SYMPOSIUM A decade of IAIMS Compiled and edited by Nancy M. Lorenzi, Ph.D.
CONTENTS Introduction: Integrated Academic Information Management Systems (IAIMS) Nancy M. Lorenzi
IAIMS: an overview from the National Library of Medicine Donald A. B. Lindberg, Richard T. West, and Milton Corn IAIMS development at Baylor College of Medicine G. Anthony Gorry IAIMS at Columbia-Presbyterian Medical Center: accomplishments and challenges Nancy K. Roderer and Paul D. Clayton
The impact of IAIMS at Georgetown: strategies and outcomes Naomi C. Broering and Helen E. Bagdoyan ACOGQUEST: the model phase of the IAIMS project of the American College of Obstetricians and Gynecologists Kathie M. DeGeorges, Pamela Van Hine, and Warren H. Pearse
Prototyping an institutional IAIMS/UMLS information environment for an academic medical center Perry L. Miller, John A. Paton, Jeffrey I. Clyman, and Seth M. Powsner
Creating the future: IAIMS planning premises at the University of Washington Sherrilynne S. Fuller
240
Bull Med Libr Assoc 80(3) July 1992
INTRODUCTION: INTEGRATED ACADEMIC INFORMATION MANAGEMENT SYSTEMS (IAIMS) All organizations change. Some change in an evolutionary way, others in a revolutionary way [1]. The concept of an Integrated Academic Information Management System (IAIMS) is no different. When it was first defined in the early 1980s, it was characterized as "academic information management," with an emphasis on increased roles for the library. In the mid1980s, the IAIMS concept was broadened to include institution-wide commitments to information management. During the past ten years, the Bulletin of the Medical Library Association has featured three symposia that presented the concept of information management and demonstrated its evolutionary growth into a broadened IAIMS concept at multiple institutions. The first symposium established the foundation for information management; the other two addressed the IAIMS concept specifically. The first symposium was edited by Rachael K. (Goldstein) Anderson and was published in the October 1983 Bulletin. In this work, "Symposium on Academic Information in the Academic Health Sciences Center: Roles for the Library in Information Management," multiple authors stressed the importance of placing libraries in the forefront of information management-hospital libraries, academic medical libraries, and general university libraries [2-10]. In the July 1986 Bulletin, Naomi C. Broering edited a second symposium entitled, "Integrated Academic Information Management Systems." This series featured papers that described IAIMS prototypes at the four pioneering institutions. Each author covered the initial steps of model development and clarified the broader institutional understanding of IAIMS. Three articles contained diagrams indicating the institutional nature of IAIMS, and one paper focused on IAIMS and the library [11-15]. The third symposium, entitled "Integrated Academic Information Management Systems (IAIMS) Model Development," was edited by Nina W. Matheson and published in the July 1988 Bulletin. It focused on the work of the second wave of institutions that began IAIMS planning and development. The papers in this symposium described IAIMS from three perspectives: information management, knowledge management, and information technology. The virtual notebook concept was introduced by the Baylor College of Medicine [16-23]. Thus, in both the 1986 and in the 1988 issues, we began to see an expansion of the concept of information management placed in a broader role than the library. In reviewing all the articles in the previous symposia, a recurrent theme emerges: IAIMS programs, and the institutions that have implemented IAIMS, have changed in evolutionary ways. "A Decade of IAIMS," the symposium presented Bull Med Libr Assoc 80(3) July 1992
in this issue, is the fourth published by the Bulletin. It features seven papers that present the full continuum of IAIMS activities from those that are well established to those that are just beginning. The authors demonstrate the continued growth of IAIMS, the expansion into broader information arenas, and the library as an important segment. The IAIMS concept has undergone an evolutionary change from earlier days when it concentrated on the library's role in information management to information management in the total organization. The first paper presents an overview from the National Library of Medicine (NLM) and discusses the significance of the IAIMS initiative, how it has improved health science information