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1.  A Virtual Notebook for biomedical work groups. 
During the past several years, Baylor College of Medicine has made a substantial commitment to the use of information technology in support of its corporate and academic programs. The concept of an Integrated Academic Information Management System (IAIMS) has proved central in our planning, and the IAIMS activities that we have undertaken with funding from the National Library of Medicine have proved to be important extensions of our technology development. Here we describe our Virtual Notebook system, a conceptual and technologic framework for task coordination and information management in biomedical work groups. When fully developed and deployed, the Virtual Notebook will improve the functioning of basic and clinical research groups in the college, and it currently serves as a model for the longer-term development of our entire information management environment.
PMCID: PMC227118  PMID: 3046694
2.  Indianapolis I3: the third generation Integrated Advanced Information Management Systems* 
In 2001, the Regenstrief Institute for Health Care and the Indiana University School of Medicine (IUSM) began an IAIMS planning effort to create a vision and a tactical plan for the first Integrated Advanced Information Management Systems (IAIMS) implementation to cross a large area and include unaffiliated institutions. A number of elements made this planning effort unique. Among these elements were the existence of a network infrastructure that supported the Indianapolis Network for Patient Care, the existence of a mature medical informatics program at the Regenstrief Institute, and the existence of a wide-area knowledge network fostered by the IUSM libraries. However, the leadership for a strong information technology role in the IUSM that could promote collaboration in support of education and research across the diverse Indianapolis hospital systems had been lacking. By bringing together various groups, each with a commitment to improve health care quality and public health across the Indianapolis metropolitan area, regardless of individual institutional affiliation, the strategic directions for I3–Indianapolis IAIMS Initiative have been defined and the foundations for a third generation IAIMS construct have been laid in Indianapolis, Indiana.
PMCID: PMC385298  PMID: 15098046
3.  The Evolution of the IAIMS 
Abstract
The Integrated Academic (Advanced) Information Management System (IAIMS) initiative emerged in the early 1980s to respond to trends in biomedical information, transfer and access, and to identify the implications for health sciences libraries. Three recurrent themes have emerged as being essential to the creation of IAIMSs : changing the paradigm ; redirecting expenditures to build reuseable infrastructure ; and working across cultural boundaries. An IAIMS penetrates an organization in four stages : from creating awareness ; through development of foundation infrastructure ; through integration as an extra effort ; to integration as a byproduct of organizational structure and information architecture. Extension of the IAIMS to support a regional area is a natural fifth stage that reapplies the processes of the first four stages and re-reuses the infrastructure that has been built within the cooperating organizations. Area IAIMSs have the potential to transform biomedicine by enabling new paradigms for manpower development and publication of information.
PMCID: PMC61483  PMID: 9067882
4.  The MEDLINE Retriever. 
Baylor College of Medicine has developed the MEDLINE Retriever, a tool to query MEDLINE, the data-base of medical literature at the National Library of Medicine. The MEDLINE Retriever communicates via the Internet to achieve excellent response time for MEDLINE queries. It uses the X Window System and the Motif toolkit, and employs the Knowbot Operating Environment developed by the Corporation for National Research Initiatives. We discuss the architecture of the MEDLINE Retriever, focusing on the graphical user interface that we have developed, as well as our experiences in developing and deploying the MEDLINE Retriever at Baylor. The MEDLINE Retriever is an extension of Baylor's IAIMS design concept that brought forth the Virtual Notebook System, and fits well with Baylor's aims with regard to the High Performance Computing Initiative.
PMCID: PMC2248138  PMID: 1482920
5.  Wisconsin IAIMS: Towards a Regional Health IT Architecture 
The goal of Wisconsin Health Sciences IAIMS initiative (WI-IAIMS) is to enhance coordination through improved communication while preserving local control of information resources. The proposed aims of the project are to strengthen the organizational, technical and informatics infrastructure to support the health science research, teaching and service needs of the University of Wisconsin. The two-year planning initiative identified that successful solutions for an IAIMS in Wisconsin must adhere to the unique aspects of UW-Madison and state of Wisconsin training and research environment. Therefore, WI-IAIMS will be in line with a management philosophy that endorses local investment and control of information technology resources, educational programs that rely on numerous clinical training sites, and a commitment by the UW Health Science schools to expand research activities to better include and be responsive to the citizens of the state.
