Information Technology Reference
In-Depth Information
In countries with a single payer health system it is feasible, but not certain, that
a single EHR or a small group of EHRs along with a national HIE would be pro-
vided, paid for by the system and used by all providers. [ 17 ] Almost by de fi nition,
this solves much of the interoperability issue. Arguably the best example of this
single-system approach in the US is the Veteran's Administration (VA) that has a
system wide EHR called VistA (Veterans Health Information System and Technology
Architecture).
The early history of VistA is a fascinating health informatics story and one in
which I was peripherally involved back in the early 1970's. The late Joseph T. “Ted”
O'Neill and a small group of “co-conspirators” hatched a plan in Ted's living room
to infiltrate the VA and launch the open-source development of a system wide EHR
based on MUMPS (Massachusetts General Hospital Utility Multi-Programming
System), a technology developed in the late 1960's to facilitate the development of
clinical information systems.
Incredibly and against very long odds, the plan eventually worked and today the
VA has a single system-wide EHR. The results can be impressive. For example, a
VA physician can, with a few mouse clicks, call up any images or other clinical data
relevant to their patient from anywhere in the nationwide VA system.
Of course this requires agreement or a mandate that everyone will use the same
systems. There is a long history of this issue playing out in US hospitals and across
the health informatics industry. Today a few companies dominate the large scale
enterprise health information system business. Listed in order of their founding or
the founding date of their oldest component, they are: Siemens (1968 as Shared
Medical Systems), MEDITECH (1969), Allscripts (1971 as Technicon Data
Systems), McKesson (1974 as HBO & Co), Cerner (1979) and EPIC (1979). To
automate virtually all aspects of a larger hospital or health system (no vendor can do
them all) these companies represent the available options. There are a few others
that specialize mostly in small hospitals.
Early on there were no vendors that could automate an entire hospital. SMS
began by offering hospital financial management systems. Two of today's market
leaders, EPIC and MEDITECH (both MUMPS-based), began, respectively, as sup-
pliers of EMR and laboratory information systems. Cerner also began as a supplier
of laboratory information systems. Two other vendors started with fairly advanced
system concepts. HBO & Co began with a patient information system called
MedPro. Technicon Data Systems began as a Lockheed effort in the mid-1960's to
commercialize technology developed in the space program by creating a very early
clinical information system at El Camino Hospital in California.
Each of these companies attempted to expand from their initial base by offering
more and more subsystems with the goal of being a sole source health informatics
provider to health enterprises. Initially virtually all spending was on financial and
administrative systems. The exception was laboratory and pharmacy automation
that were a particular focus because these departments were major revenue genera-
tors. Radiology would join them as modern imaging came into its own and comput-
ers became capable of storing images digitally. By the late 1980's a quarter of
spending was on systems in support of patient care. [ 18 ]
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