The History of the Electronic Health Record
HIMSS 2011 – Orlando, FL
February 22, 2011
by Larry Pawola, PharmD, MBA
Head, Department Biomedical and Health Information Sciences, Program Director Health Informatics
(Please note that this video is from HIMSS10 covering the same topic)
Slide 1: EHRs: A 38-year journey
Slide 2: CPR and EMR…
Slide 3: EHR
Slide 4: CPR vs. EMR vs. EH
Slide 5: History
Slide 6: It started with
Slide 7: Lockheed’s idea
Slide 8: Go live…
Slide 9: And the word spread
Slide 10: Word spread by mid-1970′s
Slide 11: By early 1980′s
Slide 12: Stratification
Slide 13: Into the 1990′s
Slide 14: Into the 1990′s cont..
Slide 15: Self development
Slide 16: Today?
Slide 17: Ambulatory side of business
Slide 18: So what happened to Lockheed
Slide 19: To bring you up to date
Slide 20: To bring you up to date
Slide 21: For more information
Slide 22: Thank you
Slide 2: CPR and EMR..
CPR
older term from 1960s through 1980s
pertains to hospitals only
EMR
More recent term from the 1990s that included ambulatory records
Slide 3: EHR
Most recent term
Includes records from a variety of sources
Used within and outside of the health entity
Slide 4: CPR vs. EMR vs. EHR
Terms have been used interchangeably for the last 38 years
Slide 5: History
Slide 6: It started with…
John Kennedy’s vision in the early 1960s
Man on the moon by 1970
Funded NASA and development of space program
Lockheed was major beneficiary of grant money
Develop space program technology
Extend it for the common good
Slide 7: Lockheed’s idea…
Develop software for patient care
Approached El Camino Hospital in 1968-9
Spent 2-3 years analyzing operational flow of data
Analysis before coding
Diversion of effort for the industrial engineers for the common good of society
Slide 8:Go live…
First unit went live at El Camino in 1973
De-bugged for over a year
Rest of hospital went live by late 1975
Used large-scale IBM mainframe computer
Slide 9: And the word spread
Slide 10:Word spread by mid-1970′s
HBO IFAS and Medpro
Renamed HBOC and purchased by McKesson
McDonnell Douglas
Purchased by HBOC and now part of McKesson
IBM PCS/ADS (gone)
SMS
Now part of Siemens Corporation
Majority of these efforts were limited systems
Communicated orders and gathered results
Could not be expanded into full patient records
Never came close to what El Camino had already installed
Slide 11: By early 1980′s
Additional companies tried to develop CPR
Nadacom, Datacare, Medicus, Tymshare, Meditech, Dynamic Control, Burroughs
Made significant investments
Many well-known hospitals invested heavily with time and resources
In the end, not much success
Majority of these companies are out of business and developments put to rest
Exception is Meditech – still going strong
By end of decade, only working CPR was still Lockheed system from early 1970s
Slide 12: Stratification
Mainframe typically housed more functional systems through 1980s
Mid-range computers typically housed more limited systems
Required hard-wired/cabled peripherals
Processing power was determining factor
Slide 13: Into the 1990′s
Technology began to move toward large-scale communication networks and distributed computing
Saw advent of powerful PCs and servers
New products from Microsoft focused on desktop computing
Overall cost of computing lessened with new emphasis on client-server technologies and communication networks
Slide 14: Into the 1990′s cont..
Compaq, Data General, and Hewlett Packard became leaders
Cerner emerged with new way of approaching EMR
Other leaders: HBOC (purchased by McKesson), Eclipsys (bought TDS and now part of Allscripts), Meditech, IDX (who purchased Phamis and later purchased by GE), Misys (purchased Sunquest and merged with Allscripts, and SMS (purchased by Siemens)
These followed with new technological designs or re-builds of old systems
EPIC initiated development of acute care system in late 1990s
Slowly, industry realized EHR systems are difficult to develop and take many years to be fully implemented
Slide 15: Self development
Handful of internal self-developed organizations deserve mention
Significant resources and time have been used
Efforts extended over long periods of time
Quite functional and served individual research needs as well
Proprietary systems utilizing older technologies and designs
Can’t be easily commercialized on a large-scale
Slide 16: Today?
Slide 17: Ambulatory side of business
Physician practices and outpatient clinics have been using EMR systems since mid-90s
Much progress has been made
Less complex patient care environment
Operations more straightforward and controlled
More easily adoptable to available technology
Many companies offer these products
Slide 18: So what happened to Lockheed
El Camino was model for the industry in mid-1970s
But Lockheed decided to focus on government work
Sold healthcare IT business to Technicon Instruments Corp
Who sold it to Revlon
Who sold it to Pantry Pride
Who sold it back to Technicon
Who sold it back to employees in late 80s, who changed name of company to TDS; merged into Eclipsys in mid 90s
Was only real EHR system until near Y2K
Recently merged with Allscripts
Slide 19: To bring you up to date
According to HIMSS Analytics (systems installed, in progress, contracted but not implemented:
Meditech, McKesson, and Cerner have over 50% of EHR (clinical) systems market in US hospitals
Meditech < 26%
McKesson < 14%
Cerner < 14%
Siemens < 10%
Self-development is the solution < 6%
CPSI, EPIC, Allscripts, and Health Management Systems with market share between 5-10%
The data base includes 4.454 hospitals. (From the HIMSS Analytics data base as posted at Modern Healthcare.com By the Numbers: Top Vendors of Acute-Care EHR Systems, January 2009 to January 2010)
Slide 20: To bring you up to date
Stage 0-7 of EHR adoption http://www.himssanalytics.org/hc_providers/emr_adoption.asp
Stage 6, HIMSS standards require
extensive functionality and systems integration
full PACS for film and digital images
structured templates for full physician documentation
computerized labs, radiology and pharmacy systems in place
a clinical data repository fed by major ancillary clinical systems
a rudimentary rules engine to perform conflict checking
clinical documentation systems integrated with the repository
clinical decision support with error checking for drug reactions
175 hospitals have achieved Stage 6
55 hospitals have achieved Stage 7, a fully paperless record
Most hospitals are entering Stage 3 (clinical documentation, some eMAR)
Slide 21: For more information
Slide 22: Thank you