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
D. Project Design and Methodology (Back to the Top)
For the recent past, the information resources and systems of the Clinical Enterprise (WVUH and UHA) and the Academic Enterprise (Education, Research, Service, and Outreach) have been managed separately, but with a high degree of cooperation. Until the recent merger of Information Systems for WVUH and UHA, even those entities were managed separately. This separateness has been maintained as the result of separate legal identities, and it dates to 25 years ago (1971) when the separate, private, non-profit, legal entities were created to provide funding mechanisms for the hospital and the group practice clinics that were not available through state funding systems.Recent changes in the health care environment have provided the opportunity to integrate more closely the management systems of the Clinical and Academic Enterprises. The opportunity afforded by the IAIMS Program to align and integrate information systems coincides with the need to increase cooperation between the two enterprises. For this reason, our IAIMS Program will be structured by using existing management and information systems groups where possible, and will establish new groups only when necessary to support or coordinate existing groups.
D. 1. Plan for Achieving Our IAIMS Goals (Back to the Top)Through our IAIMS Program, we will build on the work that has already been done to establish modern information systems for the Clinical and Academic Enterprises. We have identified five specific aims that we believe will provide the focus that we need for building the collaborative relationships that are necessary for us to operate a truly integrated information system in our environment. Such a collaboration must be based on the recognition that West Virginia University Hospitals, University Health Associates, and the University are separate legal entities although we work closely together for a common purpose--serving the health care needs of West Virginians. This consortium of health care providers was expanded recently with formation of the West Virginia United Health System with West Virginia University Hospitals (Morgantown) and United Hospital Center (Clarksburg) as the founding partners. The partnership offers new challenges and opportunities for creating information systems that improve our ability to provide health care services across institutional boundaries.
Our IAIMS Program is based on the fundamental principle that information must be accessible when and where it is needed by our students, faculty, and staff. It is our responsibility to provide this access with sufficient security measures to protect patient privacy while ensuring that information is available for patient care, education, research, and administrative functions. We are committed to ensuring that the Health Sciences Library is a full partner in our expanding information environment and that all of our students, faculty, and staff have access to the library and information resources that are necessary for their work. For us, this commitment means building better links to the Health Sciences Library in our integrated information system and establishing data repositories that can be used in conjunction with library resources for patient care, teaching and learning, and research.
Although the delivery of clinical information to independent medical records is well organized, the timeliness of the availability of this data is quite variable. Several areas maintain a "shadow chart" with relevant specialty information in order to ensure availability of required information during patient visits. This is a timely, cost consuming, redundant task that can lead to information conflict or missing information when a patient is treated in several clinical settings. Through our IAIMS Program, we plan to develop a single data repository that will be available to all providers in our HSC network, so that patient information is always available wherever a patient is being cared for in our system.
Our IAIMS planning process will help us align people, processes, and technology so that we can identify and remove behavioral, attitudinal, and system barriers to making necessary changes in systems and processes. This effort began with selection of members of our IAIMS Program Team, and it extends to preparing the Team to take an proactive role in the planning process and its follow-on implementation design.
