Report to the National Institutes of Health Division of Research Grants

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Full reference: Barnett GO. Report to the National Institutes of Health Division of Research Grants Computer Research Study Section on Computer Applications in Medical Communication and information Retrieval Systems as Related to the Improvement of Patient Care and the Medical record – September 26, 1966. J Am Med Inform Assoc. 2006;13:127-135.

Dr. Octo Barnett of the Laboratory of Computer Science at Massachusetts General Hospital, Boston, Massachusetts on September 26, 1966 authored a report for the NIH (National Institutes of Health), Division of Research Grants Computer Research Study Section. The topic the report addressed was - "computer applications in medical communication and information retrieval systems as related to patient care and medical record." Dr. Barnett argues that information processing plays a central role in healthcare. Diagnosis and treatment he argues are an "iterative process" consisting of a "sequence of acts of information processing" starting from collecting a patient’s history to prescribing a treatment regimen.

seven categories of problems

The report detailed seven categories of problems that confronted research and development efforts in the field of healthcare "automated information communication systems".

The seven categories identified were:

  • system analysis: organizational culture and personnel to study health care processes through formal methods of analysis
  • limitation of computer technology
  • personnel requirements: lack of trained personnel for researching and implementing health information system projects
  • utilization of hospital as a lab: futility of setting up parallel testing environment to gauge effects in real world environments
  • evolutionary approach: iterative approach to system development
  • terminal development: rapid and user friendly data entry mechanisms
  • transferability: reuse and knowledge diffusion

The report also alludes to the unique nature of the healthcare industry and why industrial practices from other sectors cannot be applied to healthcare, carte blanche. Finally, the report lays out recommendations for hospitals and the Public Health Service for supporting, funding, and staffing research and developments efforts in health information systems.


Dr. Barnett’s report was prescient on the challenges that the health informatics community would face. The need for enterprise-wide information systems (e.g. EMR) instead of just narrow and specialized departmental systems, the need for multi-disciplinary training in information systems and healthcare to address the problem of chronic shortage of informatics workers*, the need for systematic and iterative approach to deployment and development of health information systems, the need for user friendly UI’s ["terminal development"], and the need for building re-usable components ["transferability’] are all relevant and actively debated issues today.

  • "Probably the greatest single limiting factor that curtails rapid development in the application of computers to patient care is the unavailability of competent and experienced personnel."