Patient Care Information System (PCIS)
The Indian Health Service (IHS) is part of the U.S. Department of Health and Human Services (HHS) and is an agency of the U. S. Public Health Service. It is responsible for providing comprehensive health care to federally-recognized Native American tribes and Alaskan Native groups. As of 2010, this care is provided to 1.9 million of the 3.3 million American Indians and Alaska Natives at 31 hospitals, 50 health centers, and 31 health stations.(6)
Attracting only a modicum of attention, the Indian Health Service (IHS) developed one of the earliest clinicial information systems, the Health Information System (HIS) in 1968. The HIS was main-frame based and did not use a database management system (DBMS). It used clinically-oriented encounter forms to capture a wide range of patient data in ambulatory care settings. The HIS was expanded into the Patient Care Information System (PCIS) beginning in 1969(1). Both systems were developed using COBOL.(5,7)
The motivation for developing PCIS did not come from a national office. Instead it arose from a cooperative effort between the IHS Office of Research and Development located in Tucson and the Sells Service Unit serving the Papago reservation near Tucson, which was seeking to meet the needs of its own people.(1,2)
Functionally, the system provided relatively current patient information to providers that could be in different locations. The providers were able to get summaries and could use the information only for retrospective research. As diabetes prevalence increased in Native Americans, PCIS was a source of data used to investigate this phenomenon.(2) Specifically, the system contained demographic data, measurements, problem lists, active medications, previous inpatient and outpatient encounters, immunizations, skin tests, and laboratory & radiology results.(2)
In 1982 the system supported 340,000 patients patients in the Sells Service Unit (in Southern Arizona), Billings (Montana), and Alaska areas using a database that was 630 Mb in size. The system relied on batch processing to process data with the unfortunate consequence that data updates could take up to two weeks from the time of encounter.(1,4) Output was typically to microfiche.(4) An additional drawback was the systems’ reliance on mainframe and non-DBMS technology, which made them too expensive and inflexible to be attractive for widespread implementation.(7)
In 1983, the system was migrated to MUMPS and moved to mini-computers, but the costs per encounter remained about 3 times higher than other CIS systems.(1,5,7) In 1984, after a market survey for commercial systems for cost accounting, the HIS decided to adopt the Department of Veterans Affairs Distributed Hospital Computer Program’s (DHCP) underlying technology as the basis for development of the Resource and Patient Management System (RPMS) and to make selective use of DHCP applications while converting clinical applications such as the PCIS to operate in the DHCP setting to support ambulatory and longitudinal care. (5,7)
The reach of the system included 3 of the 12 IHS regions (Tucson, Alaska, & Billings) by 1989; however, widespread utilization suffered from high costs as well as inconsistent implementations and support.(3)
1. Nutting, P. A. and Connor, E. M. (April 1984). Community Oriented Primary Care: A Practical Assessment, Volume II, Case Studies, 138-161. Washington, DC: National Academy Press. 
2. H.R. Rep. No. HR100-222PT2 (1987). Indian Health Care Amendments of 1987. 
3. U.S. Congress, Office of Technology Assessment (April 1986). Indian Health Care, 252-253. Washington, DC: U.S. Government Printing Office. 
4. Curtis, A. C. (1982). Increasing Physician Utilization of Clinical Information Systems, Journal of Medical Systems, 6(3), 238-239.
5. Computerworld Honors Program (1994). A Search for New Heroes: Resource Patient Management System. 
6. IHS Fact Sheets. (January 2011.) Indian Health Service, US Department of Health and Human Services. 
7. Curtis, A. C. (1994). “The Patient Care Component: Patient-Centered Horizontal Integration in a Vertical World”.