One of the challenges facing healthcare in Europe is the need for effective management of clinical knowledge, or more specifically, expertise. Healthcare is essentially a knowledge industry complicated by resource constraints and imperfect communication. Historically, healthcare expertise has been stratified and needs to be reconstructed into today’s more networked, demand-driven world.

The delivery of healthcare involves a complex network of experts. In the case of cancer, where TACIT will focus its pilots, specialist Oncology consultants, Cancer nurses, Radiologists, and many other hospital based staff have to closely work with family doctors and home support teams of nurses. The hospital-based consultant holds certain specialist knowledge, but the general practitioner also holds vital knowledge about the patient and their history. The Radiologist knows how to interpret scans and x-rays from years of experience.

Each of these experts forms a "Community of Practice", constantly sharing information and exchanging expertise as best as possible using traditional data-centric IT systems and voice, written referral and discharge letters or face-to-face communications. The shortcomings of these communications mean that patients are required to visit – often unnecessarily – different experts in person, where they must repeat many common questions and receive common examinations. Moreover, many existing ICT solutions model healthcare as a sequential model of referral-diagnosis-treatment and discharge, when, in reality, a referral often leads to a chain of referrals, as the clinical understanding of the patient’s problem is iteratively tested and refined by a series of expert clinicians, therapists, lab technicians and nurses.

Effective expertise sharing is needed to streamline the healthcare delivery process for both patient and the overstretched services, improve the quality of clinical decision making – not just for diagnosis, but throughout the process – and reduce clinical risk.

Supporting the healthcare Community of Practice requires a constant capture of dynamic and semi-static knowledge, both from actual clinical practice and from published sources to correctly interpret real-time information, which also comes from disparate systems and media.

However, even this gathering and storing of knowledge can only capture explicit knowledge – meanwhile, the experts retain their tacit knowledge, which forms a vital part of their expertise, as it is held subconsciously and cannot be readily captured or codified. Tacit knowledge can only normally be communicated by example or by training, but even when taught, tacit knowledge is difficult to convey outside of its original context.

When knowledge remains tacit in healthcare, this is often reflected in problems or inefficiencies in the follow-up care process, or at worst in a breakdown of care.

Not surprisingly, the way general practitioners normally supplement their lack of specialist knowledge is usually by directly interacting with colleagues or specialists. The time invested in this necessary activity reduces the time available for vital patient contact, for example, in time to help minimise the psychological impact of cancer on individuals/families.

A step change in working practice is required and here is where the TACIT project aims to have a major impact, by supporting the sharing of clinical expertise across health communities of practice, thereby delivering significant economic as well as quality of life benefits.