Abstract—This paper illustrates a feasible health informatics domain knowledge management process which helps gather use-ful technology information and reduce many knowledge misun-derstandings among engineers who have participated in the IBM mainframe rightsizing project at National Taiwan University Hospital (NTUH). Our health informatics domain knowledge management process can be used to publish and retrieve docu-ments dynamically. It effectively creates an acceptable discussion environment and even lessens the traditional meeting burden among development engineers. An overall description on the current system development status is presented. Then, the knowl-edge management implementation of hospital information sys-tems is proposed. Its related effects on the environment pressure, user requirements and project management are also discussed.

Keywords—knowledge management, environment design, pro-

ject management

I. INTRODUCTION

The software development process has advanced at a tre-mendous rate and seems to be accelerating, as computers be-come faster and more powerful [1]. Traditional approaches in knowledge management are focused on the storage and re-trieval of knowledge, but they do not address the tacit dimen-sion of knowledge process [2].

Furthermore, the process of the virtual agency concept is attempting to balance formal process controls with the agility to adapt rapidly to new research opportunities. The virtual agency can be used to improve organizational efficiency, im-prove knowledge transfer, increase interoperability through standards, provide better alignment of agency missions with national policy, and introduce increased flexibility into the R&D process [3]. Reisman analyzed seven kinds of the man-agement processes: ripple process, embedding process, bridg-ing process, transfer of technology process, creative applica-tion process, structuring process, and empirical validation

process [4]. A vision of democracy and an understanding of the type of knowledge process can facilitate organizational constancy [5]. Appropriate process management is becoming increasingly important in improving software development performance. There can be no doubt about the value of under-standing the antecedents of software process capability [6][7].

II. HYPOTHESIS DEVELOPMENT

Learning organizations are organizations where people continually expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are natured, where collective aspiration is set free, and where peo-ple are continually learning to see the whole together [8]. The choice of the appropriate knowledge processing strategy is a complex issue [9]. This paper only considered four parts: the network utilization, the relationship between technology and knowledge, knowledge sharing, and e-learning mechanism. A. Power of Networks

The death of distance shift in the goals of internetworking

toward universal access not only mobilized more people and organizations to get connected but also generated a discourse that assumes that societal and global transformation will fol-low [10]. For example, the knowledge network concept as a means of establishing an integrated approach to knowledge management and will highlight it using observations made during system implementation in SMEs [11].

Expertise-sharing network systems differ from library-like repositories that collect explicit knowledge in forms such as databases, reports, presentations, and documents. Contempo-rary knowledge management initiatives increasingly include expertise-sharing networks that help answer questions about who knows what [12]. Furthermore, the idea of a distributed network of repositories each exchanging partial, specific

A Collaborative Knowledge Management Process for Implementing Healthcare Enterprise Information

Systems

P. H. Cheng1,2, T. H. Yang1,4, C. H. Yang3, G. H. Lin2, F. Lai1,6, C. L. Chen1,6, H. H. Lee1,6, Y. S. Sun4, J. S. Lai5, S. J. Chen2

1 Information Systems Office, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

2 Graduate Institute of Electronics Engineering and Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan

3 Department of Computer Science, Stanford University, California, USA 4 Department of Information Management, National Taiwan University, Taipei, Taiwan

5 Department of Physical Medicine and Rehabilitation and Department of Medical Informatics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

6Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan

0-7803-9139-X/05/$20.00 ©2005 IEEE. 604

knowledge giving and gaining value when distributed in the network is substituted for a common organization-wide knowledge repository [13].

Danskin et al. illustrated the process of acquisition, reten-tion, maintenance, and retrieval of knowledge within a firm by improving organizational memory and across the value chain through knowledge management systems to gain competitive advantage [14]. Meanwhile, trouble management is the han-dling of problems that require exploratory, yet routine prob-lem-solving practice [2][15]. In summary, it is our expectation that the appropriate using of networking will attract most of the engineers. Most of the engineers eagerly obtain the latest system development information through networks. If possible, they also want to enhance their capabilities simultaneously.

B. From Technology to Knowledge

Originally, technology not only consists of machines and

mechanical equipment but also comprises technical knowl-edge and participant skills. Some contend that technology is a form of knowledge. Knowledge is like pollen; it creates new knowledge by interacting with other knowledge vectors acting as stamen [16].

