2. Micros Go Macro
• Hope you remember this picture from our introduction last year,
about how the 4 epochs of computing in healthcare overlapped:
– None totally replaced the other, they just rose & fell in terms
of popularity (“the new thing”) and market share over time.
60s 70s 80s 90s
Mainframes
(eg: IBM, “BUNCH”) ++++ +++ ++ +
Shared
(eg: Blues, State Assoc,
Commercial Firms…)
++ ++++ +++ ++
Minicomputers
(eg: DEC, DG, HP…)
+ +++ ++++ +++
Microcomputers
(eg: Apple, IBM…)
+ ++ +++
3. Early Microcomputer Development
• The roots of microcomputers go back surprisingly far in the 1970s:
– 1971 = first ads for Intel 4004 chip
– 1972 = MITS offers Altair 8800 kit
– 1973 = Xerox’s PARC “Alto” project
– 1974 = Simonyi’s “Word” Processing
– 1975 = Microsoft’s BASIC for the Altair
– 1976 = Apple introduces the Apple 1
– 1979 = “VisiCalc” spreadsheet for Apple II
– 1981 = IBM “legitimizes” the PC…
TI 99-4 Tandy Radio Shack
TRS 80
Altair 8800
IMSAI 8080
4. Very Personal Computers!
• Micros were very personal, as these shots of my first one shows:
– 1981 = Our Texas Instruments 994A
• Used an old TV as a CRT
• Stored data on an audio cassette
• Started my son’s game addiction!
- 1984 = My brother Dave got hooked too, and
showed how rapidly PCs became a business:
• He later programmed an Apple II PC,
• To weigh eggs for farmers in the Midwest,
• That sorted eggs into grade A, B & C,
• Which they used for about 15 years!
• He’s a PC maven at Trenton State today.
5. PCs in Hospitals
• PC spread into healthcare started in the late 70s & early 80s:
– Individuals in Finance and ancillary departments started
using them to personalize the data they could only obtain
from an HIS system in a fixed “green bar paper” printout.
• Using breakthrough software like VisiCalc, the world’s
first spreadsheet, written for the Apple II in 1979
– (Microsoft’s Excel came much later – 1985 for the
Apple Macintosh, 1987 for Windows on IBM PCs)
– HIS Vendors – jumped on the PC bandwagon early too:
• George Weinberger enthralled my sales team at HIS Inc.
in early 1982, taking an IBM PC apart in front of our eyes.
• We then bought one for each salesman to show demo
screens of our non-existent IBM mainframe HIS system.
– The ultimate way to sell vision-ware: “See!”
6. Pioneering Hospital PC Product
• The first pure PC-based product I remember for hospitals was
written by an ex-SMS salesman named Tom Boyle circa 1980.
– Tom was a super-bright sales rep (as all SMS’ reps were!), who
targeted the dreaded SSA 2552 cost report “step-down,”
– Which you may remember was handled by a terribly user-
unfriendly SHAS module called CAP (Cost Allocation Program).
– It required labyrinthine calculations to allocate the costs from
non-revenue producing departments to revenue depts, based
on such statistics as square footage, # of employees, etc.
• Tom left SMS to develop & sell a cost report system that ran on a
PC and did this horrendous math for CFOs in the blink of an eye.
– I tried to talk McAuto into buying it in 1980, but they balked,
so Tom sold it to Coopers & Lybrand who sold hundreds!
• But what about PCs and mainstream HIS systems? Read on…
7. The Hardware Market
• A major thing holding back PCs from the HIS
world was unknown names like Apple…
• IBM’s 1981 introduction of their PC opened
the door – now PCs were “legitimate,” and
hundreds of companies jumped on the Big
Blue bandwagon besides pioneers like Tom.
• How quickly did IBM dominate the market?
Check out this next slide from SIDA’s Guide
• You should remember by now how much
IBM dominated the HIS hardware market
back in the 70s & 80s, when PCs were
introduced.
• On the left is a a chart based on figures from
Sheldon Dorenfest’s “Guide,” the bible for
HIS market statistics back then, which
showed how IBM totally trumped the BUNCH
group.
8. Taking a Byte out of Apple…
• This graph illustrates how quickly IBM took over the PC market
from early leaders like Apple & Radio Shack, based on a survey of
Sheldon Dorenfest’s 250 sample hospitals in his 1986 “Guide”
9. Sweet Revenge!
• Just in case you’re an avid Apple fan like me, however, the chart
below shows how over time the computer market reversed itself:
– IBM eventually faltered to where in 1993 they posted their first
quarterly loss in the ≈100-year history of this computing giant.
They have since shifted much of their revenue from hardware
to “services” (read: software, outsourcing & consulting).
– Apple too faltered after both Steves (Jobs & Wozniak) left in the
80s, losing its consumer-centric focus until Jobs returned and
started the “i-Revolution.”
Per the chart on the right, by
2011 Apple’s stock market
capitalization not only
exceeded Microsoft, but even
overtook its old rival IBM. For
a while in 2011, it’s cap even
exceeded Exxon-Mobil’s!
10. Early Micro’s in HIS Systems
• Total HIS
– A vendor with a complete
HIS on embryonic IBM PCs
in the 80s running on DOS!
• Bedside
- Micro systems broke down
the doors to patient rooms,
paving the way for E.H.R.s
• During the 80s, literally hundreds of companies developed PC-
based systems, mainly for ancillary department systems such as:
- Dupont’s “Trinity” RIS - Citation’s DOS/Novell-based LIS.
• In the next episodes on micros, we’re going to dig deeper into
two uses of PCs that heavily impacted the HIS industry:
