Narrative

a. Specific Aims
b. Background and Significance
c. Preliminary Studies/Progress Report
d. Research Design and Methods
e. Human Subjects
f. Vertebrate Animals
g. Literature Cited
h. Consortium/Contractual Arrangements
i. Consultants

C. Preliminary Studies (Back to the Top)
Planning and analysis for the strategic initiatives necessary to keep the HSC positioned to achieve our mission of excellence in health care delivery, education, and research have been conducted at several levels. There has not been a coordinated effort to date, however, to focus the development and use of information systems across all of these efforts.
The IAIMS Program will provide the opportunity to focus resources and develop leadership in a deliberate manner. The first step in establishing the IAIMS Program is to engage in a collaborative planning process that brings existing initiatives together in a focused way. Experience gained through recent initiatives has facilitated our submission of this IAIMS Planning Proposal. These initiatives are reviewed briefly below. (Back to the Top)

C. 1. Joint Information Access and Computer Networking Study (May, 1993)
A Study Team consisting of representatives from West Virginia University Hospitals, University Health Associates, and West Virginia University Health Sciences Center conducted a study to identify user requirements for data sharing and network connectivity in all three organizations. The study period was November 23, 1992, to April 13, 1993. The purpose of the study was to provide the executive heads of the three sponsoring organizations with recommendations about the advisability of establishing and maintaining a strategic plan for joint networking and information sharing among the three organizations. The study was conducted using the Application Transfer Study methodology developed by IBM. Information was collected through interview sessions and a survey form. The primary issues addressed were:

• Access Philosophy - Who can access what information, from where, and under what controls?

• Access Methodology - How will our information systems operations provide the access defined through the access philosophy?

• Support Operations - How will the combined user base be trained and receive support?

The major recommendations of the study were: Recommendation 1: Design and implement a Health Sciences Campus interconnected network to enable sharing of mission critical data and information throughout the Health Sciences enterprise.

Recommendation 2: Develop a training and support plan for computing and information activities common to organizations on the Health Sciences Campus.

Recommendation 3: Establish a structure for implementing and maintaining recommendations 1 and 2.

The Study Team proposed that effective implementation of the recommendations would require an executive level control structure for implementing and maintaining strategic networking and data management objectives. The team judged that the expertise and resources for implementing most of the recommendations existed within the HSC. (Back to the Top) An executive level group was charged with implementing the recommendations. Two factors intervened. Creating the necessary security systems took substantially longer than originally planned, and the merger of the hospital and group practice plan information systems superseded the center-wide joint systems initiative. Dramatic changes in the health care environment and the institution’s involvement in creating a managed care partnership became a primary focus of executive groups.

Recently, commitment to joint networking and data sharing has been renewed. Installation and activation of a security system that will permit interconnection of clinical and academic systems has been approved, and development of the firewall was defined as a systems project.

C. 2. Joint Information Access Firewall Project (June, 1995) (Back to the Top)
Stemming from the mandates developed in the Joint Information Access and Computer Networking Study, a technical task force began work on the difficult issue of designing the network interconnection between the networks and systems of the clinical enterprise and the educational enterprise. The final report recommended a series of routers and firewalls configured to enable access from all points in the local campus to all systems. Access control remains the responsibility of each system's "owners." Each individual (or class of individuals) has specifically defined rights of access to specified systems.
Interconnection is also designed to provide remote access to service with the same levels of security and access created in the local network. Agreement on specialized one-time, token-based security and single point of entry systems was also embodied in the recommendations. A project to implement the recommendations was approved in June, 1995. The firewall/router interconnection is being tested in preparation for deployment.

This agreement is a milestone in cooperation between the Health Sciences Campus entities. Additional work remains to be done in the areas of information policy, data repositories, and joint network administration.

C. 3. WVUH/UHA Information Systems Strategic Plan (May 1994) (Back to the Top)
Planning for integration of the two primary clinical systems (WVUH and UHA) was completed June of 1996 with the hiring of a CIO, Ms. Edna Bruehl, with responsibility for forming one clinical information technology organization. The two entities performed an organizational assessment and integration of budgets, personnel, projects, training, planning, and systems development was accomplished.
Central to the strategic vision of information systems for the Clinical Enterprise is the development of a Central Data Repository. In the year since the assessment was approved by the WVUH and UHA Boards of Directors, the report of the task force has been completed and the Information Systems operations of WVUH and UHA combined into a single service delivery and reporting structure. Other support systems projects (Interface Engine, Single Registration, Single Scheduling, and Managed Care) have also made significant progress and are in varying stages of implementation.
We continue to make progress in interconnection of WVUH/UHA IS and HSC academic systems with the goal of providing access for the faculty, staff, and students who work in both the clinical enterprise and the academic center. Development of policies for providing resources and information access consistent with the needs and responsibilities of the clinical and academic enterprises, will be accomplished through the IAIMS Planning Process.

