I believe it is beneficial to pause and reflect periodically, so that we can appreciate and celebrate our accomplishments and perhaps set some new goals. The topic of this column is to examine the remarkable technological changes we have all witnessed. It’s typical to discuss things that have occurred in one’s lifetime but, times have changed, and we now see remarkable advances in just a portion of a lifetime.
We are all aware of the technological changes we’ve seen in our personal lives. The telephone, to me, is an amazing example of this rapid change. I’m dating myself here, but I remember rotary telephones – one per household. The only way you could connect to more than one person was by using a party line. Touch-tone phones were only a modest improvement. Today we carry around something that we call a phone, but it’s obviously much more than that. It can be used to communicate to multiple people instantly and in numerous ways from nearly anywhere in the world. That is remarkable for the short span of time it has taken to occur. For the younger crowd, just the change from sending texts on your flip phone to the versatile smartphones we use today is a great example of the rapid pace of change.
The technological improvements in health care came to mind recently when I accompanied my wife to an appointment with a radiologist to review mammography images. This was not an ideal situation, but I was pleased to see the difference in the quality of the images when comparing studies from just a few years ago. I was also impressed by how much information was available for us to review together, so easily, in an office setting.
I have worked in hospitals since the early 1980s, starting as a maintenance engineer and then beginning my biomed career in 1987. At that time, we still had a supply of vacuum tubes in our shop. I am certain that we did not have any equipment that still used vacuum tubes, but it was not that far off in the past.
I learned some of my troubleshooting skills in that first biomed role by replacing transistors and diodes, and by locating a failed logic gate and replacing the integrated circuit. I enjoyed the challenge of that type of troubleshooting but very little of that activity happens any longer. Some of the technicians I worked with in those days were much more experienced than I was, and had used part of a transistor to replace a failed diode when they did not have the required component. Budgets were pretty small and they had to make due where they could. I know that doesn’t happen any longer.
In those early days, we were repairing equipment to the component level, but the density of equipment used in hospitals was much less than what we see today. We were just starting to use Computerized Maintenance Management Systems – CMMS. I worked with technicians that had trouble accepting the CMMS and preferred the flipbook of index cards, which were used to track Preventive Maintenance. One inspector asked a technician how he knew a piece of equipment was due for a PM and he said he had to flip through his books to check. The CMMS was clearly more efficient and those PM cards disappeared along with many other paper forms we were using at the time.
We were just starting to get involved with networked patient monitoring equipment. I remember attending biomedical association meetings where vendors would explain the Ethernet to us so that we could learn to support those early critical care networks. Although the technology used for many of the parameters in patient monitors has not changed dramatically, the systems are much more sophisticated. Integration has dramatically changed the workflow for clinical staff and has also increased our responsibilities and challenged the skills needed in order to successfully manage those enterprises.
As I mentioned, there has been a dramatic change in imaging capabilities over this period of time. This is not limited to diagnostic imaging. I would include the improvements in cameras used in surgery and endoscopy as well as the change from CRT based monitors to the high-resolution LCDs that we use today. Radiology PACS has greatly improved the ability to share and review diagnostic information. Ultrasound images used to appear pretty murky and unclear to the untrained observer, but now provide great clarity. CT scanners have also improved a great deal in this time, from single-slice to multi-slice scanners and improved post-processing capabilities. In my early years as a biomedical technician, not every hospital had MRI scanners and relied on mobile scanners.
I’ve observed the changes in the equipment we service as well. Reliability has improved and adjustments are made through software instead of adjusting potentiometers to calibrate devices. Changes have occurred to Preventive Maintenance requirements as well. There were a number of quarterly and semi-annual inspections required back in the early days and now we have equipment such as anesthesia machines and ventilators that only require annual maintenance. We spend more time now doing performance assurance rather than actually replacing parts during PM activities.
In conclusion, I think we need to pause and take a little time to appreciate the tremendous changes we have been a part of, and to consider the positive impact this has had on the capabilities of our health care system to provide higher-quality care for our loved ones. We all need to continue our efforts to learn more and grow our skills in order to support the technological advances that are still to come.