default option)o Interactive Decision Supporto Reference Informationo Surveillance decision supporto Reminderso Order sets & Templateso Expert dosingo Reports

Clinical Disciplineso –All o •Anesthesiology/Perioperative Medicine


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o •Behavioral Medicine o •Cardiac (Interventional)o •Cardiac (Medical)o •Cardiac (Surgical)o •Emergency Medicine o •Endocrinologyo •Gastroenterology o •General Medicineo •General Surgeryo •Gynecologyo •Hematologyo •Infectious Diseaseo •Nephrologyo •Neurologyo •Neurosurgeryo •Newborn/Neonatologyo •Obstetricso •Oncologyo •Orthopedico •Pediatricso •Pediatric Surgeryo •Respiratory/Pulmonaryo •Rheumatology/Immunologyo •Thoracic Surgeryo •Transplanto •Traumao •Urology/Renalo •Vascular Surgery

•Patient Safetyo –Allo –Drug Drug Interaction Checkingo –Drug Disease/Pregnancyo –Drug Lab Interaction Checkingo –Drug Food Interactionso –Expert Dosing (age, renal)o –Alerts and Notificationo –Therapeutic Duplicationo –Consequent Order/Lab Displayo --Other Patient Safety Content•Disease Managemento –Allo –Diabeteso –Prevention

7 Product reviewEnterprise content management refers to the administration of the entire lifecycle of business documents. The life of a piece of knowledge runs form creation, through processing and collaboration, and publication in a repository.

This section presents a review of what Gartner’s call “Smart Enterprise Suite” (SES) [2]: tools consisting of a portal, collaborative and content management functionality. The objective of this section is to analyse collaboration tools and present recommendations for future application of content management technologies.The following is a list of the functionality a system must posses to satisfy the requirements described above:


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o Content management as basic document management with library of services that can be published on the Web via a portal.

o Collaboration between groups of self-selected members (users) to share content and discuss it. Email communication is a requirement, while real-time capabilities are desired (Blog environment).

o Information retrieval. Searching, indexing and navigation through multiple metaphors: keyword search, group interest, content and taxonomy.

o Process management must support workflow, scheduling.o Security mechanisms must be present e.g., password protected access; different levels of

privileges based on user’s role. o Business intelligence and data analytics functionality refers to the system’s ability to provide a

minimum of functionality so activity/usage of the system can be monitored. E.g. audit capabilities, log reports.

o Portal framework is not a required feature, but the capability to link to a Web portal is required.

Besides the described functionality, a system must satisfy the following architecture requirements:o SQL compatibleo .NET compatible is desiredo Support XMLo Support MS products

7.1 MS Share Portal Point Server 2003 / SharePoint ServicesWindows SharePoint Services is a collection of services for MS Windows Server 2003 to share information, collaborate with other users on documents and create lists and Web portal pages. It can also be used as a development platform for creating collaboration and information-sharing applications.

SharePoint Portal Server 2003 is a secure scalable enterprise portal server built upon Windows Share Point Services. It can be used to aggregate SharePoint sites, information and applications into a single “easy-to-use” portal. Supported features are: News and Topics; My Site with personal and public views; Search and indexing across file shares, web servers, secure web servers, exchange public folders, lotus notes and SharePoint sites.

Microsoft components combine portal and document management capabilities. However, it does not fully support Web content management and real-time collaboration. Gartner does not consider MS Share Point a SES leading product.[2]

SharePoint will require installing Windows 2003 to run the SharePoint server. It is possible to use Office 2003 on any version of Windows, but for the most effective collaboration experience, it is necessary to have Windows SharePoint Services available. And that, in turn, requires installing Windows 2003 on the box that will host SharePoint.

Content CreationIn combination with Office 2003 edition, SharePoint provides document workspace with shared attachments to emails –the document is stored in a shared space. It provides version tracking, so users can view previous versions and roll-back changes when necessary. Documents are added automatically to a library.

Connecting with other systemsSharePoint Services are closely integrated with MS Office 2003. In other words, SharePoint requires MS Office 2003 to support and interact with the portal. However, when it comes to straight portlets, almost any application can be integrated into the portal. SharePoint Services is fully compatible


36

with MS SQL Server 2000 and MS applications. It also integrates with enterprise applications with a portal, e.g. PeopleSoft, SAP, Siebel. It leverages .NET, BizTalk too.

Lifecycle supportWindows SharePoint Services can also track versions for documents stored on a SharePoint site. Windows SharePoint Services keeps a copy of all previous versions of each document, so that you can go back and view the changes that were made to a document at any time. This is especially useful if you must roll back a document to a previous version, or if you must retrieve data that was deleted from an earlier version of a document. Version tracking in Windows SharePoint Services can help your team quickly and efficiently track and manage document creation and editing.

Automatic notification of changes/additionsContent can be targeted to users based on their job role, user profile properties, reporting structure of the organization or membership in MS Active Directory. It is also possible to use user profile properties, security groups, or distribution lists that match audience rules to determine membership in audiences.

Document workspaces provide a document-centric way to collaborate in Office 2003. A document workspace is designed to help a group of users collaborate on one or more documents. The workspace captures all facets of a particular task or activity (see Figure 14).

Web connectivity and securityShared, centralized web space where all data is kept. As for security, it is necessary to choose between using standard Windows domain accounts for portal users or Active Directory—and this cannot be changed later.

Collaboration featuresAll collaborative data is stored in a SharePoint site. Data is stored in Office documents and edited in Office applications. Users can manage the site themselves from their browsers, without any administrative help. However, SharePoint Portal does not support direct personalized portal content to specific types of portal users. As illustrated in Figure 14 the workspace captures all facets of a particular task or activity.