management in the past ten years, and prospects for future programs in areas such as high performance computing and national networks. The Baylor College of Medicine paper describes IAIMS from a college overview-the technical, organizational, and financial commitments that are necessary for a fully unified IAIMS planning and development process. The Baylor IAIMS program concentrates on full integration of science and research into an IAIMS concept, and from that, the Virtual Notebook System has evolved. The overview of IAIMS at Columbia-Presbyterian Medical Center outlines both their accomplishments and challenges. As part of their IAIMS effort, Columbia created new organizational entities, one of which is the Center for Medical Informatics, which serves as the research arm of IAIMS. The Columbia model encompasses the hospital and the academic environment. The principal investigator of IAIMS is also the information architect for all the entities of the Columbia University-Presbyterian Medical Center complex. The paper describes challenges that all institutions face, including pricing, security, computing platforms, selecting application priorities, standardized interface software, and links to other systems. Since 1983, Georgetown University has been engaged in an IAIMS project to bring together multiple sources of information that reside on different computers and database systems. Georgetown is developing a Biotechnology and Biomedical Knowledge Network that includes informational and clinical databases, scholar workstations, instruction on computer use, a campuswide network, and a modular approach to systems integration. The IAIMS project, spearheaded by the medical library, has enabled a broad spectrum of health professionals to benefit directly from new, dynamic information services. At Georgetown, IAIMS has advanced the concept of integration, accelerated the use of computers in education, increased user acceptance of advanced tech241
Lorenzi
nologies, and established cost factors for providing information resources. Georgetown provides evidence of the impact of IAIMS and highlights the return on dollars invested. The paper from the American College of Obstetricians and Gynecologists (ACOG) represents an IAIMS program at the Phase II level. This IAIMS project is based in an association that provides outreach services to physician members in the United States. Thus, the challenges of ACOG are different from those of the other IAIMS academic medical centers. Yale University indicates how one prototype, on a single workstation, has demonstrated desired capabilities to an institution and the information architecture needed to make this system a reality. The paper describes the linking of the IAIMS program to the Unified Medical Language System initiatives and how this combination enhances the information capabilities at an academic medical center. The University of Washington at Seattle is an IAIMS site that has just completed the planning stage. This paper provides an overview of the University of Washington environment and concentrates on the IAIMS planning structure. Since the University of Washington is the most recent IAIMS institution, it is cognizant of prior activities and efforts at the other sites and has adapted features from those models. It is clear from reading all of the articles in this symposium that the complexity of medical information and the management of information and knowledge presents growing challenges daily. IAIMS has been instrumental in introducing important changes in the transmission of medical information. Many institutions have benefited from NLM's support and need to continue the momentum started in 1983. The question for the future is, "Will the economic environment of the 1990s allow us to organize and manage biomedical knowledge effectively?"
By Nancy M. Lorenzi, Ph.D. Associate Senior Vice-President and Director University of Cincinnati Medical Center Information and Communications 231 Bethesda Avenue Cincinnati, Ohio 45267-0574
REFERENCES 1. GREINER LE. Evolution and revolution as organizations grow. Harvard Bus Rev 1972 Jul-Aug;50:37-46. 2. GOLDSTEIN RK. Symposium on academic information in the academic health sciences center: roles for the library in information management. Introduction. Bull Med Libr Assoc 1983 Oct;71(4):404. 3. BRAUDE RM. Symposium on academic information in the academic health sciences center: roles for the library in 242
