6
BACKGROUND
Disruptive Technologies Through History and Their Economical and Medical Implications
Disruptive and emerging technology is a term used to describe technology that is
significantly more advanced than previous iterations (Christensen & Bower, 1995). This
technology is often at the forefront of the field and generally improves on systems or diagnostics
already in place. In some instances, disruptive or emerging technology can be an entirely new
concept or idea. Often times, the technologies require extensive health care provider training to
achieve proficiency and mass overhauls are needed to implement the use of the technology. A
great deal of decisive obligations from an organization are essential to make the commitment to
adopt new technology. Clayton Christenson, an economist for Harvard Business School,
describes the adoption of disruptive and emerging technology into mainstream use difficult
because people are habitual and initially unwilling to use a disruptive product in applications
already known to them (Christensen & Bower, 1995). After the initial disruption has occurred,
newer technology adoption begins to infiltrate outdated systems with older technology
eventually becoming obsolete (refer to Figure 1.) This rule has held true many times before
within multiple fields and its validity remains consistent in health care as well.
Many older diagnostics and systems began with technology that is now widely accepted
and used today. Christenson makes note of several from within the same article such as Sony’s
first portable radios, which sacrificed sound quality for convenience and the disk drive industry’s
repeated struggles to deal with new smaller disks (Christensen & Bower, 1995).
A plethora of examples from the health care field exist as well. Another article (Pavel, et
al., 2013) mentions that to move toward a universal healthcare system, there must be a great deal
7
of data input that is shareable and readily available. Data involving individual health components
will supposedly come from devices designed to measure a variety of health indicators (Pavel, et
al., 2013). These devices could include sensors in the home, continuous monitoring of various
bodily systems, multiple new developments in robot-human interaction, and several other
emerging technologies. Many of the articles focus on the relatively new emerging technology of
3D printing. A method that involves recreating a three dimensional object that has been scanned
or designed in a computer program and is then reconstructed in a variety of materials thus
recreating the design layer by layer (Mertz, 2013). Benefits of 3D printing include customization
of many healthcare devices like hearing aids, help create more advanced structures therefore
expediting manufacturing time, and eventually recreate create organs (Ventola, 2014).
Integrating new technologies beneficial for healthcare applications requires acceptance and
willingness of health care providers and the general public for implementation, as well as
sufficient resources for education and purchasing by the adopting institutions. 3D printing and
other emerging healthcare technologies will become more common and useful in health care, but
before that can happen, they must overcome some of the more difficult problems associated with
adoption of new technology. Once primary reasons for lack of integration of new and emerging
technologies are understood, then it is possible to look for attainable processes to decrease the
time needed for implementation.
Industry thrives when capitol, materials, and labor are balanced to efficiently create a
symbiotic relationship (Christensen & Bower, 1995). These are considerable barriers to entry for
new and emerging technologies that dictate a great deal of industrial and corporate decision.
Providing healthcare services functions similar to most large business models of operation. The
8
corporate models of both for-profit and non-for profit acute care and diagnostic testing facilities
often have limited resources and readily available funds for new and emerging technology.
Christensen mentions budget limitations and restrictions associated with corporate health care
models. In his article, Christensen mentions businesses are often less likely to pursue disruptive
technology as there is very little certainty when it comes to the technology itself as well as the
emerging markets surrounding it (Christensen & Bower, 1995) . Business budgets and priorities
determine if the effort needed to develop and manage the new market is worth the risk it would
carry. Companies and businesses weigh and assess new technology integration and often find it
safer to maintain the markets and products they already know currently work rather than risk the
investment needed to implement a sweeping and costly technology change (Christensen &
Bower, 1995). There are times however when the allure of extreme profit and large returns on
market investment make it irresistible for companies to pass on technologic advancements. An
early adoption of technology through a large investment can lead to a market foothold that is
equivalent to a much larger gain further in the developmental process when emerging technology
has established itself (Christensen & Bower, 1995). For instance, it is often risky to establish and
build a new hospital with the latest technologic advancements in diagnostics and imaging for
areas with low socio-economic status or affluence due to demand being too low and a new
procedure or machine may be underutilized if there are not enough people in need of the
technology to rationalize a purchase.
