50 years EPR

50 years of Electronic Patient Records (EPR)

Since January 1st, 1968 the first electronic Patient Record has been used in daily routine. That is an occasion to celebrate and for critical review.

Important question: In 1968, was it a real EPR?

The following data for every patient of the thyroid clinic of the ‚Ev. Krankenhaus Bethesda‘ in Duisburg was stored on the disc (IBM 2314) of the computer (IBM360/30):

  • Patient identification with name, address, insurance etc. (Content of the ‚adressette‘)

  • Patient history form (anamnesis), filled in by the patient, validated by the physician and augmented, if necessary.

  • Findings of the physical examimation (status praesens) from a form.

  • Lab-results from a form including the paper printouts of the lab apparatus.

  • Szintigram description of the physician (a form).

  • Diagnosis and proposed therapy (protocol of the discharge meeting, form filled in by the physician)

All the data, partly coded partly free text, were punched on paper tape and entered into the computer. As soon as the data set was complete the automatic generation of the referral letter started as if it was dictated. The physician had to sign it – or to correct erroneous data. The patient data was kept on the disc.

Facit: Yes, it was a real Electronic Patient Record (EPR), developed in 1957, routinely being used from January 1st, 1968. That is 50 years ago and was the first. (In the USA Octo Barnett started the development of the pioneer application COSTAR in October 1968). It fulfilled the criteria for a digital electronic patient record which I published 2002 in the ‚Deutsches Ärzteblatt‘: 'Prüfsteine für die digitale Patientenakte'.

When, at my retirement, it became clear: BAIK will die due to the lack of maintenance, as there was no successor for me, and my institute Zinfo was closed, I formulated a review of BAIK – comparing it to the successful VistA of the US Veterans Administration. Even if this paper is unfinished and unpublished, I think, it is a good basis for a critical discussion: 'Principles of an active Electronic Health Record (aEHR), Lessons learned from BAIK' (Download please and scroll down to the title page).

In these Web pages on the occasion of the 50th anniversary I try again to explain the history and all aspects of BAIK as comprehensively as possible. I am grateful for constructive suggestions and do promise to improve the review as long as I am able to do so.