Detmer, Don E.

Warner, Homer R.

English

The University of Utah: J. Willard Marriott Digital Library

IAIMS Implementation and Administration at the University of UtahHomer R. Warner, Don E. Detmer, and Wayne J. PeayHealth Sciences Center, University of Utah, Salt Lake City, UtahThe Integrated Academic Information Management System(IAIMS) concept provides a framework for the incorporationof information management technologies in the healthsciences. At the University of Utah, IAIMS has acceleratedthe application of new technologies and has resulted in newadministrative structure and outlooksIRnODuCIIONThe introduction of the IAIMS concept in 1982 by Mathesonand Cooperl set the agenda for information management inhealth sciences for the next decade. At the University of Utah,IAIMS development has been successful in drawing supportfrom federal, institutional and corporate sources. However,the crucial element in the success of IAIMS has been, and willcontinue to be, the broad-based involvement of administration,faculty, staff and students in the IAIMS effortBACKRONWith the establishment of the Departnent of Biophysics andBioengineering in 1962, the health sciences at the Universityof Utah began to develop the critical mass that wouldultimately result in the current IAIMS effort. The departmentis noted for its development of the HELP hospital informationsystem which provides comprehensive management of patientinformation. In addition, the system incorporates a medicaldecision logic component that is invoked automatically inresponse to clinical data. While development of the HELPsystem has been the focus of attention for the department, ithas also made a very significant contribution by providing theuniversity with a cadre of professionals with experience inautomated information management.By the time the IAIMS report was published, the healthsciences community at the university was developing a varietyof independent automation efforts. These systems rangedfrom a large machine-intensive database in genetics, to a verysuccessful local area network in orthopedics. Instructionalapplications were emerging in the Colleges of Nursing,Pharmacy and Health. In the library, computer applicationshad developed as discrete solutions to specific problems. Forexample, separate systems were used to manage the catalog,circulation and the publication ofMEDOC: An Index to U.S.Government Publications in the Health Sciences. In the fall of1982, the library began planning a large integrated computersystem. To assist in this planning effort, the Deans and theHospital Administrator appointed faculty and staff members toan Integrated Library System Planning Committee.0195-4210/86/0000/0111 $01.00 1986 IEEEAs the Planning Committee was beginning its efforts, theNational Library of Medicine issued a request for proposalsfor an "Integrated Academic Information Management System(IAIMS) Strategic Planning - Phase r' contract. This initiativeby the National Library of Medicine was the catalyst neededfor the University ofUtah to take an institution-wide view. Toreflect its expanding vision, the Planning Committee becamethe IAIMS Task Force. While a response was submitted to theNational Library of Medicine, it was clear that, even if thecontract was not awarded, development of informationmanagement resources was essential. The University wasawarded a planning contract and an initial plan was completedin June 1985. Cunrently, the University is involved in a three-year IAIMS development project.ADMEINISTRATIONWhile it is all too easy to be enthralled by the technology, thecrucial element in the success of IAIMS at the University ofUtah has been the concerted effort made at broad-basedparticipation by all the colleges on the Health Sciencescampus. The Chairman of the Task Force and principalinvestigator of the IAIMS grant was appointed by the VicePresident for Health Sciences as his Assistant for InformationManagement. This has provided an efficient structure forplanning and policy development.The preeminent example of the participatory approach toIAIMS is the structure developed by the IAIMS Task Force forthe installation of the HELP Hospital Information System atthe University Hospital. Pre-IAIMS, the hospital informationsystem would have been viewed as a single system, designedto meet the clinical information needs of the hospital. In anIAIMS context, the hospital information system becomesmuch more. It is viewed as an invaluable health sciencesinformation resource to support research and instruction. As aresult, three different committees were appointed to direct theimplementation of the system.The Information Steering Committee is chaired by the VicePresident for Health Sciences and consists of the Deans of theColleges of Pharmacy, Nursing, Health and the School ofMedicine; the Assistant Vice President for Health Sciences, theHospital Administrator, the Director of the Library, the VicePresident's Assistant for Information Management and theDirector of Hospital Infornation Systems. This committee isresponsible for policy and planning.The second committee, the Clinical Computing ControlCommittee, is chaired by the Hospital Administrator andconsists of five department chairmen in the School of111Medicine, the University Hospital Administrator, the Directorof Hospital Information Systems, the director of nursing forthe hospital, and the chairman of the department of MedicalInformatics. This committee reviews and approves clinicalprojects involving the use of patient data, reviews andapproves additions to the expert component of the hospitalinformation system and certifies computer programs and otherclinical knowledge bases as to their suitability and performancecharacteristics prior to using them in a live clinicalenvironment. In addition, it advises the HospitalAdministrator regarding priorities for installation of clinicalservices.The final committee is the HELP Implementation andCoordination Committee. This committee is chaired by theDirector of Hospital Information Systems and includes theData Base Administrator, representatives from Nursing,Ambulatory Services, Pharmacy, the Clinical Laboratories,Medical Records, Radiology Services, the Hospital Controllerand the Associate Dean for Finances. Its responsibility is tocoordinate system access, data exchange, database profile,standards and conventions. In addition, it reviewsenhancements, interfaces with ancillary systems and serves asa clearing house for locally developed software and reportingcapabilities.This administrative structure reflects the complexity of theburgeoning information environment. The committees addressthe challenges of policy and planning; clinical, research andinstructional applications; and