The Early History of Hospital Information Systems for Inpatient Care in the United States

Abstract

In the 1960s, large hospital systems began to acquire mainframe computers, primarily for business and administrative functions. In the 1970s, lower-cost, minicomputers enabled placement of smaller, special purpose clinical application systems in various hospital departments. Early time-sharing applications used display terminals located at nursing stations. In the 1960s and 1970s, a small number of pioneering institutions, many of them academic teaching hospitals with federal funding, developed their own hospital information systems (HISs). Vendors then acquired and marketed some of the successful academic prototypes. In the 1980s, widespread availability of local area networks fostered development of large HISs with advanced database management capabilities, generally using a mix of large mini- and microcomputers linked to large numbers of clinical workstations and bedside terminals. When federal funding for HIS development diminished in the mid-1990s, academic centers decreased, and commercial vendors increased their system development efforts. Interoperability became a main design requirement for HISs and for electronic patient record (EPR) systems. Beyond 2010, open system architectures and interconnection standards hold promise for full interchange of information between multi-vendor HISs and EPR systems and their related subsystems.