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Healthcare Informatics, August 1990

July 20, 2010
by Vince Ciotti
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Stories from HCI's archives 20 years ago this month
Vince Ciotti
Vince Ciotti

Cover Story-An interview with Neil Bell, the retiring CIO of Kaiser Permanente, offers some interesting insights on HIT back then, some surprisingly relevant today:

Key to Neil's success in becoming CIO of the largest healthcare facility in the country, “be in the right place at the right time” was his initial, jocular response, followed by a more telling comment: “ability to communicate and have good relationships with the physicians.”

Biggest technical challenge faced: “When I first came here, there were no online systems at all. Everything was done in a batch mode.” Platforms were diverse too-Honeywell mainframes for HMO administrative systems and IBM 360 mainframes for clinical systems.

Hottest technological breakthroughs: Tandem's “Non-Stop” mainframes, with redundant disks and memory, which were crucial in clinical systems like Knowledge Data Systems that Kaiser had just purchased.

On PCs, another breakthrough technology back then: “We had PCs here from the earliest days of CP/M and RadioShack.” Their biggest impact “built a comfort level for people in their relationship with automated systems.”

On bedside terminals: “I really look forward to the day when terminals don't have to be wired to anything…whether low-powered FM or cellular technology or infrared. It costs more to cable and install a terminal than the terminal itself.” Wow, what a visionary! I bet Neil is relaxing on a beach somewhere reading the New York Times on his iPad.

Tough Editorial-Bill Childs was always a candid and harsh critic of HIS vendors (a courageous thing for a magazine editor relying on vendor ads for revenue!) and he came down hard on selling “smoke and mirrors,” a common trait in the early days of HIS. Bill quoted a CIO who had been sold snake oil by an eager sales rep, and only received about 20 percent of what he was promised: “You know, this guy believed that his vision and reality is the same thing.” Ah, so nice to know that today's buyers are so much wiser and never fall for vision-ware!

“High-End” PC- Check out some of these stats for Wang's latest devices:

PC 480/25C = 25MHz, 804486 processor, starting at $8,595.

PC 350/33C = 33MHz, 80386 processor, starting at $5,395.

Wow, with full desktops for under $500 today, we have made some progress!

Vendor/Consultant Deal-“Digital Equipment Corp. (DEC) and Ernst & Young announced the signing of a service alliance agreement to pursue business integration in the healthcare industry.” Curious…how can a consulting firm provide unbiased, neutral advice to a client hospital and help it pick an HIS system if it is aligned with a given hardware vendor? Nice to know we have progressed so far beyond such conflicts of interest in today's market:

IBM buying Healthlink and PwC.

HP acquiring EDS.

Dell bought Perot.

Xerox now owns ACS.

Pioneering Voice Recognition-Hewlett-Packard and Kurzweil announced an agreement to sell the “VoiceMed” speech recognition system. Quite a daring concept back then, when CPU processing power was so limited that physicians had to pronounce each word, sslloowwllyy and ddiissccrreetteellyy into a mike, and wait patiently for the words to appear on a green screen CRT to see how badly the machine botched the meaning (“I meant ‘dc the med,’ not ‘did you see the med?’”). I remember visiting a hospital in the Bronx back then where the CIO showed me a large, unpacked cardboard box under a table in Radiology, lamenting, “Would you like a good deal on a $50K Kurzweil system? Never been opened!”

In truth, we have made incredible strides in voice recognition since then: I had a motorcycle accident a few months ago, dislocating my left thumb so that I couldn't type. Bought a cheapie PC voice recognition app for $80, and knocked out the past three month's Memory Lane articles without missing a beat!

Vince Ciotti is founder and principal of HIS Professionals, LLC.

Healthcare Informatics 2010 August;27(8):48

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