February 22, 2012

The Time is Now


The original Kipton to Elyria train route was 13 miles in length and is now one of the skinniest parks in the nation.  The original corridor was an ideal route for train traffic; it was flat throughout and allowed for laying straight lines.  In 1891, this lovely park was the site of the Great Kipton Train Wreck, and the ramifications of that tragedy rippled through American history over the next century.

In April 1891, the fast mail train was heading east on the route; at the same time a slower local accommodation train was heading west.  The local accommodation train stopped in Elyria, roughly 30 miles west of Cleveland, Ohio, where the engineer and conductor received instructions to let the fast mail train pass them in Kipton.  Just as the local train left the station, the telegraph operator ran onto the station platform to advice the conductor “Be careful, Number 14 is on time.”  The conductor was rumored to have replied, “Go to thunder. I know my business.”

By the pocket watch carried by the local train engineer, the train left the station at Elyria with more than enough time to allow for a detour to a side track to let the fast mail train safely pass. Unfortunately, the engineer did not realize his watch had stopped for four minutes, then restarted, resulting in a delay in moving the local train.

The trains collided at Kipton, Ohio.  The local train was applying full brakes at the time of the collision; however, the fast mail train was running at its full speed of approximately 45 miles per hour.  In the collision, both engineers died, as did six postal clerks.  A large piece of a steam chest struck the depot roof over fifty feet away; the concussive impact blew out most of the depot windows.

In the wake of this national tragedy, railroad officials contacted prominent Cleveland jeweler Webb Ball to conduct a full investigation.  Ball found that there were no uniform design standards for railroad watches, nor was there a watch inspection schedule.  Ball instituted performance and inspection standards in 1893, and thereafter was appointed the Chief Time Inspector for many railroads companies.   In addition to leading to the production of the Ball Railroad watch, his actions are credited with the saying “on the ball.”

I would argue that we face a similar pivotal moment in medicine, with discrepancies in quality of and in access to medical care.  To paraphrase science fiction author William Gibson, “the future is already here — it's just not very evenly distributed.”

We do not have the luxury of waiting for our generation's Webb Ball.  Rather, we have an obligation to insure that the technology currently available is used in a strategic fashion to build our new model of care.

We need another Webb Ball.  The digital revolution, gives us the opportunity to crowd source him.  The time to do so is now.

Farris Timimi, M.D., is medical director for the Mayo Clinic Center for Social Media.

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