Course Name: Management Information Systems Full Marks: 10 Time: 1 hour 30 minutes

Case Study 01
U.S. Department of Defense: Enlisting Open-Source
Applications
The U.S. Defense Department is enlisting an open source approach to software
development -- an about-face for such a historically top-down organization.

In recent weeks, the military has launched a collaborative platform called Forge.mil for its
developers to share software, systems components and network services. The agency
also signed an agreement with the Open Source Software Institute to allow 50 internally
developed workforce management applications to be licensed to other government
agencies, universities and companies.

Taken together, the two developments show how the Defense Department is trying to
take advantage of Web-based communities to speed up software development and
reduce its costs.

Dave Mihelcic, CTO of the Defense Information Systems Agency, says the military
believes in the core Web 2.0 philosophy of the power of collaboration.

"The Web is a platform for harvesting collective intelligence," Mihelcic said in a recent
interview. He pointed to "remixable data sources, services in perpetual beta and
lightweight programming models" as some of the aspects of open source software
development that are applicable to the Defense Department.

One example of the Defense Department's new community-based approach to software

development is Forge.mil, which was made generally available for unclassified use within
the department in April. The Defense Information Systems Agency (DISA) has issued
version two of SoftwareForge after a three-month trial that grew to 1,300 users.

SoftwareForge provides software version control, bug tracking, requirements

management and release packaging for software developers, along with collaboration
tools such as wikis, discussion forums and document repositories, DISA said.

DISA said it will deploy a cloud computing-based version of the SoftwareForge tools for
classified environments. DISA also plans to add software testing and certification services
to Forge.mil.

Mihelcic says Forge.mil is similar to the "Web 2.0 paradigm of putting services on the
Web and making them accessible to a large number of users to increase the adoption of
capabilities. We're using the same collaboration approach to speed the development of
DOD systems."

Meanwhile, DISA has licensed its Corporate Management Information System (CMIS) to
the Open Source Software Institute to develop an open source version of the 50-odd
applications that DISA uses to manage its workforce. The CMIS applications support
Course Name: Management Information Systems Full Marks: 10 Time: 1 hour 30 minutes

human resources, training, payroll and other personnel management functions that meet
federal regulations.

CMIS has 16,000 users, including DISA employees and military contractors. Originally
written in 1997, CMIS was revamped in January 2006 using the latest Web-based tools
including an Adobe Cold Fusion front-end and a Microsoft SQL Server 2005 back-end.

Richard Nelson, chief of personnel systems support at DISA, says CMIS is easy to use
because it takes advantage of modern Web-based interfaces including drop-down lists
for data input.

"We've been able to cut down on help desk support so substantially," Nelson says. "With
the old version, we were running anywhere from 75 to 100 help desk calls and e-mails a
day. Now our average is less than five e-mails and calls. It's not because people are using
it less but because it has fewer problems."

Nelson says a key driver for CMIS is that it needs to be so intuitive that users don't need
training.

"If the customer requires instruction on the product, we have failed and we will do it over,"
Nelson says. "The reason that we're able to do that so successfully is that we take a
somewhat different approach to the way most software is designed. Most software is
designed so that business logic and processes need to follow software logic and process.
Therefore it requires substantial training. We do it exactly opposite."

The Open Software Services Institute will make CMIS available in two different licenses:
a regular open source license for government agencies and companies, and a free
license for academia.

Nelson says CMIS has a cutting-edge approach to learning management, handling

everything from training course sign-up to approvals and payment. Another unusual
feature of CMIS is its telework management application.

Nelson says he hopes many organizations will license CMIS and start adding new
capabilities so DISA can take advantage of a vibrant CMIS community of developers.

Within three years, "I would hope that a number of others inside government and beyond
are using it," Nelson said. "I'm hoping we all have ready access to qualified developers.
I'm hoping that DISA gets access to a substantial number of additional
applications...without having to build them ourselves."

Going forward, DISA wants to encourage use of and training in Adobe Cold Fusion, which
it used to build OSCMIS, to increase the talent pool of OSCMIS developers. “We would
even like to start with kids in high school to get them interested in software development
as a career,” Nelson says.”
Course Name: Management Information Systems Full Marks: 10 Time: 1 hour 30 minutes

Question:

1. Given the critical nature of defense activities, security in this environment is

primary concern. How do the agencies discussed in the case address this
issue? Can you think of anything else they could be doing? Provide some
recommendations.