D. 2. IAIMS Program Organization and Executive Review and Coordination (Back to the Top)
The IAIMS Program Team includes members of the WVUH, UHA, HSC, as well as the Interim Director of the Health Sciences Library and representation from WVNET. The Program Team is responsible for guiding the pre-planning for our IAIMS Program, the preparation of our IAIMS Planning Proposal document, and for involving faculty, staff, clinicians, and students from all segments of the joint enterprise in the IAIMS effort. This group is chaired by Dr. Floyd K. Russell, Director, Academic Technologies; members are: James K. Hackett, Associate Vice President for Finance and Administration; Edna Bruehl, CIO/Vice President for Information Technology, WVU Hospitals and University Health Associates; Hilda Heady, Associate Vice President for Rural Health; Dr. Kevin Halbritter, Associate Director of Medical Informatics and Medical Director, MDTV; Dr. Martha Mullett, Professor and Director, NICU Neonatology Pediatrics, School of Medicine/Director of Clinical Utilization and Outcomes Management Medical Affairs, WVUH Hospital Administration; Terry Burton, Interim Director, Health Sciences Library; Laura Roth, Director, Information Systems Operations/CBLC; Dr. Deborah A. Lewis, Assistant Professor, Health Systems, School of Nursing; Dr. Mary Beth Mandich, Associate Dean, Allied Health and Undergraduate Education/Associate Professor and Interim Chair, Physical Therapy; Dr. Norton Smith, Professor of Prosthodontics and Director of Information Systems/ School of Dentistry; Dr. James E. Brick, Interim Chair, Department of Medicine and Professor, Rheumatology; Dr. Marie A. Abate, Professor and Associate Chair, Clinical Pharmacy; Dr. David Swartz, WVNET; and Vicki Sanders, Staff.
D. 2. a. Executive Review and Coordination (Back to the Top) Our IT Strategic Planning Group is made up of those individuals with ultimate responsibility for information technology policy decisions and the implementation of IAIMS Program initiatives.This group consists of the Vice President of the Health Sciences Center, the President and CEO of University Health Associates, the President and CEO of West Virginia University Hospitals, the CIO/Vice President for Information Systems, the IAIMS Principal Investigator/Program Director, and the Director of the Health Sciences Library. The IT Strategic Planning Group will have oversight authority over the IAIMS program and will be the approval authority for recommendations developed by the IAIMS Program Team.
D. 2. b. Focus Area Teams (Back to the Top) Four Focus Area Teams will be established to identify the information needs in each of the following areas: Education, Research, Patient Care/Clinical, and Administrative. Members of the Teams will come from all units across the Enterprise and, as far as possible, have staff, student, administration and faculty representation. The Health Sciences Library will be represented on each Team. Team leaders for each of the four focus areas have been chosen. These are:
Research Team Leader Kenneth Landreth, PhDPatient Care/Clinical Team Leader Martha Mullett, MD
Administrative Team Leader Laura Roth
Education Team Leader Mary Beth Mandich, PhD
Each Focus Area Team will have six to eight members who will be appointed from the IAIMS Program Team named above and members nominated from clinical and academic programs. Each teams will be responsible for identifying information needs and issues important to its constituency. The Principal Investigator and Assistant Program Director, in conjunction with the Focus Area Teams, will initiate a series of events to inform the Health Sciences Center about the IAIMS planning process. Briefings and focus area discussions will be conducted at executive, school, department, and discipline levels to explain the concept, detail the planning process, and relate what the IAIMS Program and integrated information systems mean to them in their roles of faculty, clinician, student, and staff.The IAIMS Program Team will be responsible for developing recommendations for policies and procedures to address the information needs and issues identified by the Focus Area Teams. These recommendations will be presented to the IT Strategic Planning Group for action. The IAIMS Program Team and the Focus Area Teams will be responsible for reporting results of recommendations back to their constituent groups.
Focus Area Teams will be prepared for their assignment through an initial training workshop at the beginning of the Program, and they will receive two additional follow-up workshops (at nine and eighteen months) to help them develop products which can be used effectively in the planning process. These workshops will be conducted by Ms. Ann J. Olsen, Director of Information Management Planning, Vanderbilt University Medical Center. Her letter of commitment for these workshops is included in Appendix C.
D. 2. c. Project Office (Back to the Top)
The IAIMS Project Office will be located in the Academic Technologies Department of the Health Sciences Center and will be staffed by a full-time Program Manager (60%) and a secretary (50%). The Program Manager will report to the Principal Investigator and be responsible for day to day coordination of program activities such as coordinating focus area team meetings, project documentation, and publicizing the IAIMS planning activities. The secretary, funded locally, will provide a variety of support functions for IAIMS planning activities.
