Health Information Management: Integrating Information Technology ...

24 STARTING POINTS
How was the EPR introduced? Who were the important, steering actors in this
development? In this section we will (rather patchily) outline the development of
PICS from the 1960s up to the present. It is not our aim to provide an exhaustive
historical account but merely to introduce a number of essential developments
and actors as a context for the issues that will be discussed later on in this book.
The first computers actually implemented in Western health care practice were
large, centralized mainframes for the financial and patient administration of
hospitals. The design and development of these systems was strongly stimulated
by the Medicare Program, set up in the United States in 1965. This programme
required hospitals to provide extensive, aggregated patient care information.
Such systems did not play a role in the working life of physicians and nurses:
during the 1950s and 1960s, they continued to work with the familiar paper
records. The first EPRs used by health care professionals were developed in the
1970s in US outpatient clinics and general practices. One example of such a
system was COSTAR, developed by the Massachusetts General Hospital. For
each consultation, the physician was given a printout of the patient record,
whereas during the consultation he would fill out a pre-printed form. Physicians
themselves had no contact with the computer: clerical staff had to be present to
produce printouts and to enter the data from the filled-out forms into the
computer.
The much cheaper ‘mini computers’ that entered the market in the 1970s made
it possible for hospitals and clinics to experiment with computerized forms of
medical data processing. Small experiments started up, such as the Artemis
project in Paris, which supported care and research for patients in the
Hypertension Clinic of Saint Joseph Hospital in Paris, or the ‘computer aided
diagnosis’ system that helped detect acute appendicitis patients in the Department
of Surgery at the University of Leeds.
A project that started similarly small was the Nobin-HIS project, started in
1972 at the Dutch University Hospital of Leiden. This project was co-sponsored
by the Dutch government. This computerized Hospital Information System (HIS)
was aimed at streamlining the flow of information within the hospital, while a
more general goal of the project was to develop an operating system specifically
designed for hospitals. The Nobin-HIS project resulted in BAZIS, in which
initially only university hospitals participated, though after 1980 general
hospitals in the Netherlands joined as well. Each hospital that decided to
purchase the BAZIS system was allowed to pass on its cost to its general nursing
fee. In this way, a close connection was established between the software
company, whose design was indirectly funded by government money, and the
medical field:
As a result of this whole scheme, a critical mass was generated: these first
three university hospitals—Leiden, Rotterdam, Utrecht—were soon joined
by Groningen and Amsterdam, and so forth. Critical mass was developed
among the user group, for [BAZIS] was still a nonprofit foundation where