This lecture outlines the current state of healthcare simulation technology and operations including the many advancements and innovations in this field. This unique specialty within healthcare simulation is the blend of innovator, educator, project manager, stage director, and technology integrator.Healthcare has phenomenal tools and innovation to improve patient's lives, so it is no wonder that the tools available for training are no less than state of the art as well. Technological innovations in audio and video enhanced teaching, task training devices and computer simulated environments for surgical and team training are just some of the innovations that we must understand and help to develop. Every person in healthcare simulation can work to improve training and provide innovation.The special focus of groups like SimGHOSTS, INACSL and SSH have pushed the importance of technology and operations within simulation to be recognized, standardized and enhanced. These groups worked together to create a new simulation standard to ensure consistent function and understanding of this diverse role.  Those involved in healthcare simulation around the world can now easily connect, communicate and share ideas and innovation. It seems likely that the next advances in healthcare will be pioneered in the world of simulation.