244 © 2014 IMIA and Schattauer GmbH The History of the Data Systems AutoChemist® (ACH) and AutoChemist- PRISMA (PRISMA®): from 1964 to 1986 L. Ohlsén, I. Jungner, H. E. Peterson Stockholm, Sweden Summary mass scale using complete laboratory automa- 1 Introduction tion [9-12]. In 1962-64, the Swedish National Objectives: This paper presents the history of data system develop- During the 1950’s, the demand for labora- Board of Health entrusted them to carry out ment steps (1964 – 1986) for the clinical analyzers AutoChemist®, tory analyses drastically increased among blood analyses - 12 tests - on 90,000 Swedes, and its successor AutoChemist PRISMA® (PRogrammable Individual- primary care providers and hospitals. The aged 25 and above: the Varmland Project [12- ly Selective Modular Analyzer). The paper also partly recounts the workload at many laboratories became an 17]. For this purpose, the Jungner brothers history of development steps of the minicomputer PDP 8 from Digital increasing burden. An important evolution built a special equipment system capable of Equipment. The first PDP 8 had 4 core memory boards of 1 K each was the invention in 1957 by Skeggs [1) of performing automatic blood analyses with a and was large as a typical oven baking sheet and about 10 years the discrete sample analyzer (offered since fixed analyses program, the first 12-channel later, PDP 8 was a “one chip microcomputer” with a 32 K memory 1958 for sale as AutoAnalyzers® from Tech- multi-analyzer [12]. This was comprised in chip. The fast developments of PDP 8 come to have a strong influence nicon Instruments Corp.). During the 1960’s, part by an off-the-shelf apparatus, includ- on the development of the data system for AutoChemist. Five major this equipment – and its successor [2] – were ing AutoAnalyzers® and their own custom releases of the software were made during this period (1-5 MIACH). sold all over the world, and reached Sweden. constructions. The general construction is Results: The most important aims were not only to calculate the Parallel to this development, physicians, schematically displayed in Fig.1. results, but also be able to monitor their quality and automatically patients, hospital clients, health care orga- Samples were collected from a refriger- manage the orders, store the results in digital form for later statistical nizations and entire populations began to ated central unit using a vacuum unit, which analysis and distribute the results to the physician in charge of the demanded that analyzes detect diseases in distributed samples to respective analysis patient using thesame computer as the analyzer. Another result of the the earlier and earlier stages. Since the early channels at 90-second intervals. Various re- data system was the ability to customize AutoChemist to handle sam- 1950’s, Kaiser Permanente, San Francisco, agents were added along the way and the color ple identification by using bar codes and the presentation of results to with the help of computers, had gained an changes were recorded in a panel of poten- different types of laboratories. international reputation through their multi- tiometer printers that summarized the results Conclusions:: Digital Equipment launched the PDP 8 just as a new phasic health-care screening program [3-5]. of all 12-analysis channels. Recorders were minicomputer was desperately needed. No other known alternatives At the request of the WHO, the definitions, connected by a cable to the analog-digital were available at the time. This was to become a key success factor principles, and practice of screening for converter with read-out devices in an adjacent for AutoChemist. That the AutoChemist with such a high capacity disease were established by J.M.L.Wilson room, where analytical values could be read required a computer for data collection was obvious already in the and G. Jungner in 1969 [6], and are still and calibrated on the basis of measurements early 1960s. That computer development would be so rapid and recognized in 2008, 40 years later [7-8]. on standard samples. The system normally that one would be able to accomplish so much with a data system In 1959, Gunnar Jungner (Head of Clin- worked at the rate of forty measurements an was even suspicious at the time. In total, 75; AutoChemist (31) ical Chemistry, University of Gothenburg, hour, analytical channels producing 400 - and PRISMA (44) were delivered Worldwide The last PRISMA was Sweden) served as a Research Fellow at 500 analyses an hour, including calibration delivered in 1987 to the Veteran Hospital Houston, TX USA the Department of Clinical Pathology at the and checks against standard solutions. The NIH, Bethesda, MD, USA (Head Professor theoretical capacity of the system was 700 Keywords George Z. Williams). He quickly became samples and 8,400 analyses per 24 hrs. Computer systems for clinical analyzers, computers in laboratory