Isabelle Dussauge
email: isabelle.dussauge@liu.se

Julia Peralta
email: julia.peralta@oru.se

Instruments of Surveillance Welfare: Computerizing Unemployment and Health in 1960s and 1970s Sweden

Keywords: Control, health screenings, history, unemployment policy, welfare

The object of this paper is the role of computerization in the establishment of a specific form of "surveillance welfare" after World War II. Was computerization used as a technology of mass-welfaring to produce a governable population in the frame of an expanding welfare state? Large-scale welfare practices such as health screenings and databasing of the unemployed seem to have a common purpose: making the population into a governable, partially self-regulating, collective body-a welfare body. The paper analyzes the use of computers in the implementation of regional health screenings in the 1960s and the 1970s and in the transformation of (un)employment procedures in the 1970s as two sites for the exercise of state control in post-WWII Sweden.

Introduction

In line with many other sectors, the Swedish public administration introduced computerized applications in the 1960s. The post-WWII industrial growth had led to a tremendous expansion of the public sector and services. Computers made possible a breakthrough in data processing and they became an important tool in the rationalization of administrative tasks. For the public administration, they became instruments for the control of welfare procedures. Decision-makers (politicians and civil servants) saw computerization as a way to eliminate loopholes in the tax and social insurance systems and to enhance welfare services. One major aspect of these developments was the establishment of computed systems for the production and classification of data covering the population [START_REF] Agar | The Government Machine: A Revolutionary History of the Computer[END_REF][START_REF] Annerstedt | Datorer och politik: Studier i en ny tekniks politiska effekter på det svenska samhället[END_REF][START_REF] Waara | Offentliga sektorns tillväxt[END_REF].

From Discipline and Punish through History of Sexuality (1977Sexuality ( -1984)), the French philosopher Michel Foucault inquired into the emergence and installation of modern and postmodern means of societal control, which he refers to as surveillance. These forms of control did not always explicitly derive from concrete policies or political measures; instead, they were indirect and exerted by means of disciplining technologies through which individual and collective bodies/subjects were rendered manageable and compliant to societal orderings. Here, health care system and labor market policies are considered as two such instances of surveillant control of the population.

This paper will explore two cases in the use of computerization in the expansion and/or strengthening of two welfare institutions: health screenings as an instance of public health and employment agencies as an instance of labor market policies. In our conclusions, we will come back to the following two questions: Which were the goals of computerization in these two instances of the Swedish welfare system? How did the computerization of these welfare practices possibly affect the definition of the social problems (unemployment, health), which they were used to manage?

Automating the Collective Body: The Värmland Screening

In Sweden, health care policy and services as well as the National Board of Health (Medicinalstyrelsen) have had a central place in the establishment and post-WWII expansion of the Swedish welfare system. The Värmland Mass Screening Pilot Program1 was initiated by the National Board of Health and started in 1962. This was the first time in Sweden a health control was conducted that was conceived as a total screening, encompassing a whole geographical population and seeking to identify a large battery of possible diseases with the help of automated and computerized technologies.

In 1948, a governmental committee led by the Director-General of the Swedish Medical Board, Axel Höjer, released a major government report on outpatient care, which had been described as Höjer's political legacy. In this document, Höjer argued that the focus of public health care services should be to maintain the population's health and prevent diseases, rather than focusing on the treatment of known diseases, thus continuing a trend that in Sweden had emerged in the 1930s [START_REF] Berg | Den gränslösa hälsan: Signe och Axel Höjer, folkhälsan och expertisen[END_REF]. The 1948 report also recommended that public authorities conduct a series of pilot screenings [START_REF]Hälsoundersökningen i Värmland 1962-1965[END_REF]. It was not until in 1961 that the Board of Health received its first governmental funding for a pilot program [försöksverksamhet] of general health control "on a larger scale" [START_REF] Nilsson | [END_REF].

The Board referred later to the lack of doctors in Sweden in the 1950s as the reason why the large-scale health screenings had to wait [START_REF] Nilsson | [END_REF]. In hindsight, the Board also wrote that "the classification of the healthy [and sick] among the people examined" had to be done "without concrete participation of a doctor. We considered that this condition was fulfilled by the development achieved in clinical-chemical laboratory technology" [START_REF]National Archives of Sweden (Riksarkivet)[END_REF].

Technologies of Mass-Screening

The Board of Health decided that the main screening instrument in the Värmland screening would be automated blood chemical analysis, i.e. the use of an automated apparatus conducting a pre-defined range of chemical analyses of blood samples. More precisely, the Board recruited the services of clinical chemist Gunnar Jungner's and doctor Ingmar Jungner's new automated laboratory, MEKALAB [START_REF]National Archives of Sweden (Riksarkivet)[END_REF]. The Jungners were largely inspired by growing visions of mass screening at the US American National Institute of Health in the late 1950s where Gunnar Jungner had spent a sabbatical in 1959-1960. By 1961, the Jungners had designed automated machinery for chemical analysis of large amounts of blood samples [START_REF] Jungner | Berättelsen om AutoChemist[END_REF].

Whereas Höjer's 1948 report argued for a yearly health control of everyone aiming at a healthy and well-informed population, the goals of the Värmland Screening were, in comparison, more modest. By the 1960s, the agenda was reduced to test the value of the specific screening method as a way to identify sick and diseased patients [START_REF]Hälsoundersökningen i Värmland 1962-1965[END_REF][START_REF] Friman | i Värmlands län[END_REF]. In a nutshell, the argument for this was that common diseases could be identified in patients before they themselves felt the symptoms [START_REF]Hälsoundersökningen i Värmland 1962-1965[END_REF][START_REF]symptomatic diagnosis of diseases by organized screening procedures[END_REF]. Early detection of diseases was argued to be an instrument for the health authorities to better fight diseases and make health care services, as a whole, more effective by referring patients to a larger extent to primary health care [START_REF]Hälsoundersökningen i Värmland 1962-1965[END_REF].

Forty years later, Ingmar Jungner explained that "[t]he Värmland Screening could be considered an extreme attempt to conduct a mass screening in an effective manner" [START_REF] Jungner | Berättelsen om AutoChemist[END_REF]. The Värmland Screening was "planned as a methodological study in order to determine if chemical blood analysis can be used as a method for mass screening … in a general health control in the same way as x-ray examination [tuberculosis screenings]." Ivar Friman, a doctor centrally involved in the Board of Health's coordination of the Värmland Screening, also indicated that the criteria of assessment of the method would be not only the medical results of the screening but also the costs of blood-chemical testing as a method for screening. Further, Friman described the Jungners' "automated laboratory" as "precondition in order to conduct a health control of the [Värmland Screening] kind for an acceptable cost" [START_REF] Friman | i Värmlands län[END_REF]. Balancing health results and costs was an organizational equation that was not specific to the Värmland Screening, as witnessed by documents on other health controls in planning during the first half of the 1960s (which awaited the conclusions from the Värmland Screening) [START_REF]Ett förslag till allmän hälsokontroll av 4-åringar[END_REF].

Thus, although improving the population health was a general long-term rationale for the large-scale health controls, such screenings were not only aimed at controlling health but also at controlling the costs of the publically funded health services and their use of personnel resources. The Värmland Screening was an assessment of a certain kind of infrastructure and automatized laboratory for this job.

Computers in a Socio-Technical System of Control

The Värmland screening started on 1 October 1962 in the area of Arvika with the official goal to examine about 100,000 inhabitants in a three-year period [START_REF] Friman | i Värmlands län[END_REF]. "Among the 88,959 who were screened, 7,620 (8.6 percent) were singled out and sent to follow-up control with examination by a doctor. Among those, previously unknown disease was identified in 3,014 individuals," Ingmar Jungner writes [START_REF] Jungner | Berättelsen om AutoChemist[END_REF].

The Värmland Screening marked the Board of Health's implementation of a massscale infrastructure designed to mobilize, examine, screen and potentially treat a whole population, a collective body. Huge amounts of work were required to make the infrastructure work, along three dimensions:

Firstly, it mobilized the collective body of the population. The Värmland Screening created and relied on a large-scale organization reaching all the way down to the population with the creation of "local committees" in each municipality, whose role was to attempt to achieve 100 percent participation of the population. In some organizational aspects (e.g. producing lists of people to call in to the screening), the Värmland Screening was drawing on an existing structure of x-ray screening for tuberculosis. The administration of calling in the population was computerized, and the participants were registered with their "national identification number" (date of birth).

Secondly, at the core of the screening procedure were the production and analysis of health data on the participants. A Central Committee and the municipalities shared the responsibility to arrange rooms, personnel, instruments and standardized procedures for physical examination and the taking of samples for laboratory examinations. Blood samples were sent to MEKALAB, where the Jungners' automated apparatus was made to perform a huge number of analyses of bodily fluids.

Thirdly, the data produced on the health of the participants had to be analyzed for each participant in order to decide who should be contacted for a more thorough medical examination. In the first year of the Värmland Screening, doctors and subsequently automated through computerized processing conducted centrally this preliminary screening decision. Concretely, a program that identified abnormal values interpreted the health data of each participant. Data cards with abnormal values were sent to the central medical assessment group of the Värmland Screening that "made a judgment" and categorized patients for further referral [START_REF] Friman | angående uppläggning av databehandling och statistik för Värmlandsundersökningen[END_REF]. The purpose of this computerization was to minimize the involvement of doctors, for two reasons: to minimize the amount of errors (in the identification of samples and data; in the originally manual transposition of data values; and in the identification of abnormal data for further medical interpretation); and to use personnel efficiently. 2

Interpretation: Controlling the Cost of Health Screenings

The Värmland Screening was part of a historical shift in medical regimes in the Western world: from managing the sick to monitoring the healthy [START_REF] Armstrong | The rise of surveillance medicine[END_REF]. In that sense, computerization and automation were part of the historical installation of surveillance medicine and its qualitatively new object: health and healthy populations.

Although the Värmland Screening in many ways was a technical and organizational success (it worked, people participated to a large extent, diseases were diagnosed in patients), it was finally evaluated as evidence against mass-scale general screenings. Such general screenings were dismissed as a general tool for health monitoring of the population because they were too demanding on health care resources: costs and personnel; and their clinical value was therefore questioned [START_REF]Hälsoundersökningen i Värmland 1962-1965[END_REF]. This illustrates that the function of the ideal screening was not so much to control population health but rather to control the costs and organization of producing population health.

However, new pilot screenings were generated in the dawn of the Värmland Screening. According to a later governmental report, the debates that arose around the Värmland Screening triggered many counties and municipalities to plan and conduct their own screening programs. 3

Matching Labor Supply and Demand: Computerization of Employment Agencies

The computerization of the Swedish public employment services began in the late 1960s, divided into three phases. A first phase involved the development of all administrative systems. The second phase came to focus on the application of computer resources to the placement process, i.e. the service in which the unemployed were offered work positions that suited their competence profile. The third and final phase consisted in the construction of a totally integrated information management system. In the present text we inquire on the second phase and, more specifically, on the computerization of the placement work of the Swedish employment agencies in the period 1968-1984. The application of computer technology in the employment agencies became an important instrument in their efforts to achieve social policy goals, which in turn were closely related to the government's key socio-economic objectives [START_REF]Arbetsförmedling med ADB-resurser. Rapport 8, Förslag till ADB-system för platsförmedling. Arbetsmarknadsstyrelsen[END_REF].

On 6 November 1972, the National Labor Market Board (Arbetsmarknadsstyrelsen, AMS) appointed a working group named AMS-ADB-utredning [START_REF]Arbetsförmedling med ADB-resurser[END_REF], who identified a few main problems in the functioning of the labor market. The average length of periods of unemployment and the vacancy times (the time when an available position is unoccupied) had become longer in comparison with earlier periods with similar conditions of overall demand for labor. Moreover, by the early 1970s, there were large regional, sectorial and social disparities in unemployment and labor supply. The participation of women in the labor force had increased, whereas the overall employment rate had decreased; young as well as older people experienced more difficulties in employment. Regional disparities in unemployment rates and shortages of high-skilled workforce were evident [START_REF]Arbetsförmedling med ADB-resurser. Rapport 8, Förslag till ADB-system för platsförmedling. Arbetsmarknadsstyrelsen[END_REF].

The employment services envisaged computerization as a means to implement two main strategies: the production and analysis of better information on the labor market, and the improved placement of the unemployed based on this information. With these two strategies, they aimed to solve the problems connected with periods of unemployment, vacancy times, and disparities in labor supply and demand [START_REF]Arbetsförmedling med ADB-resurser. Rapport 8, Förslag till ADB-system för platsförmedling. Arbetsmarknadsstyrelsen[END_REF]. By exploring these strategic improvements in information and placement, we aim to shed light on the rationale of the computerization of employment services.

ADB in the Employment Service

In the 1970s and until 1984, three interdependent projects dominated the computerization of the employment services: Creation of job listings (platslistor); development of a search engine (terminalsökning) and a matching engine (bevakningsmatchningen); and finally a pilot employment agency (modellkontor). The last two projects had an experimental character and they were followed up regularly during the period studied.

Job Listings

In December 1971, a pilot project of computerized production of daily job listings was launched in Stockholm. The job listings were easily produced, and they were introduced in Gothenburg in 1974-75 and later in Malmö. AMS-ADB-utredning suggested a rapid expansion of computerized job lists all over the country. The AMS-ADB-utredning settled in its first report, published in 1974, that the simple job listings would be replaced by computerized regional job listings in tabloid format, which would be produced using computer graphic techniques [START_REF]Arbetsförmedling med ADB-resurser[END_REF]. The information on each job became more extensive and more clearly structured which was an improvement in relation to the previous system [START_REF]Arbetsförmedling med ADB-resurser. Rapport 2, Målstudie, verksamhet[END_REF].

Search Engine and Matching Engine

In its first report, the AMS-ADB-utredning suggested the introduction of terminals for searching and matching to achieve greater effectiveness in the placement process. 4 A comprehensive and well-structured job database was developed in connection with the computerized production of job listings, which at that time were produced in nineteen counties. The job database stored and made available computerized information on vacant jobs, which was a central prerequisite for testing the search engines and matching engines [START_REF]Arbetsförmedling med ADB-resurser. Rapport 2, Målstudie, verksamhet[END_REF].

During the study period, the scope of the search and matching engine projects gradually expanded to include 158 terminals, located at some 90 employment offices, each terminal shared between several employment agency officers [START_REF]Arbetsförmedling med ADB-resurser. Rapport 8, Förslag till ADB-system för platsförmedling. Arbetsmarknadsstyrelsen[END_REF]. These computer-based tools were adequate and they brought an improvement in the quality of job placement. The opinion of the employment office staff was that terminals "gave a better overview of the labor market and helped them activate the unemployed" [START_REF]Arbetsförmedling med ADB-resurser. Rapport 8, Förslag till ADB-system för platsförmedling. Arbetsmarknadsstyrelsen[END_REF].

Pilot Agency

The third operation consisted in developing two instances of a "pilot employment agency," carried out in two employment services districts in Södermanland. It started in 1980. The pilot projects aimed to test the implementation of organizationally and technologically more advanced terminal-assisted job placement. In these pilot projects, all employment agency staff accessed their own individual terminal. They used the terminals to search and monitor vacancies, to register job descriptions, and to produce follow-up lists of unemployed and jobs. Parallel with this development, the issuing of printed job listings was reduced [START_REF]Arbetsförmedling med ADB-resurser. Rapport 7, Försöksverksamhet 1980/81 och planering för 1981/82 m m. Arbetsmarknadsstyrelsen[END_REF]. The pilot agencies soon became the basis for the system of job placement that AMS would come to propose.

A computer system was constructed, an inventory of facilities and work environment was conducted, and new equipment was installed. The pilot agency staff went through comprehensive training in "methods of placement with terminal" (förmedlingsmetodik med terminal). Changes in the organizational and operational procedures were implemented in the pilot agencies.

In the new pilot organization, the employment officer had to follow a work schedule that included times for the new visits of unemployed as well as their return visits, appointments with companies, monitoring of placement opportunities and following-up of the arrangements made for unemployed individuals. A system of fixed-length appointments for the unemployed was introduced. Furthermore, the need for services of each unemployed person would be assessed at each contact with the employment agency. On the one hand, this assessment formed the basis for decisions about the situation of the unemployed individual, and on the other hand, such assessments were used in the agency's overall planning of labor market programs such as education, internship positions, and introductory programs.

On the companies' side, the bigger firms engaged their own contact person at the employment agencies, who was in charge of receiving new vacant job notifications from these companies and following up their previously notified jobs [START_REF]Arbetsförmedling med ADB-resurser[END_REF].

The computerization of the employment agencies was a concrete step towards better conditions for the crucial process of matching jobs with the unemployed. Computerization of the employment agencies came to provide the employment services with two enhanced forms of control: First, a more accurate and updated overview of the labor market; and second, saving time in the task of matching supply and demand of labor.

The matching of work and labor is strongly associated with the emergence of a modern labor market and more specifically with industrialization, which resulted in both wage work expansion and the separation of workers and employers. In a welfare state like Sweden, the link between matching and unemployment is of central importance: it concerns issues of economic stability and social security [START_REF] Walter | Som hand i handske: En studie av matchning i ett personaluthyrnings-företag[END_REF]. In this context, the employment services are a national institution with the central aim to influence directly the process of "matching" in the labor market. This political commitment was manifested in defining the role of the employment agency staff in the computerized agencies, whose main task was to contribute to creating a marketplace of labor where workforce (supply) and jobs (demand) could meet.

With the present investigation, we have aimed to clarify general political aspects of the computerization process in the Swedish welfare state in the 1960s and 1970s.

The Board of Health strived to enhance the management of a population and to upscale the scope of that management to encompass a broader range of (un)health. Automation and computerization seem to have filled two different functions in building up the new screening infrastructure. On the one hand, the automation of laboratory procedures functioned as a means to upscale the analysis capacity. Here we could argue that these technologies created and managed a historically new collective body: a healthy population. On the other hand, we could argue that these new health technologies were conservative of the orders they were part of. That is, the new screenings were based in part on older organizations of screening for disease (tuberculosis), and the main goal with the new screening and their technologies was to maintain and produce population health at an acceptable cost.

The National Labor Market Board strived to display a control of unemployment consisting in a shorter unemployment period for the unemployed, shorter job vacancy times, and a more geographically flexible workforce: the attributes of a well functioning market machinery of supply and demand of labor. For the involved authorities, the necessary oil in this market machinery was the computerized, effective overview of, and matching between, supply and demand of work/workforce. With the computerization of the employment agencies as a tool, the authorities could intensify the shaping of the labor market as a market.

We have observed that surveillance was exerted and enhanced by computerization at three levels. It included the mobilization of a population (the improvement of which was not a goal in the computerization of employment agencies), the production and analysis of information about that population, and the actions taken by the authorities based on that information.

