100. siemens, part 1

H.I.S.-toryby Vince Ciotti

Episode #100:

Siemens, Part 1© 2013 by H.I.S. Professionals, LLC, all rights reserved.

3rd of Today’s Leading HIS Vendors• We continue the HIS-tory of today’s vendors with

Siemens, whose est. 2012 HIT annual revenue of $1.8B puts them in 3rd place among HIS vendors:1. $3.2B = McKesson, née HBOC = Walt Huff, Bruce Barrington, & David

Owens 2. $2.6B = Cerner, still run by Neal Patterson, co-founded with Cliff Illig3. $1.8B (est) = Siemens, née SMS: Jim Macaleer, Harvey Wilson & Clyde Hyde4. $1.5B = Epic. Gee, I have to wonder, just who was it who founded them? 5. $1.4B = Allscripts, née Eclipsys, also founded by Harvey Wilson of SMS.6. $850M (est) - GE Healthcare, née IDX/PHAMIS: created by Malcolm Gleser7. $597M = Meditech, still run after all these years by Antonino Papallardo8. $375M = NextGen: née Quality Systems Inc. founded by Sheldon Razin9. $183M = CPSI, founded by M. Kenny Muscat & Denny P. Wilkins (who??)10. $156M = HMS (Healthcare Management Systems), Tom Givens & John Doss 11. $150M = Keane, parent giant by John Keane, but HIS div. built by Ray Paris 12. $106M = QuadraMed, née Compucare, founded by Sheldon Dorenfest13. $75M (est) = Healthland, formerly Dairyland, founded by Steve Klick

Siemens’ 4-Part Saga• There are actually four stories behind today’s Siemens and where

its 3 key products (Invision, Medseries and Soarian) came from:• The 1960’s roots in IBM’s SHAS, which gave

birth to SMS and dozens of other shared systems during the post-mainframe 1970s.

• Shared Medical Systems (SMS), whose PA headquarters locations gave it 3 mini-epochs: Bridgeport, King of Prussia and now Malvern.

• MedSeries 4 – as pioneering a mini system as SHAS was a shared system, with roots at IHC, then GTE, and eventually sold to SMS.

• Siemens, whose history goes back over 165 year ago, and whose healthcare division sells many products to almost every hospital department.

The Roots of IBM’s SHAS ?• Many thanks to a number of HIS-talk readers and old SMS friends

of mine who answered my inquiries about the origins of SHAS. My sick brain still remembers so much trivia about it that I am embarrassed to confess how much grey matter I am wasting:– For kicks, let’s have some fun and see who remember these

card codes – the first 2 digits on the 5081 cards we punched:• Admissions = 11, 12 (credit info) and 13 (guarantor) cards• Discharge & Transfer = 16 and 17 cards, respectfully• CDM = 30-card series (I think!?), some used later in AP…• Charge cards = 40-series for 1, 2 or 4 per (43 was a credit)• Payments: 81 = patient, 82 = insurance• Adjustments: 80-series; 87 = patient to ins, 88 = ins to pat

• This is sick!! Why do we waste our precious grey matter on such

total trivia that will never be used (except for writing this…)?

So What Was “SHAS?”• For you (very lucky) young CIOs, here’s a quick HIS-tory of SHAS:

– Mainframes dominated hospital “data processing” rooms in the 60s, like server racks do in today’s modern data centers.

– And IBM dominated mainframe sales in the 1960s just like Microsoft owns today’s business market for Office & OS, and Apple owns the home PC, iPhone, iPod and iPad markets.

– By the late sixties, IBM & its “7 Dwarf” (aka BUNCH Group) competitors had sold almost every large hospital in the US a mainframe, and all that were left were small to mid-size that couldn’t afford the million dollar price tag and large dp staff.

– So Armonk started a project to write software that enabled a group of small or mid-sized hospitals to share a mainframe, opening up thousands more prospects for their machines. They called it the “Shared Hospital Accounting System” or SHAS in geek-speak, and the question is, where did they do it?

