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PubMed1994

Developing AAC technologies: a personal story and philosophy.

Research into and development of augmentative and alternative communication (AAC) technologies is an exciting but complex field. The development of a technologically based system which will be an alternative to, or will augment, the speech modality for the interpersonal communication needs of people with communication dysfunction is not an easy task. This is only a young field and thus much of the research methodology is not yet well defined. It is also a growing field, and one to which we would wish to attract new practitioners, and provide appropriate guidance to them. In any technological development project, it is important to define clearly a number of parameters of the project. These are: the client group; the knowledge base needed to solve the problems; the potential technologies that will help and their characteristics; and the time scales envisaged for completion of the research. The authors have been part of a research team working in this field for many years, and, in this paper, they will examine three research strategies which they have found particularly beneficial, illustrating the concepts discussed mainly by reference to personal experiences. The paper concentrates on a relatively narrow definition of technology-that which is often referred to as 'high technology' or information technology. This is not to deny, in any way, the importance to the AAC field of solutions based on other technology, and the authors would hope that some of the comments in the paper are also appropriate to researchers who are working with systems and techniques which do not depend on these technologies.

Communication Devices for People with Disabilities↗
PubMed1987

Service delivery mechanisms in rehabilitation technology.

Rehabilitation technology is a rapidly advancing area involving professionals from multiple disciplines, including engineers, occupational and physical therapists, speech pathologists, computer programmers, and many others. This paper focuses on the use of computers and other personal assistive devices by disabled persons, but the concepts presented apply to all areas of personal rehabilitation technology. The topics covered include a perspective on the use of advanced technology, technological appliances versus tools, skills or special knowledge needed for the effective delivery of rehabilitation technology, new roles for the service delivery team, sources of training in rehabilitation technology, and issues in qualification or certification of rehabilitation technology professionals. The purpose of this paper is to put the use of advanced technology for rehabilitation in its proper perspective and to present ideas for consideration in building more effective service delivery mechanisms for these technologies.

Certification↗
PubMed1993

The development of technology competencies and training guidelines for occupational therapists.

The ability to use technology has become a survival skill in our society. This paper discusses technology trends related to the demands of the Information Age, the increasing availability of information and assistive technologies, and the impact of recent civil rights legislation mandating that persons with disabilities be given equal access to technologies that can enhance functional performance. Occupational therapists must become competent in the application and integration of these technologies into reasonable accommodation interventions if we are to meet the changing needs of persons with disabilities. To address this need for technology training, a multitiered set of technology competencies specifically designed for occupational therapy practitioners was authored by the American Occupational Therapy Association Technology Special Interest Section and reviewed by occupational therapists with technology expertise. The process of developing these competencies and recommendations for implementing them within occupational therapy educational programs are discussed.

Computers↗
PubMed1984

Diffusion of new technologies: rational and irrational.

The diffusion of medical technology, the process by which new clinical procedures and devices come into use in the health care system, is an historical topic, as old as medicine itself. Hospitals, physicians, manufacturers, third-party payers, and patients all are factors in the demand for, and adoption and diffusion of, new medical technologies. The federal government also plays a role both in furthering technology diffusion through federally financed health programs and in attempting to control diffusion by stimulating state certificate of need and other regulatory programs. The history of the CT scanner's diffusion illustrates the problems that can result from the lack of a coherent strategy to control the diffusion of major medical technologies. Some of these same problems are now appearing in the diffusion of magnetic resonance imaging (MRI) devices. In the current health care environment, prospective payment and the continuing period of remarkable technological innovation are major influences on technology diffusion and on initiatives for technology assessment. The diffusion of technology can be made more rational by instituting a formal process to identify technologies (both old and new) that require assessment, by financial support for assessment efforts, by selective reimbursement for clinical trials, and by regionalization of costly procedures.

Certificate of Need↗
PubMed1999

Physician acceptance of telemedicine technology: an empirical investigation.

Fast-growing interest in telemedicine and increased investment in its enabling technology have made physician technology acceptance a growing concern for development and management of telemedicine. At the dawn of large-scale technology implementation by health care organizations around the globe, it is essential to understand physicians' attitudes toward use of telemedicine technology and their intention to use the technology. In this study, we used Theory of Planned Behavior to investigate technology acceptance among physicians who practiced in public tertiary hospitals in Hong Kong. Our data supported the investigated theory and the results suggest that attitude and perceived behavioral control are crucial to physician technology acceptance. Overall, physicians showed positive attitudes toward use of telemedicine technology and exhibited moderate intention to use the technology, primarily for clinical purposes. Implications for development and management of telemedicine also are discussed.

Attitude of Health Personnel↗
PubMedDate not supplied

Use of computer technology to help students with special needs.