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Figure 14: Screenshot of SharePoint work space

Knowledge repositoryAll documents are stored on the SharePoint server, which also keeps track of members, tasks, and other information in the document workspace. SharePoint organises all relevant information for a task or meeting in one place, workspaces cut down on disk storage requirements by keeping a single copy of each document on the server.

SharePoint provides full-text search capabilities for Web site content using MS SQL Server 2000.The following table shows the features that are included in Windows SharePoint Services and SharePoint Portal Server 2003 [3].

7.2 Groove WorkspaceGroove workspace integrates with SharePoint to drive knowledge sharing, fast creation of ad hoc teams. SharePoint provides server-based team sites with a customizable portal; while Groove includes desktop collaboration software services to enable people work together. Groove can be enhanced by either adding third-party tools (e-voting, project management, collaborative GIS, multimedia, etc.), or by using Groove’s advanced forms facility, which opens up programming and customization of Groove to non-technical users.

Content CreationGroove supports standards as Microsoft file formats. However, for seamless integration Office 2003 is required. eKnowledge integrates with Lotus Notes, Outlook; accessible to SharePoint


38

users. It also allows migration of collaboration applications between platforms. E.g. Notes/Domino to SharePoint and SQL server, or from Outlook/Exchange to IBM workspace. Groove does not support RSS/XML/XHTML publishing

Connecting with other systemsCross-platform compatible; all interaction is carried out through a Web-based user interface. It supports connectivity to IBM DB2, MS SQL Server and Oracle. Also supports connectivity with SAP, R/3, PeopleSoft, and MS CRM (Customer Relationship Management). eKnowledge supports the following developer tools: MS .NET, IBM Domino design, Websphere studio.

Lifecycle supportGroove provides limited support for work cycle: subscription, notification, assembly, action, publication. However, Groove’s functionality can be complemented with third-party specialized application modules (e-voting, project management, collaborative GIS, multimedia, etc.). It alsoprovides templates and tools for developers.

Web connectivity and securityGroove can be embedded inside Windows Explorer, where users can see a new button “Groove”. Information stored in an external repository outside the firewall can be accessed by navigating through each user’s workspace. Synchronous communication can be performed using Groove’s chat rooms, while asynchronous discussions can be joined and follow by topic in “shared space”, where users can see who wrote what and when.

Collaboration featuresGroove has chat room capabilities, and supports synchronous communication between multiple users, although it does not provide out-of-the box tools for voting, project management and collaborative GIS. However, these features can be added through third-party specialized modules.

Groove can be personalized for receiving/downloading files. Users can now control the level of alerts and presence awareness signals to receive from EACH one person or object/area. Presence icons differentiate the status and location of other contacts working inside Groove and allow you to see who is where at all times.

Groove can be embedded inside Windows Explorer, where users can see a new button “Groove.” While in a folder, clicking on the button will share all files in that folder with anyone invited to that workspace. Once the workspace is created, users invite other members in the same way they invite users to any workspace. When the invitation is accepted, invited members have the option to create a new folder in their “My Documents” folder, or browse to a different location on their computer. Users work with files in file sharing workspaces in the same way as with any Files tool in a standard workspace.

Knowledge repositoryAll knowledge sits on an external server repository outside the firewall, which can be accessed through Groove’s interface.

7.3 LivelinkOpen Text Livelink enterprise suite is a Java-based collaboration solution and is available as an installable product or as an ASP/MSP solution. Livelink divides the collaboration space in tree layers: enterprise, project and personal workspaces. The enterprise workspace contains information for companywide use e.g. news, policies, procedures. A project workspace is used for storage of documents, project and organization planning, and collaboration and discussions.


39

Personal workspaces contain calendars, task planning, and documents and subscribed information channels.

Content CreationLivelink works with documents directly from the Windows desktop either online or offline. It handles MS Office, Adobe Acrobat, Windows Explorer and Web-DAV-compliant applications. It can convert documents into HTML or handle them in their native format.

Connecting with other systemsLivelink supports Web standards like TCP/IP, HTTP(S), HTML, XML, WML, PDF, SMTP, Java, ActiveX, XML WebDAV, J2EE, and Web service standards SOAP and WDSL.

Lifecycle supportLivelink manages the full lifecycle of documents. It supports check in/out, version history, event auditing, access control using permissions, management of folder structures, and alternate renditions.

Web connectivity and securityLivelink is 100% Web based and can be accessed through any standard HTTP Web browser. It supports secure HTTP servers and secure sockets layer (SSL). It also supports role-based access control with nine levels of privileges based on user login and group association.

Collaboration featuresLivelink supports project organization and management –personal and project calendars-, task planning and management, online meetings. Knowledge can be captured, organized, found, reused and shared across the application using automatic capture of email discussions and online meeting content, multiple browsable taxonomies, document ratings, and indexing of Web sites.

Knowledge repositoryLivelink Library is the central repository for storing documents, folders, queries, snapshots, reports, news channels, discussions, task lists, polls, forms, workflow maps, URLs and associated objects. Livelink supports full-text indexing, while supporting multiple searching formats, and taxonomy browsing. It supports the following DBs: MS SQL Server, Oracle and Sybase.

