This document summarizes some early electronic patient accounting systems, or "pre-cursors", that preceded modern hospital information systems. It describes systems using punched cards from companies like IBM, NCR, and Burroughs to track patient bills on individual ledger cards that were later upgraded with magnetic stripes. These pre-dated systems with CRT screens and allowed billing to be handled by a single staff member at small hospitals. The document provides examples of early bill formats, mechanical card sorting systems, and the use of punched Hollerith cards for order entry and printing patient accounts.

1. “H.I.S.-tory” by Vince Ciotti
© 2011 H.I.S. Professionals, LLC, All Rights Reserved
Episode # 5:
“Pre-Cursors”
A pathetic pun on the creative and pseudo-
automated systems that presaged HIS computers.

2. What came before 60’s Mainframes?
• My apologies to other English
majors out there, but I call them
“Pre-Cursors,” the best IT pun
I’ve ever come up with!
• In truth, it’s an accurate term, as
these pre-EDP system were used
long before the first CRTs (and
their cursors) were invented…
• They’re what we converted
hospitals from when we
installed mainframe systems:
posting cards, made by
Burroughs, NCR, and others:

3. Pre-Cursor “Systems”
• How did they work?
– Simple: an operator typed
charges & payments onto a
cardboard ledger card for
each patient visit/admit.
• Cost for pre-cursor systems?
– External, to the vendor:
• Machine = low 5-figures, posting cards = pennies each!
– Internal payroll costs:
• Staffing = one FTE (that’s Betty above) handled the entire
patient accounting volume at the first 300-bed community
hospital I destroyed, er, converted in 1969…

4. Typical Pre-Cursor Patient Bill
• How could only one FTE type all
of the charges on every
patient’s bill back then?
• Take a look at this actual bill
from the “pre-cursor” days, and
you’ll see why:
– There were no DRGs, CPT or ICD-9
(let alone ICD-10!) codes, co-pays,
insurance deductibles, etc.
– Indeed, the original SHAS program
we installed in 1969 couldn’t
handle a charge over $999, or an
account balance over $99,999!

5. 1960’s “Next Generation” Pre-Cursors
• An electronic ledger card!
– NCR, Burroughs and others made a breakthrough
in ledger cards when they added a magnetic stripe
to the side that stored the previous transactions.
– Now, all an operator had to do was enter the new
charge or payment, and the system would add/
subtract it from the balance automatically!
– Whew, hot stuff! Now,
an ATB could be printed
in a few hours, rather
than several days…

6. 5081 Hollerith Card Systems
• Invented for the 1890 (yes, Virginia, 1890, not 1990)
census, Hollerith’s 80-column cards were a
mainstay of American businesses throughout the
1900s, and two hospital pre-cursor systems put
them to use:
– Litton-McBee
• Basically, keypunch cards with needle-sorters, this
ingenious system was purely mechanical, with
operators using a long needle to “sort” the 5081 cards
by the holes in their columns.
• Of course, an overly eager
operator could always push
a little harder and create a

7. Medelco’s “Card Drop” System
• I never saw this one, but heard many stories about
this pioneering “order entry” system from the “old
folks” (people over 40) when I joined SMS in 1969.
• It worked by having a card created for every item a
patient might be charged for (today’s CDM),
• And, a card created for every patient (account #)
• Nurses then dropped the patient’s card into an IBM
1056 card reader, followed by the cards for items
they wanted to charge for.
• Don’t have a picture of a 1056, but
it was like the 029 pictured here:

8. Keypunch Card Systems
• IBM’s 1401 card sorter system was probably the
mainstay of pre-cursor EDP systems in the 50s and 60s.
– Not that IBM had a monopoly on the technology, they had a
monopoly on the industry, as the next installment explains.
• Based on Hollerith’s 5081 cards, they sorted and
printed them in myriads of ways to print ATBs, etc.
• We used them heavily in the 60s and early 70s as the
I/O device computers.
• They were also great
for writing notes, and
fit into shirt pockets!