HHH Column: Early medical computing at Philips: the remarkable role of general practitioner dr. Hein Hogerzeil by Jos Aarts
The HHH column is a monthly blog in which History, Health & Healing members share their thoughts on research, current affairs, or anything to do with medical history. Each edition is written by a different member – in due time, we hope to offer everybody a chance to publish a contribution. This month, the floor is for Jos Aarts, historian of Science and Medicine at Erasmus School of Health Policy & Management and Utrecht University. In this column Jos shares the story of dr. Hein Hogerzeil and his role in the development of early medical computing at Philips.
Early medical computing at Philips: the remarkable role of general practitioner dr. Hein Hogerzeil
Jos Aarts
More than 13,000 Dutch general practitioners are members of the Nederlands Huisartsen Genootschap (NHG, Dutch Scientific Society for General Practice), which is especially tasked with developing and maintaining medical practice guidelines. Established in 1956, one of its founders was dr. Hein Hogerzeil, a general practitioner from Zwolle who became its first chair. He emphasized that the purpose of the society was to base general practice on sound scientific research and to consider the patient in their entirety, which meant that socio-economic factors should be integrated in the medical perspective of the practitioner.[1] For Hogerzeil reliable data, to support medical care and scientific research in patient populations, was essential. He tasked a NHG workgroup to develop a structured paper-based medical record, a feature that was previously absent in general practice. This NHG medical record, also known as the ‘groene kaart’ (green card) became a national standard. After his term as chair ended in 1960, dr. Hogerzeil spent a year as a public health advisor for the World Health Organization (WHO) in Congo. In 1961, he moved to Philips Medical Service in Eindhoven as a general practitioner. Later on, in 1965, he became the adjunct-director of the service, and in 1967 its director.
From 1967 until 1973 Philips Medical Service operated a computerized multiphasic screening system (known as MICOS), containing a medical history record for each patient. Dr. Hogerzeil conceived and developed MICOS. It reflected his view on integrated primary care, because the system would allow physicians to trace and track patients throughout their lifetime and emphasize preventive care. Philips Medical Service was owned by the Philips electronics company and was part of an integrated health system for Philips employees. This system comprised insurance through a sick fund, also owned by Philips, and access to medical care provided by the company. X-ray screening for tuberculosis among employees started as early as 1931.[2] The postwar Philips integrated health system very much resembled the American Kaiser Permanente Health Plan, a health care system founded in 1945 by Henry Kaiser and Sydney Garfield, and was rooted in the social policy of the company.[3] Around 1970, the Philips system enrolled 40,000 employees and their 35,000 family members.
In a 1967 paper, Hogerzeil described his vision on computing in primary care.[4] In his view, medical computing should contain the medical history of the patient, including results of diagnostic tests, and flag for screening encounters in preventive care. All of which he deemed essential for adequate primary care. The paper showed that he was inspired greatly by a multiphasic screening system that had been developed by Morris Collen, a primary care physician at Kaiser Permanente.[5] During the 1960s Philips had already been a leader in medical technology, and especially in x-ray imaging. The Philips Medical Service served as a showcase for the latest Philips medical technology. This can be inferred from the fact that Hogerzeil had advanced x-ray equipment, laboratory blood and urine analyzers, dentistry equipment, and Philips computers at his disposal. Furthermore, the service employed primary care physicians, internists, radiologists, pharmacists, dentists, nurses, physiotherapists, and occupational therapists. Philips technology helped Hogerzeil to realize his vision of lifetime patient care. In 1973 all of this came to an end. The Dutch government enacted health insurance (sickfund) reform, which ended integrated corporate health systems, limiting their function to work-related occupational health. Corporate sickfunds were absorbed by non-for-profit health care insurers. Philips also abandoned building computers, after it turned out that they couldn’t compete with their American rivals. Dr. Hogerzeil left Eindhoven and became a professor of social medicine at the University of Groningen. His work preceded the advent of electronic medical records in Dutch general practice by more than ten years.
MICOS was possible because of a visionary medical director, an innovative technology driven company and its concern for the social and medical wellbeing of its employees. Its demise came about due to a changing political health care landscape and the company withdrawal from the computer market. Nonetheless, Dr. Hogerzeil remains an enigmatic figure, in light of his significance for general practice, his views on patient care and the role of information technology.
The Philips Corporate Archives contain limited archival material, so if you have any information on source material concerning dr. Hogerzeil, I appreciate your help. Contact: Dr. Jos Aarts, Historian of Science and Medicine at: j.e.c.m.aarts@uu.nl
Websites:
http://www.kenniscentrumhistoriezorgverzekeraars.nl/bronarchief/erfgoed/InventarisVGZ.html (timeline Philips Sickfund)
http://www.kenniscentrumhistoriezorgverzekeraars.nl/pdfs/convergbel/2.1.pdf
https://data.jck.nl/search/?page=36&qf%5B%5D=nave_technique%3Agedrukt+%26+handgeschreven&q=&qf=nave_technique%3Agestencild%26+getypt%26+gestempeld (ziekenfondskaart)
[1] H.H.W. Hogerzeil (1981), Vijfentwintig jaar NHG: terugkoppeling van signaal naar kennis (Twenty-five years NHG: from feedback loop of signs to knowledge), Huisarts en Wetenschap, vol 24, pp. 408-411.
[2] G.C.E. Burger, T. Meeuwissen, J.P. Slooff (1932). Opmerkingen over ontwikkeling, opsporing en bestrijding der longtuberculose (Observations about development, detection and treatment of lung tuberculosis), Nederlandsch Tijdschrift voor Geneeskunde, vol. 76, pp. 4915-4929.
[3] H.H.W. Hogerzeil, H.R. Beukers (1972), Een geautomatiseerd systeem voor de medische geschiedenis per persoon (An automated system for the medical history per person), in: H.H.W. Hogerzeil et al, Computer en medische zorg (Computer and medical care), Leiden: Stafleu’s Wetenschappelijke Uitgeversmaatschappij, pp. 55-67.
[4] H.H.W. Hogerzeil (1967), De huisarts op weg van de wereld zonder, naar de wereld met computor (The general practitioner on the way from the world without, to the world with the computer), Huisarts en Wetenschap, vol. 10, pp. 375-8
[5] M.F. Collen (1966), Periodic health examinations using an automated test laboratory, Journal of the American Medical Association, vol. 195, pp. 830-3.