Introduction
Information technology (IT) is an essential part of today's organization. From personal computers, the Internet, and communication technology to specialized software and hardware applications, leveraging IT solutions reduce costs and increase the quality, efficiency, and innovation of an organization.1 Examples of technology trends include the proliferation of mobile devices, cloud environments, social media, virtual environments, interactive content, and administrative business applications. In a medical school environment, technology is a vital resource in increasing academic productivity, enhancing teaching and learning modalities, and facilitating research by providing technical solutions to enable innovation.
As the sophistication and application of such technology increase, careful strategic planning is needed for successful integration, implementation, and sustainable usage. For IT to be leveraged optimally, a synergistic combination between other organizational resources must be established.1 This is especially true in the academic environments, where time and resource constraints on faculty and staff may not afford the training and knowledge needed to take full advantage of available technological opportunities.2
In facilitating the information technology needs of an organization, the IT department is an essential component in both support and application development. Areas in which a medical school's IT department is vital include the following: web-based educational programs; simulation and virtual technology; evaluation tools; technology to support administrative tasks and procedures; library support; databases for information storage, networking and communications infrastructure; portals for faculty and staff information and training; technical support both on the user and administrative ends; and security for both data and physical infrastructures.
The John A. Burns School of Medicine's (JABSOM) Office of Information Technology (OIT), under the Office of Administration, Finance, and Operations, is the IT backbone for the school of medicine. OIT supports the educational mission of JABSOM by providing information technology to faculty, staff, and students. The job of OIT is to provide technical support and application development services needed by departments and programs. The Director, Henry Glaspie, is now well versed in JABSOM's technological needs. His vision on the sustainable future for IT at JABSOM includes:
Upgrading the networking infrastructure
Consolidating of the IT infrastructure, both on campus and off campus locations
Enhancing the physical security of buildings (ie, video cameras and emergency communication systems)
Ensuring data security and compliance to security policies
Facilitating data management and storage
Developing a new up-to-date website
Offering IT solution services to JABSOM departments and programs
Training staff to maintain competency and learn opportunities in the evolving IT world
Following are examples of projects that JABSOM's OIT has been working on to support the needs of specific departments and programs. This includes the development of applications to streamline and add efficiency, as well as, improve the infrastructure by increasing bandwidth and Internet connectivity both to and across locations outside of the main medical school campus at Kaka‘ako.
Clinical Skills Examination System (CSES)
The Clinical Skills Examination System is a web application developed by JABSOM's OIT in partnership with the school's Center for Clinical Skills (CCS). In an effort to enhance JABSOM's mission of educating future healthcare professionals, CCS sought a collaborative venture with OIT to utilize technology to translate effectively the center's paper-based examination and related processes into an electronically-driven solution. The objective was to provide medical students with an exam experience that is aligned more closely with the United States Medical Licensing Examination (USMLE). Additionally, it was anticipated by CCS that an electronic approach would alleviate some cumbersome administrative procedures that are included in the exam process.
Prior to the joint undertaking with OIT, the Center for Clinical Skills had worked initially with an independent contractor to develop the CSES. However, this initial endeavor was unsuccessful. It was discarded due to a disparity between the contractor's deliverables and CCS's expectations. To prevent this problem from recurring, OIT determined that it was paramount to take an iterative development approach during the business process discovery for a cohesive analysis. This methodology included a cycle system of conceptualization and design with incremental changes developed during each iteration. At each release phase, work was modeled around the respective context, workflow and activities within the examination lifecycle such that each stakeholder group could assess progress.
The collaboration resulted in four primary impacts that fostered system adoption: (1) medical student examinees embraced the ability to type their assessments into an online mechanism. This replaced having to hand write responses on paper, and is a preparatory exercise for the USMLE; (2) administrative staff duties were reduced significantly from efficiencies attributed to the electronic collection, organization, distribution, workflow notification and storage of exam data; (3) standardized patients operated CCS-issued iPads to submit their evaluations electronically thereby allowing automatic data validation for completeness and monitoring; and (4) content of three physical documents employed during the practice were integrated into a single comprehensive interface whereby faculty graders scored examinations electronically. This procedure alleviated the need to decipher handwritten assessments.
Willed Body Database (WBD)
There are instances when a project is directed by OIT and not by a department or program within JABSOM. An example is the development of the Willed Body Database web application. The initiative was prompted when the school's Willed Body Program (WBP) requested the upgrade of both their donor and cremated databases, which were established in FileMaker Pro. This led to the discovery of sensitive Protected Health Information (PHI), which needed to be stored and secured. Although it was beyond the scope of WBP's initially identified need, OIT recommended a broadened solution to include data security.