Some Answers• Here are some of the many answers I’ve received over the past

week – the first from Ken Shumaker, easily one of the best & brightest at SMS, later famous for being the father of “Unifile”

“My recollection of SHAS goes back to my time in IBM from 1965 to 1970. A guy named Dr John(?) Duffy was IBM's medical director of the Advanced Systems Development Division with 3 geographic centers:

1. San Francisco Presbyterian and Doctor Jim Beaumont were focused on intensive care monitoring.

2. Rochester Minnesota had a 14 person group headed by Gerry Shultz working with the Mayo Clinic. That is where Jerry Vogt, Alan Sprau, Jim Vaughan, Clyde Hyde, and I worked (VC: other hard-working, brilliant guys from early SMS days). The projects were all clinical. A guy on the Mayo Clinic Board of Governors, G Slade Shuster had flown bombers in WWII with Thomas J Watson Jr. Their friendship eventually led to IBM establishing a manufacturing plant in Rochester MN. Clyde Hyde (VC: co-founder of SMS) worked with Doctor Ralph Smith on a computerized EKG analysis program using the Frank 3-lead system.”

Ken’s Story, continued– “Alan Sprau worked with Dr Welby Newlon Tauxe on nuclear medicine scans,

a precursor to CAT scanners.” (VC: Alan was Tech VP for SMS, and later formed his own company in Minnesota to sell “Metafile,” his version of the pioneering Unifile data base system, which Frank Poggio used at HMDS)

– “I worked on a multi-phasic testing program with Dr Duffy in Armonk New York and then on a Mayo Clinic registration and appointment scheduling system. There were other projects - brain probes, radiation therapy, etc.

3. The third group was in Armonk NY and did clinical work at Columbia Presbyterian Hospital with a Clinical Decision Support System. Leon Pordy, a cardiologist developed an EKG analysis program based on the classic 12-lead system that competed with Clyde Hyde's EKG program at the Mayo Clinic.

• Dave Hartinger is the name I associate with SHAS. Whereas all the clinical systems were oriented to the IBM 1800, SHAS was directed at the accounting needs of the new Medicare system and written for the 360 mainframe.

That's about all I know – and not much about SHAS”

- Ken Shumaker

Another Contribution• This from Doug Beaupit, one of the nicest IDs in King of Prussia:

– “I worked as a programmer at Atlantic City Hospital (ACH) and converted the hospitals payroll from unit record to a 1440 computer. I also brought up IBM's stand alone on-line hospital package for Census and Patient Billing, AR and GL on the 1440. The 1440 was an all disk system that had up to 4 drives to store files. Each drive had the capacity of 2 million bytes. It wasn't long before you exceeded the capacity. I did a lot of manual manipulations to keep the files open until IBM came out with their 360 system.

– IBM realized that all hospitals were not going to buy a stand alone computer, hence, the invention of SHAS with the advent of a new series of computers called the 360. IBM spent 56,000 man hours on the initial version of SHAS development. Harvey Wilson was the salesman at Atlantic City when ACH bought the 360. The 1440 was a one shift on line operation that went to a 24/7 operation on the 360. With the 360, the Patient Accounting files were on disk and the A/R , GL and Bad Debt files were on magnetic tape. At that time SHAS software was free with the purchase of the hardware.”

Doug’s Story, cont’d• “I attended IBM's kickoff of SHAS along with Earl Messick - I

think he came from HUP - we all had the jobs of implementing SHAS in our respective hospitals. I believe Jim Macaleer sold many of the Philly hospitals along with Harvey.

• I implemented SHAS (Census, IP / OP Billing, A/R, B/D and GL) in a stand alone environment at ACH. My IBM System Engineers were Bill Wagner and Elise Rimelli. Nancy Ames was the programmer in the Philly Office who maintained SHAS for IBM and when SMS was formed she was hired to maintain and expand SHAS for SMS. When SMS was formed, Harvey immediately sold West Jersey Hospital, which became SMS’ first client. The SHAS software was designed to live until the mid seventies and the next generation of computers. Earl and Nancy worked on training SMS staff on SHAS and designed the expansion of SHAS for SMS. Earl and Nancy may wish to expand on my comments. Hope everyone is doing well and is going to have a great summer,”

- Doug Beaupit

More Early SHAS Tales• From Phil Jackson, one of the great ones at SMS who led the

Terminal Development team that built ACTIon on 4 Phase minis:– “In early 1969 worked for 6-8 weeks with the IBM development group,

located in White Plains, before I came to SMS. They were part of an of the development organization which carried the internal name of “Shared Medical Systems.” When RJM, CH and HJW did their thing -- they must have quit using that name. The charge of the group was to develop SHAS. The manager was Steve ???. This is the group which developed the background job scheduler for DOS. A woman named Martha developed the insurance proration portion of PB. Later in conversation with Jean Irwin – who knew Martha pretty well and used her as a resource when modifying the ‘CYCA’ insurance proration for coordination of benefits.”

