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Editor's Notes: What Does a Car Look Like?

September 25, 2013
by Mark Hagland
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Looking at the Health Information Exchange Conundrum—A Historical Perspective

It’s fascinating to learn about the early history of such modern technologies as automobiles, airplanes, and telephones. The first cars, just like the first airplanes and telephones, were essentially created entirely “custom”; there were no models or templates of any kind. Indeed, Karl Benz, generally acknowledged to be the father of the modern motor car, spent decades thinking about the idea of creating a motorized personal vehicle and then inventing the first thing we would recognize as the embryonic form of the car, along the way patenting the concepts of the speed regulation system, the sparkplug-driven ignition system, the carburetor, the clutch, and the gear shift, and then guiding his series of inventions forward until by 1888, he was offering the first commercially available automobile in history.

Still, it took until 1902 until the first large-scale, production line-based manufacturing of affordable automobiles emerged, when Ransom Olds opened his Oldsmobile factory in Lansing Michigan. And of course, the version we’re all familiar with, the Ford assembly line debuted by Henry Ford at his factory, didn’t come about until 1914.

There are similarities, too, between the development of the commercial automobile and the history of the telephone. Though everyone has heard about Alexander Graham Bell’s experiments in the 1870s that led to his 1876 application for a patent for his invention of the electromagnetic telephone (and indeed, Innocenzo Manzetti had introduced the idea of a “speaking telegraph” as early as 1844), it wasn’t until the last two decades of the nineteenth century that the first fledgling metropolitan telephone switchboards came into being, and they faced all sorts of hurdles at the start.

I remember watching a fascinating documentary on the history of the telephone on PBS a few years ago. One segment of that documentary focused one of the first public telephone switchboards, in Kansas City, and the immediate problem that arose when four different startup telephone companies came into being there. Subscribers could only speak to others who were subscribers to the same companies, meaning, of course, that if you and your Aunt Edna had different subscriptions, you couldn’t talk to each other!

It took a few years to work out that problem, and ultimately, the resolution of the problem came via the creation of the Bell system, which eventually was broken up by the federal government based on antitrust reasons, many years later.

In short, the development of technologies we consider essential to modern life has involved long journeys on the part of every technology; and that’s to be understood, given not only the complexity of the technologies themselves, but also all the process and even societal changes that had to take place to fully accommodate their presence.

It’s relatively easy to compare the stories of these trajectories to that of the development thus far of health information exchanges in the United States. Very difficult issues around standards development, interoperability with electronic health records, driving physician consensus and culture, and resolving questions around HIE governance and sustainability, among many other issues, seem to be coming to a head these days. In fact, HIE  is still a very young phenomenon, relatively speaking, and what’s more, it is emerging out of an almost mind-bendingly complex health care system in this country. So, as we consider where HIE is going right now, we should put this all into historical perspective, and understand that there are good reasons why HIE feels like a very complex, challenging thing. Just think of the first automobiles, and it will all make sense in a new way.