D. 3. Principal Investigator (Back to the Top)Floyd K. (Rusty) Russell, EdD, serves as the Principal Investigator for our IAIMS Program. He is currently Director of Academic Technologies and a faculty member in the Department of Community Medicine. Dr. Russell’s experience with coordinating technology integration efforts includes responsibility as past Director of the Computer-Based Learning Center for the Health Sciences Center, and serving as the Coordinator for the Joint Information Sharing and Computer Networking Study (HSC, UHA, WVUH), a member of the task force for the WVU Electronic Classrooms Initiative (including chairing standards groups), and facilitating several strategic planning initiatives, including one for a national education association (The Association for Educational Communications and Technology). He is currently a co-manager and co-investigator for the Collaborative Medical Informatics Laboratory (CMIL) that is being developed to study large scale information systems in health care. Dr. Russell will oversee the efforts of the IAIMS Project Office and the IAIMS Program Focus Area Teams.
A charge to the Principal Investigator by the executive management of HSC, WVUH, and UHA to initiate an IAIMS Program is contained in Appendix C.
D. 4. Achievement of Specific Aims (Back to the Top)
The success of this effort will be determined by our ability to consolidate the information developed through previous studies and task forces and our ability to develop additional information about our systems, needs, and best practices. We believe the best way to do this is to use existing information to develop models and scenarios that our students, faculty, and staff can use to visualize an IAIMS environment. We propose to work through existing information systems groups and advisory bodies where possible. Where necessary, recommendations for changes in structure, reporting relationships, systems, and service and support will be made for executive approval.
Current work and initiatives that relate to the IAIMS Program have been discussed above. Because several initiatives that can be thought of as typical IAIMS-like initiatives are in progress in our environment, we find that we need to focus on the cultural and institutional changes that will lead to closer integration of these efforts. It is our intent, therefore, to use the IAIMS Planning Grant to address these cultural and institutional changes while continuing to plan for development of our integrated information system. We believe that is the best way for us to realize true integration of our information systems.
An IAIMS electronic newsletter will be established and widely distributed to help the IAIMS Program Team keep the RBC HSC informed about the status of the IAIMS Program and about information technology initiatives that are being considered. Paper-based dissemination will also be used during the planning process because electronic dissemination is not yet ingrained in our institutional culture.
Steps leading to attainment of each of our specific aims is discussed below.
D. 4. a. Identify the critical data and information needs, including Library resources, of the patient care, education, research, and administrative enterprises.
(Back to the Top)Two major studies have provided data about the information needs of our students, faculty, and staff. The Joint Information Sharing and Networking Study (Joint Study) was completed in May, 1993. The WVUH/UHA Computer-based Patient Record Strategy report was completed in June, 1995. Additional work has been done through the Health Sciences Library self-study. A follow-up validation study to verify results from the Joint Study was conducted during the summer of 1995.
We need to help the IAIMS Program Team, our information units, and our information users understand the different methods of data access and user interfaces that we may wish to employ. We will achieve this by creating models, drawn from user needs, that can be used to demonstrate information integration on workflow of students, faculty, and staff. It will be the responsibility of Focus Area Teams, with support from the IAIMS Program, to develop scenarios from need analyses conducted in their respective areas. Each Team will present scenarios to their constituency for validation. Validated results will be used by the Program Team to develop policy recommendations for approval by the IT Strategic Planning Group. Some projects (e.g., data repositories) for which we have pressing clinical and administrative needs will have this approach embedded in their development cycle and will be coordinated with the IAIMS Program as a prototyping example of collaboration across systems.
