While most KM principles and frameworks are applicable to different sectors and industries, the design and implementation of KM initiatives must be adaptive to unique domain situations in order to succeed. The doctors in the Partners HealthCare use highly specialized, domain-specific knowledge to provide healthcare services. The knowledge base in particular and knowledge management program in general implemented to support their works also must exhibit high levels of expertise. Expertise comes from experts, well respected experts. Since experts in the medical field usually are not familiar with best ways to extract and formulate knowledge, someone familiar with knowledge acquisition and organization must work closely with them to transfer their medical expertise into computer-processible forms. According to the experience in expert system development, this is one of the major bottlenecks in the first-generation knowledge management systems development. The challenge in transferring highly specialized, domain-specific knowledge into computerized knowledge base can not be overly emphasized.

However, it's precisely because it's not a trivial matter, whoever doing it right gets to enjoy nontrivial benefits.
Once the first version is released for regular use, the system must be subject to ongoing update and maintenance. If not designed properly, the system structure can get more and more unwieldy as system size grows. This is another hurdle that must be jumped to keep the system working.
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