Once a business has decided they want to invest in a new or advanced technology related
to healthcare, there is also a great deal of logistics to consider. The business is now responsible
for researching the technology to determine how it will be implemented and whether it is a
9
sustainable investment (Christensen & Bower, 1995). Consideration must also be allotted to
determining how influential the technology is likely to be convincing investors and board of
trustees that the technology is necessary for health care advancements in saving lives.
Other factors influencing technological advancements consist of: the economic ability of
individuals and healthcare facilities to maintain and obtain the equipment; scalability ensuring
that the technology can be widened to incorporate more people and systems; invasiveness of the
technology to ensure it impedes activities of daily living as little as possible; usability and
adaptability that allows the software or procedure to be installed with ease and remain up to date
and provide quality care as healthcare changes; accuracy and infallibility of the technology
should be high to ensure trustworthy results; security of the system should be high to maintain
privacy; and the technology can be easily integrated into the workflow to ensure there are no
additional difficulties associated with integration of the technology (Pavel, et al., 2013).
Adoption barriers and access are the primary issues holding back innovative technology in health
care integration and the possible solutions to improved and streamlined integration remain
elusive.
3D Printing Technologies
Since the advent of the technology in the 1980s it has made a great deal of progress. In
the nearly 40 years since its invention it is still a fairly expensive technique for prototyping and
has only recently joined the domestic market. In essence 3D Printing is a technology utilized to
create three dimensional (3D) objects out of various materials with the assistance of a computer
program and specialized machines that deposit materials one layer at a time until they form a
three dimensional object (Mertz, 2013). There are multiple methods of this execution with media
10
ranging from plastics to metals; however, as technology advances living cells are quickly
becoming integrated. There is variation among the speed, amount of layers, and size of the
printing capabilities of the machines, but they all create 3D objects by printing small layers one
at a time and fusing them together (Mertz, 2013).
3D technology in its infancy was mainly used by large scale companies for rapid
prototyping of products. Specially calibrated 3D machines would cost thousands of dollars and
were almost unheard of within the private sector; however, in 2006 several small kits were
released that allowed any interested person to construct their own. These kits would cost around
$1000 and were still fairly limiting, but were cheap enough to bring the technology more
prominently into the foreground (Mertz, 2013). With the advent of 3D technology kits the barrier
to entry was lowered significantly. Since then, many private citizens have created new
techniques and machinery that has allowed the price of 3D printing to drop even further.
Several innovative new techniques and materials have led to advancements in 3D printing
that relate to its use in health care. To date, 3D technology has been exclusively used for skeletal
support and replacement, such as 3D printed knee and hip replacements, 3D printed teeth
fillings, and even so far as replacing skull portions (Gross, et. Al, 2014). 3D printing is an ideal
technology for joint and bone replacements since the model that is printed can have natural bone
porosity integrated into the design. Additionally, each piece can be specialized and
individualized (Xiao, et al., 2017)(Gross, et al., 2014).
Individually tailored care is one of the major allures of 3D printing and has also led to the
use of 3D printing in surgical planning. Diagnostic scans of the individual, such as CT scans or
even serial x-rays can be used to create a 3D model of a person’s body part. There have been
11
instances where physicians have constructed 3D models of a person’s tumor and surrounding
tissue so simulated practice surgeries can be performed on the plastic stand-in without
endangering the individual’s life (Gross et al., 2014)(Irwansayah et al., 2017)(Ventola, 2014).
Bioprinting has also become a recent development in 3D printing technology. This
technology involves printing using cells and biomatter instead of plastics or metals. Thin layers
of cells are built up to form new cell structures such as ears or organs. Bioprinting technologies
are still in their infancy and have had many technological setbacks involving vasculature
formation and other difficulties involving the nutrition of the cells after they are layered. (Gross
et al., 2014)(Ozbolat, & Yu, 2013)(Ventola, 2014)
Difficulties in implementation of new technology are not exclusive to bioprinting. All
forms of 3D printing continue to struggle to meet the accuracy and resolution demands of the
health care setting as well as the expense of development in the field.
Electronic Health Records
The implementation of the EHR has been easier than the implementation of 3D printing.