As a simplest, technology is more about knowing how things are done while knowledge is more about knowing why things occur. That is, knowledge is much broader than a par-ticular technology [17]. Moreover, knowledge captures the underlying cause and effect relationships on which a technol-ogy is constructed and embedded [18].

Current Web service standards are not sufficient for automatic composition. However, the Semantic Web can re-duce manual discovery and usage of Web resources and allow software agents to automatically identify, integrate and exe-cute them for achieving the intended goals of the user [19]. The efficient forum will gradually become an information pool which serves from technology transfer to knowledge ex-change. C. Knowledge Sharing

Documentation of project information, storage and re-trieval systems for project information, information reviewing practices, vision clarity, vision stability, and management sup-port of the project impact a team’s ability to acquire and use knowledge to reduce cycle time and improve their probability of success [20]. As the engineers face an increasing load of other tasks which also demand time and effort, the decision to adopt the innovation or not seems to depend more on the ef-fort required to adapt the innovation for local use than other factors [23].

An efficient multifunctional team is welcome because every team member will be capable of communicating to each other within the team due to their multifunctional knowledge, team-work skills, as well as an established good working rela-tionship [21]. Moreover, the soft dimension assists in better understanding the process of organizational knowledge trans-fer [22]. It is necessary for the managers to clearly divide the

role of the knowledge users and let the process be created within positive effect circle. D. E-Learning Mechanism

Organizational learning has been generally measured in

aggregate. In such a way that it is difficult to determine a sin-gle individual’s contribution or how the individual improves over time. Individual-based is an alternate theoretical view of learning in organizations whereby performance is a unique attribute of each individual within the organization [24].

The results of Nord et al. help identify the educational and training requirements for future system analysts that need to be in place for both academic and corporate instructional pro-grams [25]. Thus the system analysts have to study the con-tents from the knowledge pool, in order to learn a wide range of skills.

On the other hand, the result of Lang et al. indicates that novices were variable in performance not because of differ-ences in declarative knowledge (on which they were trained) but because of these differences in procedural knowledge (on which no training was given) [26]. The novices have to browse the procedural contents from the knowledge pool just after they enter the development team and try to learn the de-velopment knowledge as soon as they could.

III. METHODOLOGY

Fundamentally, the System Design II division of NTUH transplanted a forum template from phpBB and utilized it as a discussion forum to share the view of points of engineers in-side the development team [27][28]. This forum is opened on December 5th, 2003. Fig. 1 and Fig. 2 illustrated the portal screen snapshot of the research and development forum the system development environment at NTUH, respectively.

The phpBB is an open source free community solution. We install several phpBB v.2.0.6 modules which include fo-rum statistics, document upload, and document management. The forum statistics module supports content statistical func-tionality. The document upload module provides functionality to let system analysts and system designers upload every document and to use Project Manager to track the schedule.

Fig. 1. Portal of the system R&D forum at NTUH.

0-7803-9139-X/05/$20.00 ©2005 IEEE. 605

Fig. 2. System development environment at NTUH.

This forum uses password to manage the entry privilege

and let right person to login the related web pages of the de-velopment environment. The web pages include documents, programs, and shared files (such as CVS Web and system bi-nary release), and quality assurance status report.

This forum server owns a Pentium IV 2.0GHz CPU, 1GB memory, and an 80GB hard disk. It installed the FreeBSD 4.10-STABLE operating system. Actually, the development team also installed Apache HTTP Server, CVS server, FTP server, rsync server, phpBB forum, CVSweb, Bugzilla, and MySQL database server at this machine. These services pro-vide the whole system development team members to negoti-ate, coordinate, and share resources among the rightsizing project.

There are 99 users who had registered and shared their opinions in this forum until June 2005. They can post their experiences and opinions for further discussion. Every log of the discussion is automatically controlled by the forum system and the related statistical reports are easy for reviewing. A. Role of the Forum Users

Everyone who wants to enter this forum should be granted

by the managers of the development team and the forum sys-tem administrator will physically grant privilege to a specific user. The roles of the users include the chief information offi-cer (CIO), chief of information systems office, system analysts, system designers, system programmers, quality assurance team members, part-time engineers, system engineers, data-base administrators, system consultants, and the representa-tives of end users. Table I illustrates role of the R&D forum users. Note that the end users of others in Table I were trans-ferred from R&D forum to another public forum for security reason.

