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PubMed1998

Internet information sources for the identification of emerging health technologies. A starting point.

The basis of an early warning system for new and emerging health technologies is information, and in particular, information that has been selectively extracted from the huge quantity of data in the fields of medicine, science, and biobusiness. The information will be useful only if presented in a format suitable to the needs of health care decision makers and produced at the time most likely to influence the introduction or diffusion of new technologies. In 1997 the Canadian Coordinating Office for Health Technology Assessment (CCOHTA) began a one-year pilot project to identify and provide information on developments in medical technologies that may have a significant impact on health care in Canada. We began by examining the information available to us through the Internet, based on the assumption that electronic sources can offer more timely access to a greater range of information, often with little or no cost involved. It was important to identify the sites that offered the most relevant information in the least amount of time.

Canada↗
PubMed1998

Implementing early warning messages on emerging health technologies.

The purpose of this study was to determine how horizon-scanning organizations can encourage the implementation of recommendations contained in their early warning messages about emerging health technologies. We reviewed the conclusions of the EUR-ASSESS Project Subgroup report on dissemination and impact, an overview of systematic reviews of interventions to promote implementation of research findings by health care professionals, and various Cochrane Effective Practice and Organisation of Care Group protocols and reviews. The evidence on the effectiveness of different implementation strategies aimed at distinct target groups is of variable quality. There is some evidence from rigorous study designs on the effectiveness of strategies designed to influence the behavior of health care professionals; the quality of the evidence relating to policy makers and the general public is more limited. Horizon-scanning organizations can improve the likelihood of their recommendations being acted upon by developing active implementation strategies based on the best available evidence, establishing links with key groups, and directing early warning messages at specific target audiences. Given the relative lack of good quality evidence, it is important that implementation strategies be rigorously evaluated to determine their effectiveness.

Diffusion of Innovation↗
PubMed1998

The identification of new health care technologies by the Health Council of The Netherlands.

The article gives a global overview of the 14 years of signposting experience of the Health Council of the Netherlands. The Council signals new health care technologies and emerging health care problems in briefs, comprehensive reports, and bulletins. Its main purpose is to provide the government with timely information to support rational policy decision making.

Diffusion of Innovation↗
PubMed1998

Early warning of new health care technologies in the United Kingdom.

In this paper we describe the present range of organizations that have a role in the early warning of new and emerging health care technologies in the United Kingdom. We discuss in more detail the processes and prioritization criteria used by the U.K. horizon-scanning project for the NHS Health Technology Assessment Programme, and the principal methods of technology identification for the horizon-scanning project are outlined. The United Kingdom plans to develop an integrated system for the identification of technologies for commercial planning, health service research prioritization, financial planning, and provision of information to policy makers, purchasers, and providers of health care.

Diffusion of Innovation↗
PubMed1998

The early experiences of a national system for the identification and assessment of emerging health care technologies in Sweden.

This article presents the experiences from a pilot study and the establishment of a permanent system called SBU Alert. The question of establishing a system for the identification and assessment of emerging technologies in health care in Sweden has been on the agenda since the late 1980s. The demand came primarily from policy makers. The pilot study showed that the awareness of the project in the target group (politicians, leading managers, hospital directors, and senior medical advisors) was high. Almost all of those who replied to an assessment questionnaire were in favor of a continuation of the work. In 1997, the Swedish Council on Technology Assessment in Health Care (SBU) was selected to establish a permanent organization. This work has resulted in the identification of a number of methodological problems and tentative solutions concerning all components in the SBU Alert system. We have found that a system for systematic identification and early assessment of emerging technologies is a new and promising tool in the health technology assessment arsenal. Still, experiences are limited. Methodology and the impact of early judgments on decision making need further evaluation.

Diffusion of Innovation↗
PubMed1998

Scanning the horizon for emerging health technologies. Conclusions from a European Workshop.

To share the existing, albeit limited, experience among nations and to explore the feasibility of international collaboration on the identification and early evaluation of health care technologies, an workshop was arranged in September 1997. Twenty-seven policy makers and researchers from twelve countries attended the meeting and concluded that: the policy environment in most European countries is characterized by insufficient data on safety, effectiveness, and cost-effectiveness of health care innovations; that an early warning system is perceived as an essential mechanism for facilitating communication among policy makers, technology experts, and health professionals; and that collaboration on early warning activities might be even more useful than traditional collaboration in health technology assessment.

Diffusion of Innovation↗
PubMed2000

Health technology assessment in Italy.

