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Editor's Notes: How Travel Became a Global Business-and How Imaging Informatics Might Become Globalized, Too

November 13, 2015
by Mark Hagland
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I am reading a fascinating book, Overbooked: The Exploding Business of Travel and Tourism, by Elizabeth Becker, a former foreign correspondent for The New York Times and former senior foreign editor for National Public Radio. Its title immediately caught my eye, as someone who travels very frequently on business, and often hears, upon arriving at my gate, the announcement that “We are oversold on this flight, and are asking for volunteers…" As someone who is regularly outraged by the airlines’ avarice in overselling flights as a standard business practice, I thought that Overbooked would offer an investigation into such practices.

As it turns out that, while the book barely touches on that topic, it does offer curious readers fascinating reportage on the global travel and tourism industry. It delivers well on some of the promises of its book jacket copy, including the following: “In 2012, the number of tourists traveling the world reached one billion…. Becker travels the world to take the measure of the business: France invented the travel business and is still its leader; Venice is expiring of over-tourism. In Cambodia, tourists crawl over the temples of Angkor, jeopardizing precious cultural sites,” and many other promises.

The book does provide numerous very unpleasant, but useful revelations, including the horrific wages under which cruise ship employees work. Writing about a cruise down the eastern coast of Mexico, Becker and her husband find themselves dismayed to discover that their all-inclusive, $1,200-per person cruise’s price is so low precisely because cruise employees, including two waitpeople they meet from Turkey and India, are paid $50 per month, with no time off. Such case studies certainly will raise readers’ awareness of the exploitation of travel workers, as well as physical landscapes, and other “collateral damage” inflicted on humans and on earth’s natural environment, by this industry.

But I also found the book fascinating in its explanations of how global travel and tourism, following World War II, became a commoditized industry. Fundamentally, lots of very disparate elements—people, process, business, and technological—came together over a period of several decades to create a global system of interlinked processes that is the $3 billion daily global tourism industry (and that figure does not even include the business travel industry).

There is an analogous set of processes evolving forward right now around imaging informatics in U.S. healthcare, though, to fully pursue the analogy, imaging informatics is probably closest to what the global travel and tourism industry was like in about 1950. Most diagnostic images in healthcare remain locked in siloed, often still purely departmental, systems (radiology PACS, cardiology PACS, etc.). We are just beginning to robustly incorporate diagnostic images into enterprise-wide data and information systems, and to incorporate image-sharing into meaningful health information exchange.

Yet the visionaries in this area, including Rasu Shrestha, M.D., of UPMC, and the supremely knowledgeable Joe Marion, see things moving forward towards a new dawn, one that will see images truly becoming part of a bigger whole in healthcare, benefiting patients and communities.

This issue’s cover story includes interviews with pioneering leaders and organizations helping to move the U.S. healthcare system forward in this area. Not surprisingly, it’s going to take a number of years to fully incorporate diagnostic images into broad data and information systems that will help propel the healthcare system forward in this critical area. In the meantime, it will be fascinating to see how a new, comprehensive system of images and other data will evolve forward, just as the interconnected global travel system became a huge business and consumer ecosystem.