H.I.S.-toryby Vince Ciotti, Episode #101:

Siemens, Part 2© 2013 by H.I.S. Professionals, LLC, all rights reserved.

1969 = Ross & Royal Roads,

Bridgeport 1971 = 650 Park Avenue, King of Prussia

1981 = 51 Valley Stream Parkway, Malvern

It Was A Very Good Year!• This week continues the HIS-tory of Siemens Healthcare,

today’s #3 vendor in annual revenue, whose HIS roots go back to the mid-1960s when IBM first developed SHAS, featured last week.

• Thanks to the many HIS veterans who contributed to the origins of SHAS, which automated patient accounting in thousands of US hospitals who used it through local Blue Cross, state hospital associations, and many proprietary firms like Gamut & SMS.

• This week, we cover the early days of Shared Medical Systems for CIOs who may not have been born when it was founded in 1969.I was fortunate to be one of SMS’ early employees (#24, hired in October of 1969), so I’m going to relay the inside and human story of SMS’ amazing growth to eventually being the #1 HIS vendor.

SHAS Was Not Perfect!• SMS started running IBM’s SHAS soon after its release, and

like all new HIS products (Millennium, Paragon, Soarian, etc.) it had its share of bugs, design flaws, missing features, etc., all to be corrected in the 4th quarter per the vendor (but in what year?).

• We touched on one last week which was the Scalar Date routine IBM came up with to minimize storage requirements back in the days of their 360 mainframe, whose disk drive had one (1) meg!

• An early SMS programming maven, Glen Marshall, tells the tale (he’s pictured on the right at our 2007 reunion in FL):“In the mid-1980s I rewrote the old SHAS scalar date routine, changing the base-date from 1/1/1900 to 1/1/1960. This extended the range of dates until September 2049, well past my 100th birthday. For the geeks among us: The original scalar date calculation was done in packed decimal arithmetic: year x 36525 / 100 (by lopping-off 2decimal places) then calculations for month, day, and leap-year adjustments.” (VC: pretty simple, huh?)

Y2K Pre-Cursor (still love that pun!)“My rewrite was based on the date calculation formula used in satellites, and that formula dealt with the Y2K problem as well. (I saw it coming early...) In addition, the calculation was done in binary register arithmetic, which cut the CPU time for date calculation by 90%. This time-savings was significant. The billing records were chock-full of dates that entered into the insurance proration calculations. As I recall, the savings was nearly a net 10% savings for the overnight billing program runs. That is a major savings for a mainframe.All the scalar-date using programs needed to be re-linked to pick-up the new date calculation subroutine. A one-time conversion program was run to change the date-base to 1960. Everything works like a charm. Only one program was not re-linked, though, due to an oversight. And that was the one that caused the headache and headline in 1989.” – Glen Marshall

Start-Up Ups & Downs• There was an amazing esprit de corps at SMS in those early

days – as I’m sure there was at HIS new start-up: McAuto, HBO, SAI, etc. Everyone knew we had to work hard just to survive, let alone ever make the big times. The hours were long and hard too: I got up one winter morning to a freezing rain at my home and couldn’t get the door to my ‘vette to open – the lock was frozen solid! I tried heating the key with matches, to no avail. Waiting an hour for the sun to do its job, the phone rang around 9AM – it was President Jim Macaleer wondering why I wasn’t there yet: – we were supposed to start at 8:30!

• And I’ll never forget the “Saturday Club” – a small group of fools like me who got their dull admin stuff done on Saturday mornings: “Big Jim,” Harvey Wilson (Sr. VP Sales & Marketing), Mike Mulhall (VP of Installations), Phil Jackson (Terminals), Tony Sam (CSC)… you could tell who was in by the cars parked in the near-empty parking lot at 650 Park Avenue…

Inside Humor• It wasn’t all just work

during those early 10-12 hour days either – we goofed off a lot to keep each other half sane...

• We IDs (Installation Directors) received a stream of “ID Memos” from K of P telling us of bugs that were fixed and new features or modules.

• I was an ID at SMS’ NJ office, and wrote this mock memo to a hot chick in King of Prussia HQ trying to impress her with my puny humor (she was an English Major too).

• She laughed, but didn’t buy…

Outside Humor• ID memos were pretty

technical, so they were re-written in English (sort of…) for clients to learn of new enhancements by our Customer Service Center.

• They were called CSC Memos and #531 went out in 1977 that really didn’t do a good job of explaining some changes to our new Inventory system...

• The next day, Big Jim wrote this cover memo to a re-written version of the memo apologizing to our 100-odd (sic) clients!

New Product Break-throughs• SMS had an amazingly talented team of programmers, and

one of their technological breakthroughs was called UNIFILE – Ken Shumaker led the development of this powerful & precocious 1970’s data base system, based on MRI’s “System 2000.”.

• Unlike SHAS’ batch processing, it processed transactions in real time as soon as they were entered (like rival McAuto’s HFC did), and then passed them on to an on-line data base for inquiries.

• Needless to say, it sold well, but as more and more clients jumped on board, things started to slow down as the water-cooled IBM 370s of that era had trouble handling the many census transactions, report writer requests, and db inquiries…

• It was later toned down to less-powerful but more reliable versions called Focus & Command, but at one of SMS’ infamous Xmas parties, I had a blast giving Big Jim, Harvey Wilson and Ken Shumaker three T-shirts labeled respectively Uni, Fi and Al!