information management. Academic information in the academic health sciences center: overview. Bull Med Libr Assoc 1983 Oct;71(4):405-9. 4. LORENzI NM. Symposium on academic information in the academic health sciences center: roles for the library in information management. Making a dream come true: strategies for medical school libraries. Bull Med Libr Assoc 1983
Oct;71(4):410-4. 5. GREEN EW. Symposium on academic information in the academic health sciences center: roles for the library in information management. Implications for hospital libraries. Bull Med Libr Assoc 1983 Oct;71(4):415-6. 6. WERNER G. Symposium on academic information in the academic health sciences center: roles for the library in information management. Implications for university libraries. Bull Med Libr Assoc 1983 Oct;71(4):417-9. 7. BELL JA. Symposium on academic information in the academic health sciences center: roles for the library in information management. Health sciences personnel and the academic information system: user requirements. Bull Med Libr Assoc 1983 Oct;71(4):420-2. 8. JOHNSON MF JR. Symposium on academic information in the academic health sciences center: roles for the library in information management. Implementation in an academic health sciences center. Bull Med Libr Assoc 1983 Oct;71(4): 423-6. 9. HAYES RM. Symposium on academic information in the academic health sciences center: roles for the library in information management. Manpower issues: implications for training and retraining of librarians. Bull Med Libr Assoc 1983 Oct;71(4):427-32. 10. COOPER WS. Symposium on academic information in the academic health sciences center: roles for the library in information management. Program implications for the National Library of Medicine. Bull Med Libr Assoc 1983 Oct; 71(4):433-4. 11. BROERING NC, HENDRICKSON GLF. Symposium on Integrated Academic Information Management Systems. Introduction. Bull Med Libr Assoc 1986 Jul;74(3):235-7. 12. PEAY WJ, BuTrrER KA, DOUGHERTY NA. Symposium on Integrated Academic Information Management Systems. IAIMS and the library at the University of Utah. Bull Med Libr Assoc 1986 Jul;74(3):238-42. 13. HENDRICKSON GLF, ANDERSON RK, LEvy RI. Symposium on Integrated Academic Information Management Systems. IAIMS at Columbia: a strategic plan and model project. Bull Med Libr Assoc 1986 Jul;74(3):243-8. 14. BROERING NC. Symposium on Integrated Academic Information Management Systems. Beyond the library: IAIMS at the Georgetown University Medical Center. Bull Med Libr Assoc 1986 Jul;74(3):249-56. 15. WILSON MP, BALL MJ, ZIMMERMAN JL, DoUGLAS JV. Symposium on Integrated Academic Information Management Systems. The IAIMS initiative at the University of Maryland at Baltimore. Bull Med Libr Assoc 1986 Jul;74(3):257-61. 16. MATHESON NW. Symposium: Integrated Academic Information Management Systems (IAIMS) model development. Introduction. Bull Med Libr Assoc 1988 Jul;76(3): 222-3. 17. LINDBERG DAB. Symposium: Integrated Academic Information Management Systems (IAIMS) model development. The IAIMS opportunity: the NLM view. Bull Med Libr Assoc 1988 Jul;76(3):224-5. Bull Med Libr Assoc 80(3) July 1992
Introduction
18. BARNErr GO, GRENES RA, ZIELSTORFF RD. Symposium: Integrated Academic Information Management Systems (IAIMS) model development. IAIMS development at Harvard Medical School. Bull Med Libr Assoc 1988 Jul;76(3): 226-30. 19. LoRENzI NM, MARKS EB. Symposium: Integrated Academic Information Management Systems (IAIMS) model development. University of Cincinnati Medical Center: integrating information. Bull Med Libr Assoc 1988 Jul;76(3): 231-6. 20. VAN HINE P, PEARSE WH. Symposium: Integrated Academic Information Management Systems (IAIMS) model development. The IAIMS project of the American College of Obstetricians and Gynecologists: using information technology to improve the health care of women. Bull Med Libr Assoc 1988 Jul;76(3):237-41.
Bull Med Libr Assoc 80(3) July 1992
21. STEAD WW. Symposium: Integrated Academic Information Management Systems (IAIMS) model development. Information management through integration of distributed resources. Bull Med Libr Assoc 1988 Jul;76(3):242-7. 22. LucIER RE, MATHESON NW, BurrER KA, REYNOLDS RE. Symposium: Integrated Academic Information Management Systems (IAIMS) model development. The knowledge workstation: an electronic environment for knowledge management. Bull Med Libr Assoc 1988 Jul;76(3):248-55. 23. GoRRY GA, BURGER AM, CHANEY RJ, LONG KB, TAUSK CM. Symposium: Integrated Academic Information Management Systems (IAIMS) model development. A virtual notebook for biomedical work groups. Bull Med Libr Assoc 1988 Jul;76(3):256-67.