Gradually, this R&D forum becomes a public discussion

center of the development team. Most of the mangers and en-gineers posted their information on the forum and share others view of points from the same forum. In summary, it is our expectation that the R&D forum will attract most of the engi-neers in the system development team.

B. Information Pool

The crucial challenge in achieving effective control of the

knowledge management process rests not in strategies for col-lecting and classifying relevant problem/solution information [2]. Originally, our forum only includes the kernel developers who attend the hospital system rightsizing project. Most of them are in favor of the new information techniques. Further-more, they ask for the managers to invite all of the related colleagues to use this forum to discuss the issues of the project. Sequentially, mangers accept their requests and announce this forum to most of the attending colleagues.

The R&D forum includes four categories: new outpatient system, NTUH system R&D, R&D technology, and general discussion. The new outpatient system category includes 15 folders: registration, blood bank, laboratory and pathology, medical image and nuclear medicine, pharmacy, observation, clinical room and diagnosis, treatment and scheduling, billing, insurance, credit, disease surveillance, patient record man-agement, and data exchange. The NTUH system R&D cate-gory include five folders: programming guidelines, HL7 pro-tocols, Web service, emergency system, and IBM data trans-formation. The R&D technology category includes six folders: programming frequently asked questions, .Net framework, Oracle database, user interface, quality assurance, and printing. The general discussion category includes four folders: system announcement, general comments, minutes, and travel.

The characteristic of the forum information exchange is asynchronous. The question posters and repliers can post their information and browse the related information in the forum any time. The more information the engineers post on the R&D forum, the more feedback will reply from the others.

TABLE I ROLE OF THE R&D FORUM USERS

Division Role Category Amount Manager Management 7 System design I System analysis 9 System maintenance 16 System design II System analysis 1 System design 9 Programmer (full-time) 4 Programmer (part-time) 5 Quality assurance 6 Database administrator 1 System consultant 4 System engineering System administrator 1 Database administrator 2 Network administrator 3 System operator 7 Training & research Training 5 Others Clinical doctor 8 Nurse 6 Clinical clerk 5

0-7803-9139-X/05/$20.00 ©2005 IEEE. 606

C. Dilemma of User Privileges

After one year of R&D forum opening, the knowledge sharing speed and power are beyond the original estimations of most of the managers. For example, the end users who post their requests at this forum will know the detailed system de-velopment status and spread the estimated development status to the other end users. There are two kinds view of points: positive and negative. If the development status is on schedule, then the spread information is a good advertisement for the development team. Meanwhile, it will cheer up the develop-ment team members. If the development status is not on schedule, then the rumor will spread around the whole organi-zation and development team should feedback the actual fact which already posted on the R&D forum.

Basically, most of the end users lack of fundamental in-formation technology knowledge, but abound of domain know-how. If we could not guarantee our development team can achieve the project on schedule, it is better for us to let end users to browse the well completion information of the project. Otherwise, it is necessary for the development team to explain why they should need more development time to solve some information technology questions.

In order to avoid the trouble that is illustrated as above. The development team moved its R&D forum from an Inter-net environment to an intranet environment. In the mean time, we screen all of the user accounts and only let development team members to register the R&D forum. The end users be-ing kicked out of the R&D forum are reallocated at the or-ganization forum for general development status discussions.

D. Self-Training Center

In order to speedup the learning status of the novices and

decrease the occasional disturb from novices to professionals, the project manager selects the relative important contents and integrates them in a brand new web page. For example, the novices can learn the coding style from the forum by them-selves. Furthermore, the project manager defined an orienta-tion course to let all of the novices learn the necessary guide-lines of project team by themselves. Most of the professionals favor this change, which lets them evaluate the learning status from their successor’s questions.

The R&D forum is focused on both of the technology transfer and knowledge transfer. That is, the forum supports fundamental technology knowledge and an environment for engineers to share some of their experiences, which will let their followers absorb knowledge quickly. For example, the user interface coding style had a well conclusion and follow-ers can learn it by themselves in the forum.

IV. RESULTS

Table II illustrates part of the statistical data of the R&D

forum at NTUH. Obviously, most of the engineers are eager to share the HL7 subsystem and user interface knowledge. Meanwhile, the system analysts prefer to browse most of the topics in this forum frequently.

