W. K. Kellogg Foundation of Battle Creek, Michigan. REFERENCES. [1] Matheson, N. and J. Cooper. Academic. Information in the Academic Health Sciences.
PRELIMINARY RESULTS WITH THE DESIGN AND IMPLEMENTATION OF AN ACADEMIC MANAGEMENT INFORMATION SYSTEM Steven Evans, Director Instructional Science Research
Creighton University Omaha, Nebraska 68178
Instruction. The Total-System Design starts with a process for the re-definition of all the educational programs at our Academic Health Center and an alternate "encoding" of learning resources and inventory (such as lectures, videotapes, guest speakers, etc.). This approach begins with a unified, comprehensive, and systematic definition of each program of study. To begin, each program of the health sciences was viewed as a terminal educational goal or node in an inverted tree. This ultimate goal was conceptually divided into constituent goals, and each educational subgoal was in turn divided into sub...-subgoals until there was a parsimonious definition of each entire educational program (hierarchically arranged, consistent, and uniform) in which every learning objective was logically derived and clearly articulated. This undertaking has been underway for a long while at our academic health center.
ABSTRACT This paper provides an overview of aspects of an academic management information system (AMIS) at Creighton University's Academic Health Center. This report summarizes briefly some of the features of the system, our experiences in implementing it, some of the reactions from our academic community to a "foreign" body (and our attempts to reduce the rejection mechanism), as well as successes to date. Lastly we describe steps underway to expand the system into a full-fledged example of the system as envisioned in the Matheson and Cooper report on "Academic Information in the Academic Health Sciences Center."
BACKGROUND OF THE SYSTEM DEVELOPMENT The title of an academic management information system (AMIS) is purposely borrowed from a recent major initiative provided in this area by Matheson and Cooperl. As we shall see, our AMIS contains a great many of the features and expectations of the system they recently described, even though our system in fact has been under development over the past ten years. Although the conceptual underpinnings of this effort arose much earlier2, this effort was given a major impetus in 1977 when the W. K. Kellogg Foundation provided nearly a million dollars to Creighton University to develop what was called a Total-System Design of Instruction3. In effect, this project developed and implemented a conceptual framework on which a full academic management information system could be built. Given the extent of this project, it can only be briefly summarized and described, but key features will be provided so that some of the capabilities of the AMIS system and its applications to instructional management can be somewhat explicated.
The derived goals and all related subgoals and learning objectives are then assembled into appropriate units (associated with specific courses) so that curriculum flows from program need and definitiop. Lastly each goal is the assigned responsibility of a faculty member. In nursing, which has advanced this process further than some of the other schools (but by no means all), a self-study learning resource was also associated with every learning objective. Thus a complete, unified definition of all instructional needs is created, and all the resources to be managed are defined. This Total-System Design, it should be emphasized, defined needs; all ongoing resources at the University (lectures, courses, laboratory experiences, etc.) are viewed as "inventory" to be linked to these required needs (desired goals). A System Design Derived from Information Needs:
Part and parcel to the Total-System Design approach was the design and implementation of a software management system (based on artificial intelligence principles of heuristic search, semantic net organizations, etc.). This system helps organize, coordinate, update, and generally manage the information obtained as described above. This system is called the COMMES system, which has also been used to make all the instruction available to off-site users as well4. This system component will be
THE BASIS OF AN AMIS A Theory of the Instructional Process:
Before a system could be implemented, we required a normative model that helped structure the instructional process. The information an academic manager might desire would flow from such a theoretic underpinning. This model was called the Total-System Design of
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via information stored in a semantic network which guides the system conceptually. For example, a search on "emphysema and patient care" will yield recommended videocassettes on the "emergency management of dyspnea."'
INTERCONNECTION OF THE ACADEMIC HEALTH The Total-System Design in combination with the COMMES system envisioned the integration of such resources as our Health Sciences Library in particular, the Bio-Information Center in general, and the interaction of the different health sciences programs (at Creighton, this meant Nursing, Medicine, Pharmacy, Dentistry, and Allied Health). This interconnection was pursued in several ways, most notably with two strategies.