D. 4. b. Develop a policy and planning activities to provide seamless access to data and information in a way that allows students, faculty, and staff to integrate these resources effectively in their work. (Back to the Top) The process for policy development will facilitate implementation of a modular architecture for development, testing, refinement, and adoption of the best technical solutions for our needs. It will provide also for regular review of existing policies along with efficient means of developing new policies in response to the needs of the institutions. During the IAIMS planning process, recommendations for information policy, including organizational structures, that are developed by the IAIMS Program Team will be presented to the IT Strategic Planning Group for approval and executive level coordination with overall strategic planning initiatives. Approved policies will become the basis for enterprise information technology policy and the design of a implementation program. The planning process for developing policy recommendation will be:
This planning process will lead to a comprehensive information policy for the enterprise that will guide achievement of the following: Issues and needs identification and validation in focus areas by Focus Area Teams Policy recommendation by the IAIMS Program Team Consideration by the IT Strategic Planning Group Executive level coordination and implementation
Faculty members will have a workstation in their offices which allow, via a standard interface with appropriate security, access to information necessary for teaching, research, and patient care activities. Students will have workstations available to them with access to the information necessary to support their education and learning activities. Administrators will be able to access data appropriate to administrative functions.
A revision of the integrated strategic plan that spans both the Academic and Clinical Enterprises is underway at the time of this writing, and this IAIMS Planning Grant proposal process is running in parallel with current strategic planning processes. In fact, better management of information resources is a focus area for the strategic planning process. Recommendations for information policy, including organizational structures, that are developed by the IAIMS Program Team will be presented to the IT Strategic Planning Group for approval and executive level coordination with overall strategic planning initiatives. This effort will be facilitated by the participation of the CIO/Vice President for Information Systems (Ms. Edna Bruehl) in the IAIMS Program Team and the IT Strategic Planning Group. This is an important consideration in view of the changes that occur continually in our information systems as we initiate new partnerships and continue to update our systems as the result of partnership development, health care industry change, and hardware and software upgrades.
The integration of the WVUH and UHA information systems into a Clinical Enterprise Information System under a joint CIO has taken place. The CIO is charged with assuming responsibility for academic systems when consolidation of clinical systems is complete. An enterprise-wide firewall security system to permit interconnection of Clinical and Academic Enterprise networks is currently being tested and will provide the opportunity for closer collaboration on management of and access to information and data across the networks. We view this as an opportunity to integrate other management functions where there are clearly identified advantages in doing so.
The timeline for activities leading to attainment of our specific aims for the planning phase are shown in the tables below.
Tabl1 1a. Phase I: Groundwork: Organize resources; recruit people; prepare focus groups; set tone for a major interdisciplinary effort; communicate IAIMS concept to organizations.
|
|
DATE |
MEASURE |
|
| Visit/Review other Programs & Summarize. |
|
Attendance | Summary Reports |
| IAIMS Program Team Listserv established |
|
Was Listserv established? yes/no | # of people receiving Listserv communication |
| Solicit/Appoint Membership for Focus Area Teams |
|
Appointment of Team Members | Records of Acceptance |
| IAIMS Office Set Up and Operational |
|
Is there an IAIMS Office? yes/no | Functions and products of the IAIMS office. |
| WWW IAIMS Home Page Re-designed |
|
Is there a new WWW home page? yes/no | Use/hits on WWW Home Page |
| Electronic Newsletter Established |
|
Number of people receiving newsletter | Distribution records & questionnaire |
| Focus Teams
Appointments |
|
Appointment of Team Members | Records of Acceptance |
| Initial Focus Area Team Training |
|
Participation in Retreat | Records of Attendance and Evaluations |
(Back to the Top)Table 1b. Phase II: Assessment: Answer the questions: "Where are we now? and "Where do we want to be with respect to information policy?