The use of EHR’s is considered a precise method for reducing accidents in drug therapy
administration and improving overall care for people. As such, there is likely to be little
resistance from providers in integration. (Boswell, 2013) EHR’s have not been integrated on an
international level, with multiple countries requiring extra time for integration and recognizing
hospitals need different amounts of time to provide education and training for staff. The U.S.
plan for integration of EHR’s by the year 2014 has been unsuccessful to a degree. There are still
many hospitals or specific hospital staff members that have difficulty integrating the EHR into
their workflow due to a number of reasons, such as patient confidentiality, aversion to
12
technology, lack of resources, and other factors (Odom, 2016). The Institute of Medicine (IOM)
asserted in 1991 there should be an EHR to improve medical record accuracy better than is
currently available. Reasons noted included increased legibility of orders, better communication
between caregivers, improved portability, better security features, sharing of medical information
and many other factors. (Odom, 2016) By 1996 the use of the EHR was mandated by the Health
Insurance Portability and Accountability Act (HIPAA). There has still been resistance to
integration by certain caregivers or even entire clinical settings. However, there are also
successful stories of integration that have typically taken place within the healthcare system
where use of the EHR is mandated, such as the Veteran’s Administration (VA) hospitals. There
are still several small scale or individual practices that have yet to integrate the EHR into their
practices and do not see the benefits of implementation. (Odom, 2013)
There are still plenty of individuals and healthcare facilities that do utilize electronic
health systems for data about an individual’s health. It was found there was a high correlation
with the EHR and the use of a better quality system which increased use by the staff, and the
users were more likely to access the system when the quality of the system data also highly
correlated to individual data. It was also found that in order to improve a system’s data overall,
more quality education about using an EHR is required. There are many factors that depend
heavily on each other when it comes to EHR integration in health care: self-efficacy depends on
training, quality data depends on efficacy, system data depends on individual data, and so on
(Yu, Qian, 2018).
This brings forth the issue of education and acclimating staff to the system. The
electronic health record has been fairly well integrated into healthcare in part due to its mandate
13
by HIPAA; however, there was a great deal of kickback initially and still remains today (Senior,
2006). There were multiple clinicians and nursing staff workers throughout the country that had
difficulty adjusting to the technological curve. Many of these caregivers had decades of
experience in paper records leading to a very hard set of training to overcome. In fact, it was
found through several studies that over 70% of physicians had never had any formal computer
training. Also, several large health care systems realized they would need to hire up to 50,000
additional IT professionals to cope with the induction of the EHR. Many caregivers had never
even used a mouse in their previous healthcare setting due to a smaller sized facility or lack of
exposure to a computer system. Health care executives introduced seminars throughout their
healthcare system to teach staff and providers specifically about EHR technology, such as using
a word processor, using a monitor, and other seemingly basic conditions (Huang, 2013)
Stem Cells, Bioprinting, and Other Questionable Methods
The technologies discussed this far have been technologies that are widely used in the
current healthcare environment or technologies that have been in use for more than 10 years.
Stem cells and bioprinting are still technologies that have yet to be integrated in the healthcare
setting in a widespread manner. These technologies are extremely new and laws and regulations
are still in early stages of licensing and integration. Newer, innovative, technologies are also
imposing the unique challenge of moral and ethical complications. Bioprinting is similar in
method to 3D printing, with layers of material being deposited to form a 3D shape, though in this
case the material being deposited is a layer of cells. As these cells are deposited they can be
designed to form the shape of a skin graft or a replacement nose and perhaps in the future even
entre organs. Bioprinting technology has actually existed for some time with an initial method of
14
a single 2D layer of cells being deposited by laser in 1999. (Ozbolat, YU, 2013) There were even
exploratory trials into the idea of bioprinting previous to the current level of printing ability
using biologic materials. The technology is still having trouble advancing and, in comparison to
its solid plastic or steel counterpart, 3D printing is still relatively in its infancy. The problem for
bioprinting at the moment is creating a sufficient network of blood vessels to deliver nutrients to
the printed cell structures (Ozbolat, YU, 2013) (Kirkpatrick, 2017). The technology also often
utilizes embryonic stem cells and other types of stem cells which introduce a moral element of
difficulty or barriers to harvesting respectively. Similar issues and others like cellular
maturation, difficulties in specialization of the cells, and changes in cell behavior during the
printing process are impeding advancements (Ozbolat, YU, 2013).
