IAIMS (Introduction to Medical Informatics) (http://www.cpmc.columbia.edu/edu/textbook) LAST REVIEWED: 22 September 1997 Integrated Academic Information Management System (IAIMS) National Library of Medicine (NLM) program aimed at medical centers create a prototype information architecture to be copied funding started 1984 overall goal: sponsor integration at sites in order to create a set of tools that could be disseminated widely 3 Phases: I (initial planning); II (prototype); III (full-scale deployment) goals acquire information: clinical = history, physical exam, lab, radiology bibliographic administrative share information: consultation education use information (tools) passive (statistical package) active (automated decision-support sytem) example of integration: clinical data result (that prompts billing) that prompts alert that prompts access to bibliographic info that prompts mail to consultant... a medical center is complex, with many "users" (persons, departments...) that need to communicate (regardless of computerization) users by site of information... 1. producers of information: major group (subgroups) clinical laboratory = chemistry, hematology, etc pathology pharmacy radiology = diagnostic, interventional cardiology = ECG, echo, cath lab pulmonary ward clerks (administrative clerks) patients = trend toward "patient-centric" computing 2. repositories of information central hospital administration medical records: different places and types hospital individual office ("shadow chart") electronic library patients! = esp in the absence of shared records/provider comm 3. consumers of information nursing station (hospital): nurses, doctors, clerks medical office: nurse, doctor administrative office: for management, billing research laboratories = e.g., aggregate reporting, MLMs patients! other campuses Allen Pavilion CU main campus independent entities department of health visiting nurse services private medical office other hospitals insurers actually, all users participate in all roles (not so simple) need to coordinate hard/software purchase/installation physical networks ...and by applications and functions 1. clinical laboratory results order entry decision support imaging medical record 2. administrative patient registration (admit-discharge-transfer) patient accounting (billing) payroll word processing space/facilities 3. research laboratories screen patients for a study retrieve data on study patients statistical support grants and publishing support 4. scholarly bibliographic retrieval (Medline, CLIO) computer-assisted education electronic journals 5. core resources mail security network workstations the goal of IAIMS is to let any user get whatever he wants, wherever he wants, whenever he wants, within the limits of security and privacy (ie, policy, not availability, should limit access) the basic applications already exist, the first problem is access each of the information producers and repositories has a different computer computers located around the medical center (eg, St. Lukes lab.) user interfaces differ (keystroke to exit) cannot move data from one system to another (esp. registration data) ways to bring a disparate set of applications together multiple terminals - put many terminals at each station workstation - terminal emulation can get to all applications (e.g., multiple, independent windows on same workstation, each potentially going to different servers) interfacing - applications talk to each other (on the same workstation) like transferring file from MS Word to emacs redundant storage - each application stores its own data central repository & common review departmental sys -> central repository -> applications workstations may access departmental sys independently in case of failure of central repository integration - change logic and user interface to look like one application like importing spreadsheet into Word from Excel = common interface but distinct servers can be done to varying degrees no intercommunication common authorization but no intercommunication manual data transfer (cut & paste) shared data monolithic - rewrite applications in one system integration touches other research issues communication (MIB = medical information bus: standardize protocols used by different instrumentation) vocabulary (e.g., UMLS): talk the same language psychology: human-computer interface; organizations we have used a combination of these methods general rule: once you have access, the number of applications mushrooms which access method is best (issues) common user interface amount of code rewriting ability to buy existing products open systems interface standards and common vocabulary ability to aggregate disparate data performance cost (terminals, networks, applications, ...) security main struggle of the first decade of IAIMS: networking program began before many standards (HTML, HL7) were widely accepted with time, institutions move toward the center of the list IAIMS at CPMC (history) 1984 planning 1988 major funding 1990 results, decision support, ... utilization statistics at CPMC attendings 80%, house officers 90% laboratory data most frequent continued increase in utilization over time IAIMS demo related reading Hendrickson G, Anderson RK, Clayton PD, Cimino J, Hripcsak GM, Johnson SB, et. al. The intergrated academic information management system at Columbia- Presbyterian Medical Center. M.D. Computing 1992;9(1):35-42.