This document provides a summary of the origins of Siemens' hospital information systems and its predecessor, Shared Hospital Accounting System (SHAS). It describes how SHAS was developed by IBM in the 1960s to allow small-to-mid sized hospitals to share mainframe systems. Over time, Shared Medical Systems (SMS) was formed and grew to support SHAS. Siemens later acquired SMS and its products like Invision, which still incorporates parts of the original SHAS system from the 1960s. The document shares recollections from industry veterans on the early development and implementation of SHAS.

1. H.I.S.-tory
by Vince Ciotti
Episode #100:
Siemens, Part 1
© 2013 by H.I.S. Professionals, LLC, all rights reserved.

2. 3rd of Today’s Leading HIS Vendors
• We continue the HIS-tory of today’s vendors with
Siemens, whose est. 2012 HIT annual revenue of
$1.8B puts them in 3rd place among HIS vendors:
1. $3.2B = McKesson, née HBOC = Walt Huff, Bruce Barrington, & David
Owens
2. $2.6B = Cerner, still run by Neal Patterson, co-founded with Cliff Illig
3. $1.8B (est) = Siemens, née SMS: Jim Macaleer, Harvey Wilson & Clyde Hyde
4. $1.5B =Epic. Gee, I have to wonder, just who was it who founded them?
5. $1.4B =Allscripts, née Eclipsys, also founded by Harvey Wilson of SMS.
6. $850M (est) - GE Healthcare, née IDX/PHAMIS: created by Malcolm Gleser
7. $597M = Meditech, still run after all these years by Antonino Papallardo
8. $375M = NextGen: née Quality Systems Inc. founded by Sheldon Razin
9. $183M = CPSI, founded by M. Kenny Muscat & Denny P. Wilkins (who??)
10. $156M = HMS (Healthcare Management Systems), Tom Givens & John Doss
11. $150M = Keane, parent giant by John Keane, but HIS div. built by Ray Paris
12. $106M = QuadraMed, née Compucare, founded by Sheldon Dorenfest

3. Siemens’ 4-Part Saga
• There are actually four stories behind today’s Siemens and where
its 3 key products (Invision, Medseries and Soarian) came from:
• The 1960’s roots in IBM’s SHAS, which gave
birth to SMS and dozens of other shared
systems during the post-mainframe 1970s.
• Shared Medical Systems (SMS), whose PA
headquarters locations gave it 3 mini-epochs:
Bridgeport, King of Prussia and now Malvern.
• MedSeries 4 – as pioneering a mini system
as SHAS was a shared system, with roots at
IHC, then GTE, and eventually sold to SMS.
• Siemens, whose history goes back over 165 year
ago, and whose healthcare division sells many
products to almost every hospital department.

4. The Roots of IBM’s SHAS ?
• Many thanks to a number of HIS-talk readers and old SMS friends
of mine who answered my inquiries about the origins of SHAS.
My sick brain still remembers so much trivia about it that I am
embarrassed to confess how much grey matter I am wasting:
– For kicks, let’s have some fun and see who remember these
card codes – the first 2 digits on the 5081 cards we punched:
• Admissions = 11, 12 (credit info) and 13 (guarantor) cards
• Discharge & Transfer = 16 and 17 cards, respectfully
• CDM = 30-card series (I think!?), some used later in AP…
• Charge cards = 40-series for 1, 2 or 4 per (43 was a credit)
• Payments: 81 = patient, 82 = insurance
• Adjustments: 80-series; 87 = patient to ins, 88 = ins to pat
• This is sick!! Why do we waste our precious grey matter on such
total trivia that will never be used (except for writing this…)?

5. So What Was “SHAS?”
• For you (very lucky) young CIOs, here’s a quick HIS-tory of SHAS:
– Mainframes dominated hospital “data processing” rooms in
the 60s, like server racks do in today’s modern data centers.
– And IBM dominated mainframe sales in the 1960s just like
Microsoft owns today’s business market for Office & OS, and
Apple owns the home PC, iPhone, iPod and iPad markets.
– By the late sixties, IBM & its “7 Dwarf” (aka BUNCH Group)
competitors had sold almost every large hospital in the US a
mainframe, and all that were left were small to mid-size that
couldn’t afford the million dollar price tag and large dp staff.
– So Armonk started a project to write software that enabled a
group of small or mid-sized hospitals to share a mainframe,
opening up thousands more prospects for their machines.
They called it the “Shared Hospital Accounting System” or
SHAS in geek-speak, and the question is, where did they do it?