Embryonic stem cells are becoming increasingly important to research due to their
genetic uniqueness making them perfect subjects for DNA testing. DNA testing and DNA
modification is also becoming an emerging field in healthcare and science. Genetic manipulation
and modification involves the changing of the DNA in a cell. The instructions that cells depends
on are altered and the cells function can be potentially changed. Recently several new methods
of genetic manipulation have been created. Some of the most ambitious and influential are those
of CRISPR and CAS-9. CRISPR and CAS-9 are enzymes that have been recently engineered in
laboratories to be used for gene editing. CRISPR and Cas-9 are unique in that they are extremely
affordable, with the use of CRISPR costing about $30 per use as opposed to thousands of dollars
for previous techniques (Smolenski, 2015) New gene modification tools can help damaged areas
and specific portions of DNA to deactivate poorly coded strands, so they no longer function.
This is helpful if there is a particular mutation that will affect the body negatively. DNA
15
modifying technology is being discussed and questioned by health care scientists and provider
because of its potential to create “designer babies” or babies whose attributes have been carefully
selected or corrected (Sheppard et al., 2016). Genome editing has also been called a “weapon of
mass destruction and proliferation,” by previous government agency officials (Boston College
Law Review Staff, 2018). Many issues with moral and ethical concern will present further
difficulties with integration of new biotechnology in the health care setting. Other morally
questionable technologies will, in all likelihood, continue to be created, so advances in
biotechnology and other innovative technologies that involve health outcomes will continue to
impede integration well into the future.
16
RESULTS
Of the thirty one articles reviewed, twenty articles directly referenced reasons behind a
lack of integration into widespread healthcare. Additional articles were included to supplement
information and provide a background on histories and the current level of integration. Of the
thirty one articles, nine covered the topic of 3D Printing, twelve covered the topic of Electronic
Health Records, six covered moral topics, and four additional sources spoke on overall and
generic topics covering economics and technological integration.
Table 1: Summary of Articles Focused on the Impeding Factors of Emerging Technology
Integration
Technologic Focus
Supportive articles for Risk Factor
Total
Articles
3D Printing
Gross, B. C., Erkal, J. L., Lockwood, S. Y., Chen, C., &
Spence, D. M. (2014).
Hoy, M. B. (2013),
Hurst, E. J. (2016),
I., Redyarsa, D., Lai, J., Essomba, T., & Lee, P. (2017),
Mertz, L. (n.d.), Ventola, C. L. (2014),
Sparrow, N. (2015, December 17),
Xiao, Y., Sun, X., Wang, L., Zhang, Y., Chen, K., & Wu,
G. (2017),
7
Electronic Health
Record
Boswell, R. A. (2013),
Odom, S. A. (2017),
7
17
Senior, T. (n.d.),
Yu, P., & Qian, S. (2018),
Sheppard, M., Spencer, R. N., Ashcroft, R., & David, A.
L. (2016),
Suominen, H., Lehtikunnas, T., Back, B., Karsten, H.,
Salakoski, T., & Salanterä, S. (2007),
Ventura, M. L., Battan, A. M., Zorloni, C., Abbiati, L.,
Colombo, M., Farina, S., & Tagliabue, P. (2011)
Morals and Ethics
Boston College Law Review Staff. (n.d.), Green, E. D., &
Guyer, M. S. (2011),
Kirkpatrick, K. (2017),
Ozbolat, I. T., & Yu, Y. (2013),
Potter, L. M., Bissonnette, S. A., Knight, J. D., & Tanner,
K. D. (2017)
Smolenski, J. (2015),
5
Other (economic,
systemic healthcare,
etc.)
Christensen, C. M., & Bower, J. L. (1995),
Pavel, M., Jimison, H. B., Wactlar, H. D., Hayes, T. L.,
Barkis, W., Skapik, J., & Kaye, J. (2013)
2
18
Impeding Factors
3D Printing
The cited articles mentioned in table 1, in regards to 3D printing, describe many
impeding issues surrounding cost as a barrier to entry, technical limitations, personalization, and
software problems. The cited articles describe an increase in 3D printing usage in the hospital,
but also a great deal of hesitancy when it comes to further usage. Multiple studies showed that
not only was the usage of 3D printing in the healthcare setting incredibly expensive, but also
simply technically impossible with the current technology available.
Ventola, C. L. (2014), cites that during the time of their publishing that only 1.6% of 3D
printing funding is going to medical applications. All of the articles focused on 3D printing
recommended that the technology be used more often and that more research should be put into
perfecting the technology. Gross, B. C., Erkal, J. L., Lockwood, S. Y., Chen, C., & Spence, D.