In addition to the management of this internally developed information, the system also relays information *from external sources. Through agreements being negotiated with external corporations, COMMES will relay access to innumerable external databases and materials.
COMMES itself will also create tailored study guides for a user for any area described to it by drawing on its conceptual trees of information derived from the program definitions created with the Total-System Design of Instruction. As COMMES moved into the service domain, the capability was added to COMMES to write tests (the actual construction of them rather than drawing from a pool of questions). It also can create nursing protocols of care, etc.
The first was to define and have accepted by all programs a unified "Taxonomy of the Health Sciences" that helped organize the materials of instruction in all of the health sciences programs along the same framework5. This Taxonomy was developed at Creighton and has proven quite useful in achieving its purposes. This common skeleton of descriptions permits each program to communicate with any other about similar instructional issues (e.g. ethical issues, psychobehaviorall needs of the patient, pulmonary dysfunctions, etc.) irrespective of the discipline.
SUMMARY OF FUNCTIONS ADDRESSED
The second strategy was to include within the COMMES system the documentation of the inventory and content of parts of the Bio-Information Center. Particular focus was on the Learning Resources Center which houses our audio-visual (A/V's). The incorporation of this material into the databanks, as we shall see, permits new management possibilities for these resources.
COMMES can be used either on or off-site to access and review a wide range of instructional resources. It supports instruction management across the health sciences area through the evaluation and update of programs of instruction. It transfers other information databases as a broker and can permit users to gain use of a wide range of services. Simulations we have created or are in the public domain are yet another resource that COMMES transmits. Various types of resources are described to the system (videotapes, guest lectures, etc.) and all are incorporated as instructional inventory that can be accessed for management purposes. The Total-System Design imposed an instructional lingua franca, a uniform metric, embodied in the concept of instructional goals into the academic environment. The COMMES System as an analyst, manager, and evaluator of these goals qualifies it as a systems example of an AMIS.
PERFORMANCE OF COMMES AS AN AMIS COMMES has been widely disseminated as a consulting system for health professionals to maintain or upgrade their knowledge6. Although we shall return to this particular function later, the full capabilities of COMMES as an AMIS go far beyond this level of activity. First there are basic instructional management capabilities that COMMES performs. All the goals and subgoals described above that were developed for each program are loaded into COMMES' databanks. For any given area or topic that a Creighton curriculum or instructional designer wishes to review, COMMES can search all the goals and objectives in one or more programs to find any and every learning activity related to that area. In addition, the user can specify just one school or just one department in the school or even just one faculty in one department and find just those responsibilities and assignments.
RESULTS IN THE APPLICATION OF COMMES AT CREIGHTON A wide and varying use of the different capabilities of COMMES have been made by different schools at Creighton. Nursing has used a great deal of the management and organizational features of the system. In fact, the entire program of that school is in TotalSystem Design format.
Tuned to their needs, the system will re-aggregate goals and objectives originally organized along the taxonomy of the health sciences mode so that they are organized along course lines. Faculty think in course units while the database and materials are actually oblivious to such local considerations. Nursing academic managers can (and do) call for all goals related to alcoholism, for example, in the curriculum, or all places stress is addressed, etc. Nursing also uses COMMES as a means to redistribute their instructional resources to off-site user areas. Specifically, COMMES is marketing nursing instruction to hospitals, nursing homes, etc., as a valuable and
If one wishes, one can search all the learning resources assigned to educational objectives to determine uses being made of a particular text, all learning materials dated before a certain time, etc. Audio-visuals are also being described to COMMES and stored in its databanks as mentioned above. When one shifts to the audio-visual database, one can in effect search the Learning Resources Center holdings from a computer terminal to determine any materials that relate to any issue or topic described to the system. Although methodology is not the focus of this paper, it may be briefly stated that the search of holdings is 1000
useful resource to support health care in such facilities.
have achieved most of the continuity needed. However, this continuity of participation will often be lacking (since the time for implementation is quite long) which will seriously hinder such an enterprise. Lack of continuity in the team effort will be a major hinderance even with the best of circumstances otherwise.