243
CONTENTS Introduction: Integrated Academic Information Management Systems (IAIMS) Nancy M. Lorenzi
IAIMS: an overview from the National Library of Medicine Donald A. B. Lindberg, Richard T. West, and Milton Corn IAIMS development at Baylor College of Medicine G. Anthony Gorry IAIMS at Columbia-Presbyterian Medical Center: accomplishments and challenges Nancy K. Roderer and Paul D. Clayton
The impact of IAIMS at Georgetown: strategies and outcomes Naomi C. Broering and Helen E. Bagdoyan ACOGQUEST: the model phase of the IAIMS project of the American College of Obstetricians and Gynecologists Kathie M. DeGeorges, Pamela Van Hine, and Warren H. Pearse
Prototyping an institutional IAIMS/UMLS information environment for an academic medical center Perry L. Miller, John A. Paton, Jeffrey I. Clyman, and Seth M. Powsner
Creating the future: IAIMS planning premises at the University of Washington Sherrilynne S. Fuller
240
Bull Med Libr Assoc 80(3) July 1992
INTRODUCTION: INTEGRATED ACADEMIC INFORMATION MANAGEMENT SYSTEMS (IAIMS) All organizations change. Some change in an evolutionary way, others in a revolutionary way [1]. The concept of an Integrated Academic Information Management System (IAIMS) is no different. When it was first defined in the early 1980s, it was characterized as "academic information management," with an emphasis on increased roles for the library. In the mid1980s, the IAIMS concept was broadened to include institution-wide commitments to information management. During the past ten years, the Bulletin of the Medical Library Association has featured three symposia that presented the concept of information management and demonstrated its evolutionary growth into a broadened IAIMS concept at multiple institutions. The first symposium established the foundation for information management; the other two addressed the IAIMS concept specifically. The first symposium was edited by Rachael K. (Goldstein) Anderson and was published in the October 1983 Bulletin. In this work, "Symposium on Academic Information in the Academic Health Sciences Center: Roles for the Library in Information Management," multiple authors stressed the importance of placing libraries in the forefront of information management-hospital libraries, academic medical libraries, and general university libraries [2-10]. In the July 1986 Bulletin, Naomi C. Broering edited a second symposium entitled, "Integrated Academic Information Management Systems." This series featured papers that described IAIMS prototypes at the four pioneering institutions. Each author covered the initial steps of model development and clarified the broader institutional understanding of IAIMS. Three articles contained diagrams indicating the institutional nature of IAIMS, and one paper focused on IAIMS and the library [11-15]. The third symposium, entitled "Integrated Academic Information Management Systems (IAIMS) Model Development," was edited by Nina W. Matheson and published in the July 1988 Bulletin. It focused on the work of the second wave of institutions that began IAIMS planning and development. The papers in this symposium described IAIMS from three perspectives: information management, knowledge management, and information technology. The virtual notebook concept was introduced by the Baylor College of Medicine [16-23]. Thus, in both the 1986 and in the 1988 issues, we began to see an expansion of the concept of information management placed in a broader role than the library. In reviewing all the articles in the previous symposia, a recurrent theme emerges: IAIMS programs, and the institutions that have implemented IAIMS, have changed in evolutionary ways. "A Decade of IAIMS," the symposium presented Bull Med Libr Assoc 80(3) July 1992
in this issue, is the fourth published by the Bulletin. It features seven papers that present the full continuum of IAIMS activities from those that are well established to those that are just beginning. The authors demonstrate the continued growth of IAIMS, the expansion into broader information arenas, and the library as an important segment. The IAIMS concept has undergone an evolutionary change from earlier days when it concentrated on the library's role in information management to information management in the total organization. The first paper presents an overview from the National Library of Medicine (NLM) and discusses the significance of the IAIMS initiative, how it has improved health science information management in the past ten years, and prospects for