7.4 Interwoven 5 (Includes iManage Worksite)Interwoven is an enterprise content management (ECM) software that enables businesses to create, review, manage, distribute and archive critical business knowledge. iManage, a recent addition to the Interwoven Suite, provides two full-featured document management clients: iManage DeskSite and iManage MailSite. DeskSite and MailSite provide out-of-the-box, tight integration with popular windows applications such as MS Office, WordPerfect, MS Outlook, Lotus Notes and Novell GroupWise

Content CreationDeskSite and MailSite provide out-of-the-box, tight integration with popular windows applications such as MS Office, WordPerfect, MS Outlook, Lotus Notes and Novell GroupWise. Interwoven suite maintains integrity with XML and MS formats and other data types, e.g. PDF.


40

Connecting with other systemsInterwoven content provider integration server is Java-based; it supports Solaris, Sun, IBM AIX, HP-UX, Linux, Windows NT and Windows 2000. . iManage is 100% Java based, object-oriented and supports J2EE, XML, XSL, SOAP, .COM and .NET.

iManage Mailsite fully integrates with MS Outlook. iManage Worksite provides access to workspaces, folders, documents, in addition to collaboration objects and connectors to third-party systems.

Lifecycle supportInterwoven features content exchange, versioning, workflow, metadata search, check in/out controls; also scheduling, calendar, tasklists, discussion threads, event calendar, URL link lists, and synchronization. It provides comprehensible tagging and classification capabilities to classify each document with meta-data fields.

Supports publishing in PDF format.

Web connectivity and securityAllows access to documents from any standard Web browser. WorkDocs –part of Interwoven-uses a standard HTTP protocol and supports SSL for secure transmission across the Internet.Interwoven controls access to system functionality and content at the object level based on user, group or role, so only authorized users can access information.

Collaboration featuresiManage Desksite offers access to workspaces, folders and documents in three ways: “Favourites”, “My Matters” and a list of recently visited workspaces. It fully supports version control, check in/out, audit trails, searching, document viewer, and publishing on the Web. It also offers automatic notification via email to users when a new document or new version is created.

Interwoven is very static at the backend; it does not provide enough flexibility to change code from the backend, due to a decentralized web editing with little functionality. Also, updating workspaces and relocating/updating information is hard to perform due to limited capabilities. Reporting capabilities are poor.

Knowledge repositoryManage the entire information life cycle including purging of obsolete documents to meet regulatory document retention guidelines. Supports Boolean, wildcard, number or date range searches based on document meta-data and full text. Frequently performed searches can be saved and shared.

7.5 IBM Lotus QuickPlaceIBM Lotus QuickPlace is a self-service Web tool for team collaboration. Lotus QuickPlace allows publishing, sharing, and tracking of information. It is 100% Web-based. A web browser (either MS Explorer or Netscape) is the only requirement for using it.

Content CreationUsers can create, publish and share documents using desktop tools. QuickPlace integrates with MS Office 2000, Office XP. Users can share files in formats like HTML, GIF, animated GIF, and JPEG.


41

Connecting with other systemsIt fully integrates with Lotus Sametime, as well as with Lotus Notes and MS Outlook calendars. It is also integrated with Windows XP. QuickPlace has a Java-based API so, using HTML, Java, LotusScript or C, developers can embed team collaboration capabilities into any Web application.

Lifecycle supportQuickPlace supports progress and milestones tracking through its calendar. It also supports core library services including document versioning, and check in/out.

Web connectivity and securityQuickPlace leverages security within Domino applications. Inner rooms can be managed through different security levels managed by Domino Access Control Lists (ACLs). It supports encryption using SSL. Supports sharing username and password with other applications.

Collaboration featuresQuickPlace is designed for asynchronous communication and file sharing inside and outside the firewall. Email notification can be set to automatic, so users are informed of changes, additions to the repository. Users can join threaded discussions. Progress and milestones tracking using the calendar feature, that integrates with Outlook.

Knowledge repositoryUsers can search across the domain or across all QuickPlaces, using full-text searching. Results are generated in XML and displayed in HTML.

7.6 DocumentumDocumentum is considered a leading document management vendor, and with the recent addition of eRoom, it allows the creation of a full-scale enterprise solution that spans all along the life of a document from capture, creation, discussion, review approval, distribution and archival. The Gartner group categorizes Documentum as a “leader”. Also, major drug companies have Documentum.

Content creationContent creation supports multiple file formats and integrates with MS and Adobe products, while supporting the creation of renditions as PDF and HTML. .

Connecting with other systemsDocumentum supports applications such as Siebel, SAP, PeopleSoft, BEA Weblogic Server and IBM Websphere. Documentum is a standard-compliant architecture that supports J2EE, .NET and XML. It provides open APIs for faster integration with legacy systems

Lifecycle support Documentum provides a range of library services e.g. full audit trail, check in/out, immediate version control, workflow, while supporting full, configurable lifecycle management; full text searching, and virtual document management. Each document has its own configurable life cycle, discussion threads, versions, links, attributes, functionality. . Documentum supports automatic deployment of content to external applications, content synchronization and roll-back to previous versions.


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Web connectivity and securityeRoom provides a Web-based, thin client (all information is seen in a browser e.g. IE, Netscape, Mozilla) platform independent interface, allowing synchronous (real-time meetings) and asynchronous communications, and access to structured and unstructured data in and out of the organization through secure Webspace. eRoom synchronizes both meetings and project plans with Outlook.

Collaboration featureseRoom supports immediate version tracking, voting/poll with automatic email notification based on subscription mechanisms informs members of changes/creation of documents -including a link to the document- to determined users. Members are assigned to configurable roles/permission/groups in the workspace. The collaboration environment can be configured to generate automatic notification for upcoming scheduled reviews of content

Rooms or “floors” where members “gather” and work together. Information can be rolled-up from multiple rooms into a consolidated view.

eRoom UI provides full setting up capabilities. It also provides usage reports, e.g. who uses what and when. For advanced version tracking eRoom recommends Workshare software.

