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PubMed2000

Setting priorities for the adoption of health technologies on a national level -- the Israeli experience.

The rapid development of new and expensive health technologies together with the limited resources available for the health care system, makes priority setting or rationing inevitable. The Israeli Health Insurance Law, enacted in 1995, determined a basic list of health services to be provided to all residents by public funding. Although the Israeli health care system has reached a high standard of medical care as expressed by parameters such as long life expectancy and low infant mortality, the social and professional demand for new and expensive health technologies is increasing. Towards the fiscal year of 1999, the Medical Technologies Administration of the Ministry of Health recommended a list of new technologies to be added to the list of health services. The Ministry of Finance allocated that year US dollars 35 million for this purpose, while a rough assessment found that there are new important technologies to be added at a cost of more than US dollars 350 million. The Medical Technologies Administration took a systematic approach of health technology assessment - ad-hoc teams were established for evaluating clinical safety, efficacy and effectiveness, conducting needs assessment and cost-effectiveness descriptions. Assessment of the data was based on evidence-based medicine. A set of criteria was determined in order to enable the prioritizing of the assessed new technologies. This procedure led to a list of technologies suggested for inclusion. The Minister of Health appointed a public committee whose purpose was to decide the technologies to be added to the list of health services. The committee, made up of representatives from the government, the sick-funds and the public, had to evaluate each technology, based on the analysis submitted to the committee, taking into consideration clinical, economic, social, ethical and legal aspects according to predefined criteria. The thorough work of the Medical Technologies Administration enabled the committee to adopt its recommended list with minor changes within a limited timeframe. In conclusion, we propose a practical and pragmatic model for the inclusion of new health technologies at a national level, based on health technology assessment and explicit priority setting.

Decision Making, Organizational↗
PubMed2003

Factors affecting commercial application of embryo technologies in New Zealand: a modelling approach.

New reproductive technologies include sexed sperm and embryo-based technologies. The technology of sperm sexing, for various reasons, is not available in New Zealand and its use has not been modelled. Embryo technologies are however already in use on a limited scale and various scenarios for their use in both the dairy and beef industries in New Zealand have been modelled. This review briefly discusses the various technologies available and some of their potential strengths and weaknesses. In the dairy industry, modelling has been used to simulate the production of breeding bulls for large breeding companies and the production of replacement heifers in dairy herds. For the beef industry, similar modelling has been carried out to determine the opportunities for more efficient beef production. All the models confirmed that at current levels of performance, embryo-based reproductive technologies are usually not profitable in New Zealand except in niche market situations where the returns from the resulting offspring are significantly greater than can be obtained from natural mating or artificial insemination (AI) reproduction systems. This is confirmed by the low uptake of these technologies in this country to date. Even if performance lifts to levels similar to AI, profitability is likely to occur only if the costs of pregnancies to embryo-based reproductive technologies can occur at prices less than two to four times greater than AI or natural mating. This break-even requirement depends on the returns that can be achieved and the advantages that can be captured by the technology over and above those available from AI or natural mating. Two new uses for reproductive technologies in dairy cattle could be the proliferation of novel or rare genotypes from gene discovery programs and improving the female reproductive rate for optimal marker assisted selection. In both these uses the technology is not at present competing with AI or natural mating. The challenge exists therefore for the biological scientists to satisfy these requirements, coupled with the ethical and human factors involved in the introduction of any new technology. Potential end users of the technologies have been surveyed. They are quite positive about the technologies provided they can use them profitably and are keen to obtain more information about them.

Animals↗
PubMed2004

Technology to promote safe mobility in the elderly.