|
|
DATE |
MEASURE |
|
| Develop Responsibilities & Identify Critical Issues |
|
Identified issues & Direction | Meeting Minutes and Issues Document |
| Focus Area Team Gathers Needs |
|
Specific Needs in the Four Focus Areas and Inter-relationships | Summary Document |
| Environment Forecast Complete |
|
Assessments | Formal Report |
| Advisory Council Meeting |
|
Accomplishments to Date | Briefing Document and Council Feedback |
| Review Existing Policies |
|
Were policies reviewed? yes/no | Summary Document |
| Examine Policies from other institutions |
|
Were policies reviewed? yes/no | Summary Document |
| Nine-month Team Training Follow-up |
|
Identified Issues From Focus Area Teams | Focus Area Teams Interim report |
| Draft/ Disseminate Policies, Guidelines |
|
Report to IT Strategic Plan Group | Draft Report |
| Constituency Briefings |
|
Forums, publications, focus groups, and Leadership Briefings | Number/Kind of people aware of IAIMS Project. |
(Back to the Top)
Table 1c. Phase III: Plan Development: Answer the question, "How can we achieve our strategic objectives for IAIMS?"
|
|
DATE |
|
|
| Team Workshop on Developing Implementation Proposal |
|
Draft of Specific AIMS/Goals | Outline/Draft of Implementation Proposal |
| Draft Implementation Plan |
|
Specific Aims/Goals | Draft Document |
| Advisory Council Meeting |
|
Accomplishments to Date | Briefing Document and Council Feedback |
| Recommendations to IT Plan Group |
|
Recommendations developed? yes/no | Review of Recommendations. |
| Articulate policies throughout the Three Organizations |
|
Number of individuals who received and have knowledge of the newly developed policies. | Policy distribution records and questionnaire |
| Develop Regular Review of Needs and Issues |
|
Was a responsive process developed? | Review of Policies and Procedures Developed |
| Implementation Proposal Submission |
|
Was a proposal submitted? yes/no | Completed proposal |
| Briefings for Constituencies the Implementation Plan |
|
% of participation | Attendance Records |
D. 6. Project Administration and Evaluation (Back to the Top)D. 6. a. AdministrationThe project will be administered through the Robert C. Byrd Health Sciences Center of West Virginia University. All of the activities which require expenditure of grant resources will be conducted by units which are under the administrative and budgetary authority of the Vice President for Health Sciences. In addition to the Principal Investigator the program will be staffed by the personnel identified in the budget section. Their experience includes telecommunications, computer networking, health care clinical systems, library and information systems planning, and management. Support staffing for the IAIMS Program will be provided through the Office of Academic Technologies.
All applicable regulations for management and administration of grant funds will be followed. Compliance with applicable guidelines will be monitored by the West Virginia University Office of Sponsored Programs.D. 6. b. Evaluation Plan (Back to the Top)Results of evaluation, including reviews by the Program's Advisory Council, will guide development of the IAIMS Program and attainment of the specific aims. Three types of evaluation will be used:1. Formative evaluation of progress in attaining specific aims through standard project management techniques. 2. Formative milestone reviews of Specific Aims attainment, performed by members of Focus Area Teams (Education, Clinical/Patient Care, Research, and Administration).
3. Summative Annual Review by an IAIMS Program Advisory Council.
Formative evaluation will be conducted with a process analysis approach (critical path/milestone tracking) for management of the IAIMS Program planning grant and through progress reviews by Focus Area Teams. Focus area reviews and planning grant milestone review will be the responsibility of the Principal Investigator with staff assistance. Summative evaluation will be performed through an annual progress review by the IAIMS Advisory Council. Advisory Council reviews will be the responsibility of the Principal Investigator with staff assistance. The test for attainment of Specific Aims will be approval and sign-off of each Specific Aim result by executive management of HSC, WVUH, and UHA.Evaluation results will be published in an Annual Program Report and will be submitted for presentation and publication as appropriate. Program staff will present results of the Program at appropriate local, regional, and national meetings of health care professionals. Project results will also be submitted for publication in appropriate journals. The Principal Investigator will participate in meetings of grant recipients under this award program to report on progress and exchange information with other recipients. Budget lines have been requested to make it possible to meet this dissemination commitment.D. 6. b. (1) Advisory Council (Back to the Top) The IAIMS Program Advisory Council will include internal executive stakeholders and external members with expertise in areas of computing and information technology that are critical to the success of the Program. We will convene the Advisory Council once each year to review progress and assess the program’s performance. The Advisory Council will be chaired by the Principal Investigator, and its report will be made to the executive heads of the Health Sciences Center, West Virginia University Hospitals, University Health Associates.
