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Internet Precursor

September 28, 2009
by Vince Ciotti
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Looking back at the groundbreaking online service that logged in users in just 10 “easy” steps

A look back 20 years ago to “Computers in Healthcare” magazine for October, 1989:

Featured Ad: American Express Information Services - a classy “open letter” from President Larry Ferguson extolled the virtues of this new entrant into the HIS industry, formed in 1989 by the merger of:

  • System Associates Inc. (SAI), whose “Saint” product dominated the small hospital (fewer than 100-beds) market, running on Point Four minicomputers; and

  • McDonnell Douglas Health Systems Company (McAuto), whose wide array of products covered the entire HIS market: shared systems (HFC), turnkey minis (MHS & HDC), ancillary systems (MRII, LabCom, RadCom…) and mainframes (PCS on Tandem “Non-Stop”).

It was a bit of a “David vs. Goliath” story, as SAI was a tiny upstart compared to giant McAuto, but Larry got into Amex's billions first and now ruled the roost. Interestingly, I worked at McAuto in the early '80s at their St. Louis headquarters, and actually recruited Larry on a Friday night to sell for McAuto in the southeast. By Monday morning, however, Larry got a better counter-offer from SAI and the rest is HIS-tory. In the long run, both got gobbled up by HBOC; Saint giving birth to today's “Paragon,” while almost all of McAuto's products have been sunset.

CompuServe: In a riotous description of just how “accessible” information was back in the '80s, the following 10 “easy” steps were listed for accessing Computers in Healthcare magazine via CompuServe. For you youngsters, CompuServe was an early online service in these pre-Internet days, along with competitor MacUSA, which changed its name to America Online when it wisely added IBM PCs to its target market. Here's how easy it was to log on back then:

  • Set your modem to 1200 bps, 7 data bits, even parity and full duplex

  • Dial your local access number (hopefully not long distance!)

  • Upon hearing the CONNECT signal, press Control-C

  • Enter your user ID and password

  • At the ! prompt, enter “GO PCMAGNET”

  • Select option 2: “Computer Data Base Plus”

  • Select option 6: “Publication Names,” enter the magazine name

  • Voila: there's your rag!

  • When done, enter “Off” at the ! prompt

The service costs $24-per-hour or 40-cents-per-minute for the connect surcharge, $2.50 for each complete record retrieved, and $1 for the abstract only. Wow, if you ever complained about too many pop-up ads on Google, remember these 10 easy steps.

MD Breakthrough: Another ad touted a major breakthrough in medical practice software: The Medical Manager, which came on three floppy drives and ran on an IBM PC right in your own office. Of course, this was in an era when most physician billing systems ran on mainframes or minis at a service bureau, like industry leaders CyCare in California and Interpretive Data Systems (IDS) in Vermont. IDS targeted large MD practices with 50 or more docs who could afford their fairly hefty fees of x-cents-per-claim, plus telecommunication fees. (In the 0s, IDS changed its name to “IDX” to reflect its growing penetration of the hospital market, as well through its HPA software and the acquisition of DEC's “Dec-Rad” RIS). Medical Manager was relatively inexpensive by comparison, with a one-time license fee for the diskettes, then a 1-percent-per-month software maintenance fee.

Medical Manager's business model was that of a “franchise,” with regional service bureaus providing installation, training and local support. Corporate headquarters provided R&D and national ads. By 1989, Medical Manager touted 6,000 installations with over 20,000 physicians. In the '90s, the idea caught fire and hundreds of “Mom and Pop” shops around the country jumped on the PC bandwagon and overwhelmed the shared service bureaus for physicians' business. Eventually, Medical Manager was acquired by Per Se, and, amazingly, I saw it running in a hospital early this year, still being used for salaried physicians 20 years later. DOS lives!

Healthcare Informatics 2009 October;26(10):56