The axis and nexus of e-health alliances in 2020.

Strategic partnerships between the health care and Information Communication Technology (ICT) sectors are the wave of the future, as e-health systems are implemented. Divergent perspectives between ICT and health care executives impose central challenges in forging productive strategic alliances. Bridging these perceptual differences requires strong leadership and vision, financial resources, and care provider support. Together these form the axis upon which tomorrow's e-health alliances will rest. The growth of e-health systems is inexorable. The strength of governance leadership continues to influence its rate of growth and positive impact on health care systems. The extent to which strategic partnerships with the ICT sector will evolve into dynamic e-health alliances is directly related to the quality of national and regional governance leadership--the ultimate nexus of evolving e-health systems of 2020.

IAIMS: planning for change.

The success of IAIMSs and other information technology plans depends to a great extent on the fit between the planning process and the nature of the organization. Planning processes differ as a function of both plurality of goals and the degree to which technology or the external environment changes. If all members of an organization share a common goal and the organization is in a relatively stable environment, the classic "plan, prototype, implement, evaluate" process may be appropriate. Most health care organizations are not consistent with this model. The components of the organization may have different goals, and both the health care environment and roles for technology are changing rapidly. In these circumstances, planning takes on a different light. This paper outlines approaches to IAIMS planning in various environments and provides a framework for IAIMS planning in rapidly changing environments.

Aspects of IAIMS implementation that require further research.

The Integrated Advanced Information Management System (IAIMS) program promotes an integrated approach to information management within a medical center. Since the IAIMS program was conceived, many of the initial IAIMS technologic needs have been quite widely achieved or are planned for implementation in many medical centers. At the same time, the IAIMS frontier is being steadily pushed to new issues that need to be addressed to achieve the full power of the IAIMS vision. The paper discusses 1) levels of integration where IAIMS has been successfully pursued to date and 2) challenging areas in which research is required to approach the full potential of the IAIMS in the future.

The evolution of the IAIMS: lessons for the next decade.

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 IAIMs: 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-uses 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.

IAIMS: an interview with Dick West. Integrated Advanced Information Management Systems. Interview by Joan S Ash and Frances E Johnson.

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.

IAIMS architecture.

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.

Managing information in the academic medical center: building an integrated information environment.

The strategic importance of integrated information systems and resources for academic medical centers should not be underestimated. Ten years ago, the National Library of Medicine in collaboration with the Association of Academic Medical Centers initiated the Integrated Advanced Information Management System (IAIMS) program to assist academic medical centers in defining a process for addressing deficiencies in their information environments. The authors give a brief history of the IAIMS program, and they describe both the characteristics of an integrated information environment and the technical and organizational structures necessary to create such an environment. Strategies some institutions have used to implement integrated information systems are also outlined. Finally, the authors discuss the role of librarians in integrated information system design.

IAIMS and UMLS at Columbia-Presbyterian Medical Center.

The authors use an example to illustrate combining Integrated Academic Information Management System (IAIMS) components (applications) into an integral whole, to facilitate using the components simultaneously or in sequence. They examine a model for classifying IAIMS systems, proposing ways in which the United Medical Language System (UMLS) can be exploited them.

[A combined PACS and Internet information system in a university medical center]. / Kombiniertes PACS und Intranet-Informationssystem an einem Universitätsklinikum.

PURPOSE: The Department of Radiology at the University Hospital Innenstadt Munich provides all clinical departments of a large university hospital with several radiology units at different locations. During the last four years all units have been fully digitalized with a stepwise installation of a PACS. The PACS also processes images from the Nuclear Medicine Department. METHODS: As image modalities, archive systems and review workstations, we use devices from multiple vendors, which are integrated into a consistent system using the DICOM standard. The hospital has developed its own RIS and an Internet information system, which provides access to all reports and images from radiology for all clinical departments inside the hospital. Additionally, other clinical information such as laboratory results or ECG examinations are available through the system. RESULTS: After one year of operation, the system succeeded in the clinical routine work as the primary source for radiological reports and images as well as for laboratory values. CONCLUSION: The advantages of digitalization were, besides reduction of film cost, especially optimizations of work flow with access to digital images from everywhere at any time.

Integrated Advanced Medical Information Systems (IAIMS): payoffs and problems.

