In the mid-1990s, at the Computerworld Honors Program’s Medical Symposium, a senior official from America’s Department of Defense made a flat prediction: medicine would become a major American export industry. Very few in the audience could even process this statement, because it violated everything we thought we knew about what the word “medicine” means. It was like the first note of a symphony played on an instrument never heard before, but making such a sweet note that everyone wanted to hear more. It has taken the better part of a decade, but the export of medicine has, in this year’s Collection, reached its first crescendo.

The buildup has been steady since the mid-90s and has centered around two terms: “telemedicine” and “laparascopic surgery.” Some forms of telemedicine are fairly easy to understand. For example, in one of the Collection’s case studies, psychiatrists at Veterans Hospitals have described their use of video links to treat patients in remote rural areas. The process may not be as broadly effective as meeting in person, but it goes a long way beyond the status quo where these people were not being treated at all.

Laparascopic surgery, on the other hand, was not originally driven by the issue of distance. It was driven by the need to do surgery without making massive incisions. (In traditional surgery, even a tiny repair to an artery might be preceded by a foot-long incision.) By guiding tiny robot incisors and video cameras into half-inch incisions, surgeons are now able to work both more accurately and with much less patient trauma. Older people in particular benefit from the smaller incisions. Procedures that used to require extended hospital convalescence are now done routinely on an outpatient basis.

Surgeon as conductor

Telemedicine became involved as a way of speeding up the adoption of this dramatically better way of doing surgery. Surgeons trained in traditional methods lacked the skills to do things the new way, and surgeons who had gained those skills were not always available for mentoring. So the mentoring became a remote process. This was possible because the laparascopic surgeon and her patient are actually linked electronically. The surgeon operates manipulators which guide the behavior of the robot incisors electronically. A video monitor conveys what is actually happening within the patient. Since the linkage is electronic in both directions, a skilled surgeon in another city can patch in and watch, providing guidance and advice as needed. Much of the early work in retraining traditional surgeons was done remotely.

In this year’s Collection, the physical link between surgeon and patient has been triumphantly broken. A doctor in New York City has successfully carried out surgery on a patient in Strasbourg France. The key innovation, of course, was the delays between the motions of the surgeon in New York, the action of the robot in France, and the return of the video signal to New York. The round trip now takes less than half a second.

Medicine is an export industry.

Many of the jazzier uses of the Internet in the past few years have been frankly optional. It may be nice to get reviews of the same movie from 25 newspapers across the country, but without them we can still plan our Saturday nights. Young girls in Tokyo may be bereft if their handheld messagers go dark, but they have not forgotten how to talk. And it goes without saying that trans-Atlantic surgery will have backups in place for many years to come.

More mundane uses of the internet, on the other hand, may already be losing their human backup. For five years now, the Computerworld collection has documented new and innovative ways that organizations are interacting with each other electronically. Today these innovations are coalescing into “supply chain management” systems. These in turn are starting to be offered on a server basis where the software itself resides remotely at a vendor’s site. So an organization uses a supply chain management system to manage its vendors who now include the company that supplies the supply chain management system that manages the supplier of the supply chain management system that... Etc. (And some day those suppliers will include a foreign supplier of surgery.)

It used to be that each organization had people trained to carry out the necessary interactions with its vendors and customers. If all the phones went dead, as they did in lower Manhattan on September 11th, the interactions stopped but the skills to do them remained in place, ready to resume as soon as the lines re-opened. Now it appears that those skills are disappearing into the internet. External interactions may no longer be something an organization “knows how to do”; increasingly the may be something that “just happens” with no residual human backup.

Beyond the e-glitter

Underneath all the e-glitter that fills the news media, industry is adopting the internet on a massive scale. The Computerworld Honors Collection documents the breadth and depth of this transition. Industry loves the internet because it saves money. It saves money because it eliminates the duplication of many people around the world all doing the same thing.

The Old Economy was full of this redundancy, where every organizational unit was expensively self-sufficient. The Old Economy was, however, cushioned against shocks precisely because each organization was largely able to operate on its own. The New Economy may be much more of a twitchy thoroughbred.