6. Some Answers
• Here are some of the many answers I’ve received over the past
week – the first from Ken Shumaker, easily one of the best &
brightest at SMS, later famous for being the father of “Unifile”
“My recollection of SHAS goes back to my time in IBM from 1965 to
1970. A guy named Dr John(?) Duffy was IBM's medical directorof the
Advanced Systems Development Division with 3 geographic centers:
1. San Francisco Presbyterian and Doctor Jim Beaumont were
focused on intensive care monitoring.
2. Rochester Minnesota had a 14 person group headed by Gerry
Shultz working with the Mayo Clinic. That is where Jerry Vogt,
Alan Sprau, Jim Vaughan, Clyde Hyde, and I worked (VC: other
hard-working, brilliant guys from early SMS days). The projects
were all clinical. A guy on the Mayo Clinic Board of Governors, G
Slade Shuster had flown bombers in WWII with Thomas J Watson
Jr. Their friendship eventually led to IBM establishing a
manufacturing plant in Rochester MN. Clyde Hyde(VC: co-founder
of SMS)worked with Doctor Ralph Smith on a computerized EKG
analysis program using the Frank 3-lead system.”

7. Ken’s Story, continued
– “Alan Sprau worked with Dr WelbyNewlonTauxe on nuclear medicine scans, a
precursor to CAT scanners.” (VC: Alan was Tech VP for SMS, and later formed
his own company in Minnesota to sell “Metafile,” his version of the
pioneering Unifile data base system, which Frank Poggio used at HMDS)
– “I worked on a multi-phasic testing program with Dr Duffy in Armonk New
York and then on a Mayo Clinic registration and appointment scheduling
system. There were other projects - brain probes, radiation therapy, etc.
3. The third group was in Armonk NY and did clinical work at
Columbia Presbyterian Hospital with a Clinical Decision
Support System. Leon Pordy, a cardiologist developed an
EKG analysis program based on the classic 12-lead system
that competed with Clyde Hyde's EKG program at the Mayo
Clinic.
• Dave Hartinger is the name I associate with SHAS. Whereas
all the clinical systems were oriented to the IBM 1800, SHAS
was directed at the accounting needs of the new Medicare
system and written for the 360 mainframe.
That's about all I know – and not much about SHAS”
- Ken Shumaker

8. Another Contribution
• This from Doug Beaupit, one of the nicest IDs in King of Prussia:
– “I worked as a programmer at Atlantic City Hospital (ACH) and converted the
hospitals payroll from unit record to a 1440 computer. I also brought up
IBM's stand alone on-line hospital package for Census and Patient Billing, AR
and GL on the 1440. The 1440 was an all disk system that had up to 4 drives
to store files. Each drive had the capacity of 2 million bytes. It wasn't long
before you exceeded the capacity. I did a lot of manual manipulations to
keep the files open until IBM came out with their 360 system.
– IBM realized that all hospitals were not going to buy a
stand alone computer, hence, the invention of SHAS
with the advent of a new series of computers called
the 360. IBM spent 56,000 man hours on the initial
version of SHAS development. Harvey Wilson was the
salesman at Atlantic City when ACH bought the 360.
The 1440 was a one shift on line operation that went to
a 24/7 operation on the 360. With the 360, the Patient
Accounting files were on disk and the A/R , GL and Bad
Debt files were on magnetic tape. At that time SHAS
software was free with the purchase of the hardware.”

9. Doug’s Story, cont’d
• “I attended IBM's kickoff of SHAS along with Earl Messick - I
think he came from HUP - we all had the jobs of implementing
SHAS in our respective hospitals. I believe Jim Macaleer
sold many of the Philly hospitals along with Harvey.
• I implemented SHAS (Census, IP / OP Billing, A/R, B/D and GL)
in a stand alone environment at ACH. My IBM System
Engineers were Bill Wagner and Elise Rimelli. Nancy Ames
was the programmer in the Philly Office who
maintained SHAS for IBM and when SMS was formed she was
hired to maintain and expand SHAS for SMS. When SMS was
formed, Harvey immediately sold West Jersey Hospital,
which became SMS’ first client. The SHAS software was
designed to live until the mid seventies and the next
generation of computers. Earl and Nancy worked on training
SMS staff on SHAS and designed the expansion of SHAS for
SMS. Earl and Nancy may wish to expand on my
comments. Hope everyone is doing well and is going to have a
great summer,”
- Doug Beaupit

