Part one of a series:
The modes of transportation were automobile, train, taxicab, train and automobile, in that order Friday, on a trip from my home in Northwest Indiana to Lake St. Louis, Mo., a western suburb of St. Louis. The goal was to spend the weekend witnessing the "go-live" of a new electronic health-record system at 129-bed SSM St. Joseph Hospital West.
St. Joseph West was the first hospital to configure and turn on its system in a $330 million EHR installation program called Project Beacon at the four-state, 13-hospital (general- and acute-care) SSM Health Care system based in St. Louis. The latest upgrade will be based largely on the enterprise clinical system from Epic Systems Corp., Verona, Wis., and follows the installation campaign of a picture archiving and communications system/radiology information system across SSM Health Care that began in 2005.
At the recent American College of Healthcare Executives' meeting in Chicago, I met Pat Komoroski, president of St. Joseph West, and she was kindand daringenough to invite me down to witness the beginnings of a new age, not only for her hospital, but also for the entire SSM system.
It occurs to me, on reflection, that having enough confidence to invite a journalist to hang around your hospital for three days during a go-live may represent a milepost in this journey toward a computerized healthcare system.
I'll be presenting a first-person report of that implementation this week in Health IT Strategist.
Trains, roads and the information superhighway
Marketing slogans aside, for me, trains are still magic, even though I ride one almost every weekdaySamuel Insull's historic Chicago South Shore & South Bend Railroad commuter train, affectionately known by some who love and protect it as the Last Interurban Railroad.
Time and distance between Chicago and St. Louis being what they are made taking the train a viable alternative to flying or driving for this trip to St. Joseph Hospital West. But it meant getting my daughter out of bed at 3:30 a.m. to drive me to the South Shore station in Gary to catch the 4:37 a.m. That would get me to Chicago's Randolph Street station at 5:38 a.m., plenty of time to take a cab across the Loop and grab an early breakfast at Union Station before lining up to board Amtrak's 7 a.m. Lincoln Service connecting Chicago and St. Louis through Springfield, Ill., where Old Abe lived before moving to the White House.
Once out of the city, the tracks ran through vast, flat expanses of brown and gold fallow corn and bean fields, through small towns where the train doesn't stop anymore and where many of their old brick or wood-framed stations are no longer used to serve passengers. Gray moss covered the shingles of one tired old station whose roof rafters had partly collapsed.
And I learned that for long stretches, the railroad tracks run parallel to historic U.S. Route 66, with its vintage, roadside advertisements for Burma Shave and a small town's frozen custard stand, signs that were refurbished, most likely, for the summer tourist season when the owners of restored classic cars retrace the first paved road to California, just for kicks.
There was a timeand not so long ago, it seems to methat Route 66 was far more than a museum piece, but a vibrant, bustling example of the latest road construction technology.
It occurred to me on the train ride down that one technology doesn't always sweep away another, but rather that sometimes new technologies overlap each other in series as did trains, roads and, now, superhighways; a newer technology reduces the usefulness of the oldest iteration only to be gradually eclipsed by the very newest innovation.
In March 1960, my aunt Josephine drove her 1959 Ford Fairlane 500, alone, all 2,448 miles of Route 66, from Los Angeles to Chicago, and then into Indiana, to pick up me, my brother, and my mom and dad, to take us to California for a family vacation. Then, two weeks later, she drove us back and made the return trip to California, again, all the way on that two-lane highway, alone. So, seeing that legendary old road again made me think of my favorite aunt with affection.
I also learned by observing from the train window that in places, there are two versions of Route 66. One, though just a two-lane highway, has reasonably new and functional asphalt pavement, and still serves as a connecter, if not between the Midwest and California, at least between some communities and others. The other Route 66 just beside it is concrete, with weeds even in late March poking through its myriad cracks. The older road, perhaps the original, has sections removed from it, strategically it would appear, at distances each somewhat shorter than a quarter mile, and dirt mounds piled up on each side of the road cuts topped with rectangular metal signs warning "Road Ends," no doubt to thwart any new crop of rural James Deans from using it as a drag strip. Still, in a few places, even the older highway is being used as a service road.
And beside the railroad tracks and the older and newer Route 66s, weaving in and out in the observable distance, runs four-lane Interstate 55, the latest, most modern example of American transportation technology.
Each one of these transportation modestrains, roads and interstate superhighwayshas been a profoundly disruptive technology. The steam locomotive enabled the railroads to open the Midwest and West to increased settlement, agricultural development, mining, timber cutting and other forms of industry and commerce. Electric trains helped create a market for electricity that made Insull's dream of large-scale, grid-based electronic power generation a reality.
Commuter trains also made the modern suburb possible. But most U.S. passenger trains were supplanted by concurrent improvements in highways and automobiles; first came reliable, affordable, mass-produced automobiles such as Ford's Model T and Model A, and paved, two-lane highways like Route 66, and drive-in hamburger and ice cream stands came afterward. Then, after World War II, faster cars and the Eisenhower-inspired interstate highway system, which enabled the development of just-in-time manufacturing, shopping malls, urban sprawl, and the opening, in 1989, of St. Joseph Hospital West in what is today still only a town of about 12,000 people some 38 miles west of downtown St. Louis on I-70.
We are witnessing that same overlapping now in healthcare IT.
Enterprise computer systems, like those installed at St. Joseph Hospital West, are gradually replacing paper records, but not completely, and probably not for a long time. And meanwhile, grid-based computer systems, as IT futurist Nicholas Carr writes about in his latest book, The Big Switch: Rewiring the World, from Edison to Google, are gaining traction in healthcare, appearing as application service provider-based practice-management and EHR systems, and in personal health-record systems, with the latest entries from Microsoft Corp. and Google as big-league examples. Will a healthcare grid one day relegate enterprise systems to the dustbin of technology? We'll see.
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