Especially, pharmacy system is complex and most of the

engineers like to browse the system design documents, table schema, and related explanations from the forum. Moreover, the novices of this team prefer to browse the “how to start your working and conformance statement” topics. At last, quality assurance and database topics are also popular in this forum.

V. DISCUSSION

Novices learn the orientation course through the project web site in the project team. However, the web site does not record the learning track and evaluation. Furthermore, the project materials do not manage with appropriate standards. For example, the related materials should follow the SCORM standard and implement some efficient mechanism to evaluate the engineer learning status. It will be another knowledge management factor for mangers to evaluate the project engi-neers.

Some figures from the Internet service provider America Online (AOL) support the survey’s findings that elderly in the United States are not the most frequent Internet users. Only 5% of AOL members are aged 65 years old or older [29]. This evidence might warn us that the senior manager might be afraid of using computerized knowledge management and transfer mechanism. On the other hand, they might be in favor of the statistical reports and paper documents. However, the acceptance rate of the computerized knowledge management for senior managers will be increased gradually by time pass-ing.

VI. CONCLUSION

The key contribution of this study is the development of a R&D forum for sharing information asynchronous among all of the project colleagues. No matter how many goals we achieved, the managers should remember the tale which illus-trated in the Hutchen’s book [30]. If a learning organization wants to achieve many higher goals, we should utilize the or-ganizational knowledge and illuminate the beliefs that limit our organization.

TABLE II PART OF THE STATISTICAL DATA OF THE R&D FORUM

Rank Top 10 Reply Topics Top 10 Browsing Topics 1 HL7: subsystem HL7: subsystem 2 User interface User interface 3 Quality assurance Oracle Database 4 Blood bank system Pharmacy system: SD1 5 Pharmacy system: SD Travel Information 6 Patient record management Quality assurance 7 Oracle Database HL7: e-learning courses 8 Travel Information How to start your working? 9 General suggestions Conformance statements 10 HL7: standard Pharmacy system: TS2 1SD: system design 2TS: table schema

0-7803-9139-X/05/$20.00 ©2005 IEEE. 607

ACKNOWLEDGMENT The authors would like to acknowledge the implementa-tion engineers of rightsizing project, System Design II Divi-sion, Information Systems Office, National Taiwan University Hospital. The authors also want to thanks for the collaboration from the colleagues, K. P. Hsu, C. H. Chen, S. M. Chu, et al., at Computer and Information Networking Center, National Taiwan University.

REFERENCES [1] A. H. Rubenstein, “50 years of engineering and technology manage-

ment,” IEEE Trans. Eng. Manage., vol. 51, no. 4, pp. 407-408, 2004. [2] J. Kim and J. King, “Managing knowledge work: specialization and

collaboration of engineering problem-solving,” J. of Knowledge Man-agement, vol. 8, no. 2, pp. 53-63, 2004.

[3] M. Castro, R. S. Foster, K. Gunn, and E. B. Roberts, “Managing R&D alliances within government: the ‘virtual agency’ concept,” IEEE Trans. Eng. Manage., vol. 50, no. 3, pp. 297-306, 2003.

[4] A. Reisman, “On alternative strategies for doing research in the man-agement and social sciences,” IEEE Trans. Eng. Manage., vol. 35, no. 4, pp. 215-220, 1988.

[5] D. Mercer, T. Leschine, C. H. Drew, W. Griffith, and T. Nyerges, “Pub-lic agencies and environment risk,” J. of Knowledge Management, vol. 9, no. 2, pp. 129-147, 2005.

[6] T. Ravichandran and A. Rai, “Structural analysis of the impact of knowledge creation and knowledge embedding on software process ca-pability,” IEEE Trans. Eng. Manage., vol. 50, no. 3, pp. 270-284, 2003.

[7] R. Rada and J. S. Craparo, "Standardizing management of software engineering projects," Knowledge Technology, and Policy, vol. 14, no. 2, pp. 67-77, 2001.

[8] P. M. Senge, The fifth discipline, New York: Currency, 1994. [9] S. Dutta, “Strategies for implementing knowledge-based systems,” IEEE

Trans. Eng. Manage., vol. 44, no. 1, pp. 79-90, 1997. [10] S. Iacono and R. Kling, Computerization Movement: the rise of the

Internet and distant forms of work, Information Technology and Organ-izational Transformation: History, Rhetoric, and Practice, Sage Publica-tions, Thousand Oaks, CA, USA, pp. 93-135, 2001.

