Schlumberger's "Watson" Newton
I was recently lucky enough to win bidding on a Schlumberger Newton through eBay. I know many of you Newtonians are interested in this thing, so I have put a special post together on my Newton blog to give you a peek.
The original Newton Inc. website had the following blurb on the product:
- The Schlumberger "Watson" is a dedicated solution for the French healthcare market. It incorporates two smartcard readers that allow for secure electronic transactions in healthcare, thus reducing the cost of processing claims significantly. (Sources: 1, 2, 3, 4)
The 1997 cost for a Watson unit was Fr12,000, with an additional Fr15,000 for an accounting package, and none of this included the costs of the modem transmissions, which in France are often on a per-minute basis. (Source: 5, 6). This made the Watson a very expensive option for French medical practitioners. I am not sure how many units were bought by Schlumberger and how many were eventually converted into Watsons. The cancellation of the Newton by Apple in February of 1998 doomed further development of the Watson by Schlumberger, which went on to develop other devices for this market (see below). The Watson project was one of the forerunners of this concept.
HARDWARE: Hand unit
The "Watson" system is basically a France-localized MP2000 with some added circuitry in a slightly bigger case, and a specialized cradle. The case is built around the basic MP2000 innards, with a few changes: the case houses a built-in card that occupies the top slot, allowing the insertion of the patient's smart card. The rear of the case also has another slot with similar connections for the physician's smart card.
The flip-back door and latch are familiar, but rather than clips to retain the door, the Watson uses a magnetic system (the light green segment on the door, which 'sticks' to a corresponding magnet embedded in the lower case).
The On/Off switch has been moved to the bottom of the unit simply by using longer wires on the original switch. (Schlumberger missed an opportunity to improve on this piece of hardware, which is somewhat finicky -- like those on several of my other MP2x00s, this switch is no longer reliable).
The series of data and power contacts visible here above the switch (the "socle") are described below.
The top end of the Watson preserves the IR window, the interconnect jack, and the DC power jack, however these last two are more recessed in the extended housing, and are usually hidden under a cover that is somewhat difficult to remove. Because power and Dock-I/O connectivity are supplied by the special cradle (see below) these jacks would rarely be needed in day to day use in a French physician's office.
The largest physical change is that the Watson does not have two memory card slots available for use: the upper one is permanently occupied by some of the extra circuitry. The lower slot is available as in the regular MP2x00 series, just above the battery slot.
The additions to the Newton system were made to ensure patient confidentiality and financial security of transactions within France's national health system, SESAM-Vitale, which is highly regulated and also highly automated. Each insured person carries a Vitale smartcard which contains their relevant information:
- Identity number of the insured
- First and family names
- Health Insurance scheme
- Fund and unit to which the insured is attached
- Names of beneficiaries
- Rights to services
- Exemptions, if any
- Right to Universal Medical Coverage (CMU), if applicable
- Additional coverage info
No medical information is stored by the card. This card has 10 contacts (note that the reader in the Watson could actually read a 16-contact card). Since the most frequently changed smart-card would be that of the patient, this card slot is accessible while the Watson is in its cradle. The reading circuitry for this card is what occupies the top memory card slot.
Each person using the SESAM-Vitale system receives a letter and pamphlet similar to the following one, sent by a French student friend (all relevant info removed, click on image for LARGE version, and no, it's not Paul G.):
Each practitioner in the system carries a "Carte Professionel de Santé" or CPS smartcard which uniquely identifies the doctor. The CPS card holds the keys and certificates necessary to carry out electronic signatures and to encrypt transmissions, based on a public key system. This card allowed access to the "Réseau Santé Social" (RSS), a secure electronic healthcare network, through the cradle's modem (described below). This card has 8 contacts. The Watson has a completely separate system for reading this card, built into the back (lower) casing of the unit. It is visible as a narrow slot to the right of the green ejection button in the first picture below, and as the slot with the triangular metallic portion visible in the second picture. The physical ejection mechanism for this card is visible as the lighter green button, which you squeeze to actuate, reminescent of the MP130. The arm that is moved by this button to push the card out is visible int the third photo below. The slot for this card is inaccessible when the Watson is in its base, as it is assumed that only one physician would need access to the Watson when in its cradle.
