Sunday, May 31, 2009

When was the very first electronic prescription used? I say ~1978.

I asked Fred Trotter, advocate of Free Open Source Software, in the Medical Field, a question about FOSS certification of Medical Software.

I mentioned that I did work in this field back in the 70's; In actuality it seems we were creating the field in the 70's. Fred asked that I cover this in my blog, so here we are.

"Bob,
Your work on e-prescribing is an important source of prior-art!! Please consider detailing exactly what you did, and how you did and even source code as well as the dates that you did this on your blog!!" - Fred Trotter

In the years 1977 to 1982 I was working my way through school by writing medical software for the office of Dr. Armour and Dr. McDowell, in Farrell PA.

Keep in mind the time frame, 1977, the IBM PC had not yet be invented, and Internet effectively did not exist outside of academia and the military. The top end, off-the-shelf, computers of the day were the Apple-II and the TRS-80 Model-One. Very few people knew what a personal computer was, as I'm not sure the term "personal computer" had yet been coined at that point in time.

I was a classic Nerd, the movie Revenge of the Nerds was a documentary of my life. [Us Nerds did win by the way, or you would not be reading this right now would you?] My father knew Dr. Armour through their shared interest in Amateur Radio.

Dr. Armour was interested in the new area of computers and how they might help his medical practice become more efficient. Mostly Dr. Armour and McDowell practiced obstetrics, that is they delivered babies and new born follow up care. As giving birth and what most new born's do, have not changed in many Milena, Dr. A. wanted a standardized menu you where you could enter the common things that would happen, so that the printed notes could be put in the charts, and the common prescriptions for the new mothers and children could be printed. I'm sure we all know how bad the handwriting of most all doctors are. That is because they have to write a lot, and it gets tiring.

Dr. A. setup his personal TRS-80 Model-I, as the Model-III did not yet exist; it would be out soon, in the back office of his practice, gave me a key to the back door, had me set in on a few exams, with the permission of the mothers to be, and exams of the new born's, gave me a few notes and long discussions on what he wanted, which I then coded up in BASIC. C compilers were rare and expensive then. After a few back-and-fourth sessions a basic system was setup to try out. Today this set up would be termed and Expert System, but I did not know that at the time.

I don't recall for sure if we moved the Model-I to a cart, or if we had gotten a second Model-I, anyway a cart with computer and *noisy* line printer was placed in one of the exam rooms. Eventually all of the exam rooms had TRS-80 Model-III's in them, each with quitter printers (remember the frequently sleeping babies in the room??). Networking as we know it today did not exist, it was just starting to come out in its earliest forms.

The two things I remember most are spending time in the exam rooms, remember as a Nerd, that always made me a bit queasy, and the day Dr. Armour came in and said he just got a phone call from the Druggist, I think it was RiteAid at the Shenango Valley Mall, but I don't recall for sure.

The Druggists called us and asked if the printed prescription he was holding in his hand was for real. I remember distinctly asking "Is there a problem? What is wrong with it?". To which Dr. A. replied, "No, they loved them, they could read them! They want more, and want to know if others doctors in the area will be using these, they hope.

I know Dr. Armour did discuss doing this setup with other doctors in the area, but I don't recall anything really coming of it. Remember small computers were still unknown to most anyone at this point in time.

I know Dr. Armour and I never even considered patenting or copyrighting the system back then, the nature of the time. Not sure this would count as Open Source, the term did not exist then. We would have given the code to anyone that wanted it. Few doctors seemed to 'get it' then. I wonder if they even get it now at times?

I know I don't have any of that source code or notes any longer. This does give me a good reason to go visit Dr. Armour and see how he is doing, and to see if he has anything left. He retired along ago.

One other thing worth mentioning was that Dr. A. and I attended the very first MUMPS conference in DC in 1981. Still have the DEC MUMPS badge around here some place, and the manuals on the language. Dr. A. and I thought it would be a good way to get things networked. The technology that Dr. A. could afford at that point in time, DEC machines, was just a bit out of reach, so we never did a lot with it. To this day I still look in on what is happening with MUMPS once in a while. There are many places that still use MUMPS. Still have the books:

  • Computers in Ambulatory Medicine; Proceedings of the Joint Conference of the Society of Computer Medicine and the Society for Advanced Medical Systems. October 30-November 1, 1981 Sheraton Washington Hotel, Washington, D.C.
  • A Manual of COMPUTERS IN MEDICAL PRACTICE.
  • Computer Programming In ANS MUMPS. A self-instruction manual for non-programmers, by Arthur F. Krieg and Lucille K. Shearer.

The bottom line is can anyone point to a earlier date than the late 1970's for e-prescribing?