Recently news has been floating around about a proposal drafted by the Louisville Medical Center community and the University of Louisville Libraries to plan an integrated advanced information management system. During January of this year, I met with Judy Wulff, to learn more about the Integrated Advanced Information Management System, otherwise known as IAIMS. Judy explained to me that IAIMS originated from a concept that is about 15 years old. The program is funded by the National Library of Medicine. IAIMS is not really any one system but more a culture in which information services can be planned to work together. Since all complex organizations have information systems, it is ideal to create them to work together.

Benefits of such a system
IAIMS has been envisioned differently in each of the 40 institutions that have received funding so far. Institutions that have received these types of grants are the elite of medical communities.

The Louisville proposal asked for funds to support a planning process and public awareness activities to promote a culture that will allow integration as opposed to more small separate individual systems. Integrated systems are not built by a single person, but by many people working together. Students and faculty in UofL Health Sciences schools do their work in many Louisville hospitals and clinics that are separate enterprises. It is a complex community, representing many different interests. In some ways these enterprises really are competitors. Because most of their teaching and research is supported by grants and by the income generated in their practices, physicians who work for the UofL Medical School could almost be considered free-lancers. Ideally, data collected should be considered resources for an institution and, if treated that way, the value of such resources multiplies. But when separate institutions are involved, how can the information they collect be exploited for the benefit of all?

For example, a person is a patient in a clinic. In another part of the medical center, a researcher is collecting information for a study. It may be that this patient would be a good candidate for that study. How can we connect this patient with the researcher doing the study? If parts of the patient's records were transferable to a data repository, certain of the characteristics of the patient and his or her case could trigger a flag for the physician to consider enrolling the patient in the study. Such clinical studies and trials can produce results that prove beneficial for the entire community. Building this data repository is an example of one of the kinds of projects that might be identified and undertaken under IAIMS. Another project might be to ensure that the biomedical literature—the journals and databases—is brought to the point of care in the medical center. The broad view of information management under IAIMS planning benefits the community, the conductors of trial studies, and researchers as well as patients. In fact, it is primarily supposed to benefit patient care in the long run.

The People behind the proposal and the Library's role
Many folks have been involved with this project, but the vision for embarking on an IAIMS project in Louisville began with Dr. Richard Clover and Dr. Paul McKinney. Dr. Clover, a physician, was hired in 1995 to be the Chair of the Department of Family and Community Medicine. He has since been appointed Associate Vice President for Health Affairs/Health Informatics. He had been instrumental in implementing an electronic medical records system in a Texas medical center. Dr. McKinney, also a physician, is the Chief of Internal Medicine Division and interested in informatics questions. Both men, like most School of Medicine faculty, were frustrated by the institutional boundaries that prevented access to the information they needed to make health care decisions at the time and place where the decisions are made. The two began putting together an IAIMS proposal, and they made their idea known to then-Dean Donald Kmetz. The first of many meetings to discuss this proposal began in May of 1996. Judy was invited to a meeting during August 1996 and the then-University Librarian, Ralze Dorr, was asked for a letter of support the following December. In April 1997, the two men approached Hannelore Rader, University Librarian and Diane Nichols, Acting Director Kornhauser Library, about having the Kornhauser Library take a leadership role in this project, to pull the threads together, to collect input from the health sciences community, and to do the organization, writing, and compilation of the proposal. This is when Judy Wulff got involved.

Though Judy modestly stated in our interview that this is not her project, she is nevertheless passionate about it. To understand her role, it helps to look at her previous life and education. She started out in population genetics, but decided that information science was more suitable and made a mid-life career change. She remembers that one of the assigned readings in library school was the paper on which the IAIMS program was based. Judy's first library job was at Columbia University, where she worked on a similar project from the same grant program. Gary Freiburger, current Director Kornhauser Library, had been associated with an IAIMS program at the University of Maryland, and when he arrived in Louisville, he was thrown into the project as well. He and Dr. Clover are Co-Principal Investigators.

The National Library of Medicine (NLM) supports health informatics education in a variety of ways, including a fellowship program. Judy applied last year and received a fellowship for a week in Woods Hole, Massachusetts at the Marine Biological Laboratory. Since this was the place where a lot of early molecular biology was done, it was particularly interesting for her. Approximately half the 30 persons in the group were librarians and the other half were physicians with "a smattering of other health professionals." She's also been to meetings of the IAIMS Consortium, where people who work with other IAIMS projects come together to exchange information.

Writing the proposal has been lots of fun for Judy and has provided wonderful visibility for the libraries. Funding was approved and began May 1. Money from the grant will be used to buy 80 percent of Judy's time for the next two years, varying percentages of others' salaries, bagels and coffee to fuel the planning process, special events and communication. She'll join the Health Informatics Group, consisting now of eight individuals including informaticians and computer specialists charged with carrying out the IAIMS project and various other health informatics initiatives. Elizabeth Smigielski, NLM Associate Fellow, will also be devoting 20 percent of her time to the project. A search is under way to find a librarian to perform many of Judy's regular duties while she works on this project.