1. SCHOOL OF INFORMATION UNIVERSITY OF MICHIGAN Intermed

2. SCHOOL OF INFORMATION UNIVERSITY OF MICHIGAN Function type –Distributed research center

3. SCHOOL OF INFORMATION UNIVERSITY OF MICHIGAN Distributed research center Stanford Medical Informatics Columbia U University of Utah McGill Harvard B&W Decision Systems Columbia Presbyterian Harvard Mass General

4. SCHOOL OF INFORMATION UNIVERSITY OF MICHIGAN Resource diagram

5. SCHOOL OF INFORMATION UNIVERSITY OF MICHIGAN InterMed history NIH experiment in distant collaboration Prior work by all PI’s Initial funding 1994-1997 Outside evaluator brought in 1995 Follow-ups funded by the Army AHRQ and NLM

6. SCHOOL OF INFORMATION UNIVERSITY OF MICHIGAN Alternative history Confusion Frustration Focusing Productivity (Question for discussants: Was the confusion/ frustration part a necessary phase?)

7. SCHOOL OF INFORMATION UNIVERSITY OF MICHIGAN Scientific Products Initial goals were broad Make progress in the field of medical decision support Improve standardization between regions Needed credibility of multiple sites

8. SCHOOL OF INFORMATION UNIVERSITY OF MICHIGAN Disparate goals (incentives) Clinicians wanted to efficiently develop something that would be useful in the field Researchers each wanted to ‘push the envelope’ in their area of interest. Would this project focus on… –CPSC research? –AI research? –Medical research? Differences in goals between locations

9. SCHOOL OF INFORMATION UNIVERSITY OF MICHIGAN Could these challenges negotiated? Collaboration readiness? Technology readiness?

10. SCHOOL OF INFORMATION UNIVERSITY OF MICHIGAN Collaboration readiness? Barriers of distance, discipline, institution All PI’s had a ‘family’ connection to Octo Barnett’s lab

11. SCHOOL OF INFORMATION UNIVERSITY OF MICHIGAN Technology readiness?

12. SCHOOL OF INFORMATION UNIVERSITY OF MICHIGAN Technology used Email, email lists Teleconferencing Timbuktu application sharing (for tele- presentation) Ontolingua controlled vocabulary system

13. SCHOOL OF INFORMATION UNIVERSITY OF MICHIGAN Strategic use of technology Conference calls FTF meetings

14. SCHOOL OF INFORMATION UNIVERSITY OF MICHIGAN Conference calls PI-only calls were negotiation methods of last resort Efficiency of conference calls improved significantly over time Email used to prepare for conference calls Email used to prepare for and offload content from conference calls –Role specialization was a key to increased productivity later in the collaboratory

15. SCHOOL OF INFORMATION UNIVERSITY OF MICHIGAN FTF meetings Noted increased productivity of conference calls after FTF meetings

16. SCHOOL OF INFORMATION UNIVERSITY OF MICHIGAN GLIF Post-1996: Coordinated effort to develop a machine-readable system for describing clinical decisions Settled on GLIF Guideline Interchange Format

17. SCHOOL OF INFORMATION UNIVERSITY OF MICHIGAN Example GLIF for cough treatment REPLACE WITH CHRONIC COUGH

18. SCHOOL OF INFORMATION UNIVERSITY OF MICHIGAN GLIF

19. SCHOOL OF INFORMATION UNIVERSITY OF MICHIGAN GLIF

20. SCHOOL OF INFORMATION UNIVERSITY OF MICHIGAN Challenges still remained… Communication gaps Example of unstated background knowledge by clinicians