Millions of students across the United States cannot benefit fully from a traditional educational program because they have a disability that impairs their ability to participate in a typical classroom environment. For these students, computer-based technologies can play an especially important role. Not only can computer technology facilitate a broader range of educational activities to meet a variety of needs for students with mild learning disorders, but adaptive technology now exists than can enable even those students with severe disabilities to become active learners in the classroom alongside their peers who do not have disabilities. This article provides an overview of the role computer technology can play in promoting the education of children with special needs within the regular classroom. For example, use of computer technology for word processing, communication, research, and multimedia projects can help the three million students with specific learning and emotional disorders keep up with their nondisabled peers. Computer technology has also enhanced the development of sophisticated devices that can assist the two million students with more severe disabilities in overcoming a wide range of limitations that hinder classroom participation--from speech and hearing impairments to blindness and severe physical disabilities. However, many teachers are not adequately trained on how to use technology effectively in their classrooms, and the cost of the technology is a serious consideration for all schools. Thus, although computer technology has the potential to act as an equalizer by freeing many students from their disabilities, the barriers of inadequate training and cost must first be overcome before more widespread use can become a reality.

Adolescent↗
PubMed2001

What can technology do to, and for, family medicine?

Medical technology can be divided into information technology, diagnostic technology, and therapeutic technology. These technologies can enhance the care of patients in a family practice; they also have the potential to diminish or fragment family practice when the technologies can only be provided by specialists. While some family physicians have an aversion to technological advances, we believe it is imperative that family physicians participate in the development of technologies that enhance family practice and improve patient outcomes in primary care practice. These include electronic medical records, decision support systems, tools for managing medical information, and others. Criteria are presented to help determine when these new technologies should be adopted into practice.

Diagnostic Techniques and Procedures↗
PubMed2003

Obtaining a clinical laboratory science degree via distance technology.

OBJECTIVE: To identify institutions and program officials associated with clinical laboratory science (CLS) academic programs available via distance technology; to collect and summarize data from these programs with regard to on-line instructional methodologies; to determine the level of success of educational strategies and methodologies utilized in on-line CLS programs; to determine the feasibility of developing an on-line program at Seward County Community College (SCCC), Liberal, Kansas. DESIGN: An on-line CLS program survey tool was sent to eight higher education institutions which had previously indicated that they offer a CLS academic program at the associate, bachelor, or master level via distance technology. Program officials were asked to answer questions pertaining to areas such as program format, on-line admission requirements, program costs, student costs, faculty workload, and on-campus versus on-line student performance. SETTING AND PARTICIPANTS: The survey was sent to eight program officials who identified their institutions as having a CLS program available through distance technology. MAIN OUTCOME MEASURES: Responses from current distance technology CLS program officials were collected and tallied. Responses were recorded as 'yes' or 'no' in categories such as program format, program and student costs, and comparison of on-campus versus on-line student performance. The two groups of students were compared in areas of success rate, retention rate, graduation rate, external certification pass rate, employment placement rate, and employer satisfaction level. RESULTS: The response rate for the survey was 87.5% (7/8). Program officials indicated that various educational methodologies were incorporated in providing CLS education via distance technology. All of the respondents utilize some type of Web-enhanced, Internet based access to deliver course material. Clinical laboratory procedures are taught via instruction within a cooperative laboratory, program clinical affiliate laboratory, or during on-campus student laboratories. Program officials indicated that student enrollment has increased due to the availability of the distance technology. Students enrolled via distance technology perform as well or better than the on-campus students on certification exams and in the clinical setting. Data from these institutions indicate that it is feasible to develop an on-line program at SCCC in an effort to increase student enrollment. CONCLUSION: The results indicate that CLS programs which offer the curriculum via distance technology have experienced increased student enrollment thus graduating more students to fill the employment needs. These current distance technology programs are leading the future trends in CLS education of the 21st century.

Clinical Laboratory Techniques↗
PubMed1998

Biology as technology.

