30 Years Ago In H.I.S.-tory by Vince Ciotti

© 2017 H.I.S. Professionals, LLC, all rights reserved

News from

October

1987 and

lessons for

today

September 1987 in H.I.S.-tory• It’s quite impressive that HIStalk has been on-line for over 10

years, leading to the “This Week in Health IT History” column, with headlines each week from 1, 5 and 10 years ago.

• Which inspires me to dig back into my paper files, disk drives and HIS-tory series from a few years ago to find out what was big news as far back as 30 years ago, and what lessons apply today.

• My sources are as complex as our industry:

- PERIODICALS –pioneering print journals founded by industry great Bill Childs.

- DATA BASES – created by Sheldon Dorenfest, the research maven in H.I.S.

- FRIENDS – H.I.S. pioneers willing to share embarrassing stories of their early days.

- MEMORIES – while I still have them…

Bill Childs

Sheldon

Dorenfest

TDS Withdraws from DoD

• TDS’ President John Whitehead complained about repeatedly modified schedules, unrealistic budgets and “benchmark” demos rather than site visits to existing clients. CHCS was a major component of the TRIMIS (Tri-Service MIS) program intended to be deployed in 168 military hospitals and 500 clinics world-wide.

Big shocker in Bill Child’s Healthcare Computing & Communications was the news that leading & pioneer EMR vendor TDS withdrew form the DoD’s Composite Health Care System (CHCS) procurement process. TDS was the vendor when it came to clinical systems back then.

Other DoD Bidders• Many leading HIS vendors back in 1987 were bidding for this huge

DoD contract that was budgeted for ≈$1 Billion, a lot of our tax dough back then. Who were the leading HIS vendors in 1987?

Thanks again to Shelly Dorenfest’s 1988 “Guide,” here’s the list based on total # of clients. EMRs were known as Patient Care Systems back then, and major competitors in TDS’ PCS market were:

• SMS’ ACTIon (no Invision yet)

• Baxter - IBM’s PCS/ADS

• McAuto’s PCS on Tandem

• HBO’s mini-based MedPro

A Sad DoD Tale• Bill Corum was in charge of McAuto back then, and he shared this

sad story with me over dinner one night when we were working together at a hospital client in Texas that was preparing for Y2K.

• McDonnell-Douglas had a huge footprint in DC and a large track record with DoD thanks to its many military jets, so Bill put a large part of McAuto’s HSD into the bidding process, which included programming a whole new PCS to DoD’sspecs, countless trips to and from DC, “installing” it for benchmark demos, etc. In essence, it was a make or break deal…

• When the winner was announced it was heartbreaking for Bill and his team – they had lost to a company with an even larger DC footprint called SAIC. After the loss, McDonnell-Douglass put its McAuto IT division up for sale, and the rest is HIS-tory...

Lessons For Today?• So just who was SAIC, which stood for Scientific Applications

International Corporation? They were a DC-based “consulting” firm that was one of the largest defense contractors in the US. They were far more experienced in winning DoD procurements than they were in writing PCS systems, but what counts more?

• In 2013 SAIC changed their name to Leidos – sound familiar? They were the partner Cerner chose when they bid for the recent DoD procurement process in 2015 known as DHSM (Defense Healthcare Management System), along with Accenture, one of the largest consulting firms in Healthcare. This super-trio beat other vendors who may have had superior EMR systems, but had nowhere near such DC-potent partners (who get most of the $s):

– Epic - who “only” partnered with IBM as prime contractor

– Allscripts - who partnered with CSC and Hewlett-Packard

– MedSphere - who partnered with PWC and General Dynamics.

Recent VA Win With No Bids• Maybe TDS’ CEO John Whitehead was pretty smart after all!?

Birth of HL7

• Back in 1987, there was the major market niche of HIS vendors per the Dorenfest list on the previous slide, and then a huge array of “specialty” vendors in ancillary depts: Lab, RX, Rad, ED, OB, ER, etc.

• None of the leading HIS vendors back then offered a decent app for every dept., but rather offered core clinical & financial systems, leaving DP managers to have to build scores of complex interfaces.

• Aren’t we lucky today where our core vendors have every system we need, so no more need to build these tiresome interfaces…

• Integrate vs. interface… Or is it Inte-great vs. Inter-farce?

• In this age of interoperability or lack of same for today’s EMRs, it is fascinating to read this article on the birth of the HL7 standard by Don Simborg.

Today’s Interfaces• I was only kidding! The # of interfaces hospitals need today is

appalling, even with leading vendors that have “complete” systems. Here’s examples from recent clients on Cerner, Meditech and CPSI, whose names are saved to protect the innocent:

≈25-bed CAH• 18 interfaces, many

of which are bi-directional, including:- Pyxis drugs- Transcription - PACS- HIM Encoder- Fetal monitors- Vital sign monitors- Cardiac monitors- 6 Lab instruments- Reference Lab- 4 Public Health Registries

≈300-bed IDN• 52 interfaces, many

bi-directional, including:- PACS- HIM Encoder- Dictation/transcription- 27 Lab instruments- Fetal, Cardiac & Vital Sign monitors- Drug dispensing- 2 Reference Labs- Home Health Care- Payroll- 6 Public Health Regis.- Dietary

≈150-bed Hospital• 37 interfaces, many of

which are also bi-directional, including:- PACS- HIM Encoder- Mobile Phlebotomy- Dictation/transcription- Voice Recognition- 15 Lab instruments- Cardiac monitors- Drug dispensing- Reference Labs- 340B reporting- Business Intelligence

HL7, cont’d• So actually, it was a very admirable project Don Simborg created,

getting together a slew of vendors & hospital experts to come up with standard data formats so that building point-to-point interfaces was almost affordable before the advent of I.E.s.

• The HL7 working committee was formed in March of 1987, and its members included gurus from both hospitals and vendor firms:– U of Penn., Case Western, Moses Cone, Duke, & Community Medical Center

– Enterprise Systems, Sunquest, CHC, Source Data, ESI, PHS, Digimedics & NCR

• The HL7 standards were non-proprietary, favored no vendor or architecture, based on the ANSII X12 protocol, and targeted to be released by the end of 1987 after a second meeting in October.

• Don ended his article with the question: “Will HL7 succeed?” We have to give him and his team a lot of credit for greatly simplifying the maddening world of system interfaces, although the issue of EMR “interoperability” is still a bitter controversy to this day…

Advertiser Index• So just how long will your HIS vendor be around? To

give you some indication of how challenging the HIS industry is, take a look on the left at the list of vendors advertising in the October 1987 ad index at the back of Computers in Healthcare magazine and see if yours is there? Are any of the 34 vendors listed still running under the same name 30 years later?

• Only 3M whose HIM coding is easily the dominant player in that niche after all these years, especially after QuadraMed sold its Quantum to Nuance…

• Plus a few multi-industry hardware giants like HP, IBM, and RCA, most of whom now get far more revenue from “services” like remote hosting and consulting than from pure hardware sales.

Next Month

• Some interesting news & articles from November 1987 HIS rags:

– A daring new development in communications that enables a piece of paper to be sent over a phone line in seconds!

– Something you don’t hear much about today: a self-developed HIS at Baptist Memorial in Memphis. Many large IDNs built their own systems back then – what happened?

– Interesting article on “Linking, Interfacing and Integration” with some fascinating stats on the size of PC memory & storage capacity increases from 1977 to 1987.

• Hope you enjoy jumping back to these early days of HIS-tory –glad to share any of your memories or feedback:

Vince Ciotti HIS Professionals, LLC

505.466.4958 vciotti@hispros.com