2. Product (R)evolution
• SMS bought & developed a wide array
of products over its 30 year HIS-tory,
many of which Siemens sells today.
• If you’re one of their ≈1,000 US client hospitals, this episode should
help you appreciate how amazingly long-lived a quality HIS can be:
- E.g: TDS’ MIS which started in the late 60s and ran beyond 2010:
Lockheed ->Technicon ->TDS ->Revlon ->Alltel ->Eclipsys…
• SMS’ products have such a long HIS-tory and went through so many
name changes in the hands of their talented marketing people, that I
have to extend a special thank you to the many veteran King of
Prussians who sent lengthy emails that helped me trace the roots:
Glen Marshall Ron Dixon Ken Shumaker Doug Beaupit Phil Jackson Mike Cassidy
3. All Four Platforms
• If you’ve been following this HIS-tory since it
started 18 months ago, you might remember
it started by describing the four epochs and hardware platforms
that dominated the HIS marketplace over the past four decades:
– 60s = Mainframes, led by IBM and the “Seven Dwarfs,” wherein
SMS offered several inhouse systems like Independence & ICO.
– 70’s = Shared systems, led by SMS, McAuto, Tymshare, etc.,
with SMS taking the lead in the 80s and dominating to today.
– 80’s = Minicomputers, led by HBO, DCC, Meditech, etc., where
SMS sold it’s ACTIon line, & acquired MS4 & Computer Synergy
– 90’s = Micros, led by HMDS, MedTake, CliniCom, Paragon, etc.,
in which SMS’ offered it’s “Novius” line of ancillary C/S systems.
• SMS’ products in each of these platforms/decades had a complex
evolution, which we’ll trace in detail in these next two episodes.
4. Mainframe/Shared Systems
• We’re going to lump these two together since SMS started as a
shared system with SHAS patient accounting, augmented with a
self-developed ERP suite (which so few vendors offer today!) with
several inhouse (“ICO” or Inhouse Computing Option) variants.
• As with other vendors, the diagram below illustrates the complex
evolution of SMS’ products and marketing-driven name changes,
with an emphasis on the derivation of the “modern” products
Siemens still offers to this day. Some details had to be dropped to
keep each episode to “only” a dozen slides for brevity’s sake.
5. Mainframe Financials
• Patient Accounting – we called it SHAS back in the early ‘70s, but
the name and code changed radically over the next 45 years, first
becoming the “Financial Management System” or FMS in the mid-
70s by marketing maven John Marshall’s product managers. Hard
to say how much of SHAS remained in the code over the years to
where it still forms the core of Invision & Unity’s “RCM.”
– Impossible to count the many bug fixes & enhancements
made over the years, but maybe 30% of the core remains
today, e.g.: TCEs, profiles, CYCA for insurance proration, etc.
• General Accounting – aka ERP today, was started back in the 70s
by Tony Mirigliani’s team of financial gurus: Hal Krell& Ron Ferro,
later led by John Marshall and his team of product managers, who
among them designed SMS’ own Accounts Payable, Payroll,
Personnel, Inventory, Outpatient and Physician Billing systems,
none of which came with SHAS.SMS’ ERP ran into the 90s when
they were dropped in favor of Ross &PeopleSoft partnerships.
6. Mainframe Financials, cont’d
• Other major products that survived to this day:
– Physicians Billing System, first developed by Tony
Mirigliani& Co. back in the 70s and fine-tuned over
many years when SHAS offered nada for MDs’ 1454
bills. It was modernized and re-named Signature as
advertised in this 1987 issue of Computers in
Healthcare magazine. A game-changer back in the day
when IDX BAR ruled supreme, and building interfaces
before IEs was hard! Run only as “shared,” not
inhouse
– Eagle – I’m often surprised to learn how few people
know Siemens still offers this mainframe billing
system in the demanding NYC market, where it was
designed to handle NY city & state’s intricate billing by
American Healthware Inc. To get the full story of this
amazing Brooklyn-based start-up that began life in the
70s as “H.I.S. Inc,” check out episodes 30 thru 32 at
hispros.com. About two dozen large NYC clients still
run it inhouse after all these years later, loathe to ever
7. Mainframe Near-Misses
• SMS didn’t always hit home runs as these two near-misses show:
– UNIFILE – Covered in last week’s episode (remember the Uni-
Fi-Le t-shirts?), the first on-line, real-time, data base system,
just a bit too powerful for the water-cooled IBM 370s in KOP. It
was gradually de-tuned in a series of replacement products
over the late 70s, each with a creative name of their own:
• Focus – what else does a hospital do with its patient data?