2. The U.S. Department of Defense is arguably one of the largest organizations

in the world. Managing technology for such an organization is certainly a
major endeavor. Does the shift toward open-source initiatives help in this
regard? Does it hurt? Discuss the advantages and disadvantages of
adopting open-source applications in large organizations.

Case Study 02
Duke University Health System, Beth Israel Deaconess
Medical Center, and Others: Medical IT Is Getting Personal

Personalized medicine brings to mind researchers doing complicated analysis of a single

patient’s genetic makeup and fine-tuning medicine and other treatments to those results.
But Duke University Health System is using everyday data from patients’ electronic
medical records combined with an analytics tool to personalize its approach to treating
patients. County health officials recently asked Duke how many of its patients would need
priority access to the H1N1 flu vaccine. Duke used IBM Cognos to sift through information
on the more than 20 million patients in its Oracle-based clinical data repository and in an
hour was able to identify about 120,000 of them with risk factors, such as age, pregnancy,
respiratory, and other conditions that made them vulnerable to complications from swine
flu. And now that the H1N1 vaccine is available, Duke is letting those patients know that
they’re first in line to get it.

“We put an analytics engine on top of our clinical repository and were able to stratify by
age and key illnesses millions of records, and streamline who was most at risk,” says Asif
Ahmed, diagnostics services CIO for the Duke system, which runs three hospitals and
about 100 clinics in the Raleigh/Durham, North Carolina, area and treats more than 1
million patients a year.

This is a practical example of how health care IT is being used to personalize medical
care in ways that help doctors make smarter decisions about patients’ conditions and
tailor treatment to an individual’s needs. This evolving field covers a broad range of
efforts. Beyond analytics systems like Duke’s, it includes decision-support tools that help
Course Name: Management Information Systems Full Marks: 10 Time: 1 hour 30 minutes

doctors pick the best tests and treatments for patients, remote monitoring tools that
provide close to real-time care, as well as software that helps researchers identify the
best candidates to participate in trials or experimental treatments. At Beth Israel
Deaconess Medical Center in Boston, helping doctors make better treatment choices and
arrive at more accurate diagnoses is a big and growing area of personalized medicine.
One example is clinical support software to help its 1,600 staff and affiliated physicians
choose the best radiology tests for patients.

When ordering CT scans, MRIs, X-rays, ultrasounds, and other radiology tests, doctors
enter a patient’s electronic medical record number into the Anvita Health decision support
system. Data from Beth Israel’s records system, such as recent lab tests and allergies, is
automatically loaded into the software. The doctor then adds information on the current
complaint, such as symptoms, what area of the body is a concern, and the suspected
diagnosis, as well as whether the person has any implants that might interfere with
radiology treatment.

The software analyzes the data and rates the best tests for the patient, giving five stars
for the top choices and one for the worst ones based on the risks and benefits of each. It
can also recommend that the patient forgo radiological testing. The system can catch
details that might otherwise elude a doctor, such as a previous blood test indicating
decreased kidney function that could mean the patient can’t metabolize the dyes used in
certain radiological tests. It also checks how much radiation the patient has already been
exposed to. “Excessive radiation can cause second malignancies,” says Dr. Richard
Parker, medical director of Beth Israel’s physician organization.

“The system takes that into account when ordering a scan.” For instance, the software
might point out that a patient suspected of having pneumonia has enough symptoms and
clinical indicators to make that the most likely diagnosis, and that treating the patient for
pneumonia would be better than exposing him or her to a chest X-ray. During three years
in which the hospital system has used the Anvita software, it has cut out about 5 percent
of tests as unnecessary or inappropriate, Parker says. Beth Israel launched a related pilot
project six months ago to analyze doctors’ thought processes when ordering radiology
tests. When a doctor orders a test, the system asks what diagnosis the physician is
leaning toward, with what percentage of certainty. After the test, the system follows up
with an e-mail asking the doctor whether the test confirmed the original diagnosis.