PMCID: PMC2243326
6.  IAIMS: An Interview with Dick West 
Richard T. West, IAIMS (Integrated Advanced Information Management Systems) Program Officer at the National Library of Medicine for 13 years, reflects on the origin, development, effectiveness, and future of IAIMS efforts. He dwells on the changes that have taken place as the concept of IAIMS has evolved from a technology-based to an organization-based level of integration. The role of IAIMS in patient care, education, and research is discussed, along with the role of the librarian in the implementation of IAIMS programs. He sees a need for training for librarians, informaticians, and others in preparation for these efforts and for the development of academic reward systems that encourage them. He expresses a desire for those working in information technology in hospitals to gain a clearer understanding of IAIMS, because the concept fits hospitals as well as academic health science centers. He exhorts informaticians to bring to reality the futuristic fantasies of a new information world.
PMCID: PMC61388  PMID: 10579603
7.  University of Wisconsin IAIMS planning: organizational challenges within a faculty governance model. 
The University of Wisconsin-Madison Health Sciences Schools are currently in the planning stage of developing an Integrated Advanced Information Management System (IAIMS). The planning phase of this project attends to the unique opportunities that are found at the flagship campus of a large state university system. Statewide teaching and research initiatives and accelerated campus-level capital development challenge the planners to create an IAIMS plan that anticipates an emerging health science environment. Additionally, UW-Madison has an organizational culture with a strong tradition of faculty governance, which provides a very desirable and flexible decision-making environment for a cross-discipline collaborative information management initiative. Development of a shared IAIMS vision conflicts with a governance model that most directly supports intradepartmental decision-making. The challenge presented here for an IAIMS initiative has less to do with hard wiring a technical infrastructure and more to do with increased stakeholder cooperation in a highly decentralized organization with autonomous information systems.
PMCID: PMC2243931  PMID: 11079923
8.  The impact of IAIMS at Georgetown: strategies and outcomes. 
Integration of multiple information systems of a medical center will change the way physicians work and practice medicine in the future. Several major steps must be taken by an institution to make this a reality. Since 1983, Georgetown has been engaged in an Integrated Academic Information Management System (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 with local area network nodes, 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. The network is heavily used; in 1991, more than 2,100 individual users conducted more than 148,500 computer functions and more than 104,000 searches. There is economy of scale in high-volume use. Overall, the average search cost is $1.57; for high use databases the cost is $0.38, and for low use, it is $9.41. As described in this paper, IAIMS offers a cost-effective means of enhancing patient care by improving information services to physicians. At Georgetown, IAIMS has advanced the concept of integration, accelerated use of computers in education, increased user acceptance of advanced technologies, and established cost factors for providing information resources. While progress made in improving the transfer of medical information is impressive, it is clear that IAIMS requires several more years of support to achieve full implementation.
PMCID: PMC225666  PMID: 1326369
9.  A fast track to IAIMS: the Vanderbilt University strategy. 
In July 1991, Vanderbilt University Medical Center (VUMC) initiated a fast track approach to the implementation of an Integrated Academic Information Management System (IAIMS). The fast track approach has four elements: 1) an integrated organizational structure combining various operational information management units and the academic informatics program into a single entity to enhance efficiency; 2) technology transfer and network access to remote resources in preference to de novo development; 3) parallel IAIMS planning and infrastructure construction; 4) restriction of the scope of the initial IAIMS to permit a manageable implementation project. The fast track approach is intended to provide a truly functional IAIMS within a time period (7 years) associated with other major construction projects such as the building of a replacement hospital.
PMCID: PMC2248037  PMID: 1336415
10.  Microcosm to Cosmos: The Growth of a Divisional Computer Network 
In 1982, we reported the deployment of a network of microcomputers in the Division of Gastroenterology[1]. This network was based upon Corvus Systems Omninet®. Corvus was one of the very first firms to offer networking products for PC's. This PC development occurred coincident with the planning phase of the Johns Hopkins Hospital's multisegment ethernet project. A rich communications infra-structure is now in place at the Johns Hopkins Medical Institutions[2,3]. Shortly after the hospital development under the direction of the Operational and Clinical Systems Division (OCS) development began, the Johns Hopkins School of Medicine began an Integrated Academic Information Management Systems (IAIMS) planning effort. We now present a model that uses aspects of all three planning efforts (PC networks, Hospital Information Systems & IAIMS) to build a divisional computing facility. This facility is viewed as a terminal leaf on then institutional network diagram. Nevertheless, it is noteworthy that this leaf, the divisional resource in the Division of Gastroenterology (GASNET), has a rich substructure and functionality of its own, perhaps revealing the recursive nature of network architecture. The current status, design and function of the GASNET computational facility is discussed. Among the major positive aspects of this design are the sharing and centralization of MS-DOS software, the high-speed DOS/Unix link that makes available most of the our institution's computing resources.
