- Intermountain Healthcare (IHC) formed in 1975 when the Mormon Church divested its hospitals and charged IHC's IT department to build a modern clinical information system. - Led by Larry Grandia, IHC developed the Med/38 system using the IBM System/38 minicomputer and RPG programming language. It implemented financial systems first, then clinical systems including pharmacy, medical records, and nursing. - Med/38 saw early success with 70 hospitals purchasing and implementing it within 3 years, including sales to two other multi-hospital systems. This established IHC's IT department, later called Affiliated Services Inc., as a leading hospital IT vendor in the early 1980s.

1. “H.I.S.-tory”
by Vince Ciotti
© 2011 H.I.S. Professionals, LLC, all rights reserved
Episode # 24a:
Intermountain
Health Care (IHC)’s
“Med/38” Part I

2. • Background
– IHC was formed in 1975 when the Church of the Latter Day
Saints (no HIS pun intended) divested itself of 15 hospitals in
Utah, turning them over to this not-for-profit multi system.
– IHC had a long history of computerization it inherited from the
Mormon Church’s centralized service bureau known as MDC
(Management System Corporation) in Salt Lake City. MDC
offered primarily financial systems (like SMS & McAuto then), so
2 years after IHC was formed, circa 1977, it charged its DP
department to build its own modern HIS system with clinicals.
– (we’ll see in a future HIS-tory episode how another hospital
chain out west followed this same entrepreneurial path:
American Medical International {AMI} and their PHS division)
IHC

3. • Larry Grandia
– The man in charge of IHC’s DP department, later named as
Affiliated Services Inc. (ASI), is a household word in HIS circles.
His biography alone could be a mini HIS-tory in itself!
– He is pictured below when he was appointed president of
DAOU Systems Inc., before becoming president of Premier Inc.
HIS-tory Hero
• He is probably most famous for the HELP
system (Health Evaluation through Logical
Processing) at IHC, an integrated, patient-
centered, rules-based clinical information
system that was decades before its time.
- Earning him the 1995 Davies Award
• To keep this episode under 100 slides,
however, we’ll concentrate on IHC…

4. What Mini to Build On!?
• It was an easy decision back in those days of IBM’s dominance of
the hardware market, as attested by this chart from SIDA’s Guide:
• ASI jumped on the Big Blue bandwagon,
who had just introduced their System 38
minicomputer circa 1978, successor to the
Systems 34 and 36 that IHC started on.
• Way back in 1959 (were many of you even
born that long ago? – I was 14!), IBM
introduced a programming language called
RPG – for “Report Program Generator”
• Back in those keypunch card days, the
purpose of data processing programs was
to generate a report from the stacks of
cards/data – hence the creative name…

5. Etymology of a Language
• The original RPG was indeed used with keypunch card
systems, and early IBM mainframes like the 1401 series.
• RPG II was introduced with IBM first minicomputer – the
System/3, which evolved into the System/32 and System/36.
• ASI jumped on the third generation or RPG III, written
expressly for IBM’s System 38 mini.
• Later versions, such as RPG/400
were written for the AS/400
successor to the System/38.
• Don’t mock this ancient code –
as you’ll see, hundreds of US
hospitals are still running HIS
systems that use it to this day!

6. A Maxi Mini!
• And what about the box? ASI picked a winner in
the Sysem/38, which was also the preferred
platform for a number of HIS competitors, such
as Dynamic Control Corporation (DCC), covered
in an earlier HIS-tory episode.
• The System/38 offered several breakthroughs:
– New semiconductor technology
– Built-in relational data base
• It morphed in later days into:
• AS/400
• pSeries
• iSeries
• System i
• IBM Power Series

7. Birth of “Med/38”
• So under Grandia’s guidance, ASI built its own HIS using RPG code
and running on System/38s, called creatively Med/38.
• ASI re-wrote financial apps first, completing the design and
implementation in an amazingly short time:
– By 1981, 17 IHC hospitals had been converted
– AR days declined by 3 days, a rarity in HIS circles!
– Costs were reduced from the old service bureau
– New apps were added: Inventory and Fixed Assets
• Next came clinicals, which in those days were primarily Orders &
Results, although ASI pushed the envelope with:
– Pharmacy Information System (what acronym can one safely use for RX?)
– Medical Records – including MPI, abstracting & chart completion
– Case Mix and even Nurse Staffing – very daring apps for the early 1980s!

8. Early Sales Successes
• ASI was IHC’s only “for-profit” entity, and it sure
showed it knew the not-so-subtle difference!
• Within 3 years, 70 hospitals bought and
implemented Med/38, including the sale to two
other multis eager to emulate IHC’s success.
– Check the right to see how IHC ranked in 1987, per
Dorenfest’s “3000” data base of hospitals >100 beds
• In addition, ASI sold the System/38 minis as an
IBM Value Added Remarketer (VAR), earning a
handsome royalty on hardware sales.
– (something Meditech hasn’t learned in its 40 years of
success – how many hundreds of millions {a billion by
now?} have they given to JJ Wild, Perot, and now
Dell?)
– (and Epic – how many hundreds of millions in
IBM-based
HIS Vendor
# of
Sites
Baxter 312
IBM 122
HBO 106
IHC 73
SMS 70
TDS 38
LeBlanc 14
HCS 11
AR/Mediqu
est
10

9. A Later Leader…
• Larry Grandia moved on the other successes, and the next leader
of ASI in the late 80s was Scott Holbrook, with roots back to:
– IBM (surprised?) and McAuto (another one! Wonder how many
HIS-tory heroes have not had prior experience at McAuto? Try
Walt Huff of HBO, Bill Brehm of IFAS, Ray Paris of Keane…)
• Scott originally joined IHC way back in 1977, so experienced the
whole creation of Med/38 and its amazing sales spurt in the 80s.
• Some tidbits from Scott in a 1987 interview:
- Programmed in native RPG III for the Sys/38
- System/38s ranged in size from 4 to 32 Megs
- Disk drive space ran from 387 Meg to 14 Gig
- Client base eventually included 14 multis
- Client base ranged from 84 to 520 beds
- 40 were in CA, and growth ran 25% per year

10. Sound Familiar?
• Scott Holbrook’s name should ring a bell, as his
career is almost as amazing as Larry Grandia’s:
– VP of Sales & Marketing for Sunquest, one of the
earliest and most successful mini-based LIS firms
– EVP at Park City Solutions, specializing in laboratory
orders & results to physician offices
– EVP and Co-founder of KLAS – KLAS? I swear I’ve
heard that name before, wonder what they do…
– Board member of HIMSS – ever heard of them?
– EVP at Medicity, a leading HIE that bought Park City
• And it all started with a BS in Zoology from
Brigham Young University (a propos for HIS…)

11. What’s Next?
• In Part II of IHC and Med/38, we’ll trace a series of
acquisitions that lead through several giant companies,
ending up with an amazingly large client base today.
– Meanwhile, I’m wrapping up with the last few mini stories
before starting microcomputers, so anybody got some poop on:
• AR Mediquest – an IBM Sys/36 system that Paul McVicker (
paul.mcvicker@hrhonline.org) shared some fascinating
tidbits on from his experiences at Ozarks Medical Center.
• JS Data – small hospital system that Steve Kilgus (
SKilguss@emdeon.com) and Tom Aikens (
tom.aikens@maxithc.com) have commented with.
– Anyone other major minis we’re missing??
• Please send any contributions to: vciott@hispros.com