Near Misses• The earlier HIS-tory episode on SMS (#11 –see them all at

hispros.com) as a shared system pioneer covered two near misses that might have put SMS out of business early in the 1970s:– Regionalization – expanding from 1-digit to 3-charcater

hospital codes that brought SHAS down for days on June 30– Cash Flow – turning the corner from red to black circa 1971

• Another close call was when SMS moved from its original rented space at Ross & Royal Roads in Bridgeport to a former bank building we owned at 650 Park Avenue in King of Prussia. Phil Jackson, who was assigned a number of challenging tasks (like ACTIon and the NYCHHC install) headed up moving the data center, and he asked we IDs to go to client hospitals on three Saturdays, the first 2 to test the move, the 3rd for the real thing.

• We all went to clients and dumped in batches of cards for the two tests, with only a few problems switching the hundreds of phone lines, etc. When it came time for the 3rd test we got the word: the 2nd one was the real thing – no need for #3! Few complaints…

Green IDs• Another down side to start-up firms is the lack of

experience with the system by their “green” staff. Not just green in terms of age, but practical experience.

• Most of we IDs at SMS in the early 70s were totally new to computers, hospitals and accounting basics: - I was an English major at my first “real” job- Al College (eventual VP) was a former school teacher &

coach- Takis Petrakis (sadly deceased) set the record for ID

novitiates: he was the former captain of a submarine in the Greek navy!

• So what, you ask, doesn’t every vendor hire rookies and train them? We had a 3-week class that tried to teach us every aspect of SHAS (several million lines of code!), accounting (debits vs credits) and hospitals (what’s the difference between an RN, LPN and Aide?) – lots of luck! We learned as as much as we could during those 3 weeks, then were sent out to the real world to learn in the school of hard knocks, at our client hospitals’ time & expense.

• Aren’t we so much smarter today? Every CIO insists on meeting the ICs (Implementation Consultants) before they ever sign, right?

Card Column 11 of the Header Card• Al College & I were assigned to convert St. Vincent’s Hospital in

Staten Island, which had been totally manual on NCR posting cards. We started with AR, showing them how to fill out coding sheets for their thousands of ledger cards for keypunching:

• The cards were then sorted into batches of ≈50 each for ease of handling, and SHAS required each one to have a header & footer card. On the header card went the hospital’s code (St. V = “O”), the batch type (new AR = 05), a batch number (001 to 999), etc.

• According to the SHAS OPS manual (our bible!), card column 11 indicated outpatients with a “6.” So Al & I dutifully sorted all the hundreds of batches by IP & OP, entering a 6 in cc 11 for OP ones. Wouldn’t you do the same – it’s what the book said!?

Catastrophe!• I squeezed all the boxes of 5081 cards into my car on Friday

night, drove them down to K of P to load onto our mainframe over the weekend. On Monday I went back to get the TCEs (Transmission Control & Error report), and was dismayed to have as many boxes of paper error printouts as we had submitted keypunch cards! It seems what the SHAS OPS Manual meant to say was that cc 11 separates OP vs IP charges (batch type 03): new AR from cards was batch type 05. Oy Ve!!!!!!!!

• So I drove the boxes of error reports back to the poor folks at the hospital, who started trying to correct the bewildering array of duplicate errors that each batch had generated: some from the AR program, some from the OP billing program. A nightmare!

• Precious days went flying by as all patient accounting activity halted until we could correct all the errors and balance the AR – we never did, and after a few weeks, the CFO just wrote off the difference (6 figures…) before we proceed on to ADT & Billing…

Near-Death Experience• We converted Census and Billing at St. V’s much better, and

the hospital eventually benefitted enormously from automation – it is still an SMS (Siemens) client to this day! But I must admit, I still avoid driving over the Goethals bridge thru Staten Island, afraid the CFO might still be gunning for me somewhere out there…• I probably almost got fired for the screw-up – I remember trying to explain to Steve Macaleer my ID Manager about the error in the SHAS OPS manual, but he told me to not screw-up again…

• The real irony is that I learned from my mistakes, became one of SMS’ better IDs (aced my 2nd and 3rd hospitals), and was eventually promoted to be Education Manager, in charge of teaching all new IDs the ropes. I told this story to every trainee!

• So is it better to get a rookie who’s very bright and hard-working, or a stogy old veteran who just repeats the same formula over & over? I’d look for both: a veteran who is smart & willing to learn!

• And never be any IC’s first implementation! Send them back…

The Takeaway?• So what can one take away from this story of SMS’ early days –

should a CIO stick with large proven giants like today’s leaders:– McKesson, Cerner, Siemens, and other “Top 10” HIS vendors, – or take a risk with daring new “cloud-based” products from

early start-ups like CSS HealthTech, or RazorInisghts? • Like so many HIS issues, the answer has both pros & cons. Pros:

– Giants forget their own past when they too were start-ups themselves, viz: Huff, Barrington & Owen in Walt’s kitchen struggling to write an order entry system on a Four Phase…

– Small start-ups generally give the best service as any of their early clients can get the CEO on the phone & they’ll listen!

• And on the other side of the coin, there are cons, like:– Who can remember hot new start-ups Bulldog IT, IntraNexus

and American Health Net, who rocked just a few years ago?– An adage from the 60s had it that “No One Ever Got Fired For

Buying IBM” – dare take an unknown name to your Board?The answer is different for every hospital and every HIS-tory

epoch…