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Cultural aspects of information technology implementation.

Culture sets our values and norms. It is a way of thinking that determines our behaviours, decisions, actions and knowledge. Technology transfer and integration are basically the exchange of the knowledge, know-how and skills through which technology was created and on which its use depends. Culture is deeply rooted in ourselves. We are usually unaware of its influence on our professional activity. Cultures are diverse, and their encounter through technology exchange triggers conflicts that are expressed in objective terms. We need to detect and resolve those conflicts at the right level, i.e. at the cultural level instead of only focusing on the visible 'obstacles' to the deployment of telematics applications. This paper summarises the basic concepts on which we ground a practical approach to detecting and resolving culture-based conflicts in technology transfer and integration. It investigates the relation between cultural preferences and actions. Culture is translated and reduced to a seven dimensions framework. Cultural preferences influence the decision-making process that leads to tangible actions. The structure and dynamics of that process are described as a Change Governance Framework. It considers the control aspects of decision making that are sensitive to cultural preferences, i.e. the way decisions are taken, why, by whom.

Cultural Diversity↗

Medical technology and its diffusion in Australia.

The author examines the Australian health care system by surveying the financing techniques, physical organization, and government activity. He explains the impact of the public and private sectors and comments on the effectiveness of current evaluation procedures. While the author believes that the system is relatively healthy and cost effective, he recognizes a need for more comprehensive and scientific oversight. Using regression analysis and focusing on the installation of medical technology in hospitals, the author attempts to determine the specific factors that influence technology diffusion. He concludes by stressing that further studies analyzing the actual use of specific technologies are vital.

Australia↗

Value of technology assessment in developing countries.

The contrasting cycles of changing caries prevalence in developing and industrialized countries are described, as they relate to differing needs in technology. Using this contrast as a background, the selective needs for technology in measurement, adequate quality of treatment and materials, appropriate personnel, and simplicity and mobility in equipment are discussed.

Dental Caries↗

Present and future value of dental composite materials and sealants.

This article reviews the development, composition, chemistry, recent technological advances, and extent of use of composite resin restorative materials, adhesives, and pit and fissure sealants. The problems related to the clinical behavior of these materials in the oral environment are dealt with, and methods of minimizing their present deficiencies are suggested. Future directions that might be taken to improve these materials and solve some of the inadequacies that these materials exhibit are also discussed.

Biocompatible Materials↗

Health technology development in Japan.

This article provides a comprehensive analysis of the social, cultural and economic factors which have led to the present pattern of technology utilization in Japan. It is divided into five sections. The first provides the historical framework; the second, an overview of the health care delivery context and its economic incentive structure; the third, an analysis of the various contenders involved in the process of resource allocation; the fourth, a description of the technology areas which have been emphasized in Japan; and the fifth, an examination of future issues.

Communication↗

Acquiring advanced technology. Decision-making strategies at twelve medical centers.

This study describes decision making regarding the acquisition of technology in 12 major medical centers. The financial impact of a project was the most widely cited criterion of decision, but financial considerations were less important than either the impact of a technology on the quality of clinical care or its contribution to teaching and research. Rarely were criteria set out explicitly or in advance. Although exemplary models exist, the technology assessment process at most institutions is described as "political," "informal," or "ad hoc."

Academic Medical Centers↗

Innovation and diffusion of health-related technologies. A conceptual framework.

The development and diffusion of health-related technologies constitute an extremely complex process. This article examines the phenomenon of technological innovation; discusses the factors determining the diffusion of high, medium, and low technologies; and suggests strategies for controlling the diffusion of these technologies. A research program is also proposed that should improve our understanding of the process of development and diffusion of health-related technologies.

Communication↗

Technology and disability. Assessment needs and potential.

In assessing technologies for disabled people, the aims of habilitative or rehabilitative interventions, the concepts of disability and handicap, and the potential of existing and emerging technologies in various social arenas, as well as the structure of service delivery systems, are of importance. A discussion of these issues in the light of previous work on cost and effectiveness in the field is given.

Persons with Disabilities↗

Expensive medical and surgical technology.

In summary, new developments in technology, as applied to medical and surgical practice, are to be encouraged, which is just as well, since they are probably inevitable. But they also call for critical assessment and, perhaps, a measure of formal control. It is, however, important that the criteria for their acceptance (or rejection) should not be limited to economic considerations but should also include their clinical applicability and their likely effect on outcomes.

England↗

Technology assessment in a user perspective--experiences with drug technology.

Drugs have a central place among medical technologies, and medical technology assessment can learn from the established regulation of drug technology. This article outlines how users' experiences are not part of the basis on which decisions are made today, although this knowledge is imperative for identifying the problems that are not uncovered or foreseen by today's drug assessments. Further, users' interests might not be part of assessments that are based on the controlled clinical trial. A framework for drug technology assessments based on a user perspective is suggested.

Denmark↗

Assessing medical technology in less-developed countries.

Less developed countries (LDCs) are limited in medical resources. Medical technology and the management talent required to handle it play a particularly major role in their national health care and has significant economic, political, and ethical ramifications. This study of the assessment process of medical technology in the LDCs proposes a limited framework for the analysis of the major parameters involved, i.e., stakeholders, boundaries and constraints, goals and objectives, criteria to be met, performance measures, and measurement of performance. The importance of the intangible factors is elucidated.

Decision Making, Organizational↗

Basis for decisions on emerging health technology. A Danish feasibility study.

The objectives of the feasibility study were to evaluate sources of information for an eventual Danish system for early identification and assessment of emerging health technology, to identify potential users of the system, and to clarify their specific need for information concerning emerging health technology. The methods used were questionnaires to informants within and outside the health services and to decision makers on different levels in the health services, and follow-up telephone interviews. Our study reveals a strong, and to some extent unsatisfied, need among policy makers, planners, and managers in the Danish health services for information concerning emerging health technology. The requested information should in particular concern indication for use, number of patients affected, clinical effectiveness and side effects, running cost, and investments. The time horizon most relevant to the decision makers seems to be only zero to 2 years. Furthermore, we found that numerous sources are available that frequently display information on emerging technology important to the health services. The challenges seem to be to select information of sufficient importance and quality, and to combine information, since very few, if any, single primary sources cover all the requested information. In conclusion, we recommend the establishment of a Danish national system for early identification and assessment of emerging health technology, consisting of a small secretariat that collaborates nationally and internationally, the latter in particular on identification of technology and on development of methods for early assessment.

Decision Making↗

Which are the best information sources for identifying emerging health care technologies? An international Delphi survey.

The purpose of this survey was to assess potential information sources for identifying new health care technologies. A three-round Delphi study was conducted, involving 38 selected experts who suggested and assessed potential sources by applying agreed criteria. Twenty-six potential information sources were considered. Timeliness, time efficiency, and sensitivity were important criteria in determining which were the most important sources. The eight recommended sources were: pharmaceutical journals, pharmaceutical and biotechnology companies, specialist medical journals, key medical journals, medical engineering companies, private health care providers, newsletters and bulletins from other health technology assessment agencies, and groups of expert health professionals. There is a need to use a combination of sources because the most useful sources will vary according to the type of technology under consideration.

Communication↗