future programs in areas such as high performance computing and national networks. The Baylor College of Medicine paper describes IAIMS from a college overview-the technical, organizational, and financial commitments that are necessary for a fully unified IAIMS planning and development process. The Baylor IAIMS program concentrates on full integration of science and research into an IAIMS concept, and from that, the Virtual Notebook System has evolved. The overview of IAIMS at Columbia-Presbyterian Medical Center outlines both their accomplishments and challenges. As part of their IAIMS effort, Columbia created new organizational entities, one of which is the Center for Medical Informatics, which serves as the research arm of IAIMS. The Columbia model encompasses the hospital and the academic environment. The principal investigator of IAIMS is also the information architect for all the entities of the Columbia University-Presbyterian Medical Center complex. The paper describes challenges that all institutions face, including pricing, security, computing platforms, selecting application priorities, standardized interface software, and links to other systems. Since 1983, Georgetown University has been engaged in an IAIMS project to bring together multiple sources of information that reside on different computers and database systems. Georgetown is developing a Biotechnology and Biomedical Knowledge Network that includes informational and clinical databases, scholar workstations, instruction on computer use, a campuswide network, and a modular approach to systems integration. The IAIMS project, spearheaded by the medical library, has enabled a broad spectrum of health professionals to benefit directly from new, dynamic information services. At Georgetown, IAIMS has advanced the concept of integration, accelerated the use of computers in education, increased user acceptance of advanced tech241
Lorenzi
nologies, and established cost factors for providing information resources. Georgetown provides evidence of the impact of IAIMS and highlights the return on dollars invested. The paper from the American College of Obstetricians and Gynecologists (ACOG) represents an IAIMS program at the Phase II level. This IAIMS project is based in an association that provides outreach services to physician members in the United States. Thus, the challenges of ACOG are different from those of the other IAIMS academic medical centers. Yale University indicates how one prototype, on a single workstation, has demonstrated desired capabilities to an institution and the information architecture needed to make this system a reality. The paper describes the linking of the IAIMS program to the Unified Medical Language System initiatives and how this combination enhances the information capabilities at an academic medical center. The University of Washington at Seattle is an IAIMS site that has just completed the planning stage. This paper provides an overview of the University of Washington environment and concentrates on the IAIMS planning structure. Since the University of Washington is the most recent IAIMS institution, it is cognizant of prior activities and efforts at the other sites and has adapted features from those models. It is clear from reading all of the articles in this symposium that the complexity of medical information and the management of information and knowledge presents growing challenges daily. IAIMS has been instrumental in introducing important changes in the transmission of medical information. Many institutions have benefited from NLM's support and need to continue the momentum started in 1983. The question for the future is, "Will the economic environment of the 1990s allow us to organize and manage biomedical knowledge effectively?"
By Nancy M. Lorenzi, Ph.D. Associate Senior Vice-President and Director University of Cincinnati Medical Center Information and Communications 231 Bethesda Avenue Cincinnati, Ohio 45267-0574
REFERENCES 1. GREINER LE. Evolution and revolution as organizations grow. Harvard Bus Rev 1972 Jul-Aug;50:37-46. 2. GOLDSTEIN RK. Symposium on academic information in the academic health sciences center: roles for the library in information management. Introduction. Bull Med Libr Assoc 1983 Oct;71(4):404. 3. BRAUDE RM. Symposium on academic information in the academic health sciences center: roles for the library in 242
