The document summarizes news from the healthcare IT industry from October 1987. It discusses how leading EMR vendor TDS withdrew from bidding on the DoD's CHCS contract due to issues with requirements. Many major vendors at the time bid on the large DoD project, though McDonnell Douglas subsidiary McAuto ultimately lost to consulting firm SAIC. The document also describes the founding of the HL7 standard to help address the problem of building interfaces between different clinical systems. Advertisements from the time show how few vendors from 30 years ago are still in business today under the same name.

1. 30 Years Ago In H.I.S.-tory
by Vince Ciotti
© 2017 H.I.S. Professionals, LLC, all rights reserved
News from
October
1987 and
lessons for
today

2. September 1987 in H.I.S.-tory
• It’s quite impressive that HIStalk has been on-line for over 10
years, leading to the “This Week in Health IT History” column,
with headlines each week from 1, 5 and 10 years ago.
• Which inspires me to dig back into my paper files, disk drives and
HIS-tory series from a few years ago to find out what was big
news as far back as 30 years ago, and what lessons apply today.
• My sources are as complex as our industry:
- PERIODICALS –pioneering print journals
founded by industry great Bill Childs.
- DATA BASES – created by Sheldon
Dorenfest, the research maven in H.I.S.
- FRIENDS – H.I.S. pioneers willing to share
embarrassing stories of their early days.
- MEMORIES – while I still have them…
Bill Childs
Sheldon
Dorenfest

3. TDS Withdraws from DoD
• TDS’ President John Whitehead complained about repeatedly
modified schedules, unrealistic budgets and “benchmark” demos
rather than site visits to existing clients. CHCS was a major
component of the TRIMIS (Tri-Service MIS) program intended to
be deployed in 168 military hospitals and 500 clinics world-wide.
Big shocker in Bill Child’s
Healthcare Computing &
Communications was the
news that leading & pioneer
EMR vendor TDS withdrew
form the DoD’s Composite
Health Care System (CHCS)
procurement process. TDS
was the vendor when it came
to clinical systems back then.

4. Other DoD Bidders
• Many leading HIS vendors back in 1987 were bidding for this huge
DoD contract that was budgeted for ≈$1 Billion, a lot of our tax
dough back then. Who were the leading HIS vendors in 1987?
Thanks again to Shelly
Dorenfest’s 1988 “Guide,”
here’s the list based on total #
of clients. EMRs were known
as Patient Care Systems back
then, and major competitors
in TDS’ PCS market were:
• SMS’ ACTIon (no Invision
yet)
• Baxter - IBM’s PCS/ADS
• McAuto’s PCS on Tandem
• HBO’s mini-based MedPro

5. A Sad DoD Tale
• Bill Corum was in charge of McAuto back then, and he shared this
sad story with me over dinner one night when we were working
together at a hospital client in Texas that was preparing for Y2K.
• McDonnell-Douglas had a huge footprint
in DC and a large track record with DoD
thanks to its many military jets, so Bill
put a large part of McAuto’s HSD into the
bidding process, which included
programming a whole new PCS to DoD’s
specs, countless trips to and from DC,
“installing” it for benchmark demos, etc.
In essence, it was a make or break deal…
• When the winner was announced it was heartbreaking for Bill
and his team – they had lost to a company with an even larger DC
footprint called SAIC. After the loss, McDonnell-Douglass put its
McAuto IT division up for sale, and the rest is HIS-tory...

6. Lessons For Today?
• So just who was SAIC, which stood for Scientific Applications
International Corporation? They were a DC-based “consulting”
firm that was one of the largest defense contractors in the US.
They were far more experienced in winning DoD procurements
than they were in writing PCS systems, but what counts more?
• In 2013 SAIC changed their name to Leidos – sound familiar? They
were the partner Cerner chose when they bid for the recent DoD
procurement process in 2015 known as DHSM (Defense
Healthcare Management System), along with Accenture, one of
the largest consulting firms in Healthcare. This super-trio beat
other vendors who may have had superior EMR systems, but had
nowhere near such DC-potent partners (who get most of the $s):
– Epic - who “only” partnered with IBM as prime contractor
– Allscripts - who partnered with CSC and Hewlett-Packard
– MedSphere - who partnered with PWC and General Dynamics.