the technical aspects of systemimplementation.PEUnder IAIMS support, four expert systems are beingdeveloped as prototypes for this kind of activity on the medicalcampus. In the College of Nursing, we are building a systemfor advising nurses regarding pain management in specificclinical circumstances. Nurses at the LDS Hospital have beenworking for several years on computer-based nurse-care plansand pain management is an important component of this effort.The College of Nursing has faculty who are experts in thisfield and now actively work with students and faculty fromMedical Informatics to build HELP sectors (knowledgeframes) to improve the quality of pain-management decisions.Faculty from the School of Pharmacy are building a decisionsupport system with HELP to facilitate better management ofpatients requiring antibiotics.In the School of Medicine, we are building an expert systemfor Hematology, starting with decisions involving hemolyticanemia. In addition, the Department of Orthopedics isinvolved in structuring a knowledge base which will reflect thebest thinking of specialists in this field regarding certaintherapy decisions commonly faced by clinicians, and buildinga system which will provide this knowledge on-line to thosewho need it.As these projects develop, new tools are being built to make iteasier for medical subject matter experts to express theirknowledge in a form for computer use on the one hand, andon the other, to make it easier for a user of such a system tounderstand the underlying logic and even to access the source(literature reference where appropriate). To accomplish this,we are building relational files that link the medical subject tothe literature source, the expert, a patient database (ifknowledge was derived from analysis of past cases), and tothe HELP sectors themselves.IEMPACIAIMS has focused the attention of the institution on thechallenges and opportunities in information management. Therole of the National Library of Medicine has been central tothis effort. The IAIMS initiative required participation fromthe highest levels of University administration. Theappointment of an Assistant for Information Management wasa critical organization response, brought about in part by theresponse to the National Library of Medicine and in part by therecognition of the necessity for such a position. Subsequentfunding by the National Library of Medicine for the planningcontract and for the development grant substantially enhancedthe credibility of LAIMS. This support has attracted additionalfunding from corporations and private contributors to theinstitution.The speed of change within the institution has accelerated as aresult of the IAIMS initiative. In October 1985, theDepartment of Medical Biophysics and Computing of theSchool of Medicine (since 1974) became the Department ofMedical Informatics. This change in name was institutionalrecognition of an expanded role for the department. Thedepartment now has nine tenured faculty and 26 graduatestudents. Many of these students are supported through otherdepartments of the medical school and provide the intellectual"glue" that assures that interdepartmental projects move aheadon a day-to-day basis. About two thirds of these students willcomplete their training at the Masters level and the rest go on toa PhD in,Medical Informatics.Two major information resources, the hospital informationsystem and the integrated library system, are nearingcompletion. The hospital information system (HELP) wasdeveloped over the last 20 years at the LDS Hospital in SaltLake City, Utah by the university's Department of MedicalInformatics, and is now being installed at University Hospitalby a commercial vendor (Control Data Corporation) on aTANDEM computer system. A second TANDEM has beeninstalled by the School of Medicine in the offices for theDepartment of Medical Informatics specifically for use of theHELP system for teaching and research. The systems arefully compatable and permit use not only of the HELPprograms, but also the very large patient database from LDSand University Hospitals after names have been changed toprotect patient privacy. Programs funded by a grant from theNational Library of Medicine are being developed to optimizethe use of this powerful resource for teaching and research.The ILS installation at Eccles Medical Library on the medicalcampus has been a joint effort during the past year by OCLCand library staff. The library was closed mornings during thesummer to complete the installation and flle development forthe catalog. Expanded services to begin in October 1986 willinclude full access to the status of each book in our inventory.In addition to these two major developments, new faculty arebeing appointed in the health sciences that have specificinformation management responsibilities. New local areanetworks are being installed in the Colleges of Nursing andHealth to support instructional computing and, manydepartments and administrative units of the medical schoolalready have operational local area networks. The Departmentsof Pathology and Anatomy are combining computer-assistedinstruction with videodisc technology to provide teaching andtesting facilities. The Eccles library has a grant to support thedevelopment of a system which will provide computer-based112library service for health professionals throughout theintermountain region using portable microprocessors.CONCLUSIONSuperficially, the challenge of IAIMS is the coordinatedimplementation of a dynamic new technology. In fact, thesuccess of IAIMS is dependent on new social, psychologicaland administrative structures that are capable of responding tothis new information environment. Rather than focus on thecommunication links themselves, we have chosen to try todefine what we wish to communicate, and then build ournetworks to fill these needs. This is not always possible sincemany do not yet know explicitly how they want to use thisnew technology. We have chosen to start with those few whodo know and let the others leam from watching them.We wish to thank the National Library of Medicine, theControl Data Corporation and the OCLC Online ComputerLibrary Center, Incorporated for their support of IAIMS at theUniversity of Utah.RFEERENCE1. Matheson, N.W. and Cooper, J.A.D. "AcademicInformation in the Academic Health Sciences Center: Rolesfor the Library in Information Management." J Med EducSuppl, Oct 1982.113

IAIMS Implementation and Administration at the University of Utah

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IAIMS Implementation and Administration at the University of Utah

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The University of Utah: J. Willard Marriott Digital Library