New technologies designed to help prevent adverse events related to the mobility of geriatric patients (ie, patient falls, bed-rail entrapment, patient handling, and wandering) are described. Technology offers the potential to eliminate or mitigate preventable adverse events that interfere with treatment, delay rehabilitation, potentiate impairment, and compromise patient safety. Unchecked, these adverse events can have a negative impact on patient health, functional status, and quality of life. It is not surprising that the elderly constitute the population at highest risk for adverse events, based on poor health, chronic conditions, long hospitalizations, and institutional care. Patient falls are a high-risk, high-volume, and high-cost adverse event. Key technologies to prevent falls and fall-related injuries include hip protectors, wheelchair/scooter safety features, intelligent walkers, fall alarms, and environmental aids. Bed-rail entrapment is a serious adverse event, which includes patients being trapped, entangled, or strangled in beds. New technologies to prevent bed-rail entrapment include new hospital bed designs, height-adjustable low beds, devices to close gaps in legacy beds, and bedside floor mats. Patients with mobility impairments necessitate physical assistance in transfers and other patient-handling tasks, which increases risk for the caregiver and the patient. Featured technologies to prevent patient handling injuries include innovations in floor-based lifts, new ceiling-mounted patient lifts, and improvements in powered standing lifts, new friction-reducing devices, and new patient transport technology. Wandering affects 39% of cognitively impaired nursing home residents and up to 70% of community-residing elderly persons with cognitive impairments. New technologies to prevent adverse events associated with wandering include door alarms and signal-transmitting devices. Nurses in geriatric settings would benefit from exposure to technologies that could improve patient and caregiver safety. To maximize the benefits of technology, it is critical that front-line nursing staff be involved in the testing and selection of devices that will be used in their practice. Further, to reap the full benefits of technology, a careful plan for implementation needs to be developed that would include integrating the new technology with existing infrastructure. Training needs to be provided for all staff who will be using the technology, and efforts to ensure competency over time is needed. A major barrier to widespread use of new technology is cost. Further research is needed to demonstrate the cost effectiveness of these devices. Results from these studies will help to build a business case, demonstrating that initial capital investments will result in cost savings, improved quality of care, and other benefits.

Accident Prevention↗
PubMed2002

Technological medicine and the autonomy of man.

Is technology value-free or is it value-laden? How does technology affect human autonomy? These questions, viewed within the context of medicine, are the focus of attention in this article. The central argument is that we need neither to subscribe to the value-neutrality dictum nor to the all-encompassing value-ladenness thesis to explain the pertinent position of technology in medicine. Technology is constitutive of and strongly implicated in difficult questions of value. This, however, does not mean that technology is identical to (or neutral to) these value-laden questions. Technology poses issues of value, but only some of these relate to technology qua technology. Hence, it makes a difference whether we discuss general questions of value posed by technology or whether we discuss the value-ladenness of technology. Admitting technological value-ladenness does not imply that we are subject to a technological imperative that reduces our autonomy, on the contrary, it explains how technology increases our responsibility. This is particularly prominent in medicine.

Ethics, Medical↗
PubMed1992

Job roles of assistive technology service providers in the United States.

The purpose of this study was to identify empirically the roles of assistive technology service providers in the United States. Via factor analysis, the following six job roles were identified: (a) Device Selection and Maintenance Activities, (b) Environmental Modification Activities, (c) Dissemination of Information on Assistive Technology Activities, (d) Evaluation of Suitability of Assistive Device Activities, (e) Administration Activities, and (f) Product Development Activities. The identified roles can provide a potential guide for the development of education or training curricula for assistive technology service providers. Those job role categories can be considered to be required areas of knowledge in a curriculum for assistive technology specialists. The identified roles can also be utilized to help define the profession of assistive technology. That definition could help guide the development of eligibility criterion and examination content for a credentialing programme for qualified assistive technology service providers in the future. A clear description of the job of assistive technology service providers can help administrators create needed positions within service delivery organizations such as state department of rehabilitation services and a rehabilitation hospital. The results could be valuable to the administrators responsible for setting job role criteria for assistive technology service providers. Such criteria are necessary for making effective hiring and employee evaluation decisions. In addition, the results can provide other professionals who utilize assistive technology services with an accurate picture of the services available from assistive technology service providers. When professionals on a rehabilitation team know what to expect of each other, clients are better served. Thus a better understanding of the roles of assistive technology service providers can contribute to better utilization of their services by a multidisciplinary team. This would in turn increase the chances of assistive technology services being offered to clients. Replication of the present study is encouraged to verify the obtained results. A future study should also focus on examining the roles of assistive technology service providers by directly observing their daily work activities. The task inventory used in the present study (ATTI) might be utilized to help guide such observations.

Allied Health Personnel↗
PubMed2006

Current impact of gene technology on healthcare. A map of economic assessments.

OBJECTIVES: It has been claimed that gene technology will induce revolutionary changes in healthcare. This paper investigates how and to what extent these changes have been economically assessed. METHODS: A generic framework was developed to distinguish between methodologically similar evaluations of healthcare technology. Methodological issues and the current state of economic evidence concerning human DNA technology were extracted from publications within these groups of evaluations. RESULTS: Economic evaluations of "healthcare consisting of gene technology" were identified primarily for in vitro diagnostics for hereditary disease and others for pharmacogenetics and molecular pathology. "Healthcare enabled by gene technology" is far more encompassing and includes, e.g., biotechnology drugs for which various health economic evaluations can be found. Yet here, the impact of gene technology intertwines with the impact of other technologies and is therefore hardly susceptible to evaluation. The fields of evaluation may be classified best according to the two dimensions "purpose" and "stage of development". Current evaluations cover screening, diagnostic and treatment technologies in investigational, new and established stages. Apart from prenatal screening, healthcare consisting of gene technology was cost saving only for genotype tests replacing continuous phenotype tests and for one pharmacogenetic test. Conclusive evidence of favourable cost-effectiveness ratios is available only for few conditions. CONCLUSION: Hypotheses about the impact of gene technology on healthcare must be explicit about the definition of "genetic" medicine. A general statement regarding healthcare enabled by gene technology is not possible. Based on current evidence, an era of healthcare consisting of gene technology built on widespread predictive testing is not desirable from a health economic viewpoint.

Delivery of Health Care↗
PubMed2005

The interface of genomic technologies and nursing.

PURPOSES: (a) to summarize views of the interface of technology, genomic technology, and nursing; (b) provide an overview of current and emerging genomic technologies; (c) present clinical exemplars of uses of genomic technology in two disease conditions; and (d) list genomic-focused nursing research on genomic technologies. ORGANIZING FRAMEWORK: A discussion of genomic technology in the context of nurses' views of technology, the importance of genomic technology for nurses, linking the central dogma of molecular biology to state-of-the-art tests and assays, and nurses' current use of technologies. CONCLUSIONS: Human genome discoveries will continue to be an integral part of disease prevention, diagnosis, treatment, and management. These discoveries also have the potential for being integrated into nursing science. Genomic technologies are becoming a driving force in patient management, so that nurses will be unable to provide quality care without knowledge of the types of genomic technologies, the rationale for their use, and the possible sequelae that can result from genetic diagnosis or treatment. Many nurses already are using genomic technologies to conduct genomic-focused nursing research. The biobehavioral nature of much of this research further indicates the important contributions of nurses in genomics.

Breast Neoplasms↗
PubMed1994

Technology management: case study of an integrated health system.

Technology management has assumed a role of vital importance in today's health care environment. Capital reserves and operating income have been stretched by pervasive and expensive technologies, while overall reimbursement has been reduced. It is imperative for hospitals to develop and consistently use technology management processes that begin prior to a technology's introduction in the hospital and continue throughout its life cycle. At Samaritan Health System (SHS), an integrated health care delivery system based in Phoenix, technology management provides tools to improve decision making and assist in the system's integration strategy as well as control expenses. SHS uses a systemwide technology-specific plan to guide acquisition and/or funding decisions. This plan describes how particular technologies can help achieve SHS' organizational goals such as promoting system integration and/or improving patient outcomes while providing good economic value. After technologies are targeted in this systemwide plan they are prioritized using a two-stage capital prioritization process. The first stage of the capital prioritization process considers the quantitative and qualitative factors critical for equitable capital distribution across the system. The second stage develops a sense of ownership among the parties that affect and are affected by the allocation at a facility level. This process promotes an efficient, effective, equitable, and defensible approach to resource allocation and technology decision making. Minimizing equipment maintenance expenditures is also an integral part of technology management at SHS. The keys to reducing maintenance expenditures are having a process in place that supports a routine fiscal evaluation of maintenance coverage options and ensuring that manufacturers are obligated to provide critical maintenance resources at the time of equipment purchase. Maintenance service options under consideration in this report include full-service contracts with the manufacturer, insurance coverage, time and materials, and independent service vendors/in-house support. Careful consideration of all the ramifications of each option is warranted because there are substantial cost differences among these methods. At SHS, technology management efforts resulted in equipment purchases and maintenance negotiations representing savings of more than $1.5 million in a single year. SHS undertakes an intensive review of purchases and maintenance expenditures, using the techniques described in this report, with the objective of reducing expenses by 10% per year. This report describes the technology management methods that SHS uses to achieve these results.

Arizona↗
PubMed1999

Achieving success: assessing the role of and building a business case for technology in healthcare.

As the healthcare market continues to evolve, technology will play an increasingly important role in an integrated delivery system's ability to provide high-quality, cost-effective care. Healthcare leaders must be proactive and forward thinking about their technology investments. The financial investment for technology innovation can be significant. Therefore, it is important that healthcare executives deliberately design the role of technology and develop a consistent method for evaluating, identifying, and prioritizing technology investments. The article begins by describing technology's role in a healthcare organization as a window to the organization, a key driver of business strategy, and a high-performance enabler, and it develops a seven-step process for building a business case to ensure that an organization's technology investments are wise, well-reasoned, and will provide value to its customers. In addition, the article discusses the importance of combining people and process reengineering with new technology to exponentially increase the value to an organization. Healthcare leaders must understand the multiple roles of technology and consistently develop a business case when making technology investment decisions. Organizations driven by such an understanding will have a robust infrastructure of enabling technology designed to integrate people and process elements with technology to achieve the goals and initiatives of the organization. These organizations will lead the healthcare industry into the next millennium.

Capital Expenditures↗
PubMed1996

The changing environment for technological innovation in health care.

A distinguishing feature of American health care is its emphasis on advanced technology. Yet today's changing health care environment is overhauling the engine of technological innovation. The rate and direction of technological innovation are affected by a complex of supply- and demandside factors, including biomedical research, education, patent law, regulation, health care payment, tort law, and more. Some distinguishing features of technological innovation in health care are now at increased risk. Regulatory requirements and rising payment hurdles are especially challenging to small technology companies. Closer management of health care delivery and payment, particularly the standardization that may derive from practice guidelines and clamping down on payment for investigational technologies, curtails opportunities for innovation. Levels and distribution of biomedical research funding in government and industry are changing. Financial constraints are limiting the traditional roles of academic health centers in fostering innovation. Despite notable steps in recent years to lower regulatory barriers and speed approvals, especially for products for life-threatening conditions, the Food and Drug Administration is under great pressure from Congress, industry, and patients to do more. Technology gatekeeping is shifting from hundreds of thousands of physicians acting on behalf of their patients to fewer, yet more powerful, managed care organizations and health care networks. Beyond its direct effects on adoption, payment, and use of technologies, the extraordinary buying leverage of these large providers is cutting technology profit margins and heightening competition among technology companies. It is contributing to unprecedented restructuring of the pharmaceutical and medical device industries, leading to unprecedented alliances with generic product companies, health care providers, utilization review companies, and other agents. These industry changes are already having considerable effects on investment patterns and the development, adoption, and use of new technologies. Until recently, new technologies that offered the prospect for health benefit, however, marginal or unproven, were paid for with little or no regard to cost. Technical wizardry alone no longer carries the day in health care. Today's health care market increasingly demands what other markets do--measurable improvements in benefits at acceptable costs--and innovators have begun to respond accordingly. Even so, certain key venues for health care innovation are at risk.

Biomedical Technology↗
PubMed2001

Midwives' perceptions of the use of technology in assisting childbirth in Northern Ireland.

AIM OF THE PAPER: The aim of this paper is to report a survey of midwives' views on the use of technology in assisting births. BACKGROUND: The research was designed to provide a deeper understanding of the integration of technology into midwives' practice and to identify and examine aspects of training needs. METHODS: Over 400 midwives responded to a questionnaire seeking information on their experiences and perceived competence with labour ward technology, with a particular focus on the use of cardiotocograph machines (CTGs) for electronic foetal monitoring. The survey sought views on the extent to which midwives trust the technology, their perceived levels of training and competence, their awareness of policy relating to technological intervention and the issue of women's choice in whether the progress of their delivery is technologically monitored. FINDINGS: The majority of midwives in this survey trust the use of technology but have concerns about issues of safety in relation to potential faults, and to their perceived lack of training in technology usage. The majority also indicated that they prefer a nontechnological birth although many point to the benefits of technological support when difficulties are encountered. The use of technology is seen as multi-professional and there was much support among the respondents for multi-disciplinary training in the use of technologies in future curricula. CONCLUSIONS: If the various findings of this sample survey were to be consolidated for midwives as a whole, they suggest that provisions for continuing professional development may need to address technological awareness and competence in a more focused manner than is discernible at present.