In this paper we have emphasised the technological dimension of the biosciences, especially the biosciences of our time. As a straight forward fact this dimension is less controversial than the question of its relevance is. We have argued that the existence of this dimension is a consequence of the empirical character of the biosciences (as well as of the sciences in general). Knowledge of nature can be achieved only if the subject of knowledge is able to gain access to natural phenomena, and technological means have become increasingly necessary for achieving this. The more that is already known, the greater the technological investment required to produce new knowledge. Therefore there is an interrelationship between the advancement of knowledge and the amount and complexity of the research technology required. It would be short sighted to conclude from this observation that human imagination and inventiveness have become superfluous. Nevertheless the growing preponderance of technological means for progress in science is undeniable. A particularly important insight is that this process not only involves a quantitative increase in technology within science. Our main hypothesis is that there is a close relationship between the type of means used, the type of subject required for performing research, the kinds of objects investigated in science, and the nature of the results that are generated. We have tried to illustrate this by distinguishing between three different types of bioscience: (a) a descriptive type, (b) an experimental type, and (c) and an industrial type. Without pretending this provides a universal key to the history of the biosciences and to understanding of the way science works today, we hope that such a distinction may open up new avenues of thought. We hope that this approach will provide us with a more realistic picture of science. The propositional view reduces science to its theoretical results, in particular to the theories emanating from basic research. Science is seen as a special kind of philosophy; its central aim is to provide us with a 'true' view of the world. Thus the social problems which result from scientific inquiry and from the application of its results seem to be something external to the very essence of science and thus only of secondary importance. We believe, therefore, that this picture of science is both theoretically unsatisfactory and socially misleading. An appropriate account of science cannot ignore the fact that basic research represents only a very small part of the science system of our time. It cannot neglect the fact that science today is steeped with technology and to a great extent also industrialised. And it cannot treat the social problems of science as something merely 'external'. To view science as an activity in the sense outlined in this paper permits one to integrate these different aspects into one coherent and realistic picture. 1. It is obvious that technology plays a crucial role in determining the social reality of science. This is mainly because of the high costs of contemporary research technology that science can no longer be performed by gentleman scientists like Alexander von Humboldt or Charles Darwin, who not only financed their own living but the cost of their own research too. Science today is a profession, and in many cases it can be performed only in large groups or institutions financed by the state or by private companies. At the same time this means that it is more and more dependent upon decisions made outside science. Scientific activities have assumed the economic form of wage labour. The internal structure of science is characterised by a division of labour and hierarchical forms of decision making. 2. From a more traditional point this may seem to be a development 'external' to science, without any relevance for its 'essence'. The aim of science, it may be said, is to discover the truth about the external world, and the ways of reaching it a

Biological Science Disciplines↗
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↗
PubMed2002

Future AAC technology needs: consumer perspectives.

This article suggests the need for rethinking the role that consumer perspectives will play (and ought to play) in the design and development of future augmentative and alternative communication (AAC) technologies. After carefully defining what they mean by "AAC consumers," "consumer perspectives," and "AAC technologies," the authors consider the extent to which current research has illuminated our understanding of (1) how consumers view AAC technologies and (2) how consumers themselves would define future technology needs. It's not a pretty picture. While it is clear that there already exist specific constructs and methods that could enable researchers and developers to learn more about consumer perspectives, it is equally clear that few, if any, researchers make much use of these constructs and methods. The authors focus specifically on ways that consumer perspective can helpfully infuse participatory action research, technology transfer processes, and ergonomics. In addition, the authors consider how research that investigates the ways in which assistive technologies impact the daily lives of individuals with severe communication impairment also influences public policy issues, which can in turn affect future definitions of AAC technology needs. Throughout the article, the authors advocate for a paradigm shift in the quantity and quality of the collaborations that occur between AAC consumers and AAC researchers, manufacturers, and developers. Augmented communicators and their families have a major stake in all types of research that can affect the design and development of AAC devices and accessories, and the results of this research, in turn, can affect public policy decisions about AAC technologies. This makes it all the more important that AAC consumers be involved at each step of the research and development process.

Communication Devices for People with Disabilities↗
PubMed1993

Medical technology and inequity in health care: the case of Korea.

There has been a rapid influx of high cost medical technologies into the Korean hospital market. This has raised concerns about the changes it will bring for the Korean health care sector. Some have questioned whether this diffusion will necessarily have positive effects on the health of the overall population. Some perverse effects of uncontrolled diffusion of technologies have been hinted in recent literature. For example, there is a problem of increasing inequity with the adoption of expensive technologies. Utilization of most of the expensive high technology services is not covered by national health insurance schemes; examples of such technologies are Ultra Sonic, CT Scanner, MRI, Radiotherapy, EKG, and Lithotripter. As a result, the rich can afford expensive high technology services while the poor cannot. This produces a gradual evolution of classes in health service utilization. This study examines how health service utilization among different income groups is affected by the import of high technologies. It discusses changes made within the health care system, and explains the circumstances under which the rapid and excessive diffusion of medical technologies occurred in the hospital sector.

Cost-Benefit Analysis↗
PubMed2002

Is there a technological imperative in health care?

The question in the title will be addressed by first answering the question: What is a technological imperative? A review of the literature makes it clear that there are many descriptions and explanations of the technological imperative in health care, and that not all of them are important to consider. One conception of the technological imperative that is important is the one that implies that technology reduces our responsibility toward our actions. I argue that that this conception cannot be justified. That is, there is no imperative that frees us from our responsibility for developing, producing, advertising, assessing, implementing, using, and banishing technology in health care. On the contrary, the increased possibilities provided by technology result in an increased responsibility. That is, there is no technological imperative, but technology promotes a moral imperative; in particular, it promotes a moral imperative to proper assessment.

Biomedical Technology↗
PubMed1980

The medical technologist and evaluation of health technologies.

Increased social pressure for accountability in the medical care fields and recognition that new and expensive health care technologies have limited impact on health status has brought acknowledgment that the United States has no rational approