Primary Care Office Information System

Now I'm at Octo Barnett's session.  He's at MGH – the medical mecca back in Boston.  Indeed, he's an icon of Medical Informatics … has been doing this work since most of us were toddlers.

It's an interesting talk on how they built an intranet for primary care physicians in Boston that was very successful.  No surprise there.  Formulary infomation, Up-to-date, referral forms, how-to, etc. etc.  To support this system, they have several FTEs – including a 1.5 FTE clinicians.  Big resources that only MGH or another big organization could afford.  They develop content, support old content ..

Then they did a cool thing:  they went out to places that had no such infrastrucutre – rural Maine, Rural Arizona, Nashville, etc. 

The goal of this was to see if it met Octo's three-pronged "reality test"

  • Is it used by real people for real jobs?
  • Is it supported by real money?
  • Can it work somewhere else?

Now .. does an "intranet" with such clinical information work well in other environments?  The answer is maybe.  There are things that need to be localized:

  • Formulary
  • Patient Education Information
  • Referral Information
  • Guidelines

Other barriers included hardware and software availability.  Some of the sites had insufficient hardware, connectivity or technical resources to implement even the end-user side of this.  Without good Internet access – one certainly can't use web-based resources.

Overall – the session was a good descriptor for how one could succeed in implementing a clinical web resource – but many questions about sustainability (the project was funded by an NLM grant) remain.