Knowledge repositoryAny content, in any format can be stored as an object in the content repository: a RDB. All content is fully indexed. Taxonomy-supported search is only supported in the content, and not in the communication context. Taxonomies can be created using Mesh – an out-of-the-box tool; while Content Intelligence Services provide metadata extraction, classification and taxonomy creation, and management functionality.

One-click editing a document can be carried out in three possible ways:1. Only one person can edit a document at a time2. Many persons can annotate the same document at the same time3. Check out documents in sequential order using Workshare

ContentRepository

eRoomWebsites/

Portals

Figure 15: Publishing a document - Interaction between knowledge repository, eRoom and Portal

7.7 CommunityZeroCommunityZero is a virtual community that allows a group of people to communicate and exchange information over the Internet in their own private and secure area. Within each area, called an online community, participants have access to a suite of tools that allows a group to get organized effectively, share knowledge and communicate.


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Content CreationContent is shared through online communities where users post documents in multiple formats (e.g. text, links, HTML).

Connecting with other systemsCommunityZero is an interactive website.

Lifecycle supportMinimum support through calendar feature. No audit capabilities.

Web connectivity and securityNot specified

Collaboration featuresCommunityZero provides a suite of tools to publish documents, share bookmarks, join discussions, chat in real-time, news posts, schedule events, mark milestones, post notes, compile lists, exchange files, conduct polls, exhibit images, send group emails, group calendars.

Knowledge repositoryFiles are shared through links posted in shared lists.

7.8 InfoPathInfoPath is part of Office 2003 Professional enterprise edition. It is and Office tool for XML-based data gathering and reporting. Users can use InfoPath to create simple forms applications capture and access data, create reports, all without needing to understand where all the data is stored, or a group of confusing and incompatible front-end applications. InfoPath forms are easy to create, with a WYSIWYG design mode that shields users from the nuances of XML schemas. However, functionality is quite limited and support for error validation is almost null. Although Microsoft claims InfoPath is so easy to use that any administrative assistant can use it to generate XML forms, to produce robust, really dynamic forms with full data validation, it is necessary for an experimented programmer to add lines of VBScript or Jscript code. Further, forms running in a client cannot be modified. In other words, unless a full installation is carried out in each and single client, users cannot enter data in the forms.

Content CreationInfoPath provides an authoring environment for gathering information within dynamic forms with conditional formatting and data validation. However, functionality is quite limited and support for error validation is almost null. Applications can be created using MS Visual Studio .NET using managed code. InfoPath also provides tools for working with ActiveX controls and complex XML schemas.

Connecting with other systemsInfoPath supports a variety of protocols for connecting information, e.g., MS enterprise servers, MS Windows SharePoint Services, other DBs and line business applications. Infopath connects ADO, XML, Web Protocols/Servers, DBs in a bi-directional manner. InfoPath supports SQL databases and MS Access. It also integrates with other systems to pre-populate forms and validate input data.

InfoPath does not have a rich user interface and the architecture from a .NET developer point of view is too limited.


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It can be linked to external dictionaries and knowledge repositories e.g., RxNorm, diagnosis terminologies, and HL7 schemas.

Lifecycle supportInfoPath supports document versioning, and provides alerts and messages to users when changes, additions occur.

Web connectivity and securityInfoPath only supports connections with MS SQL and MS Access databases or through Web services.

Collaboration featuresUsers can share data through XML files automatically generated from the WYSIWYG design. Data is saved in the XML format defined by customized schemas (DTD files).

Secondary sources are read-only. Only one primary source is read/write. Hence, forms can be displayed outside InfoPath if converted to HTML (there’s a tool included for that), users cannot enter any data into the form, unless a full installation is available in the user’s machine.

Knowledge repositoryBusiness information can be stored in multiple servers and Infopath can access it through ADO, XML, Web Protocols/Servers, DBs in a bi-directional manner.

7.9 WellogicThe Wellogic Platform focuses exclusively on healthcare IT engineering and mobile applications. It provides integrated solutions for clinical applications. The Wellogic Platform consists of five main modules: Catalyst clinical knowledge platform; Consult Clinical Workflow Manager; Visage Internet Application Platform; Synapse Application Integration Platform; Insight Medical Imaging Toolkit.

Wellogic architecture is SOA-oriented: formed of loosely-coupled interacting software agents, hence allowing interoperability, and modularity.

Figure 16: Wellogic Platform Modules

Catalyst is a clinical knowledge platform that provides features – ranging from medical vocabulary driven rules authoring and management to rules driven application workflows and Web questionnaires – that enable clinical decision support through pro-active reviews and at the point of care.


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Catalyst rules engine event management is knowledge based and based in a state network that maintains the truth state of rules at every time. States are time-stamped and may/may not have expiration dates.

Content CreationCatalyst allows embedding rules in healthcare information systems, reducing medical errors and costs, by facilitating the translation, distribution, vetting and adoption of the best of medical expertise by bringing appropriate information to clinicians and patients based on priority and context.

Catalyst provides an intuitive Web-based authoring tool for rules, forms, guidelines, and workflows as required by domain experts. The authoring tool provides a library of rules to:

Capture knowledge with the level of detail clinicians require Represent rules at the high semantic level. Rules can be represented in Arden Syntax

and/or custom syntax. Allow easy creation of patterns, and decision tree algorithms Code concepts using medical vocabularies including SNOMED, ICD-9, CPT-4, Multum

and LOINC Create forms that support Documentation by Exception, and whose presentation,

behaviour, and sequencing can be personalized Provide point-to-point normalization of terminology Operate on an open architecture that provides APIs for.NET and J2EE environments Produce rules shareable in HL7, Arden Syntax, and XML.

