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The diffusion of new medical technologies in the private sector of the U.K. health care system.

Eleven percent of the U.K. population holds private health care insurance, and 2.2 billion Pounds are spent annually in the acute sector of private health care. Although isolated from policy discussions about new medical technology in the National Health Service, the private sector encounters these interventions regularly. During 18 months in one company, a new medical technology was encountered on average every week; 59 leading edge technologies were submitted for authorization (18 on multiple occasions). There are certain constraints on purchasers of health care in the private sector in dealing with new technology; these include fragmentation of the sector, differing rationalities within companies about limitations on eligibility of new procedures while competing for business, the role and expertise of the medical adviser, and demands of articulate customers. A proactive approach by the private sector to these challenges is hampered by its independence. Poor communication between the public and private sectors, and the lack of a more inclusive approach to policy centrally, undermine the rational diffusion and use of new medical technology in the U.K. health care system.

Communication↗

Automation of practice management in a Lebanese University Health Clinic.

Interest in technology and the recognition that clinical practice analysis data is crucial for planning have stimulated the development of information management solutions at all levels in developing countries. The spectrum of such endeavors remains restrained due to the limitations in human resources skills. This paper describes an inexpensive operation for automating practice analysis in a Lebanese University Health Clinic. The system was developed in piecemeal fashion to accommodate the needs of the staff and their computer expertise. It demonstrates the impact of such automation on patient care, including missing medical records, appointment scheduling, referral rates, and repeat prescriptions.

Database Management Systems↗

Selected conditions common in the developing world.

Although many esoteric diseases occur in the developing world, the majority of the orthopaedic problems encountered are similar throughout the world. Most are secondary to trauma, infection, or congenital anomalies. The geographic differences in provision of care are related to timing of treatment and available facilities. The information presented in this chapter offers examples of successful treatment regimens from many locations, each with a unique set of resources. Producing successful outcomes in such varying environments requires an understanding of the fundamental pathophysiology of the disease, innovation in the application of basic treatment principles, and adjustment of outcome expectations to seek the best possible functional result using the resources available. These resources will change as socioeconomic conditions change and will drive changes in treatment protocols. An understanding of the pathophysiology and basic treatment principles should drive innovation in these changing times.

Developing Countries↗

Financial viability, medical technology, and hospital closures.

Informed investments in medical technology and information systems are associated with the financial viability of community hospitals. Financially distressed facilities are 3 to 4 years behind proactive hospitals in supporting high-speed data, voice, and image transmissions to physicians in various locations. Impact of the Balanced Budget Act of 1997, fraud and abuse activities, Y2K issues, and lack of information systems support for physicians will result in 800 hospital closures and mergers of distressed hospitals over the next 60 months. These findings are based on the application of an eight-step framework for classifying information systems in health care entities. This framework is validated by survey instruments, site visits, interviews with senior management in 44 health care entities containing 576 hospitals, and judgments on the financial status of the health care entities.

Computer Systems↗

[Medical technology and health. A lot of crunching but few nuts?].

The present work pretend to describe the development achieved in the field of health technology assessment and to propose a set of criteria to evaluate them, with the intention that it will lead to the development of health programs and policy with a tendency to maximize effectiveness, efficiency and quality, within a frame of increasing needs and scarce technical and economic resources for health care. For this work, a comprehensive review was carried out about the background of health technology adoption in our country, and the context by which to evaluate the accessibility and utilization of the health technology. In the section for technology assessment, it is propose a method to evaluate based upon the natural history of disease, that is, the traditional form of health assessment is restricted to a cross section in time (vertical evaluation), and in this study the authors propose a model with a horizontal approach, that should offer as its main virtues the development of guidelines with regards to prevention, diagnosis and treatment, in addition to cost containment, in support to a more effective and higher quality medical practice.

Developing Countries↗

The health planning context and its effect on a user's perceptions of software usefulness.

This article reports a health planner's experience in using program planning software and the contextual factors that influenced her perceptions. The software examined (EMPOWER) is designed to support program planning for prevention of breast cancer through mammography screening. Use by a health professional in an urban hospital was examined through a case study approach. The user was interviewed at 3, 6, and 12 months following initial use. Transcripts were coded using Roger's characteristics of an innovation as a framework for categorizing the user's perceptions. Contextual factors identified as important in influencing her perceptions were open-coded and themes identified. The user referred to three contextual factors in describing characteristics of the innovation: implementation factors, user background, and work and community environment. The successful dissemination of software will depend not only on characteristics of the innovation, but also on situational circumstances that must be changed by, or accommodated in the technology.

Attitude to Computers↗

Telecom 2000.

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Appointments and Schedules↗

Adoption of electronic medical records as a technology innovation for ambulatory care at the Medical University of South Carolina.

The study described in this article measured and compared the attitudes of groups of Medical University of South Carolina (MUSC) ambulatory care staff and physicians toward adopting an electronic medical record (EMR) system, using the Perceived Characteristics of Innovating (PCI) scales developed by Moore and Benbasat (1991). The PCI scale scores were compared by professional group and by clinic location. The overall findings of this study were that potential users of the ambulatory care EMR at MUSC had generally positive or neutral attitudes toward the system. There were a number of significant differences noted among the professional groups, particularly between the physician groups and other groups. The physician groups had less positive feelings than the other groups did. There were few significant differences noted for comparisons by clinic location.

Ambulatory Care Information Systems↗

High tech, high touch.

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Chronic Disease↗

Exploring the new frontier: home care gets wired.

The driving forces toward adoption of TeleCare into the non-acute care setting are more compelling than ever before. The dramatic increase in our elderly population, which provides an endless consumer base, availability of functional and affordable technologies, and a national mandate to control costs of health care are forcing even the most skeptical health care decisionmakers to accept TeleCare as a standard model of care. Add to this the most severe nursing shortage to date and the formula is complete.

Aged↗

Bridging research and practice: community-researcher partnerships for replicating effective interventions.

Long-term collaborations among researchers, staff and volunteers in community-based agencies, staff in institutional settings, and health advocates present challenges. Each group has different missions, procedures, attributes, and rewards. This article reviews areas of potential conflict and suggests strategies for coping with these challenges. During the replication of five effective HIV prevention interventions, strategies for maintaining mutually beneficial collaborations included selecting agencies with infrastructures that could support research-based interventions; obtaining letters of understanding that clarified roles, responsibilities, and time frames; and setting training schedules with opportunities for observing, practicing, becoming invested in, and repeatedly implementing the intervention. The process of implementing interventions highlighted educating funders of research and public health services about (a) the costs of disseminating interventions, (b) the need for innovation to new modalities and theories for delivering effective interventions, and (c) adopting strategies of marketing research and quality engineering when designing interventions.

Centers for Disease Control and Prevention, U.S.↗

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