The School of Medicine is more concerned with redundancy and omissions in the curriculum and has focused their management interests inward to date. Academic managers use the system to insure that critical goals are being assigned to some faculty, and conversely, they are using the Total-System Design to see that faculty teaching activities relate back to original goals. A new Total-System Design update of the entire medical program definition is being completed, and the curriculum should then be quite tightly correlated to the update.
Another fundamental barrier is tradition: "this is not the way we have done education; we have succeeded to date without management so why start now?" If the faculty do not see the value of the effort and do not contribute in a realistic way, the collected information will not be used. Conversion of the troglodytes is a relentless and thankless burden.
The development of this AMIS system has had a significant impact within the institution. Still, numerous barriers have had to be overcome, and additional hurdles remain. The focus on the next section is on the barriers successfully confronted and the hurdles to overcome.
Yet another barrier is resistance to cooperation and
exchange of information, fundamentals underlying our AMIS rationale. One of the purposes of the system is to permit interaction, exchange of information, etc., among diverse faculty. However it is frankly not the history of constituent parts of an academic health
center to have a very formalistic exchange of information (either within or between units). True, nurses talk with physicians, and someone once worked with the head of the library to identify optimal color codes for the index card catalogue, etc., but these interactions rarely go deep, become institutional, and extend past the particular personalities that prompted the interaction. An AMIS assumes an institutional interest in more formal interactions and ties. Getting the desire to cooperate and coordinate will be a
BARRIERS TO IMPLEMENTATION OF AN AMIS The report of Matheson and Cooper is, to this warexperienced analyst, perhaps a bit naive with respect to the expected resistance to change. Change is addressed in their report but not fully explored. We have had at least four years of experience in applying AMIS principles as these authors envisioned. It must be reported that there have been a few thorns among the roses.
challenge, computer systems notwithstanding.
First, it has been said in the past that universities in general (and academic health centers in particular) are surpassed only by the post office in their resistance to change. As some are aware, this represents an obvious insult to the Postal System. Change requires a perception of need. In academic centers, this perception is only a glimmer in the eyes of a few. The progress we made in our efforts originally was more a result of the vision of a limited number among top leadership rather than the recognition of the need for change by the health center as a whole. Change here has now gone further than in many other centers as a result of our small size and cohesiveness. In a much larger institution, this progress may not likely have been even possible.
A final barrier we will identify is the one of the locus of control. The presumption that the Academic Health Science Library can or will automatically be the center of a complicated information systems core represents an elusive ideal. Matheson and Cooper in the report mentioned earlier acknowledge the need for expertise which is not likely part of those divisions now. Various forces work against this locus and even suggest competing alternatives. In some centers, the strong tendency will be for the School of Medicine to set up their own unit; more rarely, the University may seek an all-health-sciences-unit. Each of these units will confront other areas such as the University computer center, the computer science department, the engineering division, or the information sciences department with competing demands. At this point, dollars will be divided, and divisiveness will be exacerbated.
Fortunately it is not the case that every institution has to recapitulate the developments we have achieved. Much could be borrowed directly or with little alteration. We have consumed, we estimate, over 80 person-years of time and over $10 million in re-computed 1984 dollars (when all sums are aggregated and inflation-adjusted over iie entire past 14 years). However, this brings us to yet another barrier: "it was not invented here." Most centers can be expected to consider (and try to) reinvent the entire undertaking and might likely do a poor job of it. This will hinder their undertaking and provide negative feedback for their efforts. Nonetheless the not-invented-here syndrome is a formidable barrier.
To solve this dilemma, Creighton was blessed with an abundant attribute, quite widely distributed: ignorance. Our AMIS undertaking was tackled before an AMIS was defined in the literature, before competing constituencies could be created, etc. Moreover our small size helped get most decisionmakers in one room at one time (which of course still did not guarantee a convergence of opinion). The unified leadership in the health sciences here at Creighton was the most instrumental element in the enterprise. Finally, most expertise needed was fortunately collected within the Office of Instructional Science Research under the Vice President for Health Sciences, combining faculty from different program areas, experts in artificial intelligence, management,
Continuity of personnel to develop such a large-scale effort is also crucial. Leadership can be expected to change over the life of the project, leadership needed to create a good AMIS. We have been fortunate to
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This Office is moving to further institutionalize its role to insure research progress and performance in the future.
etc.