PMCID: PMC2245035
11.  University of Cincinnati Medical Center: integrating information. 
The University of Cincinnati Medical Center has combined five existing units into a new organization responsible for initiating an Integrated Academic Information Management System (IAIMS). This new organization, Medical Center Information and Communications, was reorganized into nine departments, which now provide a variety of information services. Ultimate goals for IAIMS include a patient-centered database, a decision-support system, and a knowledge network. The IAIMS prototype, currently under development for the University of Cincinnati Hospital's Internal Medicine Service, consists of components representative of the IAIMS model's ultimate goals. A major premise of this IAIMS effort is that it is patient-centered.
PMCID: PMC227114  PMID: 3416099
12.  Information management through integration of distributed resources. 
Duke University Medical Center conducted a strategic planning process focused on information management needs beginning in 1983 and ending in 1985. That effort concluded that the institution was ready to establish an Integrated Academic Information Management System (IAIMS). A model was proposed in which information management was to be achieved through integrated distributed resources. The elements of the IAIMS model are ongoing policy development and planning; communications; an electronic library or resource inventory; coordination of the development or selection of the end-user function; user support; and ongoing evaluation. This model is being tested to determine its effectiveness in meeting the administrative, patient care, research, and educational needs of a basic science department and a clinical science department at Duke University.
PMCID: PMC227116  PMID: 3416101
13.  The impact of IAIMS on the work of information experts. Integrated Advanced Information Management Systems. 
Integrated Advanced Information Management Systems (IAIMS) programs differ but have certain characteristics in common. Technological and organizational integration are universal goals. As integration takes place, what happens to those implementing the vision? A survey of 125 staff members, or information experts, involved in information or informatics at an IAIMS-funded institution was conducted during the last year of the implementation phase. The purpose was to measure the impact of IAIMS on the jobs of those in the library and related service units, and the computing, telecommunications, and health informatics divisions. The researchers used newly developed scales measuring levels of integration (knowledge of and involvement with other departments), customer orientation (focus on the user), and informatedness (changes in the nature of work beyond automation of former routines). Ninety-four percent of respondents indicated that their jobs had changed a great deal; the changes were similar regardless of division. To further investigate the impact of IAIMS on librarians in particular, a separate skills survey was conducted. The IAIMS librarians indicated that technology and training skills are especially needed in the new, integrated environment.
PMCID: PMC226064  PMID: 8547905
14.  BioSYNTHESIS: bridging the information gap. 
BioSYNTHESIS is a prototype intelligent retrieval system under development as part of the IAIMS project at Georgetown University. The aim is to create an integrated system that can retrieve information located on disparate computer systems. The project work has been divided in two phases: BioSYNTHESIS I, development of a single menu to access various databases which reside on different computers; and BioSYNTHESIS II, development of a search component that facilitates complex searching for the user. BioSYNTHESIS II will accept a user's query and conduct a search for appropriate information in the IAIMS databases at Georgetown. For information not available at Georgetown, such as full text, it will access selected remote systems and translate the search query as appropriate for the target system. The search through various computer systems and different databases with unique storage and retrieval structures will be transparent to the user. BioSYNTHESIS I is complete and available to users. The design work for BioSYNTHESIS II is under development and will continue as a multiyear technical research effort of the proposed Georgetown IAIMS implementation project.
PMCID: PMC227294  PMID: 2720205
15.  Strategic Planning for IAIMS: Prototyping as a Catalyst for Change 
Yale School of Medicine has developed a prototype integrated computing and information environment as part of its strategic IAIMS planning. The prototype consists of a menu system and underlying network communications programs and networks to access a variety of medical information resources at Yale and elsewhere. This prototype has been useful in testing user needs, in designing a technical architecture, in exploring related institutional issues, and as a basis for research in integrated access to medical information using UMLS tools and concepts.