• PMS – Patient Management System, no pun intended!!
• Command – Want to take charge of your census data?
– SURPAS – an acronym for “SMS’ Ultimate Replacement Patient
Accounting System,” announced (sort of) in the early 80s to
join the growing number of SHAS replacements that were
entering the market such as Medipac and HIS, Inc. Product
Manager Jerry Anderson led the charge in the field, but the
programming went too slow to sell many inhouse shops on it.
8. Mainframe Clinicals
• As we’ll see in detail in next week’s episode on SMS’ minicomputer
systems, the ACTIon product line evolved rapidly form its original
Four Phase 4/40 & 4/90 minis, to DEC PDPs and VAXes, and even-
tually to a mainframe-based alternative called “ACTION 2000.”
• Mike Cassidy gives the technical details for you geeks below:
– “Action 2000 (A2K) was just the real-time (CICS-based) and supporting batch
("day end") programs, but it fed the SHAS and related stuff running in the
Malvern datacenter in time for the usual 1pm-8pm-1am
updates. Transactions were sent to Malvern throughout the day using
various subsystems running in the background (TIF, Batching, Comm).”
• ACTION 2000 marked SMS’ foray into mainframe
clinical systems, as this 1992 ad featuring Dr. Lynn
Witherspoon from Ochsner Clinic intoned. Lynn
actually built his own EMR and evolved it over
several decades, using SMS primarily for patient
accounting, but “A2K” led to SMS’ next product…
9. Independence Inhouse
• HIS seer and good friend Frank Poggio told me this
fascinating tale of how he goaded SMS into first
developing inhouse variants of FMS while he was
CFO at the U of Wisconsin (Judy Faulkner’s home).
• In the mid-70s, Frank signed with SMS for its shared system for
the usual (high) processing fees, but insisted in a clause in his
contract that would give him the option of running the system
inhouse within 3 years. At that time, Mediflex’sMedipac was
starting to making a splash as a SHAS replacement run on inhouse
IBM 4300 mainframes, so Frank wanted to cover his bases.
• It took many flights to KOP and meetings with Big Jim,
and Jim Carter (over Ops) before he finally got their
OK to provide an inhouse variant of FMS, which was
not delivered until the mid-80s. To cover its Philly
roots and ability to run inhouse, it was named
“Independence,” and subsumed both A2K and FMS.
10. Mainframe Breakthrough
• The biggest development in mainframe
systems for SMS was Invision, announced in
1989 at the “SNUG” Independence user
group. Invision rocked with many significant
technical breakthroughs, including the:
– OAS or “Online Architecture System” for
clients to design & build their own screens.
– Three processing options: remote (RCO),
inhouse (ICO) and turnkey (TCO)
• Over the next 20 years, Invision became
SMS/Siemens mainstay product, selling to
over 600 hospitals, including many large
AMCs. In later years, it was upgraded to “OAS
Gold” and enabled clients such as Meridian
Health in NJ (1997 HFMA article on the left) to
successfully implement CPOE a decade before
11. “The New Thing” Soars!
• Circa 1997, word started to slip out about
a brand new product SMS was
developing that was called “TNT,”
acronym for “The New Thing” or “The
New Technology.”• With their typical genius at marketing, SMS kept TNT details secret,
only announcing it to a “select” group of client/prospects (all?) who
they were considering to be “partners” in such a daring new system.
As is true with every radically new HIS (eg: Release 6.0, Paragon,
etc.), it took many more years and releases to deliver the goods.
• It took a heavy investment by Siemens
who bought SMS in 2000 before Soarian
started to deliver the clinical goods by the
mid-2000s. The wait was well worth it for
Soarian clients however, who love the
workflow engine, and are now learning
about the revenue cycle applications…
12. Next Week:
Minis & Micros
• The HIS- story of the many
products SMS developed and
acquired is just too long for
one week, so we’ll pick it up
next week with the details
on the many mini base
products such as ACTIon,
MedSeries4, and Allegra, as
well as some precocious PC-
based systems that are still
being sold today and have
helped Siemens clients
finally achieve the goal of
this 1994 ad about EMRs:
