Vosburgh Kirby G, Newbower Ronald S
CIMIT/MGH/Harvard Medical School, Cambridge, MA 02139, USA.
Stud Health Technol Inform. 2002;85:8-13.
The advancement of technical power described by Moore's Law offers great potential for enabling more cost-effective medical devices and systems. However, progress has been slow. Many factors for this failure have been cited, including the anti-rational economic structure of healthcare and the complexity and long time scale of medical development. Christensen et al. suggest that "disruptive technologies" may circumvent some of these difficulties. "Disruptive Technologies" are defined as those that are established in one market, but then penetrate and overwhelm another market. These incursions are accelerated by economic factors, and capitalize on functionality, reliability, and advancements supported by the original market. Christensen has cited many examples from industrial and service businesses, but few examples can be found yet in healthcare. We argue that positive technology impacts in medicine occur most readily when innovators augment the skills of and collaborate with caregivers, rather than seeking to displace them. In the short term, a new approach may improve efficiency or quality. In the longer term, such approaches may obviate human tasks at lower-skill levels, and even permit task automation. One successful example has been the introduction of flexible monitoring for physiologic information. Systems for computer-aided diagnosis, which have failed to impact complex decision making, have succeeded in simpler specialty areas such as the interpretation of EKG's and mammograms, and may do the same with analysis of some pathology images. The next frontier may the operating room, and the adoption of such systemic technologies by caregivers in emergency medicine and general care may then have an even wider "disruptive" effect. Responding to time and cost pressures, and the desire to move care to the patient, other workers, such as radiologists, will drive the trend away from isolated, complex, large-scale devices, and toward integrated, modular, and simpler networked technologies. In summary, technological "push" will continue in the demanding cutting-edge application areas as always, but the "disruption" will occur through wider application of lower-cost technologies, pulled by the users. The capabilities described by Moore's Law will allow the advancements necessary to facilitate this dissemination of capability and its ultimate benefit, so long sought.
摩尔定律所描述的技术力量的进步为实现更具成本效益的医疗设备和系统提供了巨大潜力。然而，进展一直缓慢。人们列举了许多导致这种失败的因素，包括医疗保健的反理性经济结构以及医学发展的复杂性和长时间跨度。克里斯滕森等人认为，“颠覆性技术”可能会规避其中一些困难。“颠覆性技术”被定义为那些在一个市场中确立，但随后渗透并主导另一个市场的技术。这些入侵会因经济因素而加速，并利用原始市场所支持的功能、可靠性和进步。克里斯滕森列举了工业和服务业的许多例子，但在医疗保健领域尚未发现很多例子。我们认为，当创新者增强护理人员的技能并与他们合作，而不是试图取代他们时，技术对医学的积极影响最容易出现。短期内，一种新方法可能会提高效率或质量。从长远来看，此类方法可能会消除低技能水平的人工任务，甚至实现任务自动化。一个成功的例子是引入了对生理信息的灵活监测。计算机辅助诊断系统虽然未能影响复杂的决策，但在诸如心电图和乳房X光片解读等较简单的专业领域取得了成功，并且在一些病理图像分析方面可能也会如此。下一个前沿领域可能是手术室，急诊医学和普通护理中的护理人员采用此类系统技术可能会产生更广泛的“颠覆性”影响。为了应对时间和成本压力，以及将护理转移到患者身上的愿望，其他工作人员，如放射科医生，将推动远离孤立、复杂、大型设备的趋势，转向集成、模块化和更简单的网络技术。总之技术“推动”将一如既往地在要求苛刻的前沿应用领域继续，但“颠覆”将通过用户拉动的低成本技术的更广泛应用而发生。摩尔定律所描述的能力将实现促进这种能力传播及其长期以来所追求的最终利益所需的进步。
