1. INTRODUCTION

In July 1991, the Vanderbilt University Medical Center (VUMC) launched a strategic initiative to establish a Medical Center-wide Integrated Advanced Information Management System (IAIMS). The IAIMS is intended to support the highest standards in health care education, biomedical research, and patient care. It will permit the management of information as a shared resource, support communication to integrate activities across organizational and geographical boundaries, and provide tools for work process redesign and improvement. Ubiquitous, one-stop information shopping will be a key element of VUMC's competitive edge.

Development of a fully functional IAIMS is a major project, analogous to planning and constructing a replacement hospital. Before construction can begin, a program statement must be developed to build and document consensus about how it will be used and what it will be able to do. Next, an architectural plan is developed to show how the pieces will fit together. Construction then proceeds in a way that lets each new step build on a prior one -- from excavation, to foundation, to weight-bearing structure, and finally, to interior elements. Detail is added, and the plans are refined iteratively, throughout the process.

VUMC intends to complete the IAIMS implementation project in seven and one-half years from the decision to begin in 1991. The project will be considered to be complete when three milestones are reached:

• The environment will permit individual initiatives to augment the IAIMS over time through sustained development
• Everyone in the medical center will use the IAIMS regularly
• It will be possible to carry out a task that requires interaction with a cross-section of the medical community solely by communicating via the IAIMS.

These end points have been selected because the power of an IAIMS derives from bringing people, information, applications, and technology together, more than from the power of any one element. One of the most difficult aspects of introducing new information management tools involves incorporating them into work processes. Once everyone is interacting with the IAIMS, it will be relatively easy to add functions.

Although this time frame seems long, comparable institutions have spent over four times as long without getting the job done. We will succeed by continuing to use a "fast track" approach that involves parallel planning and implementation, where possible, instead of a more sequential process. Project scope will be managed to stay within the time frame, much as a building can be partially shelled to stay within budget. The project will be divided into phases of six to eighteen months duration, each of which will include a number of parallel efforts. This phasing will allow VUMC to gain beneficial occupancy of portions of the IAIMS as they are developed, providing short term relief for information handling problems and early indications of what works well.

In the last four years, VUMC has made great progress in developing its information management infrastructure. We have:

• Constructed the Eskind Biomedical Library
• Put in place a backbone network throughout VUMC
• Developed a shared work station desktop to provide a single point of access to systems attached to the network
• Implemented a common electronic mail application
• Made Medline and other library databases available across the network
• Developed computer-based courses in pathology and pediatrics
• Implemented new admission/discharge/transfer and clinic registration systems
• Piloted a patient care order entry system, together with a work station interface to support decision making during the process
• Implemented teleradiology for remote image interpretation
• Began implementation of an electronic archive for patient records
• Selected new systems to support physician billing, scheduling, and managed care
• Launched the Division of Biomedical Informatics and the Active Digital Library
• Developed teams with skills in network technology, data modeling, and work flow analysis in the Department of Information Management and the Eskind Biomedical Library
• Developed processes and forums for broad-based participation and involvement in both strategic and tactical information management planning.

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The Information Policy Advisory Committee (IPAC), together with the committee structure that it has put in place, is charged with creating the on-going planning process to guide the development of the IAIMS and formulating policy about how VUMC manages and shares information. IPAC's function requires a vision of the future. How does VUMC want to meet its missions in five to ten years and what environmental pressures will we face? The visioning process opens the way for creative exploration of new strategies and ways of operating. Without it, an IAIMS planned today would be out of date before it could be completed. IPAC's mission is strategic. How do we do things differently today, so that we obtain maximum leverage from our efforts to achieve the IAIMS?

During the initial phase of this new planning process, IPAC established four broad-based groups focused on the domains of education, research, patient care, and administration. IPAC and these four Domain Committees explored four critical sets of questions during the 1992-93 planning year:

• What are the key external factors that are motivating VUMC to change? At that time, VUMC was beginning to feel acute pressure to position itself to participate in a new managed care environment and to adapt to decreasing indirect cost rates. It is vital to understand the broad environmental context to anticipate future demands and opportunities.
• What changes is VUMC currently making? What internal initiatives support our movement in new directions?
• What is the most attractive, realistic vision for VUMC's patient care services in the year 2000? What about education? research? administration? What scenarios would illustrate how we will work then?
• Given these changes, what is the mission for the information management function at VUMC? And what information management goals will best support building the VUMC of the future?

In the fall of 1993, IPAC decided to restructure the Domain Committees by shifting responsibility for considering administrative functions to the Education, Patient Care, and Research Domain Committees. IPAC and the Domain Committees engaged a new set of questions:

• What objectives must be met over the next five years to make good progress toward our goals?
• What is the critical set of functions that must be included in VUMC's IAIMS to motivate faculty, staff, and students to use it daily?

In the 1994 planning year, IPAC asked the Domain Committees to think broadly about the full range of information management capabilities they would like to have at VUMC. We used the vision statements as a key source of ideas. In addition, the domain committees sought input from a wide variety of individuals, existing groups, and discussion sessions. We then asked the following questions:

• What set of projects would provide these capabilities? Can these projects be conceptualized across domains in ways that demonstrate opportunities for leverage?
• What projects will contribute most to VUMC's competitiveness and quality within our mission areas of education, research, and patient care?
• Given these recommended priorities and know dependencies among the projects, can we suggest a sequence of infrastructure and applications projects to provide the desired capabilities over a 5-year period?