M. (2014) cited that the industrial level printers can cost upwards of $250,000. All of the studies
also felt that it could have a bright future in the clinical setting and that the technology could
likely revolutionize healthcare. Ventola, C. L. (2014) also lists several different ways that 3D
printing could be used in the future. Four of the articles on 3D printing mentioned that the
technology could be improved to make its usage in the hospital more popular. One article quoted
a surgeon saying that the change from the preoperative plan to the real surgery was markedly
different due to imperfections in the scanning software and inability of the printer to make
accurate edges. 50% of the articles on 3D printing mentioned the usage of the technology to
create new prescription medications in the future when the accuracy and fidelity have improved
enough (Xiao, Y., Sun, X., Wang, L., Zhang, Y., Chen, K., & Wu, G., 2017). All of the articles
19
mentioned the possibility of personalization of care as an enticing factor of 3D printing.
Although Ventola, C. L. (2014) also mentions that there are still issues with copyright and
getting approval from government departments to ensure that care and prosthetics are well
maintained and the quality of custom replacements are secure.
Electronic Health Records
The electronic health record articles mentioned in Table 1 describe a system that is
working relatively effectively, yet requires more proper training and incentivizing before it will
be 100% integrated into the healthcare system. Five of the articles on the subject of Electronic
Health records heavily recommend the usage of further training for healthcare professionals in
order to ensure better EHR usage.
Moral and Future Breakthroughs
The articles on bioprinting and stem cells and the like show a definitively undeveloped
area of healthcare. All of the articles on these subjects mentioned that the technology was in
some way not complete enough for usage in the healthcare setting in a wide setting. All of the
articles on bioprinting mentioned that the technology has a great deal of technical aspects to
overcome before it is able to be utilized fully. Multiple articles not only mention a technical
limitation, but also a mental limitation. (Kirkpatrick, 2017) mentions that the pure knowledge of
how the cells will interact and join over extended periods is not understood at all. All of the
articles on bioprinting also mention that more funding is required if any progress is to be made.
(Kirkpatrick, 2017) also mentions that even though the technology was initially developed over
20 years ago the technology is at least 3 to 5 years away from a breakthrough in their process and
20
will likely need several years beyond that before it is a process ready for the healthcare field. It is
also mentioned that the current model that is capable of bioprinting is roughly $2000.
As for the issues in genetic testing and gene therapy all of the articles examined
mentioned their current or past difficulties overcoming the social difficulties associated with
manipulating genetic material. Several articles also mentioned that difficulties in accruing
genetic material that was worth testing on. (Smolenski, J. 2015) mentions the difficulty in
initially sourcing embryonic stem cells, and now the difficulty in affording the expensive
procedures necessary to create induced pluripotent stem cells which do not carry as much social
stigma.
Other
There are some articles that are more general and cover a more systematic approach to
the integration of technology into healthcare. (Christensen, C. M., & Bower, J. L. 1995)
mentions a great deal about the importance of analyzing the market and understanding at what
point the cost versus the benefit is worth the investment. The article describes in detail the
importance of new technologies integration into systemic industries by outweighing the previous
iteration in fidelity and accuracy, efficiency, saved cost versus spent cost, and other more
economic aspects of integration. One article specifically mentions the importance of integrating
more healthcare technology into everyday life in order to better form a picture of the health of
the clients once they leave the healthcare system (Pavel, M., Jimison, H. B., Wactlar, H. D.,
Hayes, T. L., Barkis, W., Skapik, J., & Kaye, J. 2013).
21
Overall
Out of all of the articles found in the Table of Evidence, 13 of them mentioned cost as a
limiting factor in the integration of their respective technologies. Costs varied by technology, but
many of them mentioned the need for further research and development in order to get the
respective technologies to a level that would be acceptable and easier to justify. Most articles
often stated that further research would lead to scientific breakthroughs that would subsequently
lead to a reduction in overall cost of the use of the technology. Many of these articles also
mentioned the importance of further education of staff in the usage of the technology as
mentioned above. Along with cost the most discussed limiting factors were technical limitations.