Adult↗
PubMed1995

Apheresis technologies: an international perspective.

The developments in apheresis techniques and their clinical applications world-wide are technologically driven. In the past, apheresis survey statistics have high-lighted both the differences by region in clinical practice and in the types of technologies utilized. Such differences have provided a basis for the scientific and clinical assessments of these apheresis technologies and their clinical outcomes and have stimulated the marketing and business development of new technologies world-wide. A review of the regional practices and technologies utilized provides a perspective on the future role of apheresis and its developments in clinical practice. While technology is a driving force for the development of new techniques for clinical practice, it is not the only market force. For technology introduction, several other important issues need to be considered. Regulations at the local and, most importantly, the federal level impact the timing for new technology introduction. Reimbursement by healthcare payers is critically important from the initiation of the development of a technology through its clinical use. Clinical trials are critically important to show the safety and clinical- and cost-effectiveness of the technology in order for payers to provide reimbursement for its use, but these trials are sometimes long and costly. Research funding availability at the governmental and commercial levels critically impacts new technology investigation and its introduction. Apheresis technology developments offer new hopes and promises for the clinical team; however, their development, introduction, and utilization will be influenced by the prevailing market forces.

Blood Component Removal↗
PubMed2001

Emerging homogeneous DNA-based technologies in the clinical laboratory.

BACKGROUND: Advances in molecular diagnostic technologies have enabled genetic testing in single closed-tube reactions. The purpose of this review is to highlight some of the platforms and technologies currently available for the homogeneous detection of targets and the application of the technologies in the clinical setting. Validation issues surrounding the technologies, which may need to be addressed before they can become widely accepted, will also be discussed. APPROACH: This review discusses the principles of several of the major technologies available for performing homogeneous genetic analyses. Publications arising from the application of the technologies in a wide range of clinical areas are used to highlight and compare the potential advantages and shortcomings of the various technologies. CONTENT: This review is descriptive and focuses on three areas: the technologies available for performing homogeneous analysis, the clinical applications where the technologies are being used, and validation issues surrounding the acceptance of the technologies in the general clinical setting. SUMMARY: This review intends to give the reader a greater understanding of the various technologies available for performing homogeneous genetic testing in the clinical laboratory. Through insight into the principles and performance characteristics underlying these technologies, the end user can evaluate their value and limitations in the clinical diagnostic setting.

Clinical Laboratory Techniques↗
PubMed1997

(Ir)reconcilable differences? The debate concerning nursing and technology.

PURPOSE: To review and critique the debate concerning nursing and technology. Technology has been considered both at one and at odds with nursing. ORGANIZING CONSTRUCT: Mitcham's (1994) concepts of technological optimism and romanticism. SOURCE: Nursing literature since 1960. METHODS: Historical analysis. FINDINGS: Technological optimists in nursing have viewed technology as an extension of and as readily assimilable into humanistic nursing practice, and nursing as socially advantaged by technology. Technological romantics have viewed technology as irreconcilable with nursing culture, as an expression of masculine culture, and as recirculating existing gender and social inequalities. CONCLUSIONS: Both optimists and romantics essentialize technology and nursing, treating the two as singular and fixed entities. The (ir)reconcilability of nursing and technology may be a function of how devices are used by people in different contexts, or of the (ir)reconcilability of views of technology in nursing.

Attitude of Health Personnel↗
PubMed2000

Study design in the evaluation of breast cancer imaging technologies.