Connecting with other systemsSynapse securely handles patient data and images between organizations and systems. It hosts access integration through screen-scraping, sockets and other protocols. It also parses standardized data formats including HL7 RIM, X.12, NCPDP, XML, also supporting DBOne, HL7 RIM, Cerner Millennium, Meditech Magic and proprietary data models. The underlying data model is based on the HL7 RIM and it’s handled as a hierarchical model.

Wellogic Data Access Component (WDAC) is closely affiliated with the RIM. It provides access to multiple home data storing through real-time connectivity/querying.

Visage provides a rich API that can be utilized via a wizard-driven administrative application, or directly from your application code. Visage is built upon and supports industry-standard platforms including MS .NET and Pocket PC, and Sun’s J2EE, integrates easily with off-the-shelf development tools, and provides a truly adaptable and powerful platform that adjusts to the performance, budgetary, and architectural needs of implementations.

Lifecycle supportVisage supports time-stamp and role-stamp audit trail management; check in/out, versioning.

Catalyst provides alert notifications supported by its workflow engine. The engine functions as a state network where each rule is a node with an associated truth value. The state of the network is maintained by checking for changes in the data. Catalyst is tightly connected to database transactions, which is what generates changes in the state network.

Web connectivity and security


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Visage manages user, role and group registration; login authentication of users without need of new userID or password. It provides role-based privileges for navigation and access to information.

Collaboration featuresSynapses supports notification of actions based on distribution lists, taxonomies, time-stamps, schedules of users and workflow. It integrates with Catalyst for rules execution.

Consult –another module of the Wellogic Platform- is a healthcare portal designed to support patient-centric views of patient records. As a framework, Consult is an environment that allows assembling applications ‘on the fly’. It provides a series of APIs to link proprietary authoring tools with the rules engine.

Knowledge repositoryKnowledge can be stored in proprietary databases and can be retrieved at run time by the Wellogic Data Access Component. The WDAC handles data transactions in real-time.

7.10 Product SummaryTables Table 1 and Table 2 present a summary of features of ten reviewed collaboration products. From all of them, only Documentum and Wellogic satisfied the majority of requirements, while also providing very good customer service and technical support. Those two products are under further evaluation and negotiations are on their way to get trial versions of both products.Use cases have been designed to test Documentum.

8 Quality RequirementsAs a further step toward selecting a collaboration tool, there are some quality attributes that should be considered while evaluating the product:

a. Availability. The system must be up and running 24/7. b. Efficiency. Resources required must be minimal. System must work in real-time.c. Flexibility. System enhancements can be done by programmers with a minimum of

coding.d. Interoperability. System must be able to exchange/integrate external data and support

legacy systems.e. Reliability. System must be consistent.f. Robustness. System must be able to function correctly when confronted with invalid

input data.g. Usability. Effort required to operate/interact with the system must be minimum.h. Maintainability. Parts of the system could be changed/reprogrammed by developers.i. Portability. Fully portable: can migrate to different systemsj. Reusability. System structured in reusable components.


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Features/ Product LivelinkInterwoven 5 teamsite enterprise content management (includes iManage Worksite) IBM Lotus QuickPlace

Documentum eRoom enterprise suite

Product type Interwoven 5 suite iManage Worksite Collaboration x x x x

Document Management x x x x x Knowledge management suite x x x xCurrent version 9.1 5.x 3 3 7Date available 2002 2002 2002 2003

Architecture 3-tier web basedthin-client, server-based distributed n-tier web-based, client/server web-based, client/server

Server OS supportedNT, 2000, solaris, HP-UX 11.0

Solaris, IBM AIX, NT, 2000

NT, 2000, IBM-AIX, HP-UX, Solaris, Linux

NT, 2000, IBM-AIX, IBM OS/400, IBM OS/390, Solaris 8 NT, 2000

Web server supported

MS Internet Information Server 4, iPlanet Web Server, Sun ONE Web Server, BEA WebLogic

Microsoft Internet Information Server, Apache Webserver, iPlanet Web Server Lotus Domino 5.0, 5.1

MS Internet Information Server 4

Client OS supported

NT, 2000, XP, Macintosh, Solaris, HP-UX, MS Explorer.

98, NT, 2000,Solaris, Macintosh

Windows 98, NT, 2000, XP; Explorer, Netscape

Windows 98-XP Web-browser, MS Explorer or Netscape for Windows

Web-browser, MS Explorer or Netscape for Windows, Unix and Macintosh

User Interface

Html, java applets. Windows explorer available as option WebDesk (in Java)

browser interface, and dedicated desktop application interfaces web-based browser-only

App development tools

HTML, Oscript, SOAP, WDSL, ActiveX, Java, J2EE, object browser, CORBA

Java API, VB-COM, Perl, SOAP, command line/file system

COM-based, Java-based API. Works with VB, Microsoft Interdev, Microsoft C++, Jbuilder

Java API, HTML, Java, LotusScript, C

eRoom API compliant with XML, J2EE, .NET

Communication ProtocolsTCP/IP, HTTP(S), SMTP TCP/IP HTTP HTTP, SSL, SMTP HTTP, HTTPS


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DB supportedSQL 7.0, Oracle 8i, 9i, Sybase

Oracle, DB2, SQL server, Sybase, Informix

SQL, Oracle, Informix, Sybase and ODBC compliant DBs

SQL 7, SQL 2000 (for metadata), Siebel, SAP

Data Model object-oriented object-oriented object-oriented

Integration with otherapps/formats

MS Office, WML, PDF, HTML, Web DAV lotus e-notes (enterprise version supports MSOffice)

