Applying DIKUW to Healthcare

Healthcare value (efficiency and effectiveness) can be increased through the use of health information technology to transformation data and information into knowledge and understanding. Some ideas follow: 

• Data are structured and unstructured symbols or signs consisting of words (concepts and labels) and alphanumeric values. Data represent actual stimuli or signals, but they must be presented in some meaningful context to be useful. For example, a vital sign datum of “blood pressure=130/80” is not very useful, by itself, in making clinical decisions or determining outcomes. 

• Information is formed from multiple data elements that may come from personal experience, other people, electronic data stores, and other sources. The information becomes meaningful, valuable, and useful after processing the data upon which it is built. This data processing may be done by mental or computerized models. These process models have a specific purpose or context. They may, for example, collect data via manual and automated means; cleanse and integrate (aggregate) the data; categorize them into conceptual groupings; organize them into meaningful structures (e.g., arrays, lists and tables); identify patterns in the data (e.g., trends and outliers) through rule-based analytics; and present the data in ways that provide actionable information. An example of data being transformed into clinically useful information is the use of a computational model that assesses a patient’s blood pressure readings over time and associates those data with data about the patient’s symptoms, vital signs, lab test results, external influences, and treatments (medications and procedures) delivered. 

• Knowledge emerges from information that is gained through observation/perception, instruction, reading, interpersonal communications, research, insight and intuition, etc. Personal knowledge is stored in one’s memory and can sometimes be codified and shared in artifacts (books, paper, web sites, video, etc.). Knowledge enables a person to describe a situation by answering who, what, where, and when questions, as well as describing how and why to do something. The accuracy of knowledge depends on the soundness (validity and reliability) of the underlying information. Knowledge can be built on proven facts (valid/empirical information), unproven hypotheses/assumptions, or falsehoods (invalid/erroneous information). Using clinical knowledge enables a provider to make diagnostic and treatment decisions—correctly or incorrectly—based on a patient’s signs and symptoms, causative factors (internal and external influences), inferences and assumptions, along with diagnostic rules and treatment guidelines. 

• Understanding is the ability to use one’s knowledge, not only to describe things, but also to explain why things have happened, are happening, and likely will happen (i.e., explain what makes reality the way it is). The accuracy of one’s explanations depends of the soundness and completeness of the knowledge upon which one’s understandings are built. Profound understanding requires comprehensive knowledge of relevant factors, including key processes, models, measures, concepts, details, relationships, interactions, beliefs, etc. Knowledge required for deep clinical understanding includes human physiology and psychology; the mind-body connection; evidence-based research, guidelines, and treatment options; care plans; social and other environmental influences; clinical outcomes; etc. Armed with such understanding, collaborators are able to create new knowledge, as well as effectively use, evaluate, and improve existing knowledge.

• Wisdom is the use of valid, evidenced-based information, knowledge and understanding to continually increase care cost-effectiveness (value), and reward (a) healthcare providers who deliver high-value care and (b) patients who collaborate with their providers to management their own health effectively.

DIKUW - Definitions: Data

There has been extensive debate about how to define the related concepts of data, information, knowledge, understanding, and wisdom. So, let’s start by discussing possible definitions, beginning with "data."

Data are symbols reflecting facts, perceptions, measurements, observations, etc., which are the raw elements (building blocks) of information. Data may be:

• Measures/Values of phenomena (things, events, experiences), such as its quantity, intensity, frequency, duration, rank/position/level, rate, duration, time and location of occurrence, length/width/depth, central tendency (mean, mode, median), degree of deviation or change, correlation, trend, statistical significance, etc.
• Labels/Descriptions of some phenomena, such as identities/names of persons, places, things, and events.

Data may or may not be valid (e.g., an accurate measurement or a correct label) and reliable (dependable, consistent).

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DIKUW - Definitions (cont): Information

Information consists of integrated data collections whose meaning comes from its analysis, interpretation, organization, and incorporation into models and processes expressed as explanations, hypotheses, or instructions. Information includes explanations/hypotheses of how things are related (e.g., patterns/groupings, cause-effect, co-variation), as well as instructions guiding actions (e.g., when musical data/symbols — notes, keys, etc. — are integrated into a musical score, it instructs the musician how to play an arrangement, and thus becomes information).

Information may have been learned (via rote or experientially) or it may be innate (genetic, intuitive, instinctive).

Information Validation. Some information can be validated by mathematical-logical, empirical, objective, or other analyses of underlying data; by qualitative experience; through comparison with competing information; through replication of experimental findings; and/or by social consensus. Through such validation processes, the information may be proven valid or invalidated as misinformation or disinformation.

The information validation process may be scientifically rigorous and obvious, informal and barely noticed (e.g., a slight nod in affirmation), or consist only of the give-and-take debate over alternative views of what is accurate/correct. The method of validation and the information selected for validation may, furthermore, be influenced by the focus/motives and priorities/values of the validators.

Information can be tacit, implicit, or explicit. It's explicit if it is codified and shared. It's implicit if it can be codified and shared (i.e., can be brought to consciousness awareness and put into sharable form), but isn’t. And it's tacit if it cannot be ever be shared (i.e., they exist only in a single person’s mind, is not accessible to consciousness, and lack adequate linguistic capacity to be shared with others in codified form, like the multitude of steps necessary to ride a bike).

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DIKUW - Definitions (cont): Knowledge

Knowledge — knowing who, what, where, when, why, how — refers to information a sentient being recognizes (detects/identifies/is aware of) and recalls (recollects/remembers), either consciously or unconsciously. This knowledge “emerges” as people communicate (share information) through conversations, non-verbal interactions, and media (books, movies, music, TV, etc.).

Knowledge built on a foundation of invalid or unreliable information, is faulty/erroneous knowledge. Sound knowledge, on the other hand, may come from scientific and rational validation (methods of observation and logic), or through other forms of social consensus. Regardless of how knowledge is validated, it is a "relative truth" (i.e., truth limited to the methods of validation, which may be proven wrong in some way at some time); it is not an "absolute truth” (i.e., truth that transcends human validation and reflects a universal reality that cannot ever be proven wrong).

Knowledge is actually belief if, instead of being validated, it is based on faith.

Note that a case can be made for the existence of “machine knowledge,” which refers to a computer’s ability to recognize and recall information using rules/algorithms, as well as to a mechanical object’s ability to use gears, circuits, etc.

There are different "forms" of knowledge in a contiuum from highly tacit to clearly explicit. The following is quoted from Denham Grey's blog:

Tacit knowledge is closely related to intuition, gut feelings, compiled experiences and skills. This tacit stuff is very hard to explain, it comes from exposure, arises out of repeated learnings, consists of deeply held feelings and beliefs. Tacit knowledge allows us to reason without logic, to act without reflection and to make sense of new situations.

Implicit knowledge sits in the middle. Here we are able to model, explain, draw, surface, share insights and explicate beliefs. This often requires time, deep reflection, dialog, introspection and mulling around.

Explicit knowledge is documented, illustrated, captured, stored and retrievable. It takes many forms from transcripts, to business rules, from detailed definitions to evolving scripts e.g. such as we see in wikipedia or video sequences.

Not everyone will impute the same meaning to explicit knowledge, personal or group interpretations are context and time dependent and biased by each individuals own tacit knowledge.

DIKUW - Definitions (cont): Understanding

Understanding can be thought of as a kind of knowledge; it's knowledge that can be used/applied to do such things as:

• Explain, elaborate, interpret, uncover/discover, or gain insights into the nature of things, such as interactions (relationships, patterns, cause & effect, etc.) and implications (inferences, consequences) of phenomena
• Question/challenge assumptions, conclusions, interpretations, hypotheses
• Notice contradictions, ambiguity, inconsistencies, surprises
• Support decisions through logic and evidence
• Make high-probability predictions
  
• Judge/evaluate/assess/appraise things rationally and sensibly
  
• Create and imagine
• Emerge intention, including focusing attention and motivating actions
• Justify or negate beliefs/hypotheses/assumptions/predictions.

Understandings may or may not be valid and reliable, depending on the underlying knowledge.

Understanding is directly related to intelligence: Greater intelligence enables deeper understandings.

Understanding a phenomenon in multiple ways has the benefit that different well-connected representations let you turn ideas around in your mind and envision things from many different perspectives.

The emergence of understanding can be a totally private/tacit process, e.g., when logical connections between concepts and new intuitive insights spontaneously emerge through private contemplation/reasoning. Understandings also emerge through direct conscious activity of an individual or group.

A key difference between knowledge and understanding is that knowledge exists simply by recognizing and recalling certain pieces of information. Unlike "lesser" forms of knowledge, understanding requires that the information be relevant, clear and complete enough to enable one to explain why things happen, interpret nuance, find patterns in complexity, gain insights, make critical-thinking judgments, create, motivate, justify, etc. For example, consider the difference between knowing a joke and understanding it. Knowing it means people can recall and repeat the joke’s information (words and actions); but if they don’t understand it, then they won’t find it funny because they fail to notice the absurdities, word-play, etc. that make the joke funny.

DIKUW - Definitions (cont): Wisdom

Wisdom refers to the ability to use knowledge and understanding to make decisions and take actions that enable achievement of goals and objectives in a way that minimizes current adversities and avoids future problems, while maximizing positive gains and their sustainability.