Our interpretation is thus that computerization afforded the Board of Health and the Labor Market Board through the employment agencies, the possibility to re-shape, technologically and organizationally, the objects of their control -(un)health and (un)employment. The same tasks could be conducted at a higher pace, and therefore possibly on a larger scale. However, we want to emphasize that these Swedish welfare institutions used computer technology primarily to improve the efficacy of their welfare procedures, and therefore as an intensification of their control of the very objects of welfare. Thus, computerization was historically a part of the redefinition of social issues in the welfare state, as those became more manageable.

Allmän hälsokontroll i Värmlands län, försöksversamhet -here referred to in short as the Värmland Screening.

Additionally, the computerized processing was supposed to enable sorting the newly archived screening data by birth date (folkbokföringsnummer) -thus opening up for easier retrieval of data.

About fifteen health screening projects were conducted in Sweden on different scales between 1963 and 1978, to be compared to five projects until 1962, see[START_REF]Hälsoundersökningar och annan förebyggande hälsovård -utvecklingstendenser[END_REF].

Search through the terminal in the form that the investigation proposed had not previously been used in other countries. The benefits of search were assessed to be primarily on the qualitative side, while the match was expected to save time.

Acknowledgments. We thank Handelsbankens forskningsstiftelser for supporting the research for this paper. We are also grateful to our colleagues within the project, "Precursors of the IT Nation: Computer Use and Control in Swedish Society, 1955-1985" for comments on earlier versions of the paper.


Karin Kajbjer
email: karin.kajbjer@telia.com

Ragnar Nordberg
email: ragnar.nordberg@jmprd.se

Gunnar O Klein
email: gunnar.klein@ki.se

Electronic Health Records in Sweden: From Administrative Management to Clinical Decision Support

Keywords: Electronic health records, Melior, patient administrative system, PAX, Swedestar

des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.

Introduction

Health care is a large part of modern societies, accounting for nearly 9 percent of the GDP and a similar proportion of the labor. Although it is also a person-centric manual service, it is a business that is very information rich and in which knowledge is rapidly developing. It has been stated that owing to the large and growing amount of information that needs to be managed, a situation where the capacity of the unaided human brain no longer meets the requirements is approaching. There have also been many interesting attempts, using computers for a very long time, to provide decision support for medicine, but few of the advanced AI techniques often first developed for medical problems have actually had a broad impact.

The very first account of automatic decision support for medicine dates back to the thirteenth century with Ramon Llul, who was a scholar in Mallorca. Llul was knowledgeable in the mathematics of Arabia, as well as in European Medicine, and a practicing physician that influenced Leibniz in the early theory of computation. Llul invented a machine, now called the Lullian Circle, which consisted of three paper discs inscribed with alphabetical letters or symbols that referred to lists of attributes. The discs rotated individually to generate a large number of combinations of ideas. For medical decision support, one of the circles described possible symptoms, the next indicated possible causes/diagnoses, and the third included a set of remedies or treatments indicated by turning the circles.

Computers in health care, as studied in the scientific field of medical informatics, were used in a large number of areas and are today essential in many fields such as digital imaging and bioinformatics analysis of DNA and proteins.

However, we dedicate this paper to the history of computer support for routine tasks in health care where information, often in the form of a simple line of text or a single numeric value, manages both the medical understanding of a patient as well as to improve the management of the processes of investigation and treatment. Estimates show that nurses and physicians spend about 40 to 50 percent of their working time on information management in a broad sense.

Despite many internationally advanced and pioneering projects, it has taken quite a long time for the health sector to use the advantages of computer technology. This paper describes the early developments in Sweden, until 1995, and discusses some of the reasons for the somewhat slow, large-scale introduction.

Materials and Methods

This paper is based on a literature study and on interviews with Gert Ljungkvist, project manager at SPRI, the Swedish National Institute for Health Services Development owned by the Department of Health and Welfare (Socialdepartmentet) and the Federation of County Councils (Landstingsförbundet). In Sweden, this institute played a very important role in the development of good practices for documentation, first in the paper world, and computerized records from the early 1980s. We have also used the documented personal accounts of early Swedish IT history, particularly those of Hans Peterson, Paul Hall, and Torsten Seeman [START_REF] Seeman ; Urban | oral history interview by Isabelle Dussuage[END_REF][START_REF]Datorisering av medicinsk laboratorieverksamhet 1: En översikt: Transkript av ett vittnesseminarium vid Svenska Läkaresällskapet i Stockholm den 17 februari 2006[END_REF][START_REF]Den svenska it-historien[END_REF].

Results

Computer support for health care started in Sweden in the mid-1960s, which at an international level was very early. This was a series of pilot tests with clinical records at the Karolinska Hospital in the Stockholm region, which was using batch processing. Although these tests achieved some international fame, they had very little impact in health care due to their limited volume and scope.

The automation of chemistry laboratories and various administrative systems soon followed. It was not until the mid-1980s that computer support for medical records really started to emerge with an explosive development in primary care and with hospitals generally following fifteen years later.

Laboratory Systems

From the early 1970s onwards, the next step of automating the chemistry laboratories created many benefits in the form of increased efficiency, rapid delivery of results and possibilities of quality control.

At that time, all laboratory instruments delivered readings in analogue form, which was unsuitable for data processing and therefore required digitization. The first computerization step was therefore to develop or introduce commercial analogue for digital converters and equipment, which triggered a precise reading rate. Thereafter, automated data processing grew rapidly within the laboratories and with automated analysis instruments; the Swedish AutoChemist, the English Vickers, and the Swiss Greiner analyzers all had interfaces that made them compatible with most computers. The automated processing of the laboratory data increased productivity and made it possible to achieve a much higher level of quality. This also meant that one could send laboratory results to the wards and primary care units electronically, where they arrived at the same moment, as the results were ready at the laboratory.

The laboratory data was also stored in databases at the laboratory, which made it possible to obtain a cumulative laboratory test report per patient, even before they installed computer systems in the clinics. As hospitals had installed PAS and electronic health record (EHR) systems, they interfaced with the laboratory systems and both requests and transmitted the results automatically.

Patient Administrative System -PAS

The 1970s and first part of the 1980s also saw the independent development of several patient administration systems, based on central mainframes in the counties, as well as a large number of dumb terminals in the hospitals and later also in the outpatient clinics. These managed invoicing as well as the allocation of hospital beds and certain related tasks.

One of the systems developed was PAX, in Gothenburg. This was created inhouse, after a number of other incompatible systems had been installed, tested and disqualified. There were many discussions and arguments about which system was the best and should be used, before it was decided to develop a totally new system based on the experiences from the others and peace was established, thereof the name PAX.

They developed the basic version of this new system in two years and installations started in 1988. It took several years to install the system due to financial problems with supplying all the wards with the necessary equipment and the training of the staff. They continuously improved the system during the years and it is still in use in the region of Västra Götaland and the county of Dalarna. Another system was called PAS in SLL, the county of Stockholm; the third largest region around Malmö in Skåne developed yet another system that included diagnosis codes, codes for admission, and referrals among others.

Primary Care Record Systems

Due to the difficulties of creating computer support for the clinical staff, physicians, and nurses, it took almost twenty years after the first trials before electronic health records made their successful entry into primary care rather than in the more demanding general hospital sector.

One of the most interesting systems in Swedish primary care was called Swedestar, introduced in Lerum [START_REF] Dahlin | Datagrundjournal: datorisering av informationssystem vid Gråbo vårdcentral[END_REF] and Sundbyberg in 1984, which is still, with minor modifications, in use in places. Swedestar was a modification of Costar, developed in Boston, closely associated with the MUMPS operating system that included an integrated database function. A similar development in Finland was the Finnstar system. An important and novel idea at the time was to record all clinical information according to certain keywords from a defined local terminology. This allowed both a fast selection of the relevant parts of individual case histories for presentation and, perhaps more importantly, the easy and efficient compiling of data from groups of patients. The latter can be used both for scientific studies on various clinical issues and for quality management of the core clinical work. The system was based on a local minicomputer server for a primary care centre with asynchronous terminals, later PC workstations. This relatively innovative system came from the high-tech advanced, academic environment of Harvard.

The next step was the proliferation of a large number of small PC-based systems that in many cases were more like word processing systems rather than for the advanced management of structured data. They were often developed by a physician in co-operation with one or several, more or less, self-made software engineers. Data from a SPRI report [START_REF] Dahlin | Datagrundjournal: datorisering av informationssystem vid Gråbo vårdcentral[END_REF] illustrated in Fig. 1 shows the rapid deployment of record systems. In 1994, EHR systems operated in 85 percent of the primary care centers. As shown in Table 1, there were twenty-seven different products available on the Swedish market [START_REF] Lundberg | Patientjournaler med datorstöd -Spridning, marknadsläge och systemöversikt[END_REF]. Note that the Melior and Bedside systems were intended only for hospital care. We believe that an important reason for the popularity of these small-scale developments was the sense of participation that the clinical staff felt in being able to influence many details of the systems. This was in contrast to the later production of in some ways more advanced systems introduced through the central IT management of the various counties and often developed by large, or at least somewhat larger, software companies. Only a few clinicians were able to influence the design and many felt alienated from these systems.

Also contributing to the popularity of the small-scale systems were the improved user interfaces, employing windows techniques especially designed for the record systems and later based on Microsoft Windows with a mouse and with color.