IAIMS (Integrated Advanced Information Management Systems) is an initiative to improve the access to information needed to provide patient care, health-oriented education, biomedical research, and management of large medical center environments. This paper will review the goals, history, and accomplishments of the IAIMS initiative. Shortcomings and frustrations, lessons learned, and the future of such initiatives will also be discussed.

Standardization in health informatics in Canada.

Around the world, informatics has been cited as a key enabler of health sector reform. Recent reform programs in Canada, reflecting this global consensus, have emphasized the importance of quality information and information technology in meeting their goals. Standards are an important building block for achieving the required comprehensive and integrated health information infrastructure. This paper describes the current status of, and future plans for, health informatics and related standards in Canada.

Improving acute care through use of medical device data.

The Medical Information Bus (MIB) is a data communications standard for bedside patient connected medical devices. It is formally titled IEEE 1073 Standard for Medical Device Communications. MIB defines a complete seven layer communications stack for devices in acute care settings. All of the design trade-offs in writing the standard were taken to optimize performance in acute care settings. The key clinician based constraints on network performance are: (1) the network must be able to withstand multiple daily reconfigurations due to patient movement and condition changes; (2) the network must be 'plug-and-play' to allow clinicians to set up the network by simply plugging in a connector, taking no other actions; (3) the network must allow for unambiguous associations of devices with specific patients. A network of this type will be used by clinicians, thus giving complete, accurate, real time data from patient connected devices. This capability leads to many possible improvements in patient care and hospital cost reduction. The possible uses for comprehensive automatic data capture are only limited by imagination and creativity of clinicians adapting to the new hospital business paradigm.

Linking personal and public health information: a vision for community-centered health information systems.

As health care in the U.S. and worldwide has shifted from a centralized, institution-based model to a distributed process occurring largely in the communities, Integrated Advanced Information Management Systems (IAIMS) initiatives must also move toward addressing the challenges of integrating health information at the community level. The Wisconsin IAIMS initiative strives to create such a solution, anchoring its efforts in a regional health information technology architecture by partnering with Wisconsin-area communities as the foundation that will ensure the establishment of the appropriate collaborations to gain adequate investment and generate sustainable solutions for health information integration.

High-content screening data management for drug discovery in a small- to medium-size laboratory: results of a collaborative pilot study focused on user expectations as indicators of effectiveness.

High-content screening (HCS) technology provides a powerful vantage point to approach biological problems; it allows analysis of cell parameters, including changes in cell or protein movement, shape, or texture. As part of a collaborative pilot research project to improve bioscience research data integration, we identified HCS data management as an area ripe for advancement. A primary goal was to develop an integrated data management and analysis system suitable for small- to medium-size HCS programs that would improve research productivity and increase work satisfaction. A system was developed that uses Labmatrix, a Web-based research data management platform, to integrate and query data derived from a Cellomics STORE database. Focusing on user expectations, several barriers to HCS productivity were identified and reduced or eliminated. The impact of the project on HCS research productivity was tested through a series of 18 lab-requested integrated data queries, 7 of which were fully enabled, 7 partially enabled, and 4 enabled through data export to standalone data analysis tools. The results are limited to one laboratory, but this pilot suggests that through an "implementation research" approach, a network of small- to medium-size laboratories involved in HCS projects could achieve greater productivity and satisfaction in drug discovery research.

Integration of data systems and technology improves research and collaboration for a superfund research center.

Large collaborative centers are a common model for accomplishing integrated environmental health research. These centers often include various types of scientific domains (e.g., chemistry, biology, bioinformatics) that are integrated to solve some of the nation's key economic or public health concerns. The Superfund Research Center (SRP) at Oregon State University (OSU) is one such center established in 2008 to study the emerging health risks of polycyclic aromatic hydrocarbons while using new technologies both in the field and laboratory. With outside collaboration at remote institutions, success for the center as a whole depends on the ability to effectively integrate data across all research projects and support cores. Therefore, the OSU SRP center developed a system that integrates environmental monitoring data with analytical chemistry data and downstream bioinformatics and statistics to enable complete "source-to-outcome" data modeling and information management. This article describes the development of this integrated information management system that includes commercial software for operational laboratory management and sample management in addition to open-source custom-built software for bioinformatics and experimental data management.