- Phillip D Jackson

And From the West Coast…• Another great guy and superb salesman, Ron Dixon who opened

SMS’ LA office and sold hundreds of hospitals over his career:“I was with IBM in Los Angeles as a medical salesman (GEM Region) in 1968 when IBM put together a SHAS sales training school in Washington D.C. for all of the national medical reps. They primarily were looking to sell System 360's to all of those old 1440 hospital customers who used the old PAL patient accounting system. There were quite a few of those around the country. I was able to sell 360 Model 30's to Cedars Sinai and Children's Hospital of Los Angeles running PAL in compatibility on the 360, then planning to convert to SHAS when operational. IBM had signed a consent decree with the Justice Department agreeing not to sell timeshare services at that time, so IBM couldn't offer a shared service to hospital - they put SMS in business with that consent decree.”

- Ron Dixon

And From the East Coast• From Ken Clarke, a veteran CIO and now consultant in WV:

– “Sorry I don’t know the origins of SHAS. We uses it in mid-1970’s at Long Island College Hospital and St. John’s Episcopal Hospital in NY. It was one of the first software apps that gave you the source code and came with a hospital profile that supported multiple hospitals. You needed punch cards to update a field in the profile. It was written in COBOL and also had multiple subroutines written in IBM Assembler language.

– It stored “scalar” dates in a two character hex format that used Jan 1, 1900 as the base, which meant a Y2K-like death in 1989...

– SHAS used an ISAM (indexed sequential access method) hierarchical database which allowed for fast retrieval and reasonably fast adds. We used SHAS as the starting point for our system at St. John’s where I started WECAL (West End Computer Associates Limited). We expanded the date to 3 hex characters to eliminate the 1989 expiration problem. We also eliminated the card updates to the profile – we used CICS – remember that ancient beast? I sold the software to Bob Pagnotta at Jones/Hosplex and worked there for about a year.”- Ken Clarke, FHIMSS

So Who Cares?• Two answers to that question:

1. Look what happened to over a hundred hospitals in 1989:

So Who Cares, cont’d…2. About 500 CIOs and their C-Suites should care, as that’s about

how many hospitals are running Invision, whose “FMS” or Financial Management System for patient accounting still includes major portions of SHAS, including such jewels as:- TCEs – Transmission Control & Error Reports and “Recircu-lating Error Files” that go back to 5081 keypunch cards…- CDM - Charge Description Master, a relic of SHAS’ ISAM files

• Granted, SMS made major revisions and improvements during its 30 year run with SHAS, and Siemens’ “Soarian” is finally delivering a modern Revenue Cycle replacement product 15 years later, but most CIOs I know who are running Invision are extremely pleased with the performance of this 45-year-old machine and are reluctant to ever consider a replacement…

• Just like me with my 1965 Austin Healey 3000 from the same era, that I ride into town daily!

Last SHAS Story• The most interesting story of SHAS’ origin comes from another

SMS vet: Bob Haist, who joined us in 1976 when we merged with American Hospital Supply’s ISD (Information Services Division):“Vince, Thanks for another trip down the "M"-lane! One thought to share:

Was it Michigan BC/BS hospitals with IBM and SHAS, or Minnesota? (VC: this after I reported a story that Michigan BC/BS might have started SHAS) It was my recollection that it was Minnesota (in fact one of those BC/BS execs was head of SMS' (Lab, I think) division for a while... What fun it was, eh? Thanks again for all your work with this HIS-tory. I will look forward to seeing you again at a reunion or just on the street one day! Best regards, - Bob Haist”

• So the riddle is still unsolved – just who, when and where designed and wrote SHAS, a system that automated several thousand hospitals over its 50+ year HIS-tory? Any readers with more SHAS stories, please send them along, or next week we’ll jump to the story of how SMS grew from Ross & Royal Roads, to 650 Park Avenue in King of Prussia, to its current Malvern HQ.