Unfortunately, they had already forgotten some of the important design principles of earlier systems from the 1960s such as using defined terminologies and structuring data based on headings and subheadings useful for keyword-based searches and for the compilation of statistics.

The developments of electronic health record systems during the 1990s and into the new millennium included a large number of integration projects that had aspects such as laboratory referrals and results, electronic prescriptions and, with the patient administration systems, national and regional population registers and reporting for invoicing.

There has also been a successive return to the goals of recording clinical data in structures based on both process analysis and medical ontologies as well as using more internationally based health terminologies that are very large compared to those used in other sectors. The current and very promising clinical terminology SNOMED CT, translated into Danish and Swedish, contains some 308,000 concepts with 900,000 terms and 1.5 million relations.

Hospital Record Systems

The large-scale use of electronic health records in hospitals came considerably later than in primary care. However, already by the 1980s, a number of specialized record systems were developed particularly for various university hospital departments. Nevertheless, these mainly complemented the paper-based record systems rather than replaced them. However, we will describe two early hospital implementations. One is the adoption of what was really a primary care system in Ystad; the other is the comprehensive development in Gothenburg, first installed in 1994.

The Ystad Case

The first Swedish hospital to use comprehensively an electronic health record system was Ystad, a small hospital in the southern Swedish region of Skåne. This 190-bed hospital also had 74,000 outpatient visits a year, including 21,000 for acute illness, which installed the Swedestar system.

In 1989, HC Lennér, chief physician at the department of internal medicine, initiated the project [START_REF] Nordestedt | Datoriserad journalhantering vid Ystad lasarett -en uppföljning hösten 1994[END_REF]. The hospital management was enthusiastic, and although they received some external grants, the hospital financed some 80 to 90 percent of the investment costs from their normal budget, believing it would pay off. They divided the goals into two sets -short-and long-term goals. The short-term goals include:

 Less manual work for notes, referrals, and lab results,  More efficient care through better access to information,  Support for nurses and the evaluation of the nursing care,  Possibilities for change and trials of new processes in outpatient clinics and clinical wards,  Improved privacy protection,  Improved work situation for the assistant nurses by providing more direct patient care and reducing the time spent on paper work. The long-term goals include:

 Improved assessment of the production and costs,  Improved quality management,  Improved competence of staff.

They first used the system in 1991 in the clinical wards for internal medicine and certain outpatient clinics. There were many initial difficulties with frequent stops of the system and much integration was required for referrals and lab-test results that were not ready. Interestingly, the ways of working with records and rounds changed. Doctors and nurses now first sat down in front of a computer and discussed all the patients and then the doctors made their rounds alone, with very little documentation and no computer support. Not everyone applauded this approach. In 1994, they computerized almost the entire set of hospital's records. In the overall assessment, they at least partially met the goals in all aspects, but 25 percent of the staff felt that the computer records functioned worse or much worse than anticipated.

Melior -The Sahlgrenska Development

Sahlgrenska University Hospital is a large teaching facility in Gothenburg. They started to develop their own EHR system in 1988, using a then rather modern Microsoft technology and allowing different departments to choose their own key words and specific graphical user interfaces to create an efficient and user-friendly display for the presentation and collection of data. Although this was very popular, it caused problems for the doctors and nurses when they moved between the wards, because they did not recognize the screen-layouts. Therefore, they decided to develop one common user interface, which was very similar in appearance to an ordinary paper-based health record. This version was ready in 1993 and the installation began the following year. Unfortunately, it had taken a long time to install the system in the whole hospital for the same reasons as with the PAX system.

Attempts to Standardize Systems for Interoperability

From the early 1990s, there have also been several attempts to develop standards for record structures. In Sweden, the government organization, Swedish Institute for Health Services Development, SPRI [START_REF]Spri:Styrelsen för teknisk utveckling: DASIS -datorstött informationssytem i sjukvården: datorisering i vården -ett måste[END_REF], had an important influence in setting standards for certain elements of records, actually starting with the paper-based ones of the 1980s, but also used many in the 1990s EHRs. European standardization started in CEN/TC 251 from 1992 onwards and the first elements of the Electronic Health Record Architecture appeared in 1995 under the leadership of doctor Petter Hurlen from Norway. An object-oriented information model followed these design principles in the pre-standard 13606 in 1999. This in turn was further developed into what is now state of the art in electronic health record architecture. Based on the two-level modeling, it uses so-called archetypes for specific clinical purposes that represent constraint models of the relatively small reference model. Since 2008-09 this has been both a European CEN and an ISO standard and thus a national standard in all the Nordic countries.

Discussion

The paper presents how computer support in primary care was rapidly developed and implemented on a large scale in Sweden during the early 1990s. At an international level, this is quite early, although our neighboring countries had similar developments but somewhat later. One reason has been the public financing of health care in Sweden through the now twenty independent county councils. These had enough financial strength to support the introduction of record systems in all the primary care centers of their respective areas. The general size of a rather large group practice of four-to-ten doctors and perhaps ten-to-thirty other staff members also meant that there was a power of scale that facilitated the investment, installation, and management of the small server-based systems on a local area network with relatively advanced software. In many countries, even in European ones such as France, a single doctor's office largely manages primary care and there is little capacity to manage a computer system let alone its development.

It is interesting to note that during the rather few years of the early 1990s, when this market took off, there was a huge proliferation of at least twenty-seven different products, developed with a quite similar range, although some of them were imports from Norway, Denmark, or Iceland. This was clearly too many and ten years later only four remained as commercial products, although in some locations many of the early systems are still running. Three of the systems used in 1994 are now among the leaders in terms of number of users, Journal III, Melior, and VAS. Relatively little has happened to them in fifteen years, even if no new installations occur.

It is noteworthy that Electronic Health Record systems rarely succeed in other countries than in their country of development; many also have problems reaching beyond the region in which the company is located. In some respects, a hospital EHR system is much more demanding. Use was still very low in 1995 and it was not until 2009 that as many as 85 percent of hospital wards were using computerized records.

The goals of the early pioneers not only targeted improving the efficiency of routine activities in health care, but also the prospects of easy and comprehensive follow ups of medical results, as quality management and research into the future were often mentioned. Unfortunately, the systems of the 1990s that still dominate the scene do not provide such features, partly because medical facilities did not fully appreciate the difficulties of standardizing EHR structures and their associated medical terminologies.

Fig. 1 .

 1 Fig. 1. Number of installed EHR systems in Sweden 1988-96.

Table 1 .

 1 Systems for electronic health records in Sweden 1994.

	System name	Supplier
	AMA	Mediflex Data AB
	APEX	DDE Sverige AB
	Axept (formerly called Aesculap)	INEQ AB
	Bedside	Celsius Information System
	BIOSIS	Health Allocation System AB
	BMS journal	Bonjour Medical System AB
	Dialog Journal	Celsius Information System
	Dr Grans Datorsystem	Gran Data AB
	Infodoc	Sysdeco Profdoc AB
	Journal II and Journal III	Sysdeco Profdoc AB
	Journalia	Journalia AB
	Mac Adapt	Frontec Care System AB
	MacDoc II	Esmeralda AB
	Medex	Medex Sverige AB
	Medicus	Data 16 AB
	Medidoc	Medidoc AB
	Medilite	PCD Applitron AB
	Melior	Siemens AB
	Mia vård	Infoservice Sweden AB
	Patientjournalen	Patientjournalen AB
	PC-Praxis	Lap Power
	PMS	Bergsjö Data-och Systemutveckling AB
	Promed	PRO International AB
	Swede Star 2.0	Celsius Information System
	VANIA	CAP Programator
	VAS	CAP Programator Stockholm AB
	WordPics	DAFA Syd AB

Acknowledgments. The authors are indebted to Mr Gert Ljungkvist, retired from SPRI -the Swedish Institute for Health Services Development -for sharing his private archive and answering many questions.


Lennart Rolandsson
email: lennart.rolandsson@mnd.su.se

Teacher Pioneers in the Introduction of Computing Technology in the Swedish Upper Secondary School

Keywords: Curriculum development, education in computing, programming, system architecture, teacher, upper secondary school

The paper elaborates on programming and computing 1970 to 1983 in the Swedish upper secondary school. Articles from contemporary journals and firsthand text sources are used. During that period, programming never qualified as a separate subject; it was a tool for problem solving in engineering, economics, and mathematics, and did become a literacy subject in its own right. Early adopters of computers in education became important pioneers in the production of discourses about "how-to" and "what-to" teach. The diffusion of computer technology was substantiated in a curriculum for computing in natural sciences, which embraced programming.

Introduction

The paper describes the period from 1970 to 1983 when computing was under considerable elaboration in experimental works at schools. Computer technology had been in universities and Swedish industry since the 1940s, but the 1970s was the decade of important reforms when the gymnasium (upper secondary school) merged with vocational education into one school system. Three perspectives describe this historical movement: 1) the pedagogy offered by hardware and software, 2) the experimental works initiated by the National Board of Education, NBE (Skolöverstyrelsen) in some of the major projects concerning the adoption of computing into education, and 3) the voices of teacher pioneers concerning programming.

This paper is part of my thesis project that explores programming as a subject topic experienced by teachers in upper secondary school. The perspective of computing history is important to appreciate better the constraints that technology offers.

The learning processes of students when constructing software have always been dependent on features in peripheral and internal hardware. Students could consider themselves lucky if they did not have to load the computers, by hand for half an hour, with necessary software before beginning the work of programming.