information management. Academic information in the academic health sciences center: overview. Bull Med Libr Assoc 1983 Oct;71(4):405-9. 4. LORENzI NM. Symposium on academic information in the academic health sciences center: roles for the library in information management. Making a dream come true: strategies for medical school libraries. Bull Med Libr Assoc 1983
Oct;71(4):410-4. 5. GREEN EW. Symposium on academic information in the academic health sciences center: roles for the library in information management. Implications for hospital libraries. Bull Med Libr Assoc 1983 Oct;71(4):415-6. 6. WERNER G. Symposium on academic information in the academic health sciences center: roles for the library in information management. Implications for university libraries. Bull Med Libr Assoc 1983 Oct;71(4):417-9. 7. BELL JA. Symposium on academic information in the academic health sciences center: roles for the library in information management. Health sciences personnel and the academic information system: user requirements. Bull Med Libr Assoc 1983 Oct;71(4):420-2. 8. JOHNSON MF JR. Symposium on academic information in the academic health sciences center: roles for the library in information management. Implementation in an academic health sciences center. Bull Med Libr Assoc 1983 Oct;71(4): 423-6. 9. HAYES RM. Symposium on academic information in the academic health sciences center: roles for the library in information management. Manpower issues: implications for training and retraining of librarians. Bull Med Libr Assoc 1983 Oct;71(4):427-32. 10. COOPER WS. Symposium on academic information in the academic health sciences center: roles for the library in information management. Program implications for the National Library of Medicine. Bull Med Libr Assoc 1983 Oct; 71(4):433-4. 11. BROERING NC, HENDRICKSON GLF. Symposium on Integrated Academic Information Management Systems. Introduction. Bull Med Libr Assoc 1986 Jul;74(3):235-7. 12. PEAY WJ, BuTrrER KA, DOUGHERTY NA. Symposium on Integrated Academic Information Management Systems. IAIMS and the library at the University of Utah. Bull Med Libr Assoc 1986 Jul;74(3):238-42. 13. HENDRICKSON GLF, ANDERSON RK, LEvy RI. Symposium on Integrated Academic Information Management Systems. IAIMS at Columbia: a strategic plan and model project. Bull Med Libr Assoc 1986 Jul;74(3):243-8. 14. BROERING NC. Symposium on Integrated Academic Information Management Systems. Beyond the library: IAIMS at the Georgetown University Medical Center. Bull Med Libr Assoc 1986 Jul;74(3):249-56. 15. WILSON MP, BALL MJ, ZIMMERMAN JL, DoUGLAS JV. Symposium on Integrated Academic Information Management Systems. The IAIMS initiative at the University of Maryland at Baltimore. Bull Med Libr Assoc 1986 Jul;74(3):257-61. 16. MATHESON NW. Symposium: Integrated Academic Information Management Systems (IAIMS) model development. Introduction. Bull Med Libr Assoc 1988 Jul;76(3): 222-3. 17. LINDBERG DAB. Symposium: Integrated Academic Information Management Systems (IAIMS) model development. The IAIMS opportunity: the NLM view. Bull Med Libr Assoc 1988 Jul;76(3):224-5. Bull Med Libr Assoc 80(3) July 1992
Introduction
18. BARNErr GO, GRENES RA, ZIELSTORFF RD. Symposium: Integrated Academic Information Management Systems (IAIMS) model development. IAIMS development at Harvard Medical School. Bull Med Libr Assoc 1988 Jul;76(3): 226-30. 19. LoRENzI NM, MARKS EB. Symposium: Integrated Academic Information Management Systems (IAIMS) model development. University of Cincinnati Medical Center: integrating information. Bull Med Libr Assoc 1988 Jul;76(3): 231-6. 20. VAN HINE P, PEARSE WH. Symposium: Integrated Academic Information Management Systems (IAIMS) model development. The IAIMS project of the American College of Obstetricians and Gynecologists: using information technology to improve the health care of women. Bull Med Libr Assoc 1988 Jul;76(3):237-41.
Bull Med Libr Assoc 80(3) July 1992
21. STEAD WW. Symposium: Integrated Academic Information Management Systems (IAIMS) model development. Information management through integration of distributed resources. Bull Med Libr Assoc 1988 Jul;76(3):242-7. 22. LucIER RE, MATHESON NW, BurrER KA, REYNOLDS RE. Symposium: Integrated Academic Information Management Systems (IAIMS) model development. The knowledge workstation: an electronic environment for knowledge management. Bull Med Libr Assoc 1988 Jul;76(3):248-55. 23. GoRRY GA, BURGER AM, CHANEY RJ, LONG KB, TAUSK CM. Symposium: Integrated Academic Information Management Systems (IAIMS) model development. A virtual notebook for biomedical work groups. Bull Med Libr Assoc 1988 Jul;76(3):256-67.
243
