Disruptive technology is a term used to describe new technology that disrupts the status quo. These technologies displace existing technology—dramatically changing the production, delivery, or use of a product or service. For example, 3D printing is an innovative method of producing three dimensional objects using digital prototypes and will change manufacturing as we know it. Although the term is traditionally used in a positive light, this technology, as its name suggests, can be disruptive.
I first became intrigued by the use of technology in medicine as a sophomore in college. I took a health policy class and I learned about the advent of electronic medical records (EMRs) in the United States. Now, years later as a medical student, I use EMRs every day in the hospital. These digital records store the health information of millions of patients. I witnessed the capability of EMRs while working for a month in a surgery clinic. Doctors’ clinics are notorious for running behind schedule. But this clinic was different. The attending physician and I worked as a duo for every patient. When Mr. Jones came in with months of chest pain, it was business as usual. While the physician talked to the patient, I filled in a partially auto-populated template:
Mr. Jones is a 58 year-old male with ** history of chest pains. His chest pain is described as ** and are ** physical exertion. The pain ** radiates. He is able to walk ** flight of stairs …
At every space marked ** I chose the appropriate descriptor from a drop-down menu. In this case, no/1 month/2 month/several months; crushing/sharp/dull/achy; related to/not related to; does/does not; 0/1/2. With a few clicks of a button, Mr. Jones pertinent medical history was complete. Of course, there were instances where more editorial input was necessary, but for the most part each patient’s medical history was standardized and indistinct. We repeated this routine throughout the day and for once, clinic actually finished on time. No patients were angry about having to wait and we went home on time.
However, when patients are reduced to templates, mistakes can happen. Numerous times in the hospital I saw physician notes with ** left in the text. Other times, old notes were copied and pasted without any editing, leaving irrelevant information that was no longer pertinent to the patient’s current condition. While most of these errors do not detrimentally affect the patient’s condition, they can lead to confusion for other health care providers trying to interpret the note. Importantly, these inaccuracies are part of a living document. They are digital breadcrumbs liable to legal scrutiny in ways the medical community is just beginning to understand.
EMRs can be a great money saver in medicine. I remember one occasion when a young woman came to clinic for a follow-up appointment. Although unrelated to the reason she came in, she had symptoms concerning for anemia. One week prior, she was evaluated by another doctor and blood samples were taken to determine if she was anemic. However, we did not have her results since the other doctor was outside of the clinic’s electronic medical record network and she did not recall that doctor’s name. We sifting through her EMR and were able to find the doctor’s name and contact information in a note from years back. Instead of running the tests again, we contacted the doctor and got the results. We saved the patient and the health care system money.
However, sifting through the medical record was no easy task. Often, the electronic record is cluttered with unnecessary correspondences between doctors and mini notes which make it hard to parse out relevant information. Hopefully, as EMRs become more interoperable and move into the hands of patients, these difficulties will abate.
Outside of the EMRs, technology has become a marketing tool as hospitals purchase state-of-the-art devices to attract new patients. I first heard of the da Vinci robot at a medical school interview. The da Vinci robot, or “just pinch me” robot as I admirably call it, is a futuristic machine that is a mix of game console and sci-fi space invader. Surgeons use a 3D-vision remote console to control robotic tentacles that serve as an extension of their hands. The robot allows for minimally invasive surgeries with little blood loss, less scarring, and in theory, quicker recovery.
While it sounds lovely, the utility of these devices has been called into question. There are a number of operations that can be performed just as well with a more hands-on approach. Recently, the American Congress of Obstetricians and Gynecologists questioned the use of robotic surgery for hysterectomies. Indeed, a study in JAMA found that laparoscopic surgery, using a fiber optic scope with a camera, has equivalent morbidity to robotic surgery for hysterectomies. However, robotic surgery was associated with higher costs. The results comparing robotic to laparoscopic prostatectomy are not any more encouraging: similar survival for prostate cancer and robotic surgery may lead the higher rates of impotence and higher costs. The da Vinci robot comes with a hefty price tag of 1-2 million dollars and sizable maintenance costs. As the popularity and use of robotic surgery increases, more research is necessary to demonstrate where the robots fits in and provides benefit among the multiple options available for surgery.
From the operating room to the living room, phone applications are increasingly used by providers and patients alike for medicine care. I love my apps. At the beginning of my clinical year in the hospital, I used an app to diagnose achalasia, a disease where esophagus loses its ability to move solids and liquids from the mouth to the stomach. A young woman came into the ER with 3 months of difficulty swallowing. She described a sensation of food getting stuck in her chest. In addition, she frequently regurgitated food after she ate and had lost 20 pounds in the last 3 months. As the symptoms progressed, she finally decided to come to the hospital. Her symptoms could have been anything from GERD to cancer. I used the app to find out the possible diagnoses and ask the right questions. “Do you have difficulty swallowing solids, liquids, or both?”; “Are you having any difficulty keeping your eyes open?”; “Any history of radiation to the chest, head or neck?”
There were other occasions when I used apps for prevention. I used the Shots app by the Society for Teachers of Family Medicine and the Electronic Preventive Services Selector by the Agency for Healthcare Research and Quality for vaccinating and screening patients, respectively. Apps have helped me with medicine use and safety as well.
Currently, the majority of apps are brought to market without stringent critique. A number fall short of the benefits they claim and some may even be harmful. In fact, the FDA has recently begun to investigate a number of phone apps due to safety concerns. uChek, an application that is used with a kit to analysis urine recently came under scrutiny because it functions as an accessory to a medical device. Apple itself has discouraged apps that display medication doses. The regulation of these applications moving forward has yet to be determined.
EMRs, surgical robots, and phone apps are just a few of the many technologies used in the field of medicine. There are amazing advances on the horizon that will do everything from predicting depression using geo-location on smart phones to printing out organs. The real value of technology depends on human interaction from design to utility. The users determine whether technology is a cost-driver, a cost-saver, quality controller, error creator, the great equalizer or disruptor. It is this dichotomy—the ability to heal or harm that still intrigues me.
Kunmi Sobowale is a medical student.