7. Recent VA Win With No Bids
• Maybe TDS’ CEO John Whitehead was pretty smart after all!?

8. Birth of HL7
• Back in 1987, there was the major market niche of HIS vendors per
the Dorenfest list on the previous slide, and then a huge array of
“specialty” vendors in ancillary depts: Lab, RX, Rad, ED, OB, ER, etc.
• None of the leading HIS vendors back then offered a decent app
for every dept., but rather offered core clinical & financial systems,
leaving DP managers to have to build scores of complex interfaces.
• Aren’t we lucky today where our core vendors have every system
we need, so no more need to build these tiresome interfaces…
• Integrate vs. interface… Or is it
Inte-great vs. Inter-farce?
• In this age of interoperability
or lack of same for today’s
EMRs, it is fascinating to read
this article on the birth of the
HL7 standard by Don Simborg.

9. Today’s Interfaces
• I was only kidding! The # of interfaces hospitals need today is
appalling, even with leading vendors that have “complete”
systems. Here’s examples from recent clients on Cerner, Meditech
and CPSI, whose names are saved to protect the innocent:
≈25-bed CAH
• 18 interfaces, many
of which are bi-
directional, including:
- Pyxis drugs
- Transcription
- PACS
- HIM Encoder
- Fetal monitors
- Vital sign monitors
- Cardiac monitors
- 6 Lab instruments
- Reference Lab
- 4 Public Health
Registries
≈300-bed IDN
• 52 interfaces, many
bi-directional, including:
- PACS
- HIM Encoder
- Dictation/transcription
- 27 Lab instruments
- Fetal, Cardiac & Vital
Sign monitors
- Drug dispensing
- 2 Reference Labs
- Home Health Care
- Payroll
- 6 Public Health Regis.
- Dietary
≈150-bed Hospital
• 37 interfaces, many of
which are also bi-
directional, including:
- PACS
- HIM Encoder
- Mobile Phlebotomy
- Dictation/transcription
- Voice Recognition
- 15 Lab instruments
- Cardiac monitors
- Drug dispensing
- Reference Labs
- 340B reporting
- Business Intelligence

10. HL7, cont’d
• So actually, it was a very admirable project Don Simborg created,
getting together a slew of vendors & hospital experts to come up
with standard data formats so that building point-to-point
interfaces was almost affordable before the advent of I.E.s.
• The HL7 working committee was formed in March of 1987, and its
members included gurus from both hospitals and vendor firms:
– U of Penn., Case Western, Moses Cone, Duke, & Community Medical Center
– Enterprise Systems, Sunquest, CHC, Source Data, ESI, PHS, Digimedics & NCR
• The HL7 standards were non-proprietary, favored no vendor or
architecture, based on the ANSII X12 protocol, and targeted to be
released by the end of 1987 after a second meeting in October.
• Don ended his article with the question: “Will HL7 succeed?” We
have to give him and his team a lot of credit for greatly simplifying
the maddening world of system interfaces, although the issue of
EMR “interoperability” is still a bitter controversy to this day…

11. Advertiser Index
• So just how long will your HIS vendor be around? To
give you some indication of how challenging the HIS
industry is, take a look on the left at the list of
vendors advertising in the October 1987 ad index at
the back of Computers in Healthcare magazine and
see if yours is there? Are any of the 34 vendors listed
still running under the same name 30 years later?
• Only 3M whose HIM coding is easily the dominant
player in that niche after all these years, especially
after QuadraMed sold its Quantum to Nuance…
• Plus a few multi-industry hardware giants like HP,
IBM, and RCA, most of whom now get far more
revenue from “services” like remote hosting and
consulting than from pure hardware sales.

12. Next Month
• Some interesting news & articles from November 1987 HIS rags:
– A daring new development in communications that enables
a piece of paper to be sent over a phone line in seconds!
– Something you don’t hear much about today: a self-
developed HIS at Baptist Memorial in Memphis. Many large
IDNs built their own systems back then – what happened?
– Interesting article on “Linking, Interfacing and Integration”
with some fascinating stats on the size of PC memory &
storage capacity increases from 1977 to 1987.
• Hope you enjoy jumping back to these early days of HIS-tory –
glad to share any of your memories or feedback:
Vince Ciotti HIS Professionals, LLC
505.466.4958 vciotti@hispros.com