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As with human languages, many ways were devised to allow the computers and devices to communicate and, as with their human counterpart, most of the communication is incompatible with any of the other systems. The incompatibility can be broken into two categories: the physical layer and the protocol layer What is an industrial bus? Traditionally, the industrial bus has been used to allow a central computer to communicate with a field device. The central computer was a mainframe or a mini (PDP11) and the field device could be a discreet device such as a flow meter, or temperature transmitter or a complex device such as a CNC cell or robot. As the cost of computing power came down, the industrial bus allowed computers to communicate with each other to coordinate industrial production.The physical layer and the protocol layer can be defined using the phone system as an example. Any spoken language can be carried over a phone line. As long as both the speaker and the listener(s) understand the language, communication is possible. The phone line is not concerned with the meaning of the signal that it carries, it is merely moving those signals from one point to another physically. This is the physical layer, the conduit in which communications pass from one point to another. On the other hand, the speaker and listener(s) are concerned with what is transported over the phone line. If the speaker is talking in Spanish and the listener(s) are only fluent in English, communication is not possible. Although the physical layer is working, the language or "protocol" is not correct, and communications cannot exist. The industrial world has developed a variety of different physical and protocol communications standards.

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We can no more foresee the shape or extent of their effects on the health system than our ancestors could have foreseen the blossoming of science that followed the invention of the printing press.Our original editorial solicited articles that shed light on how new electronic applications could improve people's health—yet many of the submissions reported process measures far removed from health outcomes. For example, several papers described clinical decision software but gave no information on whether its use actually improved patient care in practice.The past decade has brought a range of electronic communication tools that promised to improve health care. As editors of this theme issue, we invited submissions describing how these innovations had lived up to their promise. These are our reflections on what we did and did not receive. The editorial announcing our theme issue resulted in the submission of nearly 100 articles—more than has been submitted for any other theme issue. The snapshot they provide shows that new media and communication tools are already transforming the way in which we communicate, learn, and think. The expansion of the internet, the launch of personal electronic assistants, and the penetration of wireless networks are making new relationships between doctors and the public possible. At the same time, they are exposing the weaknesses of our conventional approaches to clinical care, education, and evaluation of new interventions.