Of the article in the Table of Evidence, 15 of them mention a current technical limitation of the
technology in one way or another. Technical limitations were the most frequently mentioned
reason behind the lack of integration. The mention of technical limitations is often correlated
with or followed by another mention of further development and research. Cost and technical
limitations were by far the most prevalent limiting factors to integration of new and innovative
technology in health care; however, education, training, and ethical bias were still mentioned
fairly regularly. Moral reasons for difficulty in integration were mentioned in approximately
25% of the articles, with further staff education receiving the same number. Other reasons such
as personalization and regulatory issues, further biological study, and copyright infringements
were a smaller fraction of issues facing integration.
22
DISCUSSION
The studies examined provide insight into the larger healthcare system and the gap
between research and the hospital setting. The data consistently demonstrates the many problems
new technology faces for integration and must overcome such as financial, technical, or moral
and ethical barriers to integration. This review of the literature has examined the use of 3D
printing, the EHR, bioprinting, and related new technologies and the difficulties faced with use
in health care and improving health outcomes. They describe technology currently being
integrated, technology that was previously integrated and the difficulties involved with
integration, and what technology currently awaits integration. The examples provide the
framework for a common set of factors that impede integration. The factors impeding integration
of new and innovative technology in the present can be applied to current models of education
and training that advances future technology in the health care setting.
Based on the results there are several deductions that can be made. One such deduction is
the importance of funding research on sociologic adaptation of new skills and tasks related to the
adoption of new technology. The results show a series of technologies that have existed for well
over 20 years, but are only truly starting to be integrated now. High cost barriers to entry keep a
great deal of people out of the industries and leads to a select few being knowledgeable on the
subject. This esoteric group is far less likely to innovate and thus bring about higher efficiency,
lower cost of entry, and integration (Refer to Figure 1.). The results show a lack of technical
ability in some regards as well, along with multiple different moral fronts on which to contest.
The limiting factors of technical, financial, and moral grounds will continue to impede not only
23
new and emerging technologies, but those of the future as well if they are not addressed
individually and addressed at a system wide level.
24
Recommendations for Further Integration of Technology
Education
Technology integration is always difficult to do. The initial cost of changing out the old
system along with the retraining and replacement of the old system is often more than enough for
investors and healthcare executives to overlook the idea. (Christensen, C. M., & Bower, J. L.,
1995) If the executives are more aware of the benefits of the technology then there is a higher
likelihood that they may integrate it more into the system. (Xiao, Y., Sun, X., Wang, L., Zhang,
Y., Chen, K., & Wu, G., 2017). Further education of all staff is also beneficial. Education of staff
in EHR training led to a marked increase in usage among all hospital staff. (Senior, T. , n.d.) This
education leads to higher familiarity with the technology and less likelihood to disagree with its
integration and usage.
This education will also lead to a higher degree of people interested in the technology and
the heightened level of interest can often lead to more people working with the technology and a
higher likelihood of innovation amongst this population. (Mertz, L., n.d.).
Research
A higher level of research is also required if there is to be any progress. The necessity of
funding cannot be understated and a great deal of the advancements that these technologies have
made thus far are due to funding. Many of the bioprinting and gene therapy technologies are
understood on a basic level and there is a relatively high level of interest, but more research is
necessary (Ventola, C. L., 2014). A great deal of the articles mentioned cite technical problems,
but also cite exactly what needs to be done or researched to correct them only sentences later.
This shows a large amount of understanding of the problem, but a lack of research and funding.
25
Many of these technologies have already overcome some significant other impeding factors due
to research. Gene therapy has developed CRISPR, which reduces the cost of genetic
manipulation drastically and Induced Pluripotent stem cells were developed as an alternative to
the more socially guarded embryonic stem cells. These changes came about due to further
research and they have allowed great strides in innovation since their inception. With even
further funding and research there will surely be more developments that allow the technologies
to circumvent their problems.
26
CONCLUSION
These technologies have been shown to make great medical advancements, but have also
been shown to be an incredibly small portion of the financial budget. (Ventola, C. L., 2014)
These technologies are at the hands of technical, financial, industrial, and moral requirements,
and the literature shows that there is a good chance they could overcome them. The nurses and
hospitals that will be using this technology someday need to take greater action in educating
themselves and their staff so that they may better understand that the benefits do outweigh the
costs. (Christensen, C. M., & Bower, J. L., 1995) These technologies show that technology takes
a great deal of time to integrate. It has in the past, it does now, and it will in the future. These
technologies also show that there are many different things that people do to hold them back and
that with the right funding, enough research, and some innovation all technologies can be made
efficient, cost effective, and more than ready to be integrated into the healthcare system.