PMCID: PMC2245393
16.  BioSYNTHESIS: Integrating Multiple Databases into a Virtual Database 
BioSYNTHESIS is a front-end retrieval system under development as part of the IAIMS project at Georgetown University. It is designed to achieve system integration of multiple IAIMS databases maintained at Georgetown so they appear as a “virtual database” to users. The aim is to create an integrated system that enables users to easily retrieve information from various databases residing on disparate computers.
The project work has been divided in two phases: BioSYNTHESIS I, development of a single menu to access various databases which reside on different computers; and BioSYNTHESIS II, development of a search component that facilitates complex searching for the user. BioSYNTHESIS I is currently available to users, and BioSYNTHESIS II is in an early stage of development. The design work will continue as a multiyear technical research effort of the Georgetown IAIMS Implementation Project. Plans are to release portions of BioSYNTHESIS II during the project period as components become available.
PMCID: PMC2245609
17.  The MAClinical Workstation Project at Georgetown University. 
The intent of the MAClinical Workstation Project is to develop computer workstations for medical students of the sort they will use in future medical practice. The idea is to instill information query habits in the daily clinical activities of these young physicians-in-training. The Georgetown University Medical Center Library spearheads the project in conjunction with the School of Medicine. The library handles technical support, including software development, user training, equipment maintenance, and network installations. The project began in 1988 with nine Macintosh computers; today thirty machines are distributed throughout the Georgetown University Hospital conference rooms, faculty and resident offices, and at four affliated hospitals. The Macintosh computers are connected to the medical center's local area network (LAN) with access to the Integrated Academic Information Management System (IAIMS) and Library Information System (LIS) databases. The MAClinical workstations serve multiple educational purposes in the clinical setting. Primarily, students gain experience in medical informatics by using a variety of software systems installed at the stations: the H&P Writer, a history and physical system written in the C programming language, can be used by students to prepare the admission record on patients they examine; also, students can keep patient records, check findings against a diagnostic system, look up drugs and treatment protocols, develop medical sketches, and find additional information when needed in the medical literature.
PMCID: PMC225551  PMID: 1884081
18.  A Demonstration of the MAClinical Workstation 
Medical Students at the Georgetown University School of Medicine on clinical rotations at the University Hospital now have access to Macintosh IIs and ImageWriter IIs on the wards. The MACs are connected to the medical center's local area network (LAN) with access to the Integrated Academic Information Management System (IAIMS) and Library Information System (LIS) databases. The Intent of the Macintosh project is to provide students with workstations of the sort they will use in future medical practice and to instill information query habits in the daily clinical activities of physicians- in-training. Currently, there are eight MACs located in conference rooms around the hospital where students and residents hold teaching rounds and write admission notes. Faculty participating in the project have been loaned MACs.
The student workstations at the hospital are designed to serve multiple educational purposes in the clinical setting. Primarily, students gain experience in medical informatics. Secondarily, but equally essential, students can use H&P Writer, a HyperCard stack developed at Georgetown with MacWrite and MacDraw to prepare the admission record on the patients they examine. Graphics, sketches and illustrations are part of the system. The work- stations have access to IAIMS/LIS databases, such as minIMEDLINE, Alerts/Current Contents, Physicians Data Query (PDQ), a Drug/Poison Information System and RECONSIDER, a diagnostic prompting system.
PMCID: PMC2245673
19.  From HIS to IAIMS: expanding the scope of information processing applications in a German university hospital. 
Since the mid eighties the department of medical informatics at the University Hospital of Giessen (Germany) has been engaged in the development of a comprehensive hospital information system. The installation of a campus wide network has set the basis to provide not only clinical patient-oriented information, but also general information resources for research, medical education and administrative purposes, thus creating an environment which in the U.S. became known as an integrated academic information management system (IAIMS). The underlying concept of the whole approach is to provide one-stop information shopping capabilities at the clinicians and administrators desktop in order to meet the increasing information needs of health professionals with the emerging reality of the potential benefits of computer and communication technologies. This paper describes the various steps performed to realize this concept at Giessen University Hospital and the evaluation results derived from analysis of the acceptance of these new technologies among our hospital staff.
