Patient Care Information System (PCIS)

Attracting only a modicum of attention, the Indian Health Service (IHS) developed one of the earliest clinicial information systems, the Patient Care Information System (PCIS) beginning in 1969(1). The original system was developed using COBOL for use on a mainframe computer.(5) 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)

The reach of the system was expanded to reach 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) In 1982 the system supported 340,000 patients 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)

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)

The system was later migrated to MUMPS and moved to mini-computers, but the costs per encounter remained about 3 times higher than other CIS systems.(1,5) The system has since been supplanted by the Resource Patient Management System (RPMS).(5)

References

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. [1]

2. H.R. Rep. No. HR100-222PT2 (1987). Indian Health Care Amendments of 1987. [2]

3. U.S. Congress, Office of Technology Assessment (April 1986). Indian Health Care, 252-253. Washington, DC: U.S. Government Printing Office. [3]

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. [4]