In the fall of 1979, NBE made an inventory of different computer technologies used in schools [START_REF] Skolöverstyrelsen | Datorn i skolan. SÖ:s handlingsprogram och slutrapport SÖ-projekt 628[END_REF]. Fig. 1 displays the computer hardware shifts in upper secondary school during the 1970s. The figure reveals a huge investment from 1977 to 1979 when many schools purchased single unit computers. 1 According to the DIS-report, the investment for five working places with a connection to a mainframe computer or minicomputer would be approximately 25-35 million SEK [START_REF] Skolöverstyrelsen | Datorn i skolan. SÖ:s handlingsprogram och slutrapport SÖ-projekt 628[END_REF]. The prices of single unit computers were much more affordable at the time. However, technological development was rapid, which possibly led to some caution with regard to investments. According to NBE's enquiry in 1979, more than 50 percent of the schools had only one or two single unit computers and 88 percent of the schools had at most five single unit computers. In other words, schools were cautious.

2.1

Mainframe Computer

In the spring of 1970, a programming project called "Zimmermanska skolan," together with ASEA Education AB, began at an upper secondary school in Västerås, Sweden [START_REF] Andersson | Datorn i skolan (DIS): förstudie 1. Kungl[END_REF]. The working group consisted of three part-time teachers plus a full-time teacher assistant who worked together with students from the technical upper secondary school. Together they developed courses in Automatic Data Processing (ADP) combined with the regular mathematical education for natural science students. At their disposal, they had a mainframe computer, DEC PDP-8 8k/word, which was equipped with disk memory 32 k/word, seven terminals, and eleven monitors. The educational method fell into one of the following two categories:

1. Classroom teaching where the teacher used a monitor to demonstrate, for example, the parabola of moving objects in physics; 2. Students working in groups of four at typing machine terminals and monitors connected to a common computer in the classroom. The documentation reveals that it took about ten hours of students' work before they could construct their own programs in some applied subject.

Desktop Calculator

In Sunnerboskolan, teachers had their first experience of computing in 1970 when they used terminals connected via modems to companies such as IBM, Honeywell Bull, and Datema [START_REF] Emanuelsson | En gymnasieskola med lång erfarenhet[END_REF]. The educational setting was expensive and constrained to special times during the day and year. Due to the complex connecting procedures, the education consisted primarily of teacher led demonstrations. At first, teaching focused on programming in FORTRAN, and later in BASIC. The shift was based on the higher threshold for learning FORTRAN.

Due to economic constraints, teachers decided to use the desktop calculator, Compucorp 122E, which offered a higher threshold because of the lack of any advanced level language. The calculator, however, enabled more flexible classroom activities, since students could work more interactively with their algorithms. The students prepared the executable programs in assembly language, which were translated to code on card(s) that were loaded into the calculator later. They then had to wait in a line before they could see the results of their work. If students discovered errors in the code, they had to check their algorithms and repeat the process.

Minicomputer

Sunnerboskolan was also one of the very first schools that purchased a minicomputer in 1973, the PDP 8, with three teletype devices [START_REF] Emanuelsson | En gymnasieskola med lång erfarenhet[END_REF]. The computer's construction meant that you had to load the machine for twenty minutes with a BASIC compiler before one could use it in class. The connection between the teletypes and the minicomputer was slow; the teletypes printed ten characters per second. Therefore, in 1975, the school decided to buy a minicomputer, the Alpha LSI, with a magnetic secondary memory, which resolved many of the tedious preparations. According to documentation, they purchased their third minicomputer in 1978, the Nord 10, which had a much bigger primary memory and a faster response rate with its terminals. The monitors responded one hundred times faster than the teletypes could ever print. In conclusion, the educational setting for computing transformed considerably in a period of five years.

The Introduction of Programming in Upper Secondary School

The first secondary schools to offer computing courses in the 1960s were located in one of the following areas: Stockholm (Fridhemsplan), Västerås, Gothenburg, and Malmö. Computing was offered as advanced special courses at upper secondary school; as a student, you could choose between one-year specializations in administrative ADP or technical ADP [START_REF] Skolöverstyrelsen | [END_REF]. Due to its success and to meet industry standards at the time, these first schools were soon followed by eleven others [5] located in Solna, Växjö, Västervik, Norrköping, Linköping, Örebro, Karlstad, Uppsala, Gävle, Umeå, and Sundsvall [START_REF] Andersson | Datorn i skolan (DIS): förstudie 1. Kungl[END_REF]. The courses reached a peak or "programming boom" at the end of the 1960s with thirty-five to forty classes [5] all over Sweden. The programming languages offered were Assembler, FORTRAN, PL/I, Simula, Basic, Simscript, Cobol, and script languages [6,7].

In 1977, reorganization from NBE to National Board of Universities and Colleges (Universitets-och högskoleämbetet, UHÄ) meant that many schools were organized under higher education and municipality colleges. However, three schools included a local upper secondary school in the following cities: Umeå, Uppsala, and Linköping [5].

In 1980, collaboration occurred between one college and Berzeliusskolan in Linköping where they carried out the education for the natural sciences computer alignment (from now on named CANS) and evening courses for the municipal adult education [5]. In Malmö, a municipal college offered courses for teachers at upper secondary level and a college in Växjö offered courses for the municipal adult education.

Early Adopters of Programming in Technical Upper Secondary Schools

The result of an enquiry in 1970 initiated by NBE identified fourteen different technical upper secondary schools as users of computers for scrutinizing laboratory data [START_REF] Andersson | Datorn i skolan (DIS): förstudie 1. Kungl[END_REF]. A report from 1973 reveals the existence of local experimental work carried out at nine different upper secondary schools [START_REF] Fagerström | Datorn i skolkommunen (DISK): Kartläggning, beskrivning: Förslag till åtgärd[END_REF]. The educational content differed in some aspects between the schools, but the main intention was to enhance calculation and problem solving in mathematics and applied subjects. According to the report, education allocated to programming varied between the schools from a few to fiftyone hours, in languages like BASIC, FORTRAN and COBOL. Furthermore, the DISreport reveals that some schools had received special support from NBE for investments in computer technology since 1973: Erik Dahlbergsskolan in Jönköping, Berzeliusskolan in Linköping2 , Sunnerboskolan in Ljungby, and Zimmermanska skolan in Västerås [START_REF] Skolöverstyrelsen | Datorn i skolan. SÖ:s handlingsprogram och slutrapport SÖ-projekt 628[END_REF][START_REF] Fagerström | Datorn i skolkommunen (DISK): Kartläggning, beskrivning: Förslag till åtgärd[END_REF].

Another report from NBE [START_REF]Skolöverstyrelsen: Datoranvändning i eltekniska ämnen (DISEL)[END_REF] reveals that students of electrical engineering were taught how to program simpler tasks (mainly in BASIC), by the mathematics teacher. Students would acquire procedural knowledge about computing and programming to the extent that: … [students] themselves sometimes have to code and sometimes they have to use established programs. It is important that the computer interaction is not time consuming and that students do not perceive computer interaction as an unusually complex way of solving problems [START_REF]Skolöverstyrelsen: Datoranvändning i eltekniska ämnen (DISEL)[END_REF].

The report from 1976, DIS Bygg, explicitly indicates how teachers of the building/construction course perceived the necessity of programming in education [START_REF] Skolöverstyrelsen | Datorns användning i byggtekniska ämnen: Delrapport (DIS Bygg)[END_REF]. Some excerpts from these teachers' opinions reveal that there was a tendency to work more with established programs: … only one of three building/construction teachers had spent much energy in creating programs … If the school had a computer park with BASIC-compilers and enough terminals, students with interest could probably create their own programs, and in that way also learn a diversity of calculating methods [START_REF] Skolöverstyrelsen | Datorns användning i byggtekniska ämnen: Delrapport (DIS Bygg)[END_REF].

The role of computers was a calculation tool used for statistics, printing graphs, or sorting data, which would infer programming work. According to a report, the time allocated to the objectives of learning computing, with a major focus on programming, was a suggested two hundred hours distributed over four years at upper secondary school [START_REF]PRODIS report[END_REF].

A Broad Initiative with Many Projects

During the 1970s, the NBE expressed a sincere ambition to draw up a curriculum for developing computing literacy among students in secondary school. They realized early in the process that computer technology would become a pervasive technology with a huge impact on the whole of society. NBE therefore had to reach a common understanding of how to organize and standardize computing education in secondary school. Some countries considered the importance of a new subject [START_REF] Skolöverstyrelsen | Datorn i skolan. SÖ:s handlingsprogram och slutrapport SÖ-projekt 628[END_REF] with advanced technical content, while Sweden and NBE, based on recommendations from the DISK report [START_REF] Fagerström | Datorn i skolkommunen (DISK): Kartläggning, beskrivning: Förslag till åtgärd[END_REF], decided to adopt their own implementation strategy, as quickly as possible, in different subjects while experimental work would determine best practices. Subsequently, they would introduce a new subject called "Datalära." NBE formed a working group in 1974, "Computers in school," a DIS 3 group that based its work on the assumption that computing is better taught as non-specialized knowledge with the potential to facilitate and enhance conceptual understanding in other subjects like mathematics, natural, and social sciences.

The Computing Alignment in Natural Science Program

Meanwhile, in 1976 [START_REF] Björk | Datorns intåg i svenska skolan[END_REF], experimental work for eight to nine hours per week started in the Natural Science Program with a computer alignment (CANS). The intention was to "increase the number of students in natural science for the purpose of making Natural Science Program more practical with regard to connections to society as a whole" [START_REF] Wendelöv | Fortbildning i datalära Mer tid för matematik. Remissvar på kursplaneförslag för NT-linjerna[END_REF]. The intention described in 1981 was: …not intended as a difficult alternative… Hopefully students will experience learning about computing in harmony, partly by doing their own programs, mainly in BASIC, and partly by using developed programs in different subject domains. In addition, it will lead to a better understanding of computers in society. The overall objective of the work is to expose the natural scientist to the use of computers, instead of it being regarded as an education for computer specialists [START_REF] Borg | N-linjens datatekniska variant[END_REF].

This was one of four different alignments in the Natural Science Program. The other three were in energy, healthcare, and environment, of which computing was considered the most popular. One of the persons in charge of the implementation of CANS describes the process in the following way:

The experiences so far are good, with a positive attitude from students and teachers. Because of the Natural Science Program and the [computing] alignment's future, it will be very important that education in the subject does not put too much pressure on students. One of the major concerns with the alignment is to give students more time for natural science… [START_REF] Wendelöv | Gymnasielinjernas matematik[END_REF]. At a conference in 1981 [START_REF] Wendelöv | Gymnasielinjernas matematik[END_REF], teachers involved with computing alignment shared their experiences while emphasizing special concern about the importance of structure and sound habits when students use system architecture in programming. The language COMAL (a dialect of BASIC) was considered suitable for fostering sound habits because of its implicit structure.

Based on work in the DIS-project [START_REF] Skolöverstyrelsen | Datorn i skolan. SÖ:s handlingsprogram och slutrapport SÖ-projekt 628[END_REF], NBE devised a new curriculum, in 1983 [START_REF]Skolöverstyrelsen: Läroplan för gymnasieskolan[END_REF], for Computer Science or "Datakunskap," which became the course subject and guideline for the computing alignment in the Natural Science Program. It was explicitly drawn up with 190 to 240 hours [START_REF] Wettstam | [END_REF] of computing. The curriculum was extraordinary because of its descriptive texts to facilitate the teaching of computer science. Teachers in favor were mainly from the mathematics domain [START_REF] Borg | Varierande undervisning på datateknisk variant[END_REF]: Software development in a methodological sense is a relatively new knowledge domain undergoing huge change. The subject is not part of any teacher education [for upper secondary school]. Due to this, extensive commentaries about the module [concerning program development and programming] have been included to clarify and describe a strict educational design and overview of the subject for inexperienced teachers [START_REF]Skolöverstyrelsen: Läroplan för gymnasieskolan[END_REF].

The commentaries, divided into three levels, are worth reading. They consist of features of the language, elaboration about the programming concepts, and a major work project; a pattern still found today in programming courses A, B and C in upper secondary school. The curriculum description contained twenty-five pages, divided into five different modules:

1. Computer system 2. Program development and programming 3. Use of computers in natural sciences 4. Use of computers in social sciences

System technology

A clear statement about the purpose of studying "Datakunskap" is made at the beginning of the document [START_REF]Skolöverstyrelsen: Läroplan för gymnasieskolan[END_REF]:

… the education should be designed to enhance the development of students' ability to work with computers as users … The intention is not to educate people for the programming industry," meanwhile one of the objectives for the course is to "develop students knowledge in problem analysis and programming." One of the first schools carrying out experimental work with CANS was Berzeliusskolan in Linköping. Bandhagen upper secondary in Stockholm started in autumn 1977 [START_REF] Borg | Varierande undervisning på datateknisk variant[END_REF] and was followed in autumn 1978 by eleven other schools.

Step-wise Integration of Programming into Mathematics

Some teachers perceived computing as different from the rest of mathematics and sometimes too advanced for the ordinary mathematics curriculum. They state:

The change of curriculum [with numerical methods] could drastically influence mathematics education, mainly because of the implicit demands of the new way of thinking, which above all shall be integrated with the other chapters [in the literature] …teachers with not enough confidence dare not experiment with technical facilities and therefore [numerical methods] become another example of a theorized module, practiced according to the student literature mainly before central assignments [START_REF] Schreiber | Vad blev det av NUMA?[END_REF].

In 1976-77, twenty classes were doing experimental work within mathematics [START_REF] Vejde | Några fakta om NUMA försöket[END_REF] where step-wise iterations were introduced for solving differential equations which were later enlarged with numerical equations, numerical integration, simulation, and applications in physics, all under the name of the NUMA4 project [START_REF] Björk | Datorns intåg i svenska skolan[END_REF]. The material originated from a group of teachers at Sunnerboskolan in Ljungby. The overall intention of the NUMA project was to study how practical mathematics could be established in a school context with computers [START_REF] Borg | Några terminer vid en minidator[END_REF]. The following excerpt describes some of the ideas that surrounded their pedagogy:

The 1980s is the decade for problem solving in mathematics … In school we are trying different strategies for problem solving. Computers and calculators foremost affect the trial and error methods and the simulation methods. With a computer as a tool, students could experience how mathematics could be used experimentally to solve different problems. Computers in the proper hands open up possibilities for the enhancement of creative thinking [START_REF] Björk | Datorns intåg i svenska skolan[END_REF].

Teachers in general considered programming as synonymous with tedious work that took time away from the original subject, mathematics [START_REF] Wendelöv | Fortbildning i datalära Mer tid för matematik. Remissvar på kursplaneförslag för NT-linjerna[END_REF]. The dilemma between time-consuming technicalities in programming and increased conceptual understanding in mathematics is obvious. The author of the previous excerpt states:

If you intend to really do programming you should do it with a broader perspective; formulate your problem, pick one of many solution methods, code it in a language, try the algorithm and document your solution [START_REF] Björk | Datorns intåg i svenska skolan[END_REF].

Another excerpt reveals the importance of a sound and social connection when implementing programming in the school context:

We have to aim for a broader perspective of computer technology that goes beyond the common dialectic view of either the public fear of hostile technical database registries or the computer technician's light blue optimism. It is also important that a general broader perspective even includes hackers (compulsion programming) among our students and teachers [START_REF] Björk | Datorns intåg i svenska skolan[END_REF].

Analysis and Discussion

In the development of the computing curriculum, two intersecting objectives have emerged [START_REF] Fagerström | Datorn i skolkommunen (DISK): Kartläggning, beskrivning: Förslag till åtgärd[END_REF]: 1) the implementation of computing as a non-specialist subject offering literacy, and 2) computing as a tool to facilitate the education in applied subjects. The paper has exposed the existence of programming, during the time span, in different experimental works; in advanced mathematical courses (numerical methods and algorithm construction), in applied subjects for engineering in upper secondary school, and as a module in computing alignment for the Natural Science Program.

The paper also reveals the tension between the features inherent in computing devices and the intent to teach programming in an educational setting. Furthermore, the paper presents the existence of teacher pioneers who succeeded in merging technology and pedagogy to such an extent that their work became exemplary for NBE in the development of the computing curricula. Programming, however, does not appear as a subject itself, during this period, which could be understood from the contextualized view and the programming perspective as a natural tool in problem solving [24]. Nevertheless, one of the teacher pioneers explains the beauty of the conceptual understanding of loops 5 , when he writes:

The class have conquered the computer with a simple BASIC program and forced it to deliver the true answer with few loops! Is not that a miracle in itself? [START_REF] Björk | Datorns intåg i svenska skolan[END_REF] Finally, I would like to pose the question concerning advanced special courses in upper secondary school within ADP. Why did the legacy from these courses not have a greater influence in the development of computing education? They obviously used the same resources for several years.

Fig. 1 .

 1 Fig. 1. How computer hardware changed in upper secondary school during the 1970s [1].

1

  Commodore PET came on the market 1977, Apple II in June 1977, TRS 80 in December 1977, ABC 80 in August 1978, and Compis in 1984.

Table 1 .

 1 Number of schools carrying out experimental work within the Natural Science Program (CANS)[START_REF] Borg | N-linjens datatekniska variant[END_REF][START_REF] Wendelöv | Gymnasielinjernas matematik[END_REF][START_REF] Borg | Varierande undervisning på datateknisk variant[END_REF].

		Number of	Number of students
		schools
		within
		CANS
	1978	11
	1980	20
	1981	35	500 students in year two
	1983	47	1,956 students in year two, 1,029 students in year three
	1985		2,345 students

During that time the head master of Berzeliusskolan was also one of those responsible for the report "Computers in the school municipality," DISK report (translated from "Datorn I SkolKommunen").

Acronym for "Datorn I Skolan."

NUMA is an acronym for "Numerisk matematik."

A learning object in programming.


Arne Kaijser
email: arne.kaijser@abe.kth.se

The Use of Computers for Controlling Electricity Flows in Sweden, 1950-1980

Keywords: Control, computers, efficiency, power systems, stability, Sweden TIDAS

An important application of computers from the 1950s and onwards has been for designing and operating complex infrastructural systems like air traffic, telephony, railways, and electricity. This paper tells the story about how computers from the 1950s and onwards became an important tool for designing and operating the Swedish power grid. It describes two phases of this development.

In the 1950s and 1960s, computers were used for making complicated calculations for designing power grids in a reliable way and optimizing the use of the different power plants. In a second phase starting in the late 1960s, computer systems were developed for real time monitoring supporting human control of the power grid. The paper analyzes by whom and for what purposes computers became tools for controlling electricity flows. In the conclusion, it also discusses the wider implications of computers for the development of the Swedish power system.

The Challenge of Stability

In Sweden, many of the large rivers and hydropower resources are located in the northern part of the country, while most of the population and industries are located in the south. Starting in the 1930s, long power lines were built to enable transmission of power from the north to the south and these lines became the backbone in a national power grid. However, the power grid also entailed a new kind of vulnerability due to the increasing complexity and the tight coupling between all the components. This meant that a disturbance in one part of the country could spread quickly to other parts of the system [START_REF] Perrow | Normal Accidents[END_REF].

Power engineers were particularly concerned about so-called power oscillations: a sudden accident in a power plant or transformer station could cause major oscillations in the transmission lines. Such oscillations could affect transformers and power plants far away. In the mid 1920s, a young engineer at ASEA, Ivar Herlitz, studied this problem and developed a mathematical method for designing stable and robust transmission lines. His method was a forerunner of what became the new discipline of control theory in the 1950s. It was used when the first Swedish 220 kV power lines from the north of Sweden were designed in the early 1930s [START_REF] Herlitz | The Dynamic Stability of Long Transmission Lines[END_REF][START_REF] Fridlund | Den gemensamma utvecklingen[END_REF].

As the number of power lines increased, so did the complexity of the power system and Herlitz' method led to ever-larger calculations. In the early 1950s, the State Power Board, or Vattenfall as it is usually called, built a special laboratory where a physical model of the Swedish power system was constructed. (Vattenfall was responsible for operating the national grid.) It was a so-called network analyzer similar to the one built by Vannevar Bush at MIT in the 1930s [START_REF] Mindell | Between Human and Machine[END_REF]. This network analyzer made it possible for engineers at Vattenfall's Planning Division to simulate different kinds of disturbances in the grid. It was also possible to test different configurations of future power lines, but the preparation of these configurations was very time consuming.

When the computer BESK became available in the mid-1950s, Åke Ölwegård at Vattenfall's Planning Division developed a model for simulating the Swedish power system on BESK. Because of the limited capacity of BESK, the model was simplifiedfor example, it had only six power stations -yet, it behaved similar to the more "correct" model of the network analyzer. Moreover, the big advantage was that the parameters could change notably faster between subsequent simulations. A simulation that would take two days to prepare on the network analyzer could take only fifteen minutes to prepare with BESK [START_REF]Interview with Åke Ölwegård by the author 6. The Swedish State Power Board, The Swedish 380 kV System[END_REF].

When more powerful computers became available in the early 1960s, Ölwegård and his colleagues at Vattenfall's Planning Division developed a more comprehensive computer model of the Swedish power system called Dynamic Stability (DYN STAB). Vattenfall was able to make simulations at night on a big IBM 7090 computer, owned by the Swedish Defense Research Institute, FOA, until Vattenfall bought a computer of its own in the mid-1960s [START_REF]Interview with Åke Ölwegård by the author 6. The Swedish State Power Board, The Swedish 380 kV System[END_REF].

In the 1960s and 1970s, the complexity of the Swedish power system grew substantially, first because many power lines were built to neighboring countries and a Nordic grid emerged, secondly because huge nuclear power plants were built and taken into operation. These changes altered the system properties of the power system in a fundamental way [6]. The computer models described above were very important tools for planning and designing this expanding system in such a way that it would be robust and stable. These computer models were also used to make instructions for the personnel operating the grid. In particular, safety margins were calculated so the grid would be able to withstand a major disturbance, for example, the loss of a transformer or a high-tension line, without affecting consumers.

The Challenge of Efficiency

In all large-scale power systems, an important challenge is to use the various power plants in an efficient way. In the 1960s, twelve large power producers dominated the Swedish power industry. The largest one of these was Vattenfall, which owned almost 50 percent of all generating capacity. Each of the twelve power companies had a regional monopoly in some part of Sweden where it sold power to local utilities and industries [START_REF] Högselius | När folkhemselen blev internationell: Avregleringen i historiskt perspektiv[END_REF].

Until the 1960s, Swedish electricity supply was predominantly based on hydropower, and yearly variations in precipitation and winter temperature influenced the availability of power in different parts of the country. The risk of shortage could be diminished by building storage dams and thermal power plants for backup, but such facilities were expensive and managers of the power companies realized that they had much to gain from mutual cooperation. If companies with a surplus of water in their dams could sell power to those with a shortage and if many companies could use thermal backup plants jointly, it could substantially lower the overall cost for reserve capacity.

Nonetheless, the selling and buying of power called for common rules for calculating the marginal cost for power. For thermal power, the marginal cost was rather easy to calculate. The dominant cost element was the cost of fuel. However, the marginal cost of hydropower was much more complicated to estimate. It had to take into account not only the operation costs, which were minimal, but also the risks for having to use thermal power later on or to ration electricity. These risks were dependent on the water level in the up-stream water reservoirs and the expected precipitation. In the 1950s, two engineers at the Sydkraft power company, Sven Stage and Yngve Larsson, developed a rather sophisticated mathematical theory for such calculations. The latter developed a computer program for these calculations that ran on BESK [START_REF] Larsson | [END_REF]. Ölwegård recalls that he and Larsson met each other sometimes while running their respective programs at night on BESK [START_REF]Interview with Åke Ölwegård by the author 6. The Swedish State Power Board, The Swedish 380 kV System[END_REF]! Vattenfall developed a similar method for calculating marginal costs and there was a certain tug of war between the two methods. Nonetheless, a power pool agreement was reached in 1965 between the twelve largest power companies. This power exchange made possible a coordinated and very efficient use of almost all Swedish power plants and storage dams. In parallel, with negotiations about a power pool in Sweden, there were also efforts to establish power exchange among the Nordic countries. In 1963, a new Nordic organization for power cooperation, Nordel, was established. A few years later, the same principles for power exchange as in Sweden were adopted for the entire Nordic region.

Monitoring the Grid with Telephones

In the 1930s, Vattenfall established a central control room for the daily operation of their power plants and transmission lines. In 1947, the Swedish parliament made Vattenfall responsible for the management and operation of the entire Swedish power grid and Vattenfall's central control room became the national control center. The physical location of the control room was in Vattenfall's office in central Stockholm until 1962, when it moved to Vattenfall's new huge office building in Råcksta, a suburb of Stockholm.

The most important measuring instrument in the control room was a frequency gauge. The frequency should be as close to 50 Hz as possible and if it started deviating from 50 Hz this was a sign that something un-normal and unwanted was happening, but not what it was. Therefore, the key technical tool in the control center was the telephone. If an incident happened somewhere in the power system the engineers in the national control center were informed of what had happened through a telephone call from colleagues out in the country. When the control room engineers had made an analysis of the situation and what actions were needed, they phoned back and gave orders. Thus, when major disturbances occurred there was a very intensive calling [START_REF]Interview with Gunnar Ålfors by the author, who worked in the control room ca[END_REF]! Normally two people worked in the central control room. One of them was responsible for the safe operations of the national power system. He gave orders to control centers around the country to start or stop power plants so that the total generation closely followed the total consumption. This was a prerequisite for keeping the frequency close to 50 Hz. He also checked that safety margins remained at all critical nodes in the grid. The other engineer was responsible for the economic optimization of the power system. His task was to make assessments and forecasts of which power plants in the country were most economical to use at each point in time and in the coming day and week, and to make offers to other companies to buy or sell certain quantities of power. He also registered all sale and buy deals so that they could settle them afterwards. Similar deals were also made with power producers in Denmark, Finland, and Norway. Both engineers used simple rule of thumb calculations for most of their decisions and these rules were based the computer models mentioned above [START_REF]Interview with Gunnar Ålfors by the author, who worked in the control room ca[END_REF].

Daily control of the power system in Sweden was thus remarkably "low-tech" until the mid-1970s. This was possible because the power system -designed with the help of computer programs -was as stable and robust as possible. In addition, strict safety margins were established with these programs. Furthermore, many small disturbances were handled automatically without any human interference at all. For example, if the frequency dropped below a certain level, some designated hydro power plants or gas turbines would start automatically within seconds.

The engineers in the national control center had a large responsibility and mistakes could -literally -have far-reaching consequences. For example, Gunnar Ålfors, who worked many years in the control room, had a nightmare experience in the early 1970s when he was new on this job in the control center. To compensate for a burnt electronic component in a transformer station near Östersund, he ordered the closing down of a transmission line to Karlstad, but by mistake he said the wrong name and another power line between Karlstad and Gothenburg was closed down. This led to a power loss and oscillations in the southern part of Norway and within a few seconds a power line to Oslo broke down and the whole city became black [START_REF]Interview with Gunnar Ålfors by the author, who worked in the control room ca[END_REF]!

Monitoring the Grid with Computers

Another much larger blackout had occurred some years earlier abroad. On 9 November 1965, a fault occurred at the Niagara power station and within ten minutes, overloads had cascaded through the interconnected power grid in the northeastern states of the US and the whole of Ontario in Canada. Approximately twentyfive million people were left without electricity for up to twelve hours. That an electric blackout could have this magnitude was a shock to the public, politicians, and engineers alike.

The shock waves went far beyond the North American continent, and alarmed the engineers responsible for the operation of the Swedish power grid. In the mid-1960s, Sweden was connected with transmission links to the neighboring Nordic countries. This meant that up to fifteen million people in the four Nordic countries could be affected if a major blackout would occur in Sweden. Moreover, in the coming decade new big nuclear power plants would come into operation, which would make the Nordic power system even more complex.