C. 4. WVUH/UHA Computer-Based Patient Record Strategy (June, 1995) (Back to the Top)
A WVUH/UHA Information System Strategic Plan developed in 1995 included requirements for the development and deployment of a CPR. The first series of tasks in this process were visionary in nature. The nature and meaning of a CPR in the WVU Clinical Enterprise (and in the Academic Enterprise as well) had to be defined in a manner that all key stakeholders agreed to before the start of acquisition and implementation. That report has been superseded by reorganization of the WVUH and UHA systems into a single IS organization and planning for a single repository which will be the basis for an electronic record.

C. 5. Office of Rural Health Study (NASA Assisted, June, 1995) (Back to the Top)
The Office of Rural Health has conducted a study, with the assistance of the Marshall Space Flight Center (MSFC), to determine the requirements for establishing the West Virginia Rural Community Health Information Network.
The network will be developed by establishing three multi-county Community Health Information Networks (CHINs) composed of offices and clinics with varying degrees of complexity and technological sophistication. After each CHIN is established and effectively functioning, they will be interconnected to form the basis for a Statewide Health care Information Network.
The study document (Executive Summary, Appendix F) proposes that a telecommunications network be implemented in four phases. Phase I would consist of a backbone that would meet the network requirements by providing easily accessible, common user information and enhanced informal communication. Phase II would be primary information system development. Phase III would be implementation of the primary information system. Phase IV would involve building the capacity of the system to include additional users as the use of the network expands. The recommendations call for the network to be easily scaleable to protect initial investments whenever possible and to accommodate incremental growth. The full report details the major challenges of establishing the network and the requirements for establishing technical standards and support.

C. 6. WVU Libraries Self-Study and Strategic Planning Process (Back to the Top)
The Health Sciences Library completed a comprehensive self-study and strategic planning process in 1995. This study will help the Health Sciences Library create an information technology base that will be responsive to the Health Sciences Center's patient care, teaching, research mission, and state-wide service goals. These are the basic planning assumptions for the study:
1. Computer networking and hardware will be available ubiquitously to students, faculty, researchers, and to health care professionals within the state.
2. Information technology will play an ever increasing and vital role in the health sciences disciplines and for the institutions and clients they serve.
3. Health care providers will require efficient and high-speed document delivery for access to information stored in multiple formats.
4. The Health Sciences Library will have an expanded and more complex teaching and education-oriented role in the delivery of information as problem-based learning is integrated into the curriculum.
5. Remote access to information resources will become increasingly important for the utilization of electronically-stored medical data and for patient care and education programs.
6. There will need to be formal networks throughout the HSC with global access to the resources of the Health Sciences Library as well as to remote information resources via the National Information Infrastructure. (Nationally, health sciences libraries must provide users with ability to access remotely held materials and information in a seamless environment.) (Back to the Top)
Realization of this vision is contingent upon resources development, careful planning, and creation and management of a powerful information infrastructure. This infrastructure will be fully integrated into the teaching, learning, and the health care delivery environment throughout the HSC and the state. To help achieve these goals, West Virginia University has invested more than $2,000,000 within the past seven years to acquire and implement the NOTIS System, a state-of-the-art Library Information System which has capability to support further integration of information delivery to all components of the Health Sciences Center, the University, and the state. Components of the current Library Information System include an on-line catalog (MountainLynx); automated acquisitions and serials; and MDAS (Multiple Database Access System) which supports access to electronic resources such as Current Contents. More than 13 health-related CD-ROM databases (e.g., CINAHL, Science Citation Index, MEDLINE) are accessible through networked workstations.
The Health Sciences Center, and the Health Sciences Library have implemented, jointly with the University Libraries, fixed-fee access to 21 of the National Library of Medicine's databases. This access is free to the Health Sciences Center and the University community. West Virginia University Libraries participates in a multi-state consortium, supported by a National Science Foundation grant, that will enable the Health Sciences Library to use ARIEL document delivery equipment to provide rapid delivery of health related research and scientific information state-wide. Through participation in a project with the University Libraries and the West Virginia Library Commission, the Health Sciences Librarywill be able to move to a UNIX-based, distributed computing environment that will support state-wide access to health information. With collaborative planning, these disparate systems can evolve into a fully integrated network that will be an essential part of our IAIMS Program.
The Health Sciences Library ranks in the upper third of the American Association of Health Sciences Library Directors (AAHSLD) member institutions in information resources expenditures at $711,000 annually. Rebuilding of staff to support the new information environment is proceeding systematically, with the latest addition being an Electronic Resources Librarian. Two new Reference Librarian positions have been added within the past four years. A plan to support the expanded services and leadership role of the Library into the year 2004 has been developed. (Back to the Top)
The Library delivers more than 9,000 interlibrary information transactions annually. Health Sciences Center programs such as the Rural Health Education Partnerships (RHEP), CONSULT, rural internships and clerkships for student of all disciplines, and clinical outreach programs require strong programs of outreach, instruction, and high speed document delivery services. The Health Sciences Library is committed to aligning its resources to developing the leadership that is necessary to support these activities as they become a greater part of the Health Sciences outreach mission.
The Health Sciences Library has identified several unmet resources needs. These include additional space, development of integrated information resources, support for problem-based learning, access to high performance computing, additional staffing, and staff training. Strategies for meeting these needs will be addressed through self-study, the HSC's strategic planning process, WVU strategic planning process for computing and information technology, and our IAIMS Program.
The IAIMS program will provide the opportunity for the Health Sciences Library to become a fully collaborative partner in the development of an integrated information systems environment that will enhance patient care, education, research and the administration. In addition, participation in the IAIMS Program will help the Health Sciences Library consolidate its role as a primary information gateway for the state. Our IAIMS Program planning process will provide the Health Sciences Library with the forum to address its own needs as well as those of the programs that it serves. This opportunity to re-focus the mission, goals, and resources of the Health Sciences Library will provide strong linkages with the HSC decision-making processes that allocate resources and establish policy.

