H.I.S.-toryby Vince Ciotti,

Episode #102:

Siemens, Part 3

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

Product (R)evolution• SMS bought & developed a wide array

of products over its 30 year HIS-tory, many of which Siemens sells today.

• If you’re one of their ≈1,000 US client hospitals, this episode should help you appreciate how amazingly long-lived a quality HIS can be:- E.g: TDS’ MIS which started in the late 60s and ran beyond 2010:

Lockheed -> Technicon -> TDS -> Revlon -> Alltel -> Eclipsys…• SMS’ products have such a long HIS-tory and went through so many

name changes in the hands of their talented marketing people, that I have to extend a special thank you to the many veteran King of Prussians who sent lengthy emails that helped me trace the roots:

Glen Marshall Ron Dixon Ken Shumaker Doug Beaupit Phil Jackson Mike Cassidy

All Four Platforms• If you’ve been following this HIS-tory since it

started 18 months ago, you might remember it started by describing the four epochs and hardware platforms that dominated the HIS marketplace over the past four decades:– 60s = Mainframes, led by IBM and the “Seven Dwarfs,” wherein

SMS offered several inhouse systems like Independence & ICO.– 70’s = Shared systems, led by SMS, McAuto, Tymshare, etc.,

with SMS taking the lead in the 80s and dominating to today.– 80’s = Minicomputers, led by HBO, DCC, Meditech, etc., where

SMS sold it’s ACTIon line, & acquired MS4 & Computer Synergy – 90’s = Micros, led by HMDS, MedTake, CliniCom, Paragon, etc.,

in which SMS’ offered it’s “Novius” line of ancillary C/S systems.• SMS’ products in each of these platforms/decades had a complex

evolution, which we’ll trace in detail in these next two episodes.

Mainframe/Shared Systems• We’re going to lump these two together since SMS started as a

shared system with SHAS patient accounting, augmented with a self-developed ERP suite (which so few vendors offer today!) with several inhouse (“ICO” or Inhouse Computing Option) variants.

• As with other vendors, the diagram below illustrates the complex evolution of SMS’ products and marketing-driven name changes, with an emphasis on the derivation of the “modern” products Siemens still offers to this day. Some details had to be dropped to keep each episode to “only” a dozen slides for brevity’s sake.

Mainframe Financials• Patient Accounting – we called it SHAS back in the early ‘70s, but

the name and code changed radically over the next 45 years, first becoming the “Financial Management System” or FMS in the mid-70s by marketing maven John Marshall’s product managers. Hard to say how much of SHAS remained in the code over the years to where it still forms the core of Invision & Unity’s “RCM.”– Impossible to count the many bug fixes & enhancements

made over the years, but maybe 30% of the core remains today, e.g.: TCEs, profiles, CYCA for insurance proration, etc.

• General Accounting – aka ERP today, was started back in the 70s by Tony Mirigliani’s team of financial gurus: Hal Krell & Ron Ferro, later led by John Marshall and his team of product managers, who among them designed SMS’ own Accounts Payable, Payroll, Personnel, Inventory, Outpatient and Physician Billing systems, none of which came with SHAS. SMS’ ERP ran into the 90s when they were dropped in favor of Ross & PeopleSoft partnerships.

Mainframe Financials, cont’d• Other major products that survived to this day:

– Physicians Billing System, first developed by Tony Mirigliani & Co. back in the 70s and fine-tuned over many years when SHAS offered nada for MDs’ 1454 bills. It was modernized and re-named Signature as advertised in this 1987 issue of Computers in Healthcare magazine. A game-changer back in the day when IDX BAR ruled supreme, and building interfaces before IEs was hard! Run only as “shared,” not inhouse

– Eagle – I’m often surprised to learn how few people know Siemens still offers this mainframe billing system in the demanding NYC market, where it was designed to handle NY city & state’s intricate billing by American Healthware Inc. To get the full story of this amazing Brooklyn-based start-up that began life in the 70s as “H.I.S. Inc,” check out episodes 30 thru 32 at hispros.com. About two dozen large NYC clients still run it inhouse after all these years later, loathe to ever consider changing systems and jeopardizing their AR…

Mainframe Near-Misses• SMS didn’t always hit home runs as these two near-misses show:– UNIFILE – Covered in last week’s episode (remember the Uni-

Fi-Le t-shirts?), the first on-line, real-time, data base system, just a bit too powerful for the water-cooled IBM 370s in KOP. It was gradually de-tuned in a series of replacement products over the late 70s, each with a creative name of their own:• Focus – what else does a hospital do with its patient data?• PMS – Patient Management System, no pun intended!!• Command – Want to take charge of your census data?

