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.