The result is a "straw man" five-year plan to guide future information management project selection, together with documentation of input from the education, patient care, and research constituencies regarding possible future directions and project priorities. This plan, in conjunction with ongoing input on priorities, will be used by VUMC's decision-makers to make choices about the sequence in which individual projects will be funded for detailed planning and implementation.

This report should not be read as a statement of exactly what will be done. Instead, it is a road map to show how the pieces fit together and how we might reach our goals over time. It is intended to guide our decisions as we respond to opportunities and challenges and balance allocation of available resources. We will have to make choices among many good projects -- we cannot have all that we want.

The body of this report organizes and summarizes the input of the Domain Committees, the staff of the Informatics Center, and the many other individuals throughout VUMC who contributed to the capabilities lists and provided feedback on priorities for the resulting projects.

IPAC has leveraged the activities of a set of groups that are actively thinking about VUMC's information management future. The Chancellor has charged an Information Technology Strategy Group to articulate the strategic purpose for information technology at Vanderbilt University. An Information Systems Steering Committee provides oversight regarding project scope, project management, and resource allocation within the Medical Center's Department of Information Management. A Task Force on Management Information Systems for the New Environment is determining what data resources and systems can be put in place in the short term to support managed care, allow VUMC to speak with one voice, and provide needed information regarding process efficiency, utilization, and outcomes. Dr. Stead has chaired each of these groups and is responsible for coordinating their deliberations.

In addition, a Collaborative Organization Design Team is redesigning work processes in the Hospital and Clinic and will specify associated information management support requirements. This initiative is a major source of input for the IAIMS planning effort.

VUMC's information management planning has been supported, in part, by a two-year IAIMS planning grant from the National Library of Medicine. We were awarded, beginning in January 1995, a five-year IAIMS operations phase grant. We gratefully acknowledge the NLM's continuing support.

VUMC's Information Policy Advisory Committee is made up of the following individuals:

William Stead, MD (Chair)

Associate Vice Chancellor for Health Affairs

John Chapman, MD

Dean, School of Medicine

Colleen Conway-Welch, PhD, RN

Dean, School of Nursing

George Forsyth, MBA

Chief Financial Officer

James Snell, MD

Director, Ambulatory Care Programs

Judy Spinella, MS, MBA, RN

Director and COO, Vanderbilt University Hospital

Norman Urmy, MBA

Executive Director, Vanderbilt University Hospital

The domain committees, initially established by IPAC in January of 1993, guided the planning process in their respective areas, contributed their own ideas, and assisted in coordinating efforts to obtain input from others in the domains. The Information Policy Advisory Committee is grateful for the participation and creative input of the members of These committees. The leaders of the domain committees also attended and participated fully in meetings of the IPAC. The following served on the domain committees during the course of the planning project:

• James Knight, DPh, MS (Chair, 1993)
• David Aycock
• Winfred Cox, MBA, CPA
• Kathryn Edwards, MD
• Sandy Greeno, MSN, RN
• Amy Harshman Green, MPA
• Ed Solomon, MBA, MA

• Terence Dermody, MD (Chair, 1993-94)
• George Bolian, MD
• Rebecca Culpepper, MSN, RN
• Kathleen Dwyer, PhD
• Mehmet Goral, MD
• Gerald Gotterer, MD, PhD
• George Gray, MD
• Robert Janco, MD
• Linda Norman, MS
• Karen Turner, EdD

• Bonnie Pilon, DSN (Chair, 1994)
• Corey Slovis, MD (Chair, 1993)
• Julia Breyer, MD
• Frank Carroll, MD
• James Knight, DPh, MS
• Mike McRight
• Loren Nelson, MD
• Gary Perrizo, CPA
• Terrell Smith, MSN, RN

• Joel Hardman, PhD (Chair, 1993-94)
• Martin Blaser, MD
• John Bourne, PhD
• Roger Chalkley, DPhil
• Marie Griffin, MD, MPH
• Thomas Hazinski, MD
• Lee Limbird, PhD
• David Robertson, MD
• Kenneth Wallston, PhD
• Michael Waterman, PhD

In addition, the following staff of the Center for Patient Care Innovation, the Department of Information Management, and the Medical Library have served as recorders for the Domain Committees:

• Wendy Baker, RN, MS
• Oscar Miller, PhD
• Terry Minnen, MEd
• Karen Turner, EdD
• Frances Lynch, MLS
• Nancy Proctor
• Kristy Sinkfield
• Ken Williamson, PhD

The Architecture Task Force has the following members:

• Paul McNulty, Chair
• Randy Bates
• Jeff Byrd
• Johniene Doran
• Don Eddleman
• Alice McClellan
• Dean Sittig, PhD
• William Stead, MD

Ann Olsen, Director, Medical Center Information Management Planning, has coordinated the planning process.

Many others assisted in the development of this plan: through rounds, interviews, and discussion groups to identify desired capabilities; through participation in the Vanderbilt University Hospital and The Vanderbilt Clinic's Collaborative Organization Design process and the VUMC 21st Century task forces; and through surveys of selected staff and faculty to obtain input on project priorities.