Once an Alabama farm boy, G. Octo Barnett, M.D., has made a career-long commitment to advancing clinical information technology.
 |
| G. Octo Barnett, M.D. |
“I’m just a country doctor,” G. Octo Barnett, M.D., likes to say, and you might fall for the ruse if you discard the surroundings, titles and achievements of a lifetime of research, development and teaching. Still, it’s easy to see how Barnett’s Alabama accent and humble persona have served him in becoming one of the great pioneers during the past half century in the application of computers to health care.
Although his career should be long in its reflective phase by now, Barnett just can’t seem to retire. He still holds positions as professor of medicine at Harvard Medical School and senior scientific director at the Laboratory of Computer Science (LCS) at Massachusetts General Hospital in Boston. Barnett was director of the laboratory for decades after helping found it in 1964, and it wasn’t long after that he and his team of engineers, clinicians and researchers created MUMPS, the first computer language for health care applications. MUMPS provided the foundation for some of the most advanced clinical systems in the country, including ones used today by the U.S. Department of Veterans Affairs and Boston-based Partners HealthCare, the umbrella organization for hospitals including MGH and Brigham and Women’s. In the course of advancing the science of clinical IT, Barnett and the LCS also helped nurture generations of medical informaticists, many of whom have become leaders in the field.
Called to Research
It all started humbly enough. Born in 1930 in Chula Vista, Calif., Barnett moved to Alabama at the age of six, where he grew up on what he calls a “dirt-poor, worn-out farm” raising cotton, peanuts and 20 pecan trees that provided the family’s only cash crops. “My father died during the Second World War, so I had to run the farm. Anybody who harbors the idea of a gentleman farmer has never been a farmer,” he says. His teacher mother enjoyed reading and helped pique the young Octo’s intellectual interests.
It was also here in the Alabama backcountry that a series of fortuitous circumstances and connections began that have since moved Barnett along what seems like a preordained path. While sitting in a barber chair, he learned that scholarships were available to Vanderbilt University. Matriculating there, he majored in chemistry and math. “I thought I’d be a country doctor, but I had no money and planned to go to medical school in Alabama,” he says. “While I was washing dishes in the biology lab, a professor very kindly said I should instead go to Harvard or Yale, which I’d never heard of. I really came from the backwoods.”
He won a scholarship to Harvard Medical School, graduated in 1956 and completed a residency in internal medicine, specializing in cardiology, especially the mathematics of blood flow. That led to using computers. “I was fortunate enough to live with a bunch of MIT grad students,” which accelerated his interest, Barnett says. When a brilliant engineer suggested that computers could be used to look at the flow of information in a hospital, his calling became clear. “I did a right turn in my career to focus on use of computers in medical decision-making.”
Barnett had always enjoyed research and found a willing and generous patron in the National Institutes of Health, which he credits with the vision to gamble on the nascent field of medical informatics in the 1960s. “I have been enormously fortunate to be at the right place and time with extraordinary people,” Barnett says. Working with a “couple of geniuses” at LCS, he says, led to NIH-funded development of MUMPS, a direct result of his team’s frustration with the assembly language running on the Digital Equipment Corp. computers of the time. DEC itself provided new computers to run the new language.
The 1970s followed with development of more complicated applications such as a medication ordering system and—far ahead of its time—an electronic medical record system for both inpatient and ambulatory environments. Barnett’s team also focused on the first software system for a pre-paid health plan, Harvard Community Health Plan. It was more of the same in the 1980s and 1990s. “The technology just kept getting better and better. We were able to work in every area of the hospital,” he says, adding that the LCS has moved a half dozen times on campus and now has almost 60 staff, 10 of whom are doctors. It also has a training program for physicians.
Enter the Internet. The laboratory has developed a clinical decision-support system available on the Web called DXplain, which uses a set of clinical findings—like symptoms—to produce a ranked list of diagnoses.
Can Advances Be Shared?
Barnett acknowledges that he’s been working in a rarified environment, and he’s learned that there’s a wide chasm between the haves and have-nots in health care.
“One thing that bothers me is that I can’t find an easy way to transfer our advances to mainstream health care. I don’t know how to handle the transferability issue and don’t know the right relationship with industry. They work very well at MGH,” he says of the computer applications developed by LCS, but not necessarily at hospitals with far less resources than a health system like Partners. Barnett once tried to share the clinical systems his lab had developed with hospitals in the inner city and on the Navajo reservation. “It was an enlightening experience,” he says. “They lacked leadership, infrastructure and training resources required to be successful in IT. You can’t drop it in place. There’s so much else required besides just the technology. I got a bit humbled by the transferability issue.”
It’s not something he takes lightly. Compassion for the less fortunate and a deep commitment to social equality arise from his Quaker faith. “Life is just not good for a lot of people, and with the resources we have we could change that. It bothers me. Each day we spend $1.4 million on a war in Iraq while there are 20,000 to 30,000 homeless people in Boston,” says Barnett.
That commitment to people has been present since he started his research. From the first DEC computer to the Web-based DXplain, the work of LCS has never wavered in its belief that IT is a enabling tool and nothing more. Says Barnett: “The work we’re doing today is still very much like what we’ve always done, but on a much greater scale. The computer is not a thing in and of itself. We always ask what we can do with it to make a better care environment. We’ve never deviated from that commitment.”
And he has always stopped to smell the roses. “I have a continuing sense of gratitude that my life has been very kind to me.”
Chuck Appleby is a freelance writer specializing in health care and technology.
Click here to e-mail suggestions for future IT Visionaries.
GIVE US YOUR COMMENTS!
HHNMostWired welcomes your comment on this article. E-mail your comments to hhn@healthforum.com, fax them to Most Wired Magazine Editor at (312) 422-4500, or mail them to Editor, Most Wired Magazine, Health Forum, One North Franklin, Chicago, IL 60606.
This article first appeared on March 26, 2008 in HHN's Magazine online site.
To respond to this article, please click here.
