The document discusses the rise of microcomputers in healthcare in the 1980s. It describes how early microcomputers like the Altair 8800 and Apple I laid the foundations, and how the IBM PC's 1981 launch legitimized microcomputers. PCs started being used individually in hospital finance and ancillary departments using software like VisiCalc. Early hospital PC products included a cost report system. The IBM PC quickly dominated the market according to surveys. The document outlines how PCs were incorporated into hospital information systems, including for bedside use and ancillary department systems, paving the way for electronic health records.

1. “H.I.S.-tory” by Vince Ciotti
© 2011 H.I.S. Professionals, LLC, all rights reserved
Episode # 38:
The Micro
Revolution

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: