The Origins of Healthcare Software: 1960s to the 1990s

I have dedicated my career to exploring innovations in healthcare, especially how new technologies can improve access and efficiency around the world. My experiences in South Africa, Zambia, Mozambique, the USA, and other locations have shown me how technology can transform care delivery. To understand AI’s impact on modern healthcare, we need to look back at the beginnings of software in this field. This post kicks off a 5-part series discussing the vision for software in healthcare. We will cover early digital innovations that sparked change, examine the developments and challenges that followed, and conclude with AI’s real-world applications, such as enhancing care by facilitating better information use. Let’s start with the chaotic early days that set the stage.

The greatest opportunity offered by AI is not reducing errors or workloads, or even curing cancer: it is the opportunity to restore the precious and time-honored connection and trust - the human touch - between patients and doctors.

Eric Topol, MD
Executive Vice President, Scripps Research

A World Buried in Paper

Before software emerged, healthcare was overwhelmed by paperwork. In the mid-20th century, patient records were written on loose sheets, piled into folders, and stuffed into overflowing cabinets that filled clinic spaces. Mistakes were common: files got lost, handwriting was often hard to read, and sharing information between providers was a headache. This often meant mailing or hand-delivering documents, a process that, in some regions, still continues today.

This inefficiency was more than just frustrating; it cost lives due to delayed diagnoses and broken care. As an entrepreneur and scientist dedicated to improving healthcare, I’ve often reflected on how these paper systems widened gaps in global care. Some urban hospitals managed to keep up, but remote clinics were left behind.

Sparks of Innovation Amid Mainframe Madness in the 60s

Real change began in the 1960s when early computer technology started to show promise as a better solution. Hospitals and researchers, encouraged by advances in data processing, began experimenting with digital storage. The Mayo Clinic in Rochester, Minnesota, became a trailblazer by adopting early electronic health records (EHRs) to manage patient data more effectively. Around this time, the aerospace company Lockheed created one of the first clinical information systems, aiming to make data not just storable but also shareable, reducing errors and speeding up decisions.

These systems weren’t the sleek apps we know today; they operated on bulky mainframes that filled entire rooms and required punch cards or magnetic tapes. Yet the idea was revolutionary: turning disorganised forms and notes into structured, retrievable information that could seamlessly accompany a patient.

Building Momentum with Structured Systems in the 70s

By the 1970s, progress picked up as computers became more accessible. In 1972, the Regenstrief Institute in Indiana launched the first comprehensive electronic medical record (EMR) system. This system organised patient information for better tracking, analysis, and early decision support. This wasn’t just about storage; it introduced logic for spotting issues or trends, a precursor to today’s analytics.

One key innovator was Dr. Lawrence Weed, who developed the Problem-Oriented Medical Record (POMR) in the late 1960s and refined it in the 70s. His approach shifted records from a disorganised mess of dates to focused, problem-based structures, organising data around a patient’s specific issues, like symptoms or diagnoses, rather than scattered notes. It made collaboration and tracking progress easier.

Other notable achievements included early hospital-wide systems, like those at the University of Utah, which integrated lab results and orders digitally. Challenges remained, including high costs, limited tech adoption, and privacy concerns, but this decade solidified software’s role in managing healthcare data.

The Paperless Push and Widespread Adoption in the 90s

As we entered the 1990s, the dream expanded to fully “paperless clinics.” With personal computers becoming common and networks improving, EHRs promised to eliminate filing cabinets altogether: instant access, portable data, built-in audits for compliance, and reduced waste. Governments and institutions invested heavily in these systems, driven by reports from the U.S. Institute of Medicine about cutting errors. Adoption increased, paper processes faded, and data sharing began to develop, allowing records to flow smoothly between providers.

However, this era had its own quirks. While successes like better portability changed operations, the rigid interfaces often clashed with clinicians’ workflows, indicating the time-consuming problems we would face later.

Wrapping Up the Origins: A Foundation for What’s Next

These early decades were far from perfect, but they established digital foundations through standards and technologies that paved the way for today’s connected systems. Yet even in a country like South Africa, with relatively high levels of digital adoption, paper-based systems persist, a stark reminder that the journey remains unfinished.

In part two, we’ll examine the rise of specialised tools and the hidden cost of “time theft” in clinical workflows, where software evolution quietly created new frictions that steal time from patient care.

Our team at Akili AI is driven by a passion for learning alongside healthcare professionals, ensuring this journey continues to evolve in the right direction.

Some Interesting Reading

Elation Health – The History of Electronic Health Records (EHRs)

Electronic medical records – The good, the bad and the ugly

The Purpose of the Medical Record: Why Lawrence Weed Still Matters

University of Utah – 50 Years of Biomedical Informatics Exhibition

Institute of Medicine (US) – To Err is Human: Building a Safer Health System (1999)

You can also read this article on Substack and follow Charles Faul on Substack here: https://charlesfaul.substack.com/p/from-paper-purgatory-to-digital-dawn