Italy has a national health service (SSN) dating to 1978. Italy's system of government is characterized by a rather high degree of decentralization of power, and the health system is likewise decentralized. Most of the responsibilities for health care have been ceded to the regions. The state retains only limited coordinating and supervisory powers. The state has a financial responsibility for the national health service, but state contributions are limited and expenditures in excess of this made by the region must be financed from other sources. Health reforms of 1992-93 aimed at making the regions more sensitive to the need to control aggregate expenditure and to monitor measures to promote efficiency, quality, and citizen-patient satisfaction. The diffusion of individual health technologies has been relatively uncontrolled in many regions in Italy, although tight central constraints on capital spending have contained diffusion of new technology. Regulation of placement of services is a planning function and is the responsibility of both the Ministry of Health and the regions. Health technology assessment (HTA) activities have been expanding since the early 1990s, but these activities tend to be untargeted, uncoordinated, and without priorities. Nonetheless, the principal actors in the SSN at national, regional, and local levels are becoming more sensitive to the need to apply criteria of clinical and cost-effectiveness and to be more rigorous in deciding what services to guarantee. There are reasons to be guardedly optimistic about the future of HTA in Italy.

Delivery of Health Care↗
PubMed2000

Health technology assessment in Luxembourg.

Luxembourg's public health insurance is a compulsory insurance for all employees, self-employed professionals, farmers, and pensioners. It is financed through contributions of the insured people, as well as by state taxes. Providers of health care are mainly private nonprofit institutions and self-employed professionals. All healthcare procedures are defined in fee schedules determined by a common decision of the Ministers of Social Security and Health according to proposals of a board of experts. The relative value of a service is also determined by the corresponding fee schedule. Hospitals are financed by individual budgets negotiated between each hospital and the health insurance. These hospital budgets do not cover services provided in hospitals by medical specialists, who are reimbursed on a fee-for-service basis. A low on hospital planning and organization allows the government to restrict the installation in hospitals of very expensive equipment or of equipment for which there is only a limited need in Luxembourg hospitals. Until recently there has been limited interest in or use of health technology assessment (HTA). However, large hospital investments have provoked some interest in the last few years. The Ministry of Health has asked for some HTA studies when a concrete decision had to be taken. Luxembourg decision makers have become more aware that HTA may help them to become more informed about the short- and long-term consequences of the application of health technology.

Delivery of Health Care↗
PubMed2000

Health technology assessment in Spain.

The Spanish Constitution of 1978 established a healthcare system available to everyone and free at the point of service. The General Health Law of 1986 also established the framework for a National Health System (NHS). The Constitution and the law form the regulatory framework for the devolution of healthcare services to the Autonomous Regions. All the 17 Autonomous Regions have complete power regarding public health and planning. However, responsibilities on healthcare financing, organization, provision, and management have devolved to only seven Autonomous Regions. Financial support for health services comes mostly from taxes. Global budgets are a mechanism used by hospitals to control the acquisition of medium and low health technology. Major capital investments for health technology are controlled by the central government in 10 Autonomous Regions (population coverage of 38%) and by the Regional Health Services in the seven remaining Autonomous Regions. In 1995 a regulation for basing the introduction of new procedures and medical equipment on the assessment of safety, efficacy, and efficiency was issued. Health technology assessment (HTA) has a long history in Spain, beginning with the Advisory Board on High Technology in the government of Catalonia in 1984. This board evolved into the Catalan Agency for HTA (CAHTA) in 1994. The Basque Country established a unit for HTA in 1992 (Osteba) and the Andalusian government created an agency in 1996 (AETSA). A national agency for HTA (AETS) was established in 1994. These different programs coordinate their work and together act as an Advisory Committee of the Interregional Council of the NHS.

Aged↗
PubMed2003

The great escape? Prospects for regulating access to technology through health technology assessment.

OBJECTIVE: Health technology assessment (HTA) can be used both to promote access to safe, efficacious, and cost-effective technologies, and to discourage access to undesirable ones. Yet HTA has had less success than might be hoped in pursuing the latter goal. This paper examines the scope of HTA as currently practiced to contribute to regulation of access to undesirable technologies. DESIGN: The study design is a critical analysis of HTA's methods, based on an exposition of the normative issues involved in restriction of access to health technologies. The paper classifies technologies that might figure as potential candidates for exclusion into five categories and underscores the key social and ethical dilemmas associated with limiting their use. RESULTS: For four of the five categories of technology outlined, limitation of access necessarily involves denial of benefit. Limitation of access thus inevitably raises difficult normative issues. We show that these are ill-addressed by the range of "evidence" typically considered in technology assessments, which centers predominantly on clinical and technical features such as efficacy, safety, and costs. CONCLUSIONS: If HTA is to enhance our ability to make reasonable decisions concerning the use and diffusion of health technologies, it must better integrate consideration of the social, political, and ethical dimensions of health technologies into the process of technology assessment. We suggest a framework within which to approach this goal.

Canada↗
PubMed1999

Effects of collimator size of a dental X-ray unit on image contrast.

