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January - Disruptive Technology in Healthcare

Beverly Miller

Beverly Miller, MHA, MBA, Acting Area Director

Indian Health Service California Area Office


One way that we measure the value of technological development is in its ability to reshape the landscape in terms of how we live our lives. The term for this sort of innovation is disruptive.  A “disruptive” technology changes something foundational in our business or lifestyle.  The iPhone was disruptive when it hit the market.

In the context of healthcare, we can point to numerous advances over time that have been disruptive.  Wilhelm Conrad Roentgen noticed a fluorescent glow of crystals near a cathode-ray tube in his laboratory, and his curiosity led to X-rays.

Disruptive technology flows from disruptive thinking, and intellectual pioneering can lead to new medicines and vaccines. In 1954 there were 37,476 cases of polio reported. By 1962, polio had become almost extinct, with only 910 cases. Jonas Salk whispers across the decades. put together a list of the greatest medical inventions of the last fifty years, which was redistributed by[1].  They include the active bionic prosthesis, laser and robotic surgery, the artificial heart, and of course the magnetic resonance imaging (MRI) scanner, which uses strong magnetic fields and radio waves to form images of the body that can assist health providers in diagnosis and disease staging analysis. Also on their list is Health IT, which the IHS has embraced in the form of the Electronic Health Record (EHR) - a system that allows for health information to be structured into accessible data.

In Indian Country, we find ourselves surrounded by technologies that will improve the health of Indian people. Improvements in our networks are such that many of the health facilities we serve are able to participate in the sort of data transfers that allow remote access to centrally located patient records. Sites that once had 1.544 megabit per second T1 circuits (or even less bandwidth) are now able to enjoy twenty eight times that throughput by deploying DS3 circuits, at considerably lower cost than only a few years ago. This allows telemedicine to reach further into the rural areas typically served by Indian health clinics.

While there are examples of world shaking technologies and methodologies created by the “lone genius” working in a garage by the bare light of a 60-watt bulb, the EHR provides another perspective on what drives disruptive technology; at times technological progress is driven by societal imperative and/or federal mandate. By establishing  rules for the meaningful use of EHRs and incentivizing their adoption, the Centers for Medicare and Medicaid Services is helping health care providers move to a system in which patient medical records can move between information systems and exchanges, and indeed be accessible from anywhere by the patients themselves.

At the California Area Office we’re making use of another technology that is shaking things up: virtualization.  The Virtual Desktop Infrastructure (VDI) allows us to centrally administer our computing environments, manage our IT asset life cycles, assure security by deploying common configurations, and provide a disaster recovery/failover capability by imaging and backing up critical servers. Beyond this administrative “use case”,  virtualization is an even more significant aid to health providers in the field, who are able to move from room to room in a clinical setting and access patient records from  mobile devices instead of fixed workstations.

There is a movement (driven in part by provisions in the Affordable Care Act) toward a more comprehensive approach to patient care, in which health decisions are coordinated among various health professionals and the patients themselves, with a central primary care provider coordinating health care delivery.   Terms for this include Patient Centered Care (PCC) and Patient Centered Medical Home (PCMH).   The success of this evolution of health care delivery will depend heavily on the efficacy of the technical innovation we are implementing now.