[11] E. Scherer, “The knowledge network: knowledge generation during implementation of application software packages,” Logistics Information Management, vol. 13, no. 4, pp. 210-217, 2000.

[12] A. Tiwana and A. A. Bush, “Continuance in expertise-sharing networks: a social perspective,” IEEE Trans. Eng. Manage., vol. 52, no. 1, pp. 85-101, 2005.

[13] M. H. Larsen and M. K. Pedersen, “Distributed knowledge management in health care administration,” in Proc. 34th Hawaii Int’l Conf. on Sys-tem Science, pp. 1-10, Hawaii, USA, 2001.

[14] P. Danskin, B. G. Englis, M. R. Solomon, M. Goldsmith, and J. Davey, “Knowledge management as competitive advantage: lessons from the textile and apparel value chain,” J. of Knowledge Management, vol. 9, no. 2, pp. 91-102, 2005.

[15] P. S. Adler, “When knowledge is the critical resource, knowledge man-agement is the critical task,” IEEE Trans. Eng. Manage., vol. 36, no. 2, pp. 87-94, 1989.

[16] R. Garud and P. R. Nayyar, “Transformative capacity: continual struc-turing by intertemporal technology transfer,” Strat. Manage. J., vol. 15, no. 5, pp. 365-385, 1994.

[17] S. Gopalakrishnan and M. D. Santoro, “Distinguishing between knowl-edge transfer and technology transfer activities: the role of key organiza-tional factors,” IEEE Trans. Eng. Manage., vol. 51, no. 1, pp. 57-69, 2004.

[18] D. A. Garvin, “Building a learning organization,” Harv. Bus. Rev., pp. 78-92, July-Aug. 1993.

[19] C. P. Yugyung Lee, S. A. Chun, and J. Geller, “Compositional knowl-edge management for medical services on semantic web,” in Proc. WWW2004, pp. 498-499, New York, USA, May 2004.

[20] G. S. Lynn, R. R. Reilly, and A. E. Akgun, “Knowledge management in new product teams: practices and outcomes,” IEEE Trans. Eng. Manage., vol. 47, no. 2, pp. 221-231, 2000.

[21] S. J. G. Chen and L. Lin, “Modeling team member characteristics for the formation of a multifunctional team in concurrent engineering,” IEEE Trans. Eng. Manage., vol. 51, no. 2, pp. 111-124, 2004.

[22] G. A. C. Guzman and J. Wilson, “The ‘soft’ dimension of organizational knowledge transfer,” J. of Knowledge Management, vol. 9, no. 2, pp. 59-74, 2005.

[23] K. H. Chai, M. J. Gregory, and Y. S. Shi, “An exploratory study of in-trafirm process innovations transfer in Asia,” IEEE Trans. Eng. Manage., vol. 51, no. 3, pp. 364-374, 2004.

[24] D. A. Nembhard and M. V. Uzumeri, “An individual-based description of learning within an organization,” IEEE Trans. Eng. Manage., vol. 47, no. 3, pp. 370-378, 2000.

[25] G. D. Nord and J. H. Nord, “Information systems project development: knowledge and domain requirements for the systems analyst,” Industrial Management and Data Systems, vol. 97, no. 1, pp. 17-24, 1997.

[26] G. T. Lang, R. E. Eberts, M. G. Gabel, and M. M. Barash, “Extracting and using procedural knowledge in a CAD task,” IEEE Trans. Eng. Manage., vol. 38, no. 3, pp. 257-268, 1991.

[27] C. Wege, "Portal server technology," IEEE Internet Computing, vol. 6, no. 3, pp. 73-77, May-June 2002.

[28] M. A. Smith, "Portal: toward an application framework for interoperabil-ity," Communications of the ACM, vol. 47, no. 10, pp. 93-97, 2004.

[29] R. Voelker, “Seniors seeking health information need help crossing ‘digital divide’,” J. of American Medical Association, vol. 293, no. 11, pp. 1310-1312, 2005.

[30] D. Hutchens, Shadows of the Neanderthal: illuminating the beliefs that limit our organizations, Pegasus Communications, Waltham, MA, USA, pp. 61-82, 1998.

0-7803-9139-X/05/$20.00 ©2005 IEEE. 608