Office, PDF, Lotus, Outlook, XML, eCommerce engines, Siebel Relationship Management 7. Adapters for Microsoft integration available

MS Office suite, Coreloffice suite, Vantive, Siebel, web application servers, MAPI-compliant email systems, ODMA-compliant applications. Standard interface connectors to multiple systems

MS Office 2000, XP; HTML, GIF, JPEG, Lotus sametime, lotus notes, SMTP

PDF, HTML, XML, Siebel, PeopleSoft, Office 2000 applications (through APIs)

Context exchange xAudit features audit trails x x X x versioning x + roll-back x X x x + roll-back workflow x x x x metadata x x + Taxonomy search check in/out x x x x xScheduling features scheduling x x calendar x x x x tasklists x x discussion threads x x event calendars x x URL link lists x Synchronization x xSecurity x xTemplate development using teamsite

Content Integration x

using Content Provider Integration Server

Content authoring x x x x


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email integrationoutlook, lotus notes

Outlook, Lotus Notes, GroupWise outlook, SMTP outlook, POP3, SMTP

email notification x x x xAsynch collab x x x

Search capabilities x x

workspaces, files, folders, collab objects, connections with third-party using Imanage Desksite x x

Document viewing > 200 formats > 185 > 400 >200

Import/export files x x x xCustomization features x x"Microsoft friendly"

integrates with Microsoft

enterprise version support integration with MS

with interwoven WorkTeam

Imanage mailsite integrates with outlook

through pre-built connectors with Office 2000 applications

reqs for integration

IE 5.x, 6.x or Netscape 4.7 Windows 95, 98, 2000, ME, NT 4.0, XP

Windows 98, ME, NT 4.0, 2000, XP. 64MB RAM, 50MB HD. For mailsite only: Outlook 98, 2000 Office 2000 Apps

Based on software/language Java 100% Java

Integrates with other platforms/software XML

J2EE, XML, XSL, SOAP, COM, NET

COMMENTS:- Does not support .NET - Does not support .NET - Vendor not evaluated GOOD- Vendor not evaluated - Static Backend, not flexible for change code

- Follow ups with vendor scheduled

- Web editing with little functionality

- Hard to update/relocate data

- Poor reporting capabilities

Table 1: Summary of collaboration tool features (1/2)


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Features/ Product

MS SharePortal Server 2003 / SharePoint

Services Groove Workspace CASAHL

ecKnowledge InfoPath CommunityZeroProduct type Integration tool Collaboration x x limited

Document Management x xsoftware to create dynamic forms limited

Knowledge management suite xCurrent version 2003 2.5 2Date available 2003

Architecture single serversingle server or hosted mode

integration tool between applications

full-client required for full functionality

Server OS supported Windows 2003Windows 2000 or hosted mode

MS Windows XP or later, Windows 2000 SP3 or later

Active Server Pages (ASP)

Web server supportedMicrosoft Internet Information Server MS Explorer

Microsoft Internet Information Server

Client OS supportedWindows 98/2000/2003/XP

Windows 98/ME/NT/2000 /XP.

Supports standards asMicrosoft file formats, templates and tools for developers

Windows XP, 2000 SP3 or later, Internet Explorer 6 or later.

4th generation browser

User Interface browser-based browser-based browser-based

App development tools HTTP, ASP.NET HTTP

Supports: MS Visual Studio .NET, IBM Domino Design, Websphere Studio Visual Studio .NET

Communication Protocols FTP

DB supported SQL server 2000 IBM DB2, MS SQL, Oracle

connects to IBM DB2, MS SQLServer, Oracle

MS SQL Serve, Access browser-based

Data Model Object Model (DOM)HTML, DHTML, Java


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Features/ Product



ecKnowledge InfoPath CommunityZero

Integration with other apps/formats

XML, Office 2003 suite, PeopleSoft, Siebel

XML, HTTP, FTP, UDP, RVP, MSWord, SharePoint, PeopleSoft, MS CRM

SharePoint, SQL Server, Outlook, infopath

SharePoint, MS SQL Server, MS software, XML, HTML forms. ActiveX coded exclusively for InfoPath.

VERY LIMIITED FUNCTIONALITY

Context exchange x xAudit features audit trails x x versioning x + roll-back x x + roll-back workflow x x x metadata check in/out xScheduling features scheduling x

calendar synch with outlookintegrates with outlook

tasklists x discussion threads x event calendars x URL link lists to documents x Synchronization xSecurity x x

Template development xx Integrates withinfopath x

Content Integration x x x xContent authoring x

email integration outlook outlookoutlook, Lotus Notes, Domino outlook

email notification x xAsynch collab Synch/ Asynch

Search capabilities xDocument viewing x x x

Import/export files xExport into XML. Import from MS files


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Features/ Product



ecKnowledge InfoPath CommunityZeroCustomization features x"Microsoft friendly" x

Integrates with Microsoft MS SQL Server 2000

Sharepoint for knowledge sharing/access data outside firewall

Supports standards asMicrosoft file formats, templates and tools for developers. MS Access, Excel, XML, XML Webservices

Part of Office 2003. If not, it is required. Integrates with SharePoint and MS software. Latest versions are required

Reqs for integration

Windows SharePoint Services: Collection of services for MS Windows Server 2003 Office 2003 Editions:document workspace with shared attachments to emails. Requires Windows Share Point Services not included in price.

To integrate with SharePoint requiresMS Windows Server 2003, Office 2003 // Client requirements: Windows 98, NT 4.0, ME, 2000, XP. Latest IE Latest MS Office

Windows XP, 2000 SP3 or later, Internet Explorer 6 or later.