10. More Early SHAS Tales
• From Phil Jackson, one of the great ones at SMS who led the
Terminal Development team that built ACTIon on 4 Phase minis:
– “In early 1969 worked for 6-8 weeks with the IBM development group,
located in White Plains, before I came to SMS. They were part of an of the
development organization which carried the internal name of “Shared
Medical Systems.” When RJM, CH and HJW did their thing -- they must
have quit using that name. The charge of the group was to develop SHAS.
The manager was Steve ???. This is the group which developed the
background job scheduler for DOS. A woman named Martha developed
the insurance proration portion of PB. Later in conversation with Jean Irwin
– who knew Martha pretty well and used her as a resource when
modifying the ‘CYCA’ insurance proration for coordination of benefits.”
- Phillip D Jackson

11. And From the West Coast…
• Another great guy and superb salesman, Ron Dixon who opened
SMS’ LA office and sold hundreds of hospitals over his career:
“I was with IBM in Los Angeles as a medical salesman (GEM
Region) in 1968 when IBM put together a SHAS sales training
school in Washington D.C. for all of the national medical
reps. They primarily were looking to sell System 360's to all of
those old 1440 hospital customers who used the old PAL patient
accounting system. There were quite a few of those around the
country. I was able to sell 360 Model 30's to Cedars Sinai and
Children's Hospital of Los Angeles running PAL in compatibility on
the 360, then planning to convert to SHAS when operational. IBM
had signed a consent decree with the Justice Department
agreeing not to sell timeshare services at that time, so IBM
couldn't offer a shared service to hospital - they put SMS in
business with that consent decree.”
- Ron Dixon

12. And From the East Coast
• From Ken Clarke, a veteran CIO and now consultant in WV:
– “Sorry I don’t know the origins of SHAS. We uses it in mid-1970’s at Long
Island College Hospital and St. John’s Episcopal Hospital in NY. It was one
of the first software apps that gave you the source code and came with a
hospital profile that supported multiple hospitals. You needed punch cards
to update a field in the profile. It was written in COBOL and also had
multiple subroutines written in IBM Assembler language.
– It stored “scalar” dates in a two character hex format that used Jan 1,
1900 as the base, which meant a Y2K-like death in 1989...
– SHAS used an ISAM (indexed sequential access method) hierarchical
database which allowed for fast retrieval and reasonably fast adds. We
used SHAS as the starting point for our system at St. John’s where I started
WECAL (West End Computer Associates Limited). We expanded the date
to 3 hex characters to eliminate the 1989 expiration problem. We also
eliminated the card updates to the profile – we used CICS – remember that
ancient beast? I sold the software to Bob Pagnotta at Jones/Hosplex and
worked there for about a year.”
- Ken Clarke, FHIMSS

13. So Who Cares?
• Two answers to that question:
1. Look what happened to over a hundred hospitals in 1989:

14. So Who Cares, cont’d…
2. About 500 CIOs and their C-Suites should care, as that’s about
how many hospitals are running Invision, whose “FMS” or
Financial Management System for patient accounting still
includes major portions of SHAS, including such jewels as:
- TCEs– Transmission Control & Error Reports and “Recircu-
lating Error Files” that go back to 5081 keypunch cards…
- CDM - Charge Description Master, a relic of SHAS’ ISAM files
• Granted, SMS made major revisions and improvements during its
30 year run with SHAS, and Siemens’ “Soarian” is finally delivering
a modern Revenue Cycle replacement product 15 years later, but
most CIOs I know who are running Invision are extremely pleased
with the performance of this 45-year-old machine
and are reluctant to ever consider a replacement…
• Just like me with my 1965 Austin Healey 3000
from the same era, that I ride into town daily!

15. Last SHAS Story
• The most interesting story of SHAS’ origin comes from another
SMS vet: Bob Haist, who joined us in 1976 when we merged with
American Hospital Supply’s ISD (Information Services Division):
“Vince, Thanks for another trip down the "M"-lane! One thought to
share: Was it Michigan BC/BS hospitals with IBM and SHAS, or
Minnesota? (VC: this after I reported a story that Michigan BC/BS might
have started SHAS) It was my recollection that it was Minnesota (in fact
one of those BC/BS execs was head of SMS' (Lab, I think) division for a
while... What fun it was, eh? Thanks again for all your work with this HIS-
tory. I will look forward to seeing you again at a reunion or just on the
street one day! Best regards,
- Bob Haist”
• So the riddle is still unsolved – just who, when and where
designed and wrote SHAS, a system that automated several
thousand hospitals over its 50+ year HIS-tory? Any readers with
more SHAS stories, please send them along, or next week we’ll
jump to the story of how SMS grew from Ross & Royal Roads, to