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INTRODUCTION: HISTORY OF THE HIS

Key Points

  • Hospital information systems (HISs) started as business, financially oriented systems rather than patient-care-oriented, clinical systems.

  • While the potential promise of artificial intelligence was clear from the outset, despite some successful demonstration projects, they never took hold in patient care.

  • The fundamental principles for the design of good medical computer systems have changed since they were first described in the 1960s.

  • Early medical systems were deployed on “mainframe” computers and interfaced to the user through “dumb” terminals.

  • As clinical subsystems (i.e., radiology) were developed and matured, many hospitals took a “best-in-breed” approach and married disparate systems to one another through a central hub.

  • The alternative approach is to go to a core vendor who supplies most of the needed services.

Hospitals were a logical and early spot for the implementation of computerized processes. The history of hospital information systems goes back to the 1960s and the early players included IBM and a company known at the time as Burroughs (which subsequently merged with Sperry Rand to become what is most recently known as Unisys). There were also a number of smaller, medical software companies that originated in the 1960s and 70s such as IDX, Shared Medical Systems (which is now owned by Siemens), and Meditech. These companies were all focused on patient billing (Fig. 8-1).

Figure 8-1

The first hospital computers were designed for patient billing and were often owned by off-site contractees.

As is the way with all industries, the medical software industry has undergone substantial consolidation and reformation over the past 3–4 decades, but it is still possible to discern the evolution of the requirements that drove the development of the hospital information system of today.

The possibilities of medical computing were recognized in the very early days of computing, and artificial intelligence applications were developed very early for medicine. Articles can be found dating back to the end of the 1950s pertaining to the potential applications of medical electronics. Certain medical institutions and individuals developed medically oriented computing programs in the 1960s and early 1970s, such as Octo Barnett M.D. at MGH who led the development of the MUMPS programming language, which was designed for medical computing applications. Patient screening and health evaluation programs were developed at Kaiser Permanente in California and the Latter Day Saints hospital in Salt Lake City. Medline, the on-line version of the Index Medicus, was developed in the early 1960s. There were other clinically oriented projects, but it was really patient billing that drove the corporate development of medical software.

Octo Barnett developed a set of commandments, many of which are fundamentally applicable to today’s health care informatics environment:

  1. Thou shall know what you want to do (i.e., be clear-cut in your design goals).

  2. Thou shall construct modular ...

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