In 1980, the first issue of Computers in Hospitals came out. When readers turned the page, they saw a picture of Bill Childs and the headline: “A Snapshot of Where We Have Been and Where We Are Going.”
Childs was the founder, editor and publisher of Computers in Hospitals. Ten years later, that magazine would be renamed Healthcare Informatics. Two years after that, in 1992, the first version of what was then called the Healthcare Informatics 50 (later 100) was released. The first company ranked at the top, SMS Corporation (now a part of Siemens), had revenue of $438.7 million. This year, the top company, McKesson, had revenue of $3.4 billion.
Indeed, where Healthcare Informatics, the Healthcare Informatics 100, and the entire healthcare IT industry have been and where they are going is a case study in how things can evolve. What started off as a “light bulb” idea after Childs met with a famous publishing industry magnate has evolved into a popular, well-known industry standard comprised of billion dollar companies. In many ways, it mirrors how healthcare IT in itself has changed over the past three decades.
Healthcare Informatics Senior Editor Gabriel Perna recently spoke with Childs, who currently works as a consultant to the industry, on the history of the magazine, the list, and how it has grown over the years. Below are excerpts from that interview.
Credit: Bill Childs
Bill, explain to our readers who you are and your significance to Healthcare Informatics.
I was recently putting together a presentation and I was thinking about necessity being the mother of invention. Often, new things come up, because something is not right with the old thing. What came up with me was I met with a publisher of specialty magazines at a Christmas party in Denver in 1979. He published magazines that went out to communications industry and other things like that. We began talking and he had asked me about radio frequency design, which was a magazine he wanted to start. It turns out that at Lockheed, the RF engineers that had worked for me a number of years before. Not too many people understand the nuances of radio frequency, which I do, and he was looking for a publisher for that magazine. I wasn’t interested but said that in our business, we’re trying to reach information systems people and people who have a vision what information systems can do for healthcare. We go into Modern Healthcare and Hospitals Magazine but their reach is broad. We might put in an ad for a million dollar ad system and they might put it next to an advertisement for diapers. Or they might put an ad for diapers right in the middle of technological discussion about information systems. I thought there was a real need for a magazine devoted to actual computerization information systems within hospitals. He said, if you will help publish this radio frequency magazine, I will help you publish something we called Computers in Hospitals. We launched both magazines in 1980. The timing was perfect. Immediately we had people in hospitals and from the vendor side who wanted to write articles about what they were doing. We had the circulation list and we had advertisers.
First cover of Computers in Hospitals Credit: Bill Childs
Where did the idea behind what eventually came to be the Healthcare Informatics 100 come from?
I was honored at an awards ceremony in New York City for publishing the most read editorial of any magazine in the U.S. as a percentage of circulation. It was close to 90 percent. I met Malcolm Forbes there, and we sat at the same table. He was talking at that time about his Forbes magazine’s Forbes 500. He was lamenting the fact that because that had not jumped on the right name the first time, it impressed upon him of being first with the right name. Fortune had beaten them to list with the Fortune 500.
I took that home. At the time, we were having problems with the name of the magazine. What happened was Marion Ball, who I go way back with, and I were invited to do a speaking tour throughout Europe one summer. We spoke at a lot of university medical centers. We were at one in France and we saw on the blackboard a word that said “informatique” in French, which translated into the “science of information.” That’s how we came up with Healthcare Informatics. Then we named the list, at that time, the Healthcare Informatics 50 and then later it grew to 100 as more and more got interested.
The first issue of Healthcare Informatics Credit: Bill Childs
Had you been thinking of doing something like this when you met Malcolm Forbes, or did the light bulb go off after you met him?
I was an admirer of Forbes editorials and of the magazine, and I think it was the light bulb that went off and having the opportunity to sit and talk with such an established, well-spoken gentleman.
How did you eventually come up with 100?
In the beginning, we only had 50 because that’s all we could get. We called everyone and some were reluctant to share numbers. For instance, IBM was reluctant to break out healthcare revenue from the other revenue. Large companies have those issues like GE, IBM, at the time NCR and Burroughs. It was chore getting them to break out the healthcare parts. 3M was another. To get them to do just healthcare was an effort. I personally met with the healthcare heads and told them how important this would be. Many of them bought into it. It took a while to get the approvals. One hundred was our initial goal, but an unachievable one. We were able to achieve 50 at first then later we got to 100.
Credit: Bill Childs
How did you keep them honest in those early days?
Sometimes when you’re doing it over the phone or through email, it’s easy to be not be as honest. I did a lot of face to face meetings with the people responsible for these numbers. It was really a wonderful time and I got to sit down with executives at SMS, IBM, NCR, and Burroughs. That was another thing that I had picked up from Malcolm Forbes. He said, “Do not be afraid to call at the highest levels in the medical centers you visit and with the vendors you deal with.” I always had that as a goal. If I was going to see someone responsible for advertising, I said I also want an hour with your CEO. And I always got it. I found that these people, they might push the letter of honesty, but they want to be saw in the best of light. But they all wanted to tell their story.
How have you seen it evolve over the years and what does it say about this industry?
I was one of the founders of TDS (Technicon Data System), which was the first system that had 100 percent electronic medical record. We had 80 percent physician usage in 1971. One of the hallmarks we used was to reduce costs and improve quality. As I look at revenues and as I look at the cost to get any one of these systems implemented, I’m disappointed it costs so much money. We have not done a good job in those areas.
In 1968, Medicare and Medicaid became the law of the land. [Back in those days] the federal government came to us and said, “The hospitals will never be able to report on the requirements we are going to put in place when they get Medicare and Medicaid money. So we would like you to build financial information systems, patients billing, general ledger for hospital and clinics so they can do this.” So we received matching funds, for every dollar we spent to develop these capabilities, they would give us matching funds. Several companies got into the business that way. We had great computing capabilities back in the 1960s, back when computers cost tens of millions of dollars and there weren’t many around.
So today, I am amazed at the amount of money they are making. I’m disappointed savings have not offset the rising costs. Reducing costs is one of the big challenges because as we approach 20 percent of the GDP, there is a great cry among everyone in the U.S. Not just patients and consumers, but healthcare executives who all say we’ve got to do something about these high costs. I believe there is definitely a next generation capability that will replace or enhance the current systems that will provide quality improvement and cost improvement. That’s something that has to come.