Advisory Council members are listed below. Letters of commitment that have been returned to date are included in Appendix C. Verbal commitments exist for other named persons.
IAIMS Advisory Council
Robert D’Alessandri, MD; Vice President for Health Sciences D. 7. Summary (Back to the Top)Bruce McClymonds; President and CEO, West Virginia University Hospitals
Robert Wright; President and CEO, University Health Associates (Group Practice Plan)
Bernard Westfall, President and CEO, West Virginia United Health System
Edna Bruehl; CIO/Vice President, Information Systems
Virginia A. Hunt; Vice President for Planning and Strategic Initiatives, Robert C. Byrd Health Sciences Center, West Virginia University Hospitals, University Health Associates
James E. Brick, MD; Interim Chair, School of Medicine; and Chairman of the Practice Plan Board of Directors
Robert Hornbrook; DDS; Interim Dean, School of Dentistry
E. Jane Martin, Ph.D., RN, FAAN; Dean, School of Nursing
George R. Spratto, Ph.D.; Dean, School of Pharmacy
Henry Blosser; Director, West Virginia Network (WVNET)
Kenneth Orgill; Associate Provost for Computing and Information Resources, West Virginia University
Sherrilynne Fuller, Ph.D.; External IAIMS Consultant, University of Washington Health Sciences Center IAIMS Program
Susan P. Gibson; Regional Health Care Applications Manager, Bell Atlantic
Hilda Heady; Associate Vice President for Rural Health, Robert C. Byrd Health Sciences Center of West Virginia
James K. Hackett; Associate Vice President for Finance and Administration, Robert C. Byrd Health Sciences Center of West Virginia
The Robert C. Byrd Health Sciences Center brings together remarkable resources for implementing our IAIMS Program. Participants include our provider practice plan, our hospitals, our academic center, our Charleston campus, and West Virginia University as well as other health care and information technology partners. Though the IAIMS planning process, we will focus our strengths, identify our weaknesses, and develop a plan for implementation, support, and administration of an integrated information system. Our IAIMS Program Team has expertise in information systems, education, patient care, research, administration, and outreach. The people who will work together collaboratively in this process will help us achieve our prime mission of improving the health of West Virginians. Their commitment is critical to our success in all of our programs, including research, education, and administrative as well as our clinical programs. Our mission is to provide excellence in health care for West Virginia, but to achieve this as an academic health sciences center, we must also achieve excellence in our research, education, and service programs. The constituents of all our programs have information needs that we must meet to help them achieve excellence. We are committed to supporting those needs through our IAIMS Program by addressing change in technology and the cultural structure of our center.
We have designed a planning process that will be effective for the environment at the Robert C. Byrd Health Sciences Center. Our process will contribute to further definition of the IAIMS concept as it is applied to academic health sciences centers. Specifically, we believe our experience with bringing together resources from independent systems to create a collaborative planning process will provide a model that can be applied in other academic health sciences centers that have a rural commitment. We have benefited from the experience and advice of other IAIMS Programs, and we are committed to sharing our experience with others who feel that they will benefit from it.
As we continue the process of moving from a provider-controlled, fee-for-service care system to a covered-life, payer-controlled system, we are committed to a comprehensive analysis and planning process that includes participation of all our computing, information, and clinical systems and that leads to a fully collaborative IAIMS Program. The funding that we have requested through the NLM IAIMS Program represents a significant enabling mechanism for this planning effort because it will help us create a collaborative environment for facilitating change and designing effective systems.
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.