a member of a working group developing automation, barcode used to identify sample tubes, quality con- automation for hospital laboratories using trol in clinical laboratories, software development for PDP 8 robots and computers. One thing that the Lessons Learned from the group agreed upon was that if such a robot Yearb Med Inform 2014:244-54 were to be built, it had to have a computer to Varmland Project http://dx.doi.org/10.15265/IY-2014-0029 manage results and process quality control. The production of more than one million Published online May 22, 2014 Returning back to Sweden in 1960, and analyses during a two-year period was a inspired by experiences at the NIH, Gunnar demanding task. Every weekday, about 500 Jungner, together with his brother Ingmar, blood samples arrived by train from Varmland started to automate single analyses. Soon, to be analyzed. The daily print-out of about they aimed at producing analytical results on a 5,000 lab-reports was a burden as the market IMIA Yearbook of Medical Informatics 2014 245 The History of the Data Systems AutoChemist® (ACH) and AutoChemist-PRISMA (PRISMA®): from 1964 to 1986 for small data units was still in its infancy. The experience with the equipment was not satis- factory. The mechanical units, in particular, were likely to break down, interruptions for repair were frequent, and the flow principle for reading the peaks was troublesome. Over time, the Jungner brothers became increasingly focused on how to construct more stable equipment aiming at a real round-the-clock work with industrial-like performance. In front is the computer first used (LGP 21) from Eurocomp, shown here with the FlexoWriter printer and data tape punch. Because of these discussions and the experiences from the Varmland Project the Jungner brothers decided in 1963 to build a Fig. 1 Schematic Representation of the Apparatus System for Automatic Blood Analyses – Varmland Project. prototype, which in turn would lead to the A Housing with refrigerated sample holder and suction device to aspirate samples. B Housing with two sample holders, pumps, a 3-channel development of the AutoChemist® [18-23]. photometer, automatic reagent pipettes etc. C Housing with pumps, heating baths, cooling units, dialyzers, colorimeters and reagent supply; waste Another conclusion was that the need for at bottom. D Console with six potentiometer recorders, operating panel with lamp signals, and alarm system. E Registration unit with scanner, calibration was strong. Valuable experience analogue-digital converter, line-arising unit, a sorting unit with register, and print-out on a Flexowriter with paper tape punch (e) was nevertheless gained and would later be Fig. 2 The prototype for applied to the specific problem of producing AutoChemist was built in- chemical analyses under industrial condi- house (1964). tions. This could only be achieved with the In front is the computer first assistance of a computer. used (LGP 21) from Euro- AGA AB, Lidingo, Sweden, best known comp, shown here with the FlexoWriter printer and data for gas-powered lighthouses and the famous tape punch. AGA stove, had a division for advanced electronics and optics for both civilian and military applications. Examples include ther- mal cameras (Termovision) and range finder equipment (Geodiometer), used to measure the exact distance to a hexagonal mirror positioned on the moon. AGA was asked to develop and manufacture the system. A concept and prototype launch was advertised on October 6, 1964. The first AGA-manufac- tured AutoChemist was revealed for the first time on June 10-24, 1965 at the international ”Sjukhus 65” exhibition in Stockholm. heads and 4K with a 32bit word length. It (DIGITAL®) in Maynard, outside of Bos- had four different instructions and all oper- ton, MA, had a modest number of PDP-5s ations were coded using these instructions. available. However, a system-compatible Programming was first achieved by writing successor, the PDP-8, was in development. 2 First Computers Used in binary machine code on a form. This was A used PDP-5 was acquired in order to begin then punched on an 8-channel paper tape the system development while anticipating the with the AutoChemist (ACH) that could be inserted into the computer. delivery of the first PDP-8 [24-25]. The program for the AutoChemist prototype Prototype (1964) could gather data for one analysis channel at The first computer used with AutoChemist a time and provide a rough printout. LGP 21 MACH (Main Program ACH) was a German-made LGP 21 from Eurocomp proved to have insufficient capacity as well MACH was first developed on a PDP-5 com- (Fig. 2). This computer did not actually have as inadequate operating reliability, which puter from Digital Equipment (Fig. 3). This what we now call a main memory – only a meant that there quickly was a need to find computer was one of the first so-called mini- disk memory.