– SURPAS – an acronym for “SMS’ Ultimate Replacement Patient Accounting System,” announced (sort of) in the early 80s to join the growing number of SHAS replacements that were entering the market such as Medipac and HIS, Inc. Product Manager Jerry Anderson led the charge in the field, but the programming went too slow to sell many inhouse shops on it.

Mainframe Clinicals• As we’ll see in detail in next week’s episode on SMS’ minicomputer

systems, the ACTIon product line evolved rapidly form its original Four Phase 4/40 & 4/90 minis, to DEC PDPs and VAXes, and even-tually to a mainframe-based alternative called “ACTION 2000.”

• Mike Cassidy gives the technical details for you geeks below:– “Action 2000 (A2K) was just the real-time (CICS-based) and supporting batch

("day end") programs, but it fed the SHAS and related stuff running in the Malvern datacenter in time for the usual 1pm-8pm-1am updates. Transactions were sent to Malvern throughout the day using various subsystems running in the background (TIF, Batching, Comm).”

• ACTION 2000 marked SMS’ foray into mainframe clinical systems, as this 1992 ad featuring Dr. Lynn Witherspoon from Ochsner Clinic intoned. Lynn actually built his own EMR and evolved it over several decades, using SMS primarily for patient accounting, but “A2K” led to SMS’ next product…

Independence Inhouse• HIS seer and good friend Frank Poggio told me this

fascinating tale of how he goaded SMS into first developing inhouse variants of FMS while he was CFO at the U of Wisconsin (Judy Faulkner’s home).

• In the mid-70s, Frank signed with SMS for its shared system for the usual (high) processing fees, but insisted in a clause in his contract that would give him the option of running the system inhouse within 3 years. At that time, Mediflex’s Medipac was starting to making a splash as a SHAS replacement run on inhouse IBM 4300 mainframes, so Frank wanted to cover his bases.

• It took many flights to KOP and meetings with Big Jim, and Jim Carter (over Ops) before he finally got their OK to provide an inhouse variant of FMS, which was not delivered until the mid-80s. To cover its Philly roots and ability to run inhouse, it was named “Independence,” and subsumed both A2K and FMS.

Mainframe Breakthrough• The biggest development in mainframe

systems for SMS was Invision, announced in 1989 at the “SNUG” Independence user group. Invision rocked with many significant technical breakthroughs, including the:– OAS or “Online Architecture System” for

clients to design & build their own screens.– Three processing options: remote (RCO),

inhouse (ICO) and turnkey (TCO)• Over the next 20 years, Invision became

SMS/Siemens mainstay product, selling to over 600 hospitals, including many large AMCs. In later years, it was upgraded to “OAS Gold” and enabled clients such as Meridian Health in NJ (1997 HFMA article on the left) to successfully implement CPOE a decade before ARRA MU.

“The New Thing” Soars!• Circa 1997, word started to slip out about

a brand new product SMS was developing that was called “TNT,” acronym for “The New Thing” or “The New Technology.”• With their typical genius at marketing, SMS kept TNT details secret, only announcing it to a “select” group of client/prospects (all?) who they were considering to be “partners” in such a daring new system. As is true with every radically new HIS (eg: Release 6.0, Paragon, etc.), it took many more years and releases to deliver the goods.

• It took a heavy investment by Siemens who bought SMS in 2000 before Soarian started to deliver the clinical goods by the mid-2000s. The wait was well worth it for Soarian clients however, who love the workflow engine, and are now learning about the revenue cycle applications…

Next Week: Minis & Micros• The HIS- story of the many

products SMS developed and acquired is just too long for one week, so we’ll pick it up next week with the details on the many mini base products such as ACTIon, MedSeries4, and Allegra, as well as some precocious PC-based systems that are still being sold today and have helped Siemens clients finally achieve the goal of this 1994 ad about EMRs: