History of the development of medical information systems at the Laboratory of Computer Science at Massachusetts General Hospital

G. O. Barnett
1987 Proceedings of ACM conference on History of medical informatics -  
The reconstruction of history is always a difficult task. The important decisions, the critical issues never seem to be adequately documented and cannot easily be recalled. It is difficult enough in affairs of national importance to try to establish "who knew what, and when did he know it?" In considering the history of the activities of the Laboratory of Computer Science at Massachusetts General Hospital, I have found it equally difficult to try to establish: "what did we do, and why did we do
more » ... it?" I have little confidence in my judgment as to what were the important contributions of the Laboratory of Computer Science in the first decade of its existence, and even less confidence in my ability to recall and to interpret appropriately the contributions of a host of individuals who participated in the effort. The only option seems to be to frame this presentation as a series of flashbacks consisting mostly of hazy memories of incidents and selected extracts from grant requests and progress reports. I do not pretend that these flash-backs are either a valid scientific quest or a valid historical review, and I fully appreciate that these memories are greatly colored by the events and the activities that have happened since that time. Two observations, however, seem uniquely important. Claude Bernard wrote: "Art is I; Science is We." I cannot emphasize too strongly this statement in reflecting over the history of the Laboratory of Computer Science which it has been my privilege to lead for almost twenty-five years. I have been enormously fortunate in having had the opportunity to work with a large number of enormously creative, imaginative, and effective colleagues who have played a major role in the contributions we have made in the past twenty years. No presentation would be complete and accurate without giving recognition to these individuals. I have often felt that my primary responsibility was to recruit good colleagues, and then try to provide the environment where they could be optimally productive. There are too many people to name individually in this short presentation, but I will identify some of the key individuals in relation to specific projects. I know that I will fail to recognize many individuals who have made important contributions; this failure haunts me in my writing of an historical account of the Laboratory. The second observation I would offer is that much of what is accomplished in life and in science seems in large part to be dominated by luck, by the accident of being in the right place at the right time, with the right resources, the right funding, the right opportunities. I believe this to be true in much of what we have accomplished at the Laboratory. I feel most fortunate that thirty years ago, due to a chance association of living together with a group of MIT electrical engineering graduate students, I became acquainted with computer technology and became captivated by it as an idle recreation. I still live in fear that someday it will be discovered that I am getting paid for doing my hobby, and that I will have to get a real job. Preparing this manuscript has been somewhat of a revelation and somewhat distressing. Technology has developed at a fantastic rate and yet progress in implementation has been laborious and slow. I found it interesting and somewhat entertaining to read two paragraphs I wrote in reviewing this field for the New England of Medicine [1] almost twenty years ago: "Early interest in bringing the revolution in computer technology to bear on medical practice was plagued with over enthusiasm, naiveté and unrealistic expectations. The use of computers would, it was held, allow rapid and accurate collection and retrieval of all clinical information, perform automatic diagnosis, collect, monitor and analyze a variety of physiological signals, perform and interpret all laboratory tests immediately, and replace the telephone and the medical record by fulfilling their functions. In fact, however, attempts to apply computer technology to medicine have had only limited success, with numerous failures. The growing pains encountered in applying computer technology are not unique to medicine; the same types of experiences have been realized in all other areas of computer application. Indeed, one of the benefits of the computer revolution is that it stimulates and requires an intensity of thinking, a level of sophistication and a strictness of semantic behavior that are needed badly in the development of improved methods of delivering health care." "The initial wave of optimism and enthusiasm generated by beguiling promises of an immediately available total hospital computer system has passed. Now, efforts are directed toward the painful, slow evolutionary
doi:10.1145/41526.41531 dblp:conf/hmi/Barnett87 fatcat:odmy3vp6vjdrndcxehobmvdlvq