RATIONALE AND OBJECTIVES: Bringing a new imaging technology to market is a complex process. Beyond conceptualization and proof of concept, obtaining U.S. Food and Drug Administration (FDA) approval for clinical use depends on the documented experimental establishment of safety and efficacy. In turn, safety and efficacy are evaluated in the context of the intended use of the technology. The purpose of this study was to examine a conceptual framework for technology development and evaluation, focusing on new breast imaging technologies as a highly visible and current case in point. MATERIALS AND METHODS: The FDA views technology development in terms of a preclinical and four clinical phases of assessment. With a concept of research and development as a learning model, this phased-assessment concept of regulatory review against intended use was integrated with a five-level version of a hierarchy-of-efficacy framework for evaluating imaging technologies. Study design and analysis issues are presented in this context, as are approaches to supporting expanded clinical indications and new intended uses after a new technology is marketed. CONCLUSION: Breast imaging technologies may be intended for use as replacements for standard-of-care technologies, as adjuncts, or as complementary technologies. Study designs must be appropriate to establish claims of superiority or equivalence to the standard for the intended use. Screening technologies are ultimately judged on their demonstrated effectiveness in decreasing cause-specific mortality through early detection, but they may be brought to market for other uses on the basis of lesser standards of efficacy (eg, sensitivity, specificity, positive and negative predictive value, and stage of disease detected).

Breast Neoplasms↗
PubMed1989

The Swedish Council on Technology Assessment in Health Care.

During its first year of operation (1988) the Swedish Council on Technology Assessment in Health Care focused on nine areas. Additional activities will be added as need requires and resources permit. Also, preparations for 1989 projects have begun. The nine areas include: identification of technologies needing assessment, including international comparisons; review and synthesis of the value of preoperative routines; review and synthesis of the value of gastroscopy for diagnosing stomach pain; assessment of different treatment methods for back pain; assessment of the value of vascular surgery for vascular spasms in the legs; organization of a strategy conference concerning medical technology assessment in Sweden; creation of a strategy that addresses an international review of medical technology, future technologies in health care, waiting lists for medical care--the importance of medical technology, resource utilization and organizational and educational aspects of introducing new technology in health care, and costs and medical technology; translation of foreign assessment studies, with comments; national and international cooperation. SCTA has discussed the need for assessing specific technology such as bone marrow transplantation and surgical treatment of epilepsy. SCTA's Scientific Advisory Committee has additionally considered the following subjects for future projects: medical, social, and economic consequences of alternative technologies screening for prostate, colorectal, breast, and cervical cancer; costs, indications, and medical benefit of surgery for varicose vains; and modern urology technologies, particularly those related to prostate care.

Organizational Objectives↗
PubMed1981

Medical technology and academic medicine: the doctor-producers' dilemma.

Diagnostic technologies differ from therapeutic technologies in several ways. Use of a diagnostic technologies is increasing faster than overall medical care. New diagnostic technologies tend to be additive and often have multiple uses. In evaluating their benefits, one should assess marginal, not absolute, utilities and measure clinical as well as financial costs. Although the use of therapeutic technologies is more circumscribed, these technologies tend to be in continuous evolution, especially when new. Comparative evaluations of therapeutic technologies are expensive and time-consuming. Pro-technology reimbursement biases may be the most important of the many factors promoting technology use. Academic medical centers, which have become increasingly clinically specialized, must now compete with their own graduates for specialty patients. At the same time they are urged to respond to contradictory national health policies that favor production of more generalists under a pro-specialty reimbursement system. Suggestions for more appropriate technology use should cover multiple approaches, including the changing of current financial incentives and the use of technology assessment to improve quality of care and education.

Academic Medical Centers↗
PubMedDate not supplied

Role of the Biomedical Engineering Department in William Beaumont Hospital's technology assessment process.

Biomedical/Clinical Engineering Departments with expertise in engineering and technology management have a vital role to play in determining the potential for implementation and cost effectiveness of new medical technologies through technology assessment. Technology assessment offers the essential bridge between basic research and development and the prudent practical applications of medical technology. Because of the recent explosion of healthcare technologies, it is almost impossible for any single individual to stay abreast of these new technologies, much less provide an adequate assessment. To meet this need for comprehensive technology assessment, a multidisciplinary team approach is desirable. This paper deals with the assessment of medical technologies in a hospital environment and explores the possible roles biomedical engineering departments can play in the technology assessment process. It shares the experiences of the Biomedical Engineering Department of William Beaumont Hospital, a major, tertiary-care teaching institution currently involved in the technology assessment process utilizing a multidisciplinary team approach.

Biomedical Engineering↗