EHR - Time for a New Paradigm? (Part I)

The first commercially available digital computer was shipped in 1951. Not long after, in 1960, Robert Ledley suggested "some of the potential advantages of computer aids to medical data processing."[1] His interest was in using the computer to statistically analyze data about patients to improve care. He envisioned using one of several possible methods to collect and organize data, including McBee cards and a telephone dialing process. The data would subsequently be punched on cards and fed to the computer for analysis. Almost immediately, efforts to realize these advantages were initiated.

Concurrently, the banking, shipping, manufacturing, and merchandising sectors began to incorporate computer technology; many firms have had considerable success and some been completely transformed. This has raised the expectations within the medical community and society in general that similar benefits could be achieved in healthcare. Many physicians, healthcare organizations and IT business have made diligent efforts to develop and deploy computer systems.

Huge sums and much effort have been expended in the process. Despite an occasional localized success, the majority of implementations have left the physicians and healthcare organizations dissatisfied with some, if not all, aspects of their system. Many projects have failed outright, most have cost more and taken longer than anticipated. Few have delivered the expected functionality, ease of use, improvements in efficiency or cost savings. Others, observing these outcomes have simply avoided making an attempt.

The history of healthcare computing began between 1960 and 1965. Guy Octo Barnett's Laboratory of Computer Science at the Massachusetts General Hospital gained access to new computer hardware built by Digital Equipment Corp. (later Compaq, now HP) and developed software to allow it to be used in the hospital setting. The lab developed a programming language, Massachusetts General Hospital Utility Multi-Programming System, or MUMPS (later known as M) and a time-sharing operating system. Pre-dating video terminals, the input and output employed Model 33 teletype consoles. Small magnetic tape devices call DECtapes were used as the primary storage medium.

This early history is important for two reasons. First, it demonstrates that the popular view which holds that doctors have been slow to adopt computer technology misconstrues the lack of success as a lack of effort. The pioneering physicians were acutely concerned about how best to do it to satisfy the myriad of demands and expectations coming from all directions and tried their best to surmount the challenges they confronted. Second, the technical limitations imposed by those early machines affected decisions about the design of MUMPS and how best to store data that, to this day, exert a dominant influence over many software products used in the healthcare environment.

In part two of this blog post, Daniel Essin will explore how the past of healthcare computing has influenced the present and what that means for the current state of EHRs.
[1] Ledley RS. Lusted LB., The use of electronic computers in medical data processing: aids in diagnosis, current information retrieval, and medical record keeping. IRE Transactions on Medical Electronics. ME-7:31-47, 1960 Jan.

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