PMCID: PMC2247913  PMID: 7949903
20.  A planning process for a fast track to IAIMS. 
The strategic planning process that is part of Vanderbilt University's fast track to IAIMS is evolving based on feedback from the process itself. Led by a committee of VUMC's top management, broad-based sub-committees for administration, education, patient care, and research worked initially on the following strategic issues: identifying key external pressures that constrain and provide opportunities, visioning how VUMC might operate in the future, and establishing a mission and high-level goals for information management. Next steps include identifying the critical mass of function that will prompt daily use of the IAIMS by everyone at VUMC and adding groups to focus on information and technology architectures and developing academic informatics. This manuscript gives detailed, practical information about the evolution of the planning process, committees' responsibilities, working relationships, and lessons learned.
PMCID: PMC2850636  PMID: 8130533
21.  The IAIMS initiative at the University of Maryland at Baltimore. 
With support from the National Library of Medicine, the University of Maryland at Baltimore is creating an Integrated Academic Information Management System (IAIMS) that will serve as a prototype for academic health centers. A campus-wide undertaking, the IAIMS initiative at Maryland is characterized by its functional comprehensiveness and its planning model. The resulting strategic plan is serving as a guide in the ongoing model development within an interdisciplinary Hypertension Center.
PMCID: PMC227844  PMID: 3527313
22.  Integrated Advanced Information Management Systems: a twenty-year history at the University of Cincinnati* 
The University of Cincinnati (UC) has been active in the National Library of Medicine's Integrated Advanced Information Management Systems (IAIMS) program since IAIMS' inception in 1984. UC received IAIMS planning and modeling grants in the 1980s, spent the 1990s practicing its own form of “iaims” and refining its vision, and, in May 2003, received an IAIMS operations grant in the first round of awards under “the next generation” program. This paper discusses the history of IAIMS at UC and describes the goals, methods, and strategies of the current IAIMS program. The goals of UC's IAIMS program are to: improve teaching effectiveness by improving the assessment of health professional students and residents in laboratory and clinical teaching and learning environments; improve the ability of researchers, educators, and students to acquire and apply the knowledge required to be more productive in genomic research and education; and increase the productivity of researchers and administrators in the pre-award, post-award, and compliance phases of the research lifecycle.
PMCID: PMC385297  PMID: 15098045
23.  IAIMS Architecture 
Abstract
An information system architecture defines the components of a system and the interfaces among the components. A good architecture is essential for creating an Integrated Advanced Information Management System (IAIMS) that works as an integrated whole yet is flexible enough to accommodate many users and roles, multiple applications, changing vendors, evolving user needs, and advancing technology. Modularity and layering promote flexibility by reducing the complexity of a system and by restricting the ways in which components may interact. Enterprise-wide mediation promotes integration by providing message routing, support for standards, dictionary-based code translation, a centralized conceptual data schema, business rule implementation, and consistent access to databases. Several IAIMS sites have adopted a client-server architecture, and some have adopted a three-tiered approach, separating user interface functions, application logic, and repositories.
PMCID: PMC61487  PMID: 9067884
24.  Network information security in a phase III Integrated Academic Information Management System (IAIMS). 
The developing Integrated Academic Information System (IAIMS) at Columbia-Presbyterian Medical Center provides data sharing links between two separate corporate entities, namely Columbia University Medical School and The Presbyterian Hospital, using a network-based architecture. Multiple database servers with heterogeneous user authentication protocols are linked to this network. "One-stop information shopping" implies one log-on procedure per session, not separate log-on and log-off procedures for each server or application used during a session. These circumstances provide challenges at the policy and technical levels to data security at the network level and insuring smooth information access for end users of these network-based services. Five activities being conducted as part of our security project are described: (1) policy development; (2) an authentication server for the network; (3) Kerberos as a tool for providing mutual authentication, encryption, and time stamping of authentication messages; (4) a prototype interface using Kerberos services to authenticate users accessing a network database server; and (5) a Kerberized electronic signature.
PMCID: PMC2248133  PMID: 1336414
25.  Using Hypertext to Facilitate Information Sharing in Biomedical Research Groups 
As part of our effort to create an Integrated Academic Information Management System at Baylor College of Medicine, we are developing information technology to support the efforts of scientific work groups. Many of our ideas in this regard are embodied in a system called the Virtual Notebook which is intended to facilitate information sharing and management in such groups. Here we discuss the foundations of that system - a hypertext system that we have developed using a relational data base and the distributable interface the we have written in the X Window System.
PMCID: PMC2245694

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