C. 7. West Virginia Network (WVNET) Initiatives (Back to the Top)
WVNET serves West Virginia's state system of higher education by providing central computing and telecommunication facilities. The statewide system of computers and WVNET's participation in national/international computing networks provides users with access to resources at many educational and research centers throughout the world. WVNET currently supports communications at 25 campuses, the Central Site in Morgantown, and the State College and University Systems Central Office in Charleston, West Virginia.
The Robert C. Byrd Health Sciences Center obtains Internet access and mainframe computing resources from the West Virginia Network. The WVNET communications system is an intrastate Wide Area Network (WAN) of Local Area Networks (LANs). High-speed digital telephone circuits connect LANs throughout the state to the WVNET central site in Morgantown. (Please see Appendix B "Network Configuration Maps" for diagrams.)
WVNET is a member of SURAnet (Southeastern University Research Association Network), a branch of the National Science Foundation computing network, NSFNET. Through the communications protocols used on this network, WVNET users can access national supercomputing centers and log into and transfer data to and from computers in the Internet. WVNET is also a member of BITNET, an international, inter-university network with gateways to other specialized networks. WVNET users have access to the worldwide USENET news network, its bulletin boards and discussion groups. WVNET's MountainGopher is a computer facility which provides access to a vast amount of on-line information within the state and around the world. (Back to the Top)
WVNET provides access to a number of other state networks and systems of significance to the HSC, including:
• The West Virginia Library Network System (VTLS-based), an interconnected system of library databases at ten sites throughout the state;
• MountainLynx, the gateway to the West Virginia On-line Catalog Databases, maintained by WVU Libraries and the West Virginia Academic Library Consortium;
• WV CONSULT
WVNET has initiated the "Connections" project with National Science Foundation funding. Through this project, WVNET enhanced the dialup modem access at its member system sites to 28.8-Kbps and extended the connectivity to anyone affiliated with state institutions. While this upgrade has improved connectivity for some Health Sciences students, faculty, and staff who travel off-site, the extended capability does not reach all of our Rural Health Education Partnership sites(Appendix B). WVU is working with WVNET to assess opportunities for extending this new capability in a way that will help the HSC meet our rural health commitments.

C. 8. WVU Office of Computing and Information Resources (OCIR) Strategic Planning Study (Back to the Top)
The three West Virginia University (WVU) campuses in Morgantown are interconnected by the West Virginia University Information Network (WINnet), which provides fiber optic connectivity to 47 major buildings for video, voice, and data communications. This campus-wide network includes a Fiber Distributed Data Interface (FDDI) backbone, satellite uplink, and connectivity between voice systems. A diagram of WINnet is provided in Appendix B.
ISDN plays a major role in WINnet connectivity by bridging buildings that are not directly on fiber and by connecting remote users, such as telecommuters, to WINnet. ISDN provides SNA connections for administrative computing devices and packet data access for users who are not on a LAN, but who need access to University data services such as our financial system.
WINnet, academic computing, and administrative computing are managed by the Associate Provost for Computing and Information Resources (OCIR). The computing environment at WVU includes over 50 departmental and college computer laboratories, three major public computer laboratories, an Instructional Technology Resource Center, and a centrally managed facility for electronic distribution on instructional materials to multiple classrooms.
The strategic information technology decisions that West Virginia makes are extremely important to the HSC. We have benefited from the participation of the Computing and Information Resources participation in our IAIMS planning process.
(Back to the Top)

If you have any comments or questions, please contact IAIMS Program Administrator Sr.
Valerie Frey-McClung at vfreymcc@wvu.edu
Copyright 1996 WVUCUS Board of Trustees. Standard Disclaimer Applies.