History of Health Information Technology in the U.S.Evolution of Health IT: The

Early YearsLecture b – The 1970s

This material Comp5_Unit1 was developed by The University of Alabama Birmingham, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology

under Award Number 1U24OC000023

Evolution of Health IT: The Early Years

Learning Objectives

2

• Discuss how the problem-oriented medical record changed the structure of medical records

• Discuss the impact that increased access to healthcare had on the use of computers in healthcare in the 1970s

• Describe how key informatics innovations such as the problem-oriented medical record, MEDLINE, early EMRs and CDSS relate to the general healthcare environment of the 1970s

• Describe some of the early forerunners of today’s EHR including COSTAR, TMR, and the Regenstrief CPRS

• Describe early clinical decision support systems including INTERNIST-1, MYCIN and the HELP system

Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture 1b

General Environment – 1970s

• Access to higher education• Increase in science funding

3Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

General Environment – 1970s

• Access to higher education• Increase in science funding• Science applied to education

4Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

General Environment – 1970s

• Access to higher education• Increase in science funding• Science applied to education• Mainframe computers• Computer specialists in industry

5Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

6Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

(Courtesy: Lawrence Livermore National Laboratory)

Healthcare Environment – 1970s

• Increase in medical students

7Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

Healthcare Environment – 1970s

• Increase in medical students• Increase in NIH funding

Source: (Kalberer and Newell, 1979)

8Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

Healthcare Environment – 1970s

• Increase in medical students• Increase in NIH funding• Fee-for-service practice model• Few controls on physicians

9Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

Healthcare Environment – 1970s

• Increase in medical students• Increase in NIH funding• Fee-for-service practice model• Few controls on physicians• Escalating healthcare costs

10Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

Healthcare Environment – 1970s

• Increase in medical students• Increase in NIH funding• Fee-for-service practice model• Few controls on physicians• Escalating healthcare costs• Mainframe computers (fiscal)• Computer specialists

11Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

Healthcare Organizations

• Increase revenue– Increase number of physicians

• Increase in procedures, hospitalizations

12Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

Healthcare Organizations

• Increase revenue– Increase number of physicians

• Increase in procedures, hospitalizations

• Fiscal, data processing automation– Administrative Data Processing– Billing and Collections– Director of Data Processing

13Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

Physicians

• Solo, group private practice• Artful application of science • Increase in use of technology• Increase in income

Source: (Berg, 1997)

14Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

Physicians

• Solo, group private practice• Artful application of science • Increase in use of technology• Increase in income• Physician dominance• No direct use of computers

15Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

Academic Physicians

• Scientific practice of medicine

Source: (Berg, 1997, p. 22)

16Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

Academic Physicians

• Scientific practice of medicine– Technology– “Objective” data

• Emphasis on laboratory medicine

17Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

Academic Physicians

• Scientific practice of medicine– Technology– “Objective” data

• Emphasis on laboratory medicine– Systematic data collection/recording

• Problem-oriented medical record (Weed)

Source: (Weed, 1968)

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History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

Old-Fashioned Progress Note

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History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

Problem List

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History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

SOAP Note

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History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

Academic Physicians

• Scientific medical education

22Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

Academic Physicians

• Scientific medical education– Behavioral objectives– Objective evaluation

• Multiple choice tests

23Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

Academic Physicians

• Scientific medical education– Behavioral objectives– Objective evaluation

• Multiple choice tests– Problem-based learning– Teach medical problem solving

Source: (Neufeld and Barrows, 1974)

24Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

Medical Informaticians

• Automated clinical systems

Source: (Collen et al., 1971)

25Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

Medical Informaticians

• Automated clinical systems• Computers to promote the scientific practice

of medicine

26Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

Medical Informaticians

• Automated clinical systems• Computers to promote the scientific practice

of medicine– Access to knowledge and patient databases– MEDLINE

27Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

Medical Informaticians• Computers to systematize practice

– Computer-based Patient Record

28Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

Medical Informaticians• Computers to systematize practice

– Computer-based Patient Record• COSTAR – Mass General Hospital• TMR – Duke University Medical Center• RMRS – Regenstrief Institute

Sources: (Barnett et al., 1979) (Hammond, 2001)(McDonald et al., 1977)

29Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

Medical Informaticians• Computers to systematize practice

– Computer-based Patient Record• COSTAR – Mass General Hospital• TMR – Duke University Medical Center• RMRS – Regenstrief Institute

• Expert systems research– Clinical decision support, reminders, alerts

• MYCIN – Stanford • INTERNIST-1 – Pittsburgh • HELP – LDS Hospital

Sources: (Shortliffe and Buchanan, 1976)(Miller et al., 1982)(Warner et al., 1972)

30Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

Evolution of Health IT: The Early Years

Summary — Lecture 1b• Fee-for-service medicine• Artful application of science• Teaching medical students the “scientific practice of

medicine”• Automation of billing processes in hospitals• Research on clinical computer applications to make

clinical practice more scientific and to systematize practice.

Source: (Schwartz, 1970)

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History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

Evolution of Health IT: The Early YearsReferences – Lecture b

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History of Health Information Technology in the U.S. Evolution of Health IT: The

Early Years Lecture b

a

References

• Barnett GO, Justice NS, Somand ME et al. COSTAR – A computer-based medical information system for ambulatory care. Proc IEEE. 1979;67:1226-37.

• Berg M. Rationalizing medical work. decision-support techniques and medical practices. Cambridge, MA:MIT Press; 1997. • Collen MF, Davis LS, van Brunt EE. The computer medical record in health screening. Methods Inf Med. 1971;10(3):138-

42.• Hammond WE. How the past teaches the future: ACMI distinguished lecture. J Am Med Inform Assoc. 2001;8(30):222-34.• Kalberer JT Jr, Newell GR Jr. Funding impact of the National Cancer Act and beyond. Cancer Res. 1979;4274-84.• McDonald CJ, Murray R, Jeris D, Bhargava B, Seeger J, Blevins L. A computer-based record and clinical monitoring system

for ambulatory care. Am J Public Health.1977;67(3):240-5.• Miller RA, Pople HE, Myers JD. INTERNIST-1: An experimental computer-based diagnostic consultant for general internal

medicine. N Engl J Med.1982;307:468-76.• Neufeld VR , Barrows HS. The “McMaster Philosophy”: an approach to medical education. J Med Educ. 1974;49(11):1040-

50.• Schwartz WB. Medicine and the computer: the promise and problems of change. N Engl J Med. 1970;283(3):1257-64.• Shortliffe EH, Buchanan BG. A model of inexact reasoning in medicine. Math Biosci. 1976;23:351-79.• Warner HR, Olmsted CM, Rutherford BD. HELP, a program for medical decision-making. Comp Biomed Res. 1972;5:65-74.• Weed LL. Medical records that guide and teach. N Engl J Med. 1968 Mar 14;278(11):593-600.• Weed LL. Medical records that guide and teach. N Engl J Med. 1968 Mar 21;278(12):652-7 concl.