The Early History of Hospital Information Systems for Inpatient Care in the United States

Abstract

In the 1960s, large hospital systems began to acquire mainframe computers, primarily for business and administrative functions. In the 1970s, lower-cost, minicomputers enabled placement of smaller, special purpose clinical application systems in various hospital departments. Early time-sharing applications used display terminals located at nursing stations. In the 1960s and 1970s, a small number of pioneering institutions, many of them academic teaching hospitals with federal funding, developed their own hospital information systems (HISs). Vendors then acquired and marketed some of the successful academic prototypes. In the 1980s, widespread availability of local area networks fostered development of large HISs with advanced database management capabilities, generally using a mix of large mini-and microcomputers linked to large numbers of clinical workstations and bedside terminals. When federal funding for HIS development diminished in the mid-1990s, academic centers decreased, and commercial vendors increased their system development efforts. Interoperability became a main design requirement for HISs and for electronic patient record (EPR) systems. Beyond 2010, open system architectures and interconnection standards hold promise for full interchange of information between multi-vendor HISs and EPR systems and their related subsystems.In 1962, the American Hospital Association surveyed more than 7,000 registered hospitals regarding their usage of computer data processing applications. They found that only 7 % of hospitals used data processing equipment. Fewer than 1 % of smaller hospitals (<100 beds) used computer data processing, and 33 % of larger hospitals (at least 500 beds) used it. Among hospitals with electronic data processing capabilities, 63 % used it for payroll, 53 % for inventory control, and 44 % for patient billing. Only 28 % of such hospitals used data processing for patients' medical records; and 14 % used it for medical research [ 61 ].During the 1960s and 1970s, most American HISs focused on automation of hospital administrative services. Ball [ 6 ] categorized the earliest (1960s) operational HISs as the First Generation Level-1 HIS. These encompassed a basic set of inpatient-oriented computer applications, including: an ADT (admission-dischargetransfer) application with bed status and census reporting; an order/requisition entry, communication, and charge collection application; and an inquiry application for today's charges for demand bill purposes. Ball characterized changes in the 1970s as Second Generation Level-1 systems, with enhancements that included: computer-assigned patient identifi cation; nursing order-set entry, nursing notes and care plans, medication schedules and medication monitoring; laboratory-specimen collection lists and labels; order entry and results reporting; scheduling for patients, radiology procedures, and the operating room; medical records indexing, abstracts, and chart locations; diet-list preparation; utilization review; and doctors' registries. An advanced ...

Successfully implementing a national electronic health record: a rapid umbrella review

“…Whilst hospital information systems (HIS) in the USA have been in existence since the 1960s 23 , HIS are a more recent phenomenon in the Republic of Ireland where public healthcare is managed by the Health Service Executive (HSE) which co-exists with a private health system. The Office of the Chief Information Officer (CIO) has overall responsibility for embedding technology within the health infrastructure 24 and to date, EPRs have been implemented in some individual private and public hospitals and the majority of general practitioner (GP) offices (i.e., private primary care physicians often with HSE contracts), as well as for specific cohorts of patients (e.g., maternal and newborn and epilepsy) 25 .…”

Validating the extract, transform, load process used to populate a large clinical research database

“…(5, 6) Later, in the 1970s and 80s, systems oriented toward clinical decision-making, such as radiology results reporting, were developed as generally stand-alone applications. (5, 6) Then in the late 1990s, as previously stand-alone applications began to be integrated into larger offerings, software vendors started to market the notion of the complete “electronic healthcare record” (EHR) as a solution to healthcare’s integration needs. (5, 6) These were billed as comprehensive applications that included everything from patient registration through order communications to billing and accounting, all under one software roof, so to speak.…”

“…(5, 6) Then in the late 1990s, as previously stand-alone applications began to be integrated into larger offerings, software vendors started to market the notion of the complete “electronic healthcare record” (EHR) as a solution to healthcare’s integration needs. (5, 6) These were billed as comprehensive applications that included everything from patient registration through order communications to billing and accounting, all under one software roof, so to speak. As EHRs became more common, it became increasingly clear that huge amounts of electronic data were available for purposes other than clinical and financial decision making and support.…”

Estimation of Medication Dispensing Errors (MDEs) as Tracked by Passive RFID-Based Solution

“…Soon, more reliable approaches were explored, including the use of HIS to save time for the caregivers while reducing medication errors. Indeed, when HIS first appeared in the 1960s, it was used solely for administrative purposes; eventually, it was cleverly exploited for logging in of timely health history data of hospitalized patients and the continuous tracking of their medication use in order to improve safe clinical practices in complex, evolving healthcare environments (Ball, 1971;Barnett, 1974;Collen & Miller, 2015).…”