Based on software/language

100 MS/Windows based. Compatible with XML

100 MS/Windows based. Compatible with XML

Integrates with other platforms/software possibly using XML possibly using XML possibly using XML

COMMENTS:

- Requires Windows 2003 and Office 2003 in all computers to provide full functionality

- Data sits on external server outside firewall

- Limited functionality and error validation

- Very limited functionality and customization

COMMENTS (Cont)

- Requires Office 2003 for seamless integration

- Further coding by experienced VB, Jscript programmer required to produce robust dynamic forms


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Features/ Product



ecKnowledge InfoPath CommunityZero

- Full installation required in all clients to enter data (modify) forms

Table 2: Summary of collaboration tool features (2/2)

Collaboration and Content Management Requirement AnalysisMargarita Sordo

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9 Recommendations1. Redefine procedures: Refine current ones as a first step. Set up timelines, state required ‘tools’ and indicate

where in the process, they can be incorporated. Diagrams in “summary of interviews” section provide an excellent start-up point for further refinement.

2. Identify and design business metrics around the processes to measure and enhance impact of deploying collaboration and content management tools

3. Identify minimum information required so requests can be carried out without ambiguity or the need for further clarification

4. Define communication templates/guidelines for requests (additions, updates, and deletions), forms

5. Determine levels of technical skills of users and evaluate software accordingly. Consider efficiency, interoperability and usability quality requirements

6. Suggest most appropriate collaboration tools based on observations/suggestions from interviews and features from reviewed applications. So far, Documentum and Wellogic seem to be suitable tools. Wellogic also has a rule engine as one of its component modules. Documentum just received a very positive review by Gardner [4].

7. Time for doing daily tasks plus time required to get up-to-date with backlogged tasks plus time required to migrate into new collaboration environment. A transition plan will be required.

8. Resistance to change must be considered. Although people are aware that their current processes are inefficient, changes bring uncertainty and people resist that. A part of the transition plan should focus on communication and management of future changes.

9. ‘Buying-in’ employees into the new system by providing enough information about new system capabilities, how they meet their needs.

10. Maintaining at least current level of deliverables during transition. Of course, the goal is to improve/optimize processes, but during transition, it is important to keep in mind that the time required to migrate into a new collaboration environment may impact the organization’s ability to meet current deliverables. A part of the transition plan should contemplate providing enough support in both processes and tools, and consultants to support employees all along the transition period.

11. Consider transition period as multi-phase incremental approach by setting intermediate measurable goals at the end of each phase, so ‘tweaking’ can be done as required while moving forward into next phases.

12. In the long term a unified approach will reduce costs and improve/optimize knowledge sharing processes.

10 Pending IssuesStill pending are further follow-up reviews of Documentum and Wellogic. These activities continue as part of the Knowledge Management Initiative led by Tonya Hongsermeier, but fall out of the timeline for this report. Issues that require further evaluation are listed below. So far, none of the reviewed systems fully satisfies them.

It is important to further identify ownership of every piece of knowledge in the current applications. Many authors may “own” different products by the fact that they own small pieces of knowledge embedded in such applications. Clear ownership is vital to facilitate the collaborative authoring process and to ensure consistency and quality of knowledge.

It is important to have the proper versioning criteria in place, e.g. whole document v. content-within-document versioning, product version, author, date, etc.


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The ability to “roll back” to a prior version will be necessary in certain circumstances, while checking for inconsistencies that may arise during the roll back process.

Authoring access controls keep track of who/when access content. Document lifecycle management is also important to capture (a spectrum from read to read/write capabilities (based on role of user), as well as read only access upon content publication.

A more complex version control is required. Version control should also be cognizant of the structure of the content, for instance, the ability to version the antecedent of a rule as opposed to the whole rule, rule version, author, date, etc. The ability to roll back rules also involves deleting the instances of the rule being executed in the current production systems, and compensating for any of it’s effects

11 References

[1]. KM Portal:UI Interface Design Proposal for Prototype Based upon Functional Specifications. Tonya Hongsermeier, Judith Colecchi, Muffie Martin, et al.

[2]. Management Update: Gartner’s Smart Enterprise Suite Magic Quadrant for 2003. S. Hayward, M. Gilbert, G. Phifer, F. Caldwell. IGG-03192003-01.

[3]. White Paper “Deciding when to deploy Microsoft Windows SharePoint Services and Microsoft Office SharePoint Server 2003. Microsoft SharePoint Products and Technologies. http://www.microsoft.com/sharepoint/

[4]. Vendor Rating: EMC Content Management. (Vendor Ratings, VDR-23-3613). Karen M. Shegda, KennethChin, Lou Latham. Research Note. 17 August 2004.

Appendix A. Evaluation tool for knowledge management of computerized rules

The objective of this evaluation tool is to: Clarify the information workflow for the definition, encoding, validation and maintenance of rules

in a computerized knowledge base Identify requirements for an optimal workflow Identify skills of each individual involved in the workflow Identify critical steps in the workflow Identify input/output of critical information at each step of the workflow process Disseminate current appropriate methodologies Identify opportunities or needs for change to improve the quality and reliance of knowledge

through the workflow Propose and evaluate new technology aids to improve workflow and formalize processes for

knowledge management

Please answer the following questions:

Current State:1. Is there a current schedule/process for updating information? ________________________________

___________________________________________________________________________________________________________________________________________________________________________________________________________


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2. Briefly describe the whole workflow for the definition, encoding, validation and maintenance of rules in a computerized knowledge base. _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. Describe your role, procedures and tasks for current updating process. _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4. In the workflow process, where do you position yourself? Mark in the workflow line to indicate the approximate position within the whole process.

