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Before John von Neumann in the mid 1940s described how a
computer could store instructions in memory in other to carry out calculations,
computers were programmed by calculating circuits that were manually wired
together for mathematical calculations to be performed.
This was followed by the release of the first software by the
University of Manchester in England, which ran on a computer called
Baby. Series of computer programs followed suit and could be loaded onto the
computer through the use of memory tapes and punch cards. However only one
software program at could be loaded onto the computer.
This changed with subsequent improvements in the loading of
programs into computer memory and led to the birth of the software industry in
the late 1950s. Software programs were written for large mainframe computers,
which were usually kept in the basement of large corporations. It was not until
the 1960s that some healthcare organisations begun to use mainframes to run
hospital services such as admissions and billings. A lot of the software in use
then were written by the computer hardware companies and were given out ‘free’
as part of the computer purchase. However computer users till had the option of
having software either being written for them either in-house programmers or
contracted out to a software company.
The 1970s saw an increase in the number of software products,
especially after the introduction of the personal computer (PC). The software
applications written then were not primarily aimed at getting different
computer systems to talk to one another and the information gathered by
departmental were very much isolated.
The 1980s saw the PC gain more prominence and with that came a
wide range of off-the-shelf applications. However it was not until the 1990s
with the introduction of the Internet, as we know it today and network
computing that the islands of information within healthcare organisations could
now be integrated to give an almost seamless flow of information. Or so it
Although it was now possible for computers within different
parts of the hospital or even different hospitals could talk to one another,
the data collected by different software packages from different manufacturers
were stored in incompatible formats. The concerns raised by the lack of
communication between various medical information location points led to the
introduction of the Electronic Data Interchange (EDI). EDI defines how the
communications (called messages) should occur between different systems, and
its primary concern is the content of the messages and not how the message is
carried across the network.
There are now various protocols available and amongst the more
popular protocols are ASTM E1238 for laboratory data, HL7
for hospital information and DICOM for radiological images.
Healthcare organisations no longer expect software
applications to operate in isolation as they are keen to integrate all their
operations, not only to improve care delivery but also reduce costs, and with
that in mind, software companies now have to ensure that their products has an
interface that adheres to a communication protocol.
It is not only communication protocols software firms have to
keep in mind, as the passing of the Health
Insurance Portability and Accountability Act of 1996 (HIPAA) by the US
congress means that they have to ensure that data used and collected by their
products are secure or face the consequences.