From data to wisdom

From data to wisdom | Image Credit: © Fabio Balbi - © Fabio Balbi - stock.adobe.com.

Efficiency and accuracy are the cornerstones of a successful women’s health practice. In the ever-demanding health care environment, with the concomitant issues of burnout and financial optimization, maximizing time, resources, and patient care requires a robust framework. The DIKW pyramid—Data, Information, Knowledge, Wisdom—may provide answers for practices seeking to improve their services and efficiency. One method lies in refining provider documentation. By examining how the principles of DIKW align with the structure of SOAP notes (Subjective, Objective, Assessment, Plan), practices can uncover ways to streamline workflows and ensure every team member practices to the top of their license. This approach has the potential to enhance efficiency, improve outcomes, and reduce provider burnout.

Understanding the DIKW pyramid in health care

The DIKW pyramid illustrates the transformation of raw data into actionable wisdom. In health care, each layer has a distinct role:

• Data: Raw, unprocessed facts, such as a patient’s blood pressure or chief complaint.
• Information: Organized and contextualized data, such as identifying trends; for example, noting that a patient’s blood pressure has been steadily increasing.
• Knowledge: Insight derived from analyzing information, leading to clinical impressions such as identifying conditions as diagnoses.
• Wisdom: The ability to apply knowledge effectively to make informed, patient-specific decisions, such as creating a tailored treatment plan.

The DIKW model aligns seamlessly with SOAP notes. Each component of the SOAP structure corresponds to a layer of the DIKW pyramid (Figure):

• Subjective: Patient-reported data form the base of the pyramid. This can be enhanced with the efficient use of an electronic health record (EHR) and previsit applications to input information.
• Objective: Measured information adds context and clarity, including blood pressure readings, lab results, and past medical history.
• Assessment: Interpretation of data and information transforms them into knowledge. This involves applying the subjective and objective findings to create a clinical impression, leveraging experience and potentially artificial intelligence.
• Plan: Applying wisdom to develop actionable, patient-focused care plans.

Enhancing efficiency with role optimization

A practice’s efficiency hinges on its ability to delegate tasks effectively. When team members practice to the top of their licenses, workflows are optimized, and no one is overburdened with tasks outside their expertise. This ensures that team members are both productive and stimulated by their work. Practicing at a level too high can lead to delays in patient care, prolonged documentation time, and increased risk of errors. Conversely, practicing below one’s capacity wastes time, increases burnout, and diminishes overall efficiency. Each team member plays a specific role in contributing to the DIKW pyramid:

Data collection (data layer)

• Patients: Fill out screening forms and demographic information before visits, including medical, surgical, gynecologic, obstetric, and family history, as well as allergies, medications, and habits. These forms can be integrated directly into the EHR previsit.
• Medical assistants (MAs): Collect or confirm baseline patient data, such as vital signs, intake forms, and chief complaints, and input this information into the EHR.
• Nurses: Confirm documentation accuracy, perform medication reconciliation, and ensure completeness of health histories.
• Front desk staff: Verify patient demographic and insurance information, laying the groundwork for seamless care.

Data to information (information layer)

• Nurses and MAs: Summarize findings using standardized protocols and flag abnormal results or screeners for provider review.
• EHR tools: Compile and present trends, such as highlighting a steady rise in glucose levels, abnormal screens for social determinants of health, depression screens, genetic screens, or low-dose aspirin screening.

Information to knowledge (knowledge layer)

• Advanced practice providers (nurse practitioners/physician assistants): Analyze information to create preliminary assessments and collaborate with physicians as needed. The division of tasks should depend on the complexity of the patient’s needs and the provider’s expertise. Having cases that are too difficult leads to increased time per patient and possible errors.
• Physicians: Synthesize complex data and clinical insights to confirm diagnoses and identify broader care needs. Again, care complexity must be evaluated for the possibility of the need for a subspecialist referral. Conversely, constantly providing care for cases at a lower level of difficulty may lead to physician burnout or inadequate use of practice resources.

Knowledge to wisdom (wisdom layer)

• Physicians: Develop personalized care plans based on patient-specific nuances and evidence-based practices, including referrals to additional resources that enhance care.
• Care coordinators or case managers: Bridge care plans with patient resources, addressing social determinants of health to improve adherence and outcomes.

Practical strategies for DIKW integration

To fully leverage the DIKW model and optimize roles, practices can implement strategies that improve the flow from DIKW to SOAP while enhancing efficiency and care:

Previsit planning

Use structured templates to ensure all essential data are gathered before patient visits. MAs and nurses can prepare previsit summaries, giving providers a clear starting point. Where possible, implement features into the EHR to streamline the process and improve workflow.

Huddle culture and PDSA cycles

Hold brief daily meetings to review patient schedules, flag potential concerns, and align team priorities. This ensures seamless transitions from data to wisdom. Additionally, employ Plan-Do-Study-Act (PDSA) cycles to assess and refine processes. These cycles are particularly valuable during initial implementation but should be ongoing to sustain optimization.

Standing orders

Implement protocols that empower nurses or MAs to handle routine tasks, such as ordering labs or administering vaccinations, without waiting for provider input.

Technology integration

Utilize EHR features such as automated trend analysis, practice protocols and macros, and prepopulated templates to transform data into actionable information efficiently.

Feedback loops

Regularly review workflows and gather input from team members to identify bottlenecks, improve processes, and ensure everyone’s skills are fully utilized.

The benefits of role optimization

When practices align workflows with the DIKW pyramid and empower team members to practice to the top of their licenses, the benefits are significant:

• Improved patient outcomes: Better data organization and decision-making lead to more accurate diagnoses and tailored care plans.
• Increased efficiency: Delegating tasks appropriately reduces redundancies and frees up providers to focus on complex decision-making.
• Reduced burnout: A well-structured team approach prevents providers from being overburdened, improving job satisfaction and retention.

Conclusion

The DIKW pyramid offers a powerful lens through which to evaluate and improve practice efficiency. By aligning SOAP notes with the DIKW framework and ensuring every team member operates at the top of their license, women’s health practices can enhance workflows, reduce burnout, and deliver superior patient care. Now is the time to evaluate your practice’s processes and implement strategies that turn data into wisdom—and wisdom into action.