Guideline Definition Guideline Specification for Encoding -- Guideline Encoding

5. Are there any preceding tasks/communication that impact the success of your work? If yes, what are they?_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

6. Do you consider yourself a key element in the process? Why? _______________________________________________________________________________________________________________________________________________________________________________________________________________

7. What input/data do you require to carry out the task(s) assigned to you? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

8. Is this input information/data:a. In the correct format? Yes No b. Well-defined? Yes No c. Are the instructions clear? Yes No

Start ofWorkflow

End ofWorkflow


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d. Is this data validated? Yes No (If Yes, who?) ____________

9. From whom do you receive the required information? ___________________________________________________________________________________________________________________________________________________________________

10. What is the output of your task? ____________________________________________________________________________________________________________________________________________________________________________________

11. Is output data:a. In a structured format? Yes No b. Well-defined? Yes No c. Are the instructions clear? Yes No d. Is this data validated? Yes No (If Yes, who?)_______________e. Is there an audit trail of changes/updates? Yes No

12. Are there templates or tools you use to perform guideline definition? Guideline design? Guideline encoding? If so, please describe them (or attach).____________________________________________________________________________________________________________________________________________________________________________________________________________________________

13. To whom you send the resulting information/data? _____________________________________________________________________________________________________________________________________________________________________

14. Do you have any additional handoffs (tasks/communication), that impact the success of these updates? If yes, what are these? ______________________________________________________________________________________________________________________________________________________________________________

15. Are there any time constraints you need to comply with while you carry out your responsibilities in the workflow? Yes No If yes, Are they realistic? Yes No Why? ________________________________________________________________________________________________________________________________________________________________________

16. Is there an evaluation process to measure the compliance to procedures? Yes No If yes, Are there any key indicators?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

17. Do you know where information/knowledge is kept for maintenance and updating purposes? Yes No

18. Do you have access to it? Yes No If Yes,Rank the ease to access such information/knowledge?


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easy somewhat easy difficult very difficult

19. Rank the ease to update information?easy somewhat easy difficult very difficult

20. Is there a mechanism for maintaining a human-readable inventory of the content. If so, what is it?____________________________________________________________________________________________________________________________________________________________________________________________________

21. Is there a standard way to keep track of changes? Yes No If yes, is it easy to follow? __________________________________________________________________________________________________________________

22. What features do you consider important for a system to keep proper track of information and ease communication? _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

23. From your point of view, what methods, processes or information gathering techniques for maintaining and updating the knowledge base that are currently used have been most useful to you or created the most success in maintaining the knowledge assets? Why? (If need more space use back of sheet) ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

24. From your point of view, is there anything in the workflow that has not been useful or successful l in the past? Yes No Why? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

25. What problems have you found in the current workflow, and how have you solved/addressed them? (Example, Are there any redundancies or inconsistencies?) (If you need more space, please continue at the back)

Problem: _________________________________________________________________________________________________________________________________Solution: __________________________________________________________________________________________________________________________________



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Future State/Possible Improvements:

26. If you could have some application tools to help you perform your role more effectively, how would those tools function? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

27. From the following, indicate whether such aid could help you to improve your work and the whole workflow, and why? (Mark as many as you consider useful)

a. Automatic notification of Requests and/or changes in the knowledge base.Your work knowledge updating process Why? ______________________________________________________________________________________________________________________________________________________

b. Automatic distribution of supporting documents or updates to the knowledge base to subject matter experts or appropriate committees for validation.Your work knowledge updating process What types of supporting documents (Microsoft docs, knowledgebase links, databases, etc)? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

c. Email support for communication. Your work knowledge updating process Why? _________________________________________________________________________________________________________________________________________________________________________________________________________________________

d. WebMeetings. Your work knowledge updating process Why? _________________________________________________________________________________________________________________________________________________________________________________________________________________________

e. Automatic version control of changes. Your work knowledge updating process Why? ________________________________________________________________________________________________________________________________________________________________________________


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________________________________________

f. Central repository with file structures that support easy navigation and organization of all information involved in the knowledge updating process. (screen shots, versioning, process flow diagrams, data elements, etc)Your work knowledge updating process Why? _______________________________________________________________________________________________________________________________________________________________________________________________________________________

g. Browsing capabilities by keyword, topic to access all knowledge in the knowledge base. Your work knowledge updating process Why? _______________________________________________________________________________________________________________________________________________________________________________________________________________________

h. Predefined templates for easy capture/input/update of information. Your work knowledge updating process Why? ________________________________________________________________________________________________________________________________________________________________________________________________________________________

i. User profiles of all people involved in the workflow. Your work knowledge updating process Why? _________________________________________________________________________________________________________________________________________________________________________________________________________________________

j. Project scope, Milestones and task lists, status reports. Your work knowledge updating process Why? _________________________________________________________________________________________________________________________________________________________________________________________________________________________

k. How would you envision the knowledge updating process changing with this these process changes/tools (best case scenario)?________________________________________________________________________________________________________________________________________________________________________________________________________________________________

l. How would you envision these tools impacting your role and your workflow? ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

28. Do you have any suggestions/comments/additional ideas? __________________________________________________________________________________________________________________________________________________________________________________________


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__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Your Name: _____________________________________________________________

Your position: ___________________________________________________________

Email: __________________________________________

Thank you for your time!

KNOWLEDGE MANAGEMENT FOR CLINICAL DECISION SUPPORT Requirement Analysis of Collaboration Tools for...

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