“H.I.S.-tory” by Vince Ciotti

© 2011 H.I.S. Professionals, LLC

Episode # 24:

Intermountain

Health Care (IHC)’s

& “Med/38” Part I

• Background– IHC was formed in 1975 when the Church of the Latter Day

Saints (no HIS pun intended) divested itself of 15 hospitals in Utah, turning them over to this not-for-profit multi system.

– IHC had a long history of computerization it inherited from the Mormon Church’s centralized service bureau known as MDC (Management System Corporation) in Salt Lake City. MDC offered primarily financial systems (like SMS & McAuto then), so 2 years after IHC was formed, circa 1977, it charged its DP department to build its own modern HIS system with clinicals.

– (we’ll see in a future HIS-tory episode how another hospital chain out west followed this same entrepreneurial path: American Medical International {AMI} and their PHS division)

IHC

• Larry Grandia– The man in charge of IHC’s DP department, later named as

Affiliated Services Inc. (ASI), is a household word in HIS circles. His biography alone could be a mini HIS-tory in itself!

– He is pictured below when he was appointed president of DAOU Systems Inc., before becoming president of Premier Inc.

HIS-tory Hero

• He is probably most famous for the HELP system (Health Evaluation through Logical Processing) at IHC, an integrated, patient-centered, rules-based clinical information system that was decades before its time.

- Earning him the 1995 Davies Award• To keep this episode under 100 slides,

however, we’ll concentrate on IHC…

What Mini to Build On!?• It was an easy decision back in those days of IBM’s dominance of

the hardware market, as attested by this chart from SIDA’s Guide:• ASI jumped on the Big Blue bandwagon,

who had just introduced their System 38 minicomputer circa 1978, successor to the Systems 34 and 36 that IHC started on.

• Way back in 1959 (were many of you even born that long ago? – I was 14!), IBM introduced a programming language called RPG – for “Report Program Generator”

• Back in those keypunch card days, the purpose of data processing programs was to generate a report from the stacks of cards/data – hence the creative name…

Etymology of a Language• The original RPG was indeed used with keypunch card

systems, and early IBM mainframes like the 1401 series.• RPG II was introduced with IBM first minicomputer – the

System/3, which evolved into the System/32 and System/36.• ASI jumped on the third generation or RPG III, written

expressly for IBM’s System 38 mini.• Later versions, such as RPG/400

were written for the AS/400 successor to the System/38.

• Don’t mock this ancient code – as you’ll see, hundreds of US hospitals are still running HIS systems that use it to this day!

A Maxi Mini!• And what about the box? ASI picked a winner in

the Sysem/38, which was also the preferred platform for a number of HIS competitors, such as Dynamic Control Corporation (DCC), covered in an earlier HIS-tory episode.

• The System/38 offered several breakthroughs:– New semiconductor technology– Built-in relational data base

• It morphed in later days into:• AS/400• pSeries• iSeries• System i• IBM Power Series

Birth of “Med/38”• So under Grandia’s guidance, ASI built its own HIS using RPG code

and running on System/38s, called creatively Med/38.• ASI re-wrote financial apps first, completing the design and

implementation in an amazingly short time:– By 1981, 17 IHC hospitals had been converted – AR days declined by 3 days, a rarity in HIS circles!– Costs were reduced from the old service bureau– New apps were added: Inventory and Fixed Assets

• Next came clinicals, which in those days were primarily Orders & Results, although ASI pushed the envelope with:– Pharmacy Information System (what acronym can one safely use for RX?)– Medical Records – including MPI, abstracting & chart completion– Case Mix and even Nurse Staffing – very daring apps for the early 1980s!

Early Sales Successes• ASI was IHC’s only “for-profit” entity, and it sure

showed it knew the not-so-subtle difference!• Within 3 years, 70 hospitals bought and

implemented Med/38, including the sale to two other multis eager to emulate IHC’s success.– Check the right to see how IHC ranked in 1987, per

Dorenfest’s “3000” data base of hospitals >100 beds

• In addition, ASI sold the System/38 minis as an IBM Value Added Remarketer (VAR), earning a handsome royalty on hardware sales.– (something Meditech hasn’t learned in its 40 years of

success – how many hundreds of millions {a billion by now?} have they given to JJ Wild, Perot, and now Dell?)

– (and Epic – how many hundreds of millions in hardware revenue have they passed up - odd…)

IBM-based HIS Vendor

# of Sites

Baxter 312

IBM 122

HBO 106

IHC 73

SMS 70

TDS 38

LeBlanc 14

HCS 11

AR/Mediquest

10

A Later Leader…• Larry Grandia moved on the other successes, and the next leader

of ASI in the late 80s was Scott Holbrook, with roots back to:– IBM (surprised?) and McAuto (another one! Wonder how many

HIS-tory heroes have not had prior experience at McAuto? Try Walt Huff of HBO, Bill Brehm of IFAS, Ray Paris of Keane…)

• Scott originally joined IHC way back in 1977, so experienced the whole creation of Med/38 and its amazing sales spurt in the 80s.

• Some tidbits from Scott in a 1987 interview:- Programmed in native RPG III for the Sys/38- System/38s ranged in size from 4 to 32 Megs- Disk drive space ran from 387 Meg to 14 Gig- Client base eventually included 14 multis- Client base ranged from 84 to 520 beds- 40 were in CA, and growth ran 25% per year-

Sound Familiar?• Scott Holbrook’s name should ring a bell, as his

career is almost as amazing as Larry Grandia’s:– VP of Sales & Marketing for Sunquest, one of the

earliest and most successful mini-based LIS firms– EVP at Park City Solutions, specializing in laboratory

orders & results to physician offices– EVP and Co-founder of KLAS – KLAS? I swear I’ve heard

that name before, wonder what they do…– Board member of HIMSS – ever heard of them?– EVP at Medicity, a leading HIE that bought Park City

• And it all started with a BS in Zoology from Brigham Young University (a propos for HIS…)

What’s Next?• In Part II of IHC and Med/38, we’ll trace a series of

acquisitions that lead through several giant companies, ending up with an amazingly large client base today.– Meanwhile, I’m wrapping up with the last few mini stories before

starting microcomputers, so anybody got some poop on:• AR Mediquest – an IBM Sys/36 system that Paul McVicker (

paul.mcvicker@hrhonline.org) shared some fascinating tidbits on from his experiences at Ozarks Medical Center.• JS Data – small hospital system that Steve Kilgus (

SKilguss@emdeon.com) and Tom Aikens (tom.aikens@maxithc.com) have commented with.

– Anyone other major minis we’re missing??• Please send any contributions to: vciott@hispros.com