After this assessment WBP recognized that it was imperative to protect the sensitive data, which included the community of anatomical donors. OIT proposed transitioning WBP's existing database into a Structured Query Language (SQL) database solution that would leverage and be safeguarded by OIT's infrastructure. OIT also gathered information about WBP's processes for the expressed purpose of automating the program's database-related activities into a new system. OIT also converted variables into standardized inputs to increase efficiency and organization of data.
The resulting system included data security through the implementation of encrypted Security Socket Layer (SSL) channel transmissions, authentication and authorization at the individual account level, and Internet Protocol (IP) restrictions that confined application visibility to only WBP and OIT internal subnets. The new Will Body Database is facilitated by cleansed, parsed, and standardized data. The WBP now utilizes the product, which provides authorized personnel the ability to access simultaneously the database from their workstations, independent of the underlying operating system. A consolidated entry point incorporated elements from their two previous FileMaker Pro databases, which included notation and task tracking, and workflow and report generation.
Non-Compensated Faculty Renewal System
The Non-Compensated Faculty Renewal system is based on the initiative of the former Department Chair of Surgery, Dr. Danny Takanishi. The department was currently using a paper-based system that incorporated sections of the Annual Faculty Report as well as human resource (HR) forms for review and renewal. The problem was that the Department had over 200 non-compensated faculty members spread across several hospitals and shifts. Obtaining signatures for all of the forms that needed to be processed, or to locate the status of a renewal was cumbersome. Dr. Takanishi felt that an on-line system would help facilitate these issues and enlisted the help of JABSOM OIT.
In six months, the Department of Surgery staff, JABSOM HR, and IT Staff, worked together to produce an initial prototype web application that was launched in late-2009 for the December 2009 faculty renewals. This new system automatically queried which faculty members needed to be renewed by linking itself to University of Hawai.i (UH) at Manoa's HR database, to which digital signatures could be applied. This allowed faculty members, as well as the department staff, to determine the status of each and every renewal and update when necessary. Over the next few years, enhancements were made to this system, which included adding the Departments of Psychiatry and Pediatrics. Currently, there is an initiative to create a unified JABSOM-wide renewal system, in which over 1,200 non-compensated faculty members would participate.
Hospital Network Upgrades
JABSOM has departmental offices located at Queen's Medical Center, Kuakini Medical Center, and Kapi‘olani Medical Center for Women & Children. In the past the networks for these locations were separated from the JABSOM network and offered limited wireless services. Over the past six months, OIT initiated a $700,000 network upgrade project that will increase the bandwidth at the hospital locations and integrate the networks with JABSOM and UH. This upgrade will enhance data security and disaster recovery. Data traveling between the locations will be encrypted and allow for off-site storage and replication. Additionally, the network integrations will permit JABSOM to offer UH wireless networking. The wireless networking upgrade will be critical to medical education as students, faculty, and staff access data more often through mobile devices.
OIT into the Future
The projects discussed above are some of the initiatives in which OIT is currently involved and supports. As OIT moves into the future, information technology to support the education, research and infrastructure needs will continue to be a mission, with the aim to improve the current system. For example, an area of exploration is the use of “cloud computing.” Cloud computing uses shared resources, such as email services, data storage, or software applications, that are accessible over the Internet. Technology such as document sharing in the cloud allows the ability for students, faculty, and staff to share, collaborate and access documents from any location, at any hour of the day. Another example is supercomputing and/or distributed computing that allows researchers to crunch and analyze data. In the past this capability would have been difficult, costly and time consuming.3 With the completion of the University of Hawai‘i Information Technology Center, access to high performance computing, data storage, analysis, and visualization services will be available to all members of the University of Hawai‘i System. How these resources can be optimally utilized by JABSOM and supported by OIT will be explored both by the individual users and departmental levels.
Challenges for information technology management include the trend in decentralized computer technology. Threats and dangers not only include hardware failures, but issues of data protection, intellectual property rights, poor security management practices, and misallocation of resources.4 Recognizing these threats, data security, and proper storage of data will remain at the forefront of OIT in all aspects of IT management. As a standard practice for OIT, network communication and software updates are monitored heavily, as well as procedures to ensure that all computers on JABSOM's networks include anti-virus software and are backed-up on a weekly basis. JABSOM faculty, staff and student training on the protection of data, such as health information or sensitive data, is currently under development. Although no system connected to the Internet can be 100% secure, OIT strives to put in place best practices to avoid compromises and proper procedures to safely and efficiently recover if such compromises do occur.
The future of information technology will be broader and more complex as technology becomes more advanced and ubiquitous in daily life. As the World Wide Web this year celebrates its 25th anniversary, most students entering medical school do not remember not being able to access the Internet or send an email. The technological expectations of students and faculty will not only see technology as a tool, but as a necessity for communication, collaboration, and innovation. JABSOM's OIT will continue to assess, plan strategically, and serve the needs and requirements of the school.
References
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