Shortly after the big American blackout, Lars Gustafsson, the head of the Operations Division at Vattenfall, initiated an investigation concerning measures to avoid similar events in the Swedish grid. The investigators recommended the procurement of a computer system for monitoring the grid. The system could collect current data from power plants and transformer stations from all over the country approximately every ten seconds, process these data and present them in a lucid and usable way, and make calculations to determine the optimal mode of operation of the power system a week ahead. The system was called Totally Integrated Data Acquisition System (TIDAS), a name that tells something of the ambitions [10].

In the spring of 1971, a call for tenders was sent out to about twenty potential bidders, and the incoming tenders were carefully assessed half a year later. In 1972, the Swedish firm ASEA, which had been a major supplier of equipment to Vattenfall for half a century, was chosen as the main supplier for the new computer system. To be more precise, a new subsidiary called ASEA-LME Automation was responsible for the project. They established this subsidiary the previous year and recruited engineers from both ASEA and the telephone manufacturer LM Ericsson. ASEA engaged TRW Control, as a subcontractor for the computer part of the project. TRW was a company with headquarters in Houston, Texas and specialized in control engineering for the space and automobile industry, but also with some experience from the power industry. It was absolutely crucial for Vattenfall that the computer system would be reliable; therefore, Vattenfall participated actively in the development of TIDAS. Vattenfall engineers went both to Houston and to Västerås and Ludvika in order to follow the development work and to make sure that the computer system would be well adapted to the Swedish grid.

ASEA-LME Automation was responsible for the transmission part of the system. At an early stage some of the engineers read an article in an IEEE publication on "Adaptive Routing Techniques for Computer Communication Networks" describing the new ARPA network, [11]. The ASEA engineers found this promising and decided to embark on this road. However, the communication network for TIDAS was more complex than the ARPA network and contained more nodes. According to Torsten Cegrell, one of the ASEA engineers, they redesigned the ARPA network to achieve a robust and stable system, and according to him, this new design was important for the further development of the internet [START_REF] Cegrell | A Routing Procedure for the TIDAS Message-Switching Network[END_REF].

In parallel, TRW Control worked on the data processing part of the project, called TIDAS-D. TRW in turn worked closely with Xerox Data Systems. Two Sigma 9 computers from Xerox were chosen as the hardware for the system. A whole series of very extensive tests had taken place before Vattenfall would accept the new system. When the Houston team had completed its work, the computers and all the peripherals were flown to Stockholm in a chartered Boeing 747 Jumbo Jet [START_REF] Cegrell | A Routing Procedure for the TIDAS Message-Switching Network[END_REF].

In Stockholm, the computer part was merged with the communication networks from ASEA. The combined TIDAS system was very carefully tested and personnel from the central control room as well as the regional control centers were thoroughly trained before Vattenfall dared make the decision to take it into operation. The TIDAS system went into service at 7 AM on 7 February 1977 and it worked [START_REF] Vedin | Technology, Tumbling Walls of[END_REF].

The cost to develop and install the entire TIDAS system amounted to about a hundred million SEK. It was unique in several respects. In particular, the data transmission part was very advanced at the time. Data accumulated at 150 power plants and transformer stations and about a thousand measurements went to the national control center via sixteen nodes with eight-second intervals using packet switching technology. ASEA managed to develop a robust and stable routing mechanism with very high reliability. The data processing part was also advanced. It consisted of two identical Sigma 9 computers, one of which was in continual operation while the other was on stand-by and used for the training of personnel. The computer linked a number of workstations and key boards. The operators could look at no less than eight-hundred different graphs of the current situation in the power system. In addition, the computer automatically made statistical compilations of all incoming data to serve as a basis for planning the operations for the coming week [10].

TIDAS was not an automatic control system, but a monitoring system that assisted control room engineers. Through TIDAS, they had a much better overview of the entire power system and they did not have to rely on rule of thumb calculations any more. This led to a more efficient use of the generating (and storage) capacity in the power system. The estimated gain equaled a medium sized hydropower station. Moreover, the national power grid could operate with more precise safety margins than before. This meant that the system operated at a higher capacity, as the earlier rules of thumb had been more conservative in compensating for the insufficient overview. One could compare this with a driver in a new car with better breaks and controls who is tempted to drive faster than in his or her old car. We should note, however, that TIDAS did not prevent some major blackouts; for example, a major blackout occurred 27 December 1983 when all of southern Sweden lost power.

Conclusion

Let me finally briefly discuss the wider implications of computers for the development of the Swedish power system at large. This paper has described how computers from the 1950s and onwards became an important tool for designing and operating the Swedish power grid. It has outlined two phases of this development. In the 1950s and 1960s, computers were used for making complicated calculations for designing power grids in a robust and reliable way, and for optimizing the use of the different power plants. In a second phase starting in the late 1960s, computer systems were developed for real time monitoring supporting human control of the power grid. We should note that Vattenfall did not dare introduce the kind of automatic process control systems that for example IBM had developed for industrial purposes [START_REF] Johan | oral history interview by Per Lundin[END_REF]. Instead, they developed a system "with a man in the loop"; that is, one in which a human operator made the crucial decisions but continuously received data about all components in the system. The responsibility for controlling electricity flows thus remained in human hands and minds.

The introduction of TIDAS meant rather big changes in the daily operation of the Swedish power grid, and this spurred certain resistance. One kind of resistance came from inside Vattenfall, because TIDAS altered the tasks and responsibilities for different divisions and groups as well as for individual people. Another resistance came from other power companies as TIDAS gave Vattenfall a much better overview of the entire Swedish power system than any other entity. However, the advocates of TIDAS overcame these different kinds of resistance.

TIDAS was only one part of the computerization of the Swedish power industry. In parallel, also other parts of the industry were computerized, including the local distribution and the billing of customers. This meant that the ability to monitor and control electricity flows from the power plants all the way to the final consumers increased rather dramatically, and this in turn was a technical prerequisite for the deregulation of the power industry that occurred in Sweden during the 1990s. This is arguably the most profound effect of TIDAS and other computer systems in the industry. However, no one anticipated this effect when computerization was initiated in the late 1960s.

Acknowledgments. I am grateful to Handelsbankens forskningsstiftelser for supporting the research for this paper. I am also grateful to my colleagues within the project, "Precursors of the IT Nation: Computer Use and Control in Swedish Society, 1955-1985" for comments on earlier versions of the paper.


Søren Duus

Østergaard ( Denmark

Ingeborg Torvik Sølvberg

What Can We Learn from the History of Nordic Computing?

The panel discussion took place during the second day of the conference. Professor Hans Andersin (Finland) had planned to participate but was unable to do so. Historian Dr. Lars Ilshammar (Sweden) was invited to participate with prepared questions for the panel.

The panel members had prepared introductory statements that expressed specific comments about the historical development. In regard to this, before the conference, Hans Andersin had distributed comments addressing the role of cooperation with government in forming an information society that would otherwise, to a great extent, have turned out to be guided by university research and industrial achievements.

At the start of the session, the panel members were given time to make introductory comments. The panel addressed the limited role of women's activities in the development of computing as well as the role of the type of education given during that time. With a different type of education, could the development have been different?

The panel noted the challenge of the increasing complexity of systems developed from early times and onwards. Did this lead to a complexity that was too great and unstable, and if so, what can be done? It also pointed out that there can be different types of historical lessons learnt depending on who is being taught. Some lessons address the needs and practices of applied research; others are structural and address cooperation, or relate to specific achievements in industry and, to some extent, the broader society.

A discussion followed between the members of the panel. Comments were made about the role of education for early development, and about the varying rates of progress during different historical phases. What types of external conditions had been instrumental for the different phases?

Lars Ilshammar added comments regarding who questioned how possible lessons learnt could be of value for further historical research after pointing out the experiences gained from three HINC conferences. Is there need for increased methodological refinement? He added that as computing has become increasingly transnational over time cooperation over borders may become more relevant, inviting more comparative approaches. Ilshammar also added that it may be of interest to question how Nordic activities had contributed to the view on information systems in which systems structures have changed from standby computers to ever-enhancing networks.

With this as background, panelists commented about the role of computing history as an emerging new field of research and the possibility of finding value from more established scientific fields with historical contact.

It was then noted that early Nordic computing development had, to some extent, reaped some benefits from certain types of governmental support, and surely also from cooperation between industry, education, and research. However, central parts of the development of Nordic computer systems can hardly be said to have been the sole fruit of explicit governmental planning.

After a number of remarks from the panel, the discussion was opened up for comments and questions from the public. Numerous aspects were added, among them observing the importance of lessons learnt from insufficient concern about systems security and supporting compatibility between system dialects.

In a review of the points made during the panel discussion, certain aspects were emphasized. These often took the form of questions rather than answers:

 How can we address the concept of Nordic influence in a situation where the Nordic countries acted separately, to some extent?  Was there a geographically related type of influence, concerning shared responsibility?  Did the Nordic computing mentality (e.g., cooperation in systems work and user influence) transcend internationally?  What role can historians play in the further analysis of computing development in an information society?  Could the Nordic influence have taken a different path if computing scientists and engineers allocated greater concern to computing security in its early stages of development?

In summarizing the panel discussion, we note that the discussion raised more questions than answers provided. For future endeavors, statements were made about the importance of specific types of education that already start at elementary school. The need for increased security concern was also noted. Comments were added about the importance of a more evident gender balance in different phases of the historical development. These comments are important for future types of analyses, where lessons from the past may be a historical ladder upward and forward. A concluding remark of the panel discussion was as follows:

The Nordic countries are now part of the world, a situation where cooperation may be of increased value. It is worth remembering that we are only at the beginning of a movement into the online society, a development that contains much change.