The study aims to gain insight into how doctors decide which tests to use, and in which
situations doctors are most likely to prescribe the wrong test for a given set of symptoms.
Information technology isn’t just helping doctors choose the right test for a patient; it’s
also making more personalized medical tests possible. For example, diagnostic testing
services provider Quest Diagnostics and Vermillion, a molecular diagnostic test
developer, have developed a test to assess the likelihood that women diagnosed with
pelvic masses have ovarian cancer as opposed to benign tumors. Its use helps those
women most at risk for cancer get to specialists faster. Many of the newest personalized
medicine efforts are focused on giving analytics and decision-support tools to doctors and
other clinicians. But medical researchers are also still focused on the more complex
Course Name: Management Information Systems Full Marks: 10 Time: 1 hour 30 minutes

efforts to analyze genomic data and use the results to create individualized treatments
that doctors will use in the future.

One such initiative is Cancer Biomedical Informatics Grid, or caBig, a biomedical

informatics network that the National Cancer Institute launched in 2004. Its mission is to
develop more personalized cancer treatments and get them into doctors’ hands faster.
Researchers at the approximately 100 academic and community-based cancer centers
that make up caBig use the network to share data and research results. They can make
use of the data in analytics, data-mining, decision-support, and other software tools.
Members are using the network’s data and software today to identify the best patients to
participate in clinical trials of experimental cancer treatments.

Multiple myeloma, a cancer that strikes white blood cells and eventually bone marrow,
can be difficult to treat. Now, the Dana-Farber Cancer Institute in Boston is harnessing
the dual power of business intelligence and Web 2.0-based scientific search tools to
gather complex, scattered data to better treat patients and work toward a cure for this
formidable disease. Dana-Farber is a treatment, research, and teaching facility affiliated
with Harvard Medical School. Its physicians and researchers regularly slog through
complex calculations to find connections between data gleaned from tumor biopsies and
other clinical samples and the vast genetic research housed within the organization or
spread among three massive public domain databases. Dana-Farber officials are working
to leverage grant money and other resources to blend data warehousing capabilities with
Web-based data-collection tools, since vital connections between patient samples and
analytical data will almost certainly prove the crux of both effective patient treatment and
any potential breakthroughs tied to the disease, according to researchers.

To make the hunt for precious genetic information easier, Dana-Farber officials have
stitched together a system that wraps in Oracle’s Healthcare Transaction Base, a
serviceoriented architecture that supports the medical industry’s HL7 standard for the
electronic exchange of clinical data. Increased use of e-medical records should make
more patient data available for research, says Ken Buetow, director of the center of
bioinformatics and IT at the National Cancer Institute. Ultimately, Buetow expects the
caBig network, combined with doctors’ growing use of electronic data. will shorten the
time it takes for research findings to show up as clinical treatments. “We think this could
be one of those moments for a big shift,” he says.

John Glaser, CIO at Partners Healthcare, which operates several Boston-area hospitals,
including Massachusetts General. Brigham, and Women’s, sees that shift coming. As the
use of EMRs become more pervasive and the amount of digitized clinical data increases,
it will be easier to provide patients with more personalized care, says Glaser, who also is
an adviser on the U.S. Department of Health and Human Services’ Health IT Policy
Committee. EMRs make data on patients easier to search and analyze. Doctors using
them are also more likely to use decision support tools, Glaser says. “Science is moving
rapidly,” he says, and health IT helps capture and disseminate to doctors perspective and
Course Name: Management Information Systems Full Marks: 10 Time: 1 hour 30 minutes

research findings that are impossible for even the most diligent physicians to keep up
with.

Once the use of EMRs is standard practice, the federal government is likely to put
greater emphasis on personalized medicine initiatives, Glaser predicts. In the future,
health care providers could be rewarded in terms of patient outcomes, and personalized
medical treatments are one of the most likely ways to improve outcomes and improve
health care across the board.

Questions

1. What are the benefits that result from implementing the technologies
described in the case? How are those different for hospitals, doctors,
insurance companies and patients? Provide examples of each from the case.

2. Many of the technologies described in the case require access to large

volumes of data in order to be effective. At the same time, there are privacy
considerations involved in the compiling and sharing of such data. How do
you balance those?