The simultaneous use of both cards allowed the doctor to sign an electronic record of the care given (Feuille de Soins Eléctroniques, FSE). The FSE serves both as medical record and as a financial claim for reimbursement. (Source: 5, 6)
Close-ups of the CPS smartcard circuitry:
The cradle is just as nicely designed as the hand unit, and provides a place to rest the Watson in a position convenient for handwriting (being sloped towards the user) and to simultaneously synchronize with a desktop, recharge, and connect through a modem to the RSS.
Connections from the cradle to the Watson are made through two sets of contacts: fifteen for data and three for power.
These match the contacts on the bottom case of the Watson:
The cradle has a built-in modem called "Kortex" and connections for both Mac and PC serial ports.
The Watson used a France-localized NewtonOS: ROM F2.1 (F1-037)-1, with several specialized extensions to deal with the added smart-card circuitry and Kortex modem.
(due to built-in soft- and hardware security, absolutely no I/O is possible without a physician's CPS smart card inserted-- so I couldn't get screenshots - sorry).
The system had an internal RAM of 3523 Kb, and a Sytem RAM Installed 924 Kb (note that they are listed in the picture above as kilo "octets" as used in France for bytes).
There apparently also existed Watsons with a system numbered (B1-007)-1, possibly for Belgium, but I have not been able to confirm the existence of Watsons specialized for Belgium or of a separate OS version. What is certain is that in preparation for the pan-European integration of health systems under the European Union, a bi-national experiment in health-care systems compatibility called TRANSCARDS was carried out in the area of Thiérache in the 2000-2002 period, allowing Belgian citizens access to eight nearby hospitals in France. The Belgian Watson OS may have been a positioning for a wider use of the system, which was made permanent on January 1, 2003. A similar experiment was carried out in the Alsace region, giving French citizens needing dialysis access to German hospitals, but I cannot find any traces of Watson use in that context. (source (.pdf), and I note as an aside that in typically schizophrenic fashion, Québec is part of this system)
A specialized program to handle software settings for the Watson was called, imaginatively, "Configuration," and has the following items:
- Access code setup
- Personal Information
- Professional Information
- Default Settings
- Transmission(Comm) Parameters
- Communications Log
- Active Code Values
- A4 Printing
- A5 Printing
- Prior Agreement Printing
- Handwriting Recognition
Note that some of these overlap with the functions of the Prefs application, which was also present.
In order for a lot of this extra hardware to operate, there are a lot of extensions that are not found on other Newtons.
Here's a list of these special extensions:
- B2 Unit
- Back Light
- HeapEx Angel
- NOEMIE Unit
- FSE Print
NOEMIE stands for Norme Ouverte d'Échange entre l'assurance Maladie et les Intervenants Extérieurs, or Open Exchange Format between Health insurers and External service Providers. This was the format of a reply-file to the service provider giving either confirmation or reasons for rejection.
Xmodem-CNAMTS is a file transfer protocol to allow connection to the central CNAM system. CNAMTS stands for Caisse Nationale d'Assurance Maladie de Travailleurs Salariés, or National Account of Health Insurance of Salaried Workers. The older CNAMTS system has now been replaced by AMeli, "on-line Health Insurance."
The Storage folder in Extras of course has many specialized soups that are protected -- patient data, accounting/billing, etc. (all deleted before I got the unit, of course).
(to do: list/translate the stores)
Both Apple and Schlumberger have long killed the project and removed references from their on-line materials to the equipment and software. One remaining French software developer involved in the support of the Watson program still has a driver posted -- Easter Eggs still has a link for the SLB Watson 3.0F modem enabler.
After the cancellation of the Newton, Schlumberger moved on to produce other devices for the highly automated French healthcare system. From simple Vitale card readers like the MagIC 6000 and 6100, to integrated systems like the Ingénius-Saficard.
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