REMINISCENCE - HOSPITALS - PART 1

by BERNARD A HODSON

Canada took an early lead in the development of hospital information systems. While this article is about developments in Manitoba, other work was going on across the country.

In the mid sixties Manitoba decided to build a new hospital, the Victoria General Hospital (VGH), adjacent to the University of Manitoba, to replace one down town. The Administrator, Tony Quaglia, approached the University to see if computers might play a role in the new hospital. A feasibility study (involving a study of three hospitals and two major clinics) showed how an integrated hospital information system could be developed at a reasonable cost.

As far as is known it was the first hospital design in the world, to include provision for computer terminals in every patient room, necessitating significant architectural design considerations.

The response to the feasibility report was phenomenal, between 2000 and 3000 copies being requested from all around the world. I was also invited to speak to a vast array of medical groups. These invitations included the Medical Faculty at Birmingham, Newcastle and London Universities, as well as King's College Hospital in the UK. Presentations were made to medical groups in Eindhoven and Paris. Hoffman Roche in Switzerland commissioned a major article produced in English, French and German. An invitation to the annual gathering of international hospital consultants for Arthur Andersen (held in Chicago) was another, as was Columbia Medical School (Missouri), groups in St. Louis, the Massachusetts General Hospital along with members of Harvard Medical School, and the University of Michigan Summer School on Hospital Administration. In Canada presentations were made to doctor groups in British Columbia, Manitoba, Ontario and Quebec, as well as various hospital associations (in Canada and the USA) and nurses groups, including the Quadrennial Congress of Nurses when they met in Montreal.

The presentations covered the possible use of computers to assist in diagnosis, accept the various orders given by doctors, accept test results, monitor prescriptions, help in the preparation of nurses notes, maintain the patient record, and similar topics related to patient care.

It was decided to develop a pilot system based on the feasibility study and funding was sought and received to proceed, at which point a development team was assembled.

On the nursing side the team consisted of three research oriented nurses, Kathy Goos, Margaret McCrady and Grace Alexander. Tony Quaglia and his assistant gave input on the administrative side, and Dr. Bill Alexander later Dean of Pharmacy at the University of Toronto) worked on the pharmacy side, also doing some of the early work on drug interactions. Generalised Computer programs were developed under my direction by Ed Tretiak, who later became a lawyer, and Don Costin, with some help from graduate students. On the medical side input was received from the Rosenfeld brothers, on staff at VGH and several doctors on the Faculty of Medicine.

In addition Dr Sukenik, from the Harvard Medical School and the Massachusetts General Hospital, flew to Winnipeg from Boston once a month to review progress and give advice. He was involved in some of the early hospital automation activity in Boston working with Dr. Octo Barnett, a pioneer in the area.

A demonstrat1on to the American Hospital Association Convention in Houston was seen and reviewed by a considerable number of people, including senior people from medical groups in Canada as well as various industrial participants. The response to the demonstration was very favourable, the system itself being way in advance of anything else shown at the convention.

Dr. Goyette, (of the Federal Department of National Health and Welfare) reviewed the demonstration, (which was offered bilingually) and indicated his pleasure at seeing this development taking place in Canada. Several prominent medical groups reviewed the system in detail. As a guest with the Governor of King's College Hospital in London, England, he told me that his reviewers were amazed that 'so much had been accomplished in so short a time with so few people and so little money' (it was of course due in part to the generalised software concepts). Similar sentiments were expressed by groups in France, Holland, the USA and other countries. It confirmed that while generalised programs were radical, they nevertheless were feasible and did in fact work. Dr.C H Walton, Chairman of the Executive Council of a major Winnipeg based Clinic, said at the time, referring to the hospital project, ' We are fortunate in Manitoba in having one of the most advanced of such centres in Canada and it has developed a continent-wide reputation as a leader in its field'.

One group of reviewers said that they had conducted a world wide survey of software for time-sharing networks and that the generalised software system used in the project was the only one coming close to a reasonable system for practical operations. Similar favourable sentiments were received from many other groups.

The project was probably at least two years ahead of any other in North America at that time, a view confirmed by visitors from, and visits to various hospitals and installations in North America and Europe, with one exception to be shortly discussed.

Most hospital systems up to this time (there weren't many in actuality) had concentrated on the rather mundane patient billing and insurance activity. The VGH system linked the physician with the Labs, X-ray, Pharmacy, and other patient oriented situations, all tied together through the physician's order. This was the key to its success.

The one exception to its uniquness was the Mayo Clinic system developed by Lockheed Missiles and Aerospace. They phoned me and asked 'is your system for real', a legitimate question in view of all the published garbage of the period. They visited Winnipeg three times, while I visited their base in Sunnyvale once and also their project at the Mayo Clinic in Rochester, Minnesota. It was uncanny how we had independently gone through the same thinking processes and arrived at the same solutions. There were only two differences in what we had developed. Lockheed had the physician enter one order at a time while we allowed the doctor to initiate several at once, the computer keeping track. The other difference was in the application software, we used a single generalised program while Lockheed had a separate program for each application.

The way the system operated will be the subject of Part 2.