OBJECTIVES: To examine the effect of collimator size on image contrast in dental radiography. METHODS: Two conventional collimators, one circular (53 mm in diameter) and one rectangular (35x45 mm2), were compared with a small rectangular collimator (26x39 mm2). Low-contrast and high-contrast resolution was assessed with the aid of contrast-detail and line-pair phantoms. RESULTS: Shallower holes were observed with the small rectangular collimator. Two-thirds of 17 observers assessing high-contrast resolution considered the small collimator to result in a clearer image than the conventional collimators. The same effect was demonstrated with the line-pair phantom and by microdensitometry. With the small collimator the energy imparted is estimated to be reduced by 54 and 36% compared with the conventional circular and rectangular collimators respectively. CONCLUSIONS: Decrease of the collimator size to fit the film size used for children will result in improved low-contrast and, under some conditions, improved high-contrast resolution. This improvement might have implications for caries diagnosis and monitoring.

Absorptiometry, Photon↗
PubMed1999

Physical evaluation of a system for direct digital intra-oral radiography based on a charge-coupled device.

OBJECTIVES: To determine technical properties of a direct digital intra-oral radiographic system, the Dixel(R) (J Morita Corporation, Kyoto, Japan). METHODS: A dose response function and the dark current were calculated from two series of exposures to a homogeneous radiation field. The line spread function (LSF) and the modulation transfer function (MTF) were determined from radiographs of an edge. The noise power spectrum (NPS) was determined at three exposures from radiographs exposed to homogeneous radiation fields. Noise equivalent quanta (NEQ) were calculated from the one-dimensional NPS and the MTF. The detective quantum efficiency (DQE) was determined from the NEQ and a representative value of the photon fluence. Signal-to-noise ratios (SNR) were calculated from the NEQs and different signal contrasts. RESULTS: The dose response function demonstrated a slight curvature. There was no effect of the dark current. NPS ranged from 10-5 - 10-7 mm2 depending on exposure and frequency. At a peak of about 2 cycles/mm the DQE is on an average about 30 per cent. SNRs are favorable. CONCLUSION: The technical properties found in this study indicate that the Dixel(R) system is suitable for intra-oral dental radiography.

Artifacts↗
PubMed2001

[Rapid assessments"--quick evaluation of medical technology].

Assessing the clinical, economical and other consequences of medical technologies (health technology assessment, HTA) is an important instrument to support decisions in many health care systems. A comprehensive HTA, however, is time-consuming and costly while, on the other hand, decisions have to be made quickly. A number of international HTA programmes established rapid assessment tracks although they are variable in scope and methods. In the first part of this paper, these programmes were compared with respect to scope, methods and time to complete assessments. It can be shown from this comparison that there is no common definition of "rapid assessments". In the second part of the paper, a model for processing rapid assessment in the German context is introduced and discussed. The model aims at rapid assessments serving the needs of German decision-makers and ensuring high scientific quality at the same time. The model consists of a modular system that is tailored to the actual demand of the decision-maker. Modules are obligatory (such as a systematic literature search) or optional (such as meta-analysis). All modules are subject to standardisation as far as possible. However, it should be kept in mind that a close collaboration between commissioners and executives of an HTA is necessary to focus on the question and work out the HTA accordingly.

Cost-Benefit Analysis↗
PubMed1979

Medical technology -- a different view of the contentious debate over costs.

There is a growing conviction that medical technologies are major contributors to escalating costs, and regulating them is generally viewed as the least contentious way to control expenses in the 1980's. Five forms of technology control are being discussed or developed. All aim to reduce costs by controlling big, expensive technologies in the class of computed tomographic (CT) scanning. We present evidence that technologies such as the CT scanner account for far less of the growth in medical expenditures than do the collective expenses of thousands of small tests and procedures. Furthermore, we suggest that each strategy for controlling large technology involves substantial practical and conceptual problems that would severely limit its effectiveness. We thus suggest a shift away from attempts to harness the big technologies, and toward incentives to encourage the more discerning use of all technologies. To this end, we propose changes in physician reimbursement and education and expanded insurance incentives to encourage physicians and hospitals to be more selective in the use of technology.

Clinical Laboratory Techniques↗
PubMed2000

Role of ergonomics in the transfer of technology to industrially developing countries.

Technological development has contributed to economic growth and social progress as well as a reduction of many sources of occupational accidents, injuries and stresses. However, advanced technology has also brought new sources of work stress and injuries. Industrially developing countries (IDC) have tended to try to achieve economic growth and development by importing technology designed for IDC. However, because of several complex technical, cultural and socio-economic factors, this policy has not been always successful. Inappropriate technology transfer has led to many work environment and productivity problems. Consideration of ergonomics in the choice and utilization of the transferred technology can help to create a good fit between technology, technology users and the operating environment. Application of ergonomics is, however, not widely spread in most IDC. Ergonomics input will create the appropriate working environment in which people are safe and motivated to participate and can better utilize company resources for increasing system productivity, reliability and availability.

Developing Countries↗