SUMMARY
Within the vast area of academic management, information processing, and the development of systems for artificial intelligence and management science purposes, a number of flowers have been blooming. One such undertaking has been a largescale, long-term effort at Creighton University to create, implement and test an Academic Management Information System (AMIS) along some of the lines that have been recently described elsewhere by others, notably Matheson and Cooper. Our effort has accumulated a great deal of experience, including identifying information instructional managers desire, strategies to overcome barriers, expectations of problems or hurdles likely to arise, etc. The organizational behavioral issues have been as great a factor in the development process as systems and technological matters. As we continue to pursue wider and wider implementation, we have recognized that there is as much "art" in providing an AMIS as there is "science" in the enterprise.
In short, organizational behavior issues involved in creating and implementing an AMIS are as critical, if not more so, as the technical capabilities that must be brought to bear. The theoretical underpinnings (the Total-System Design combined with its partner, the COMMES system) provide a suitable basis, in our opinion, to build an AMIS as described and desired by national observers and analysts. The organizational lessons we have learned, however, are perhaps as important, if not more so, as any others in this undertaking.
DIRECTIONS AHEAD We approach our tenth anniversary at Creighton in this undertaking to create a full-service AMIS with service ties to the health care community as well as to the provision of services nationally and even internationally. Toward this end, several positive developments have been already observed, particularly the effort underway within the medical faculty to bring their definition completely up-to-date (and maintain it) and correlate the curriculum tightly to it. We expect to achieve 85% fidelity by the end of this coming academic year. Progress has already reached and exceeded this level in nursing, in medical technology, and several other programs as well. Use of the management techniques available from COMMES is increasing as faculty move from one step to another in their comfort with the system, and their reduction of anxiety with the Total-System Design process.
ACKNOWLEDGEMENTS This project was supported in part by grants from the W. K. Kellogg Foundation of Battle Creek, Michigan.
REFERENCES [1]
Moreover, other expert systems either under development or being tested now will provide new impetus for further use of the rest of the AMIS system; one success tends to spread activity over adjacent parts of the project as comfort levels rise.
Matheson, N. and J. Cooper. Academic Information in the Academic Health Sciences Center. J. Med. Educ., 57:Part 2, 1983.
[2] Evans, S. "The Structure of Instructional Knowledge: An Operational Model," Instructional Science, 2 (1974), pp. 421-50.
[3] Evans, S.
Institutionalizing Change: A TotalSystem Design of Health Professions Instruction, Creighton University, Omaha, 1975.
LIMITATIONS IN TECHNOLOGY TRANSFER
[4] Evans, S.
There appear to be few adequate forums for the dissemination of information about AMIS activities. There is a rather narrow focus and readership to such journals as the Journal of Medical Education or the Journal of Medical Systems. SCAMC is an attractive arena, but here too one article is likely to be lost in a sea of technical papers. Hence the service component of COMMES as a consulting system may provide greater impact and awareness than is achieved in communicating in traditional media (journals,
"The COMA System:
An
Inquiry/Answer On-line System as the Basis for a Network-wide Redistribution of Health Sciences Instruction," Proceedings of the Third Annual Symposium on Computer Applications in Medical Cae Washington, D.C., October 1979. [5] Evans, S., ed. Taxonomy for the Health Sciences, Creighton University, Omaha, 1977.
[6] Ryan, S.
"Applications of a Nursing Knowledge Based System for Nursing Practice: Inservice, Continuing Education, and Standards of Care," Proceedings of the Seventh Annual Symposium on Computer Applications in Medical Care, Washingon, D.C.-, October 1983.
conferences, etc.). If our national systems distribution materializes as expected, this distribution process will also help disseminate information about COMMES as
an AMIS.
One should not underestimate, however, the capacity of academia to reinvent the wheel; one need only read any three arbitarily picked issues of the Journal of Medical Education to see this. We hold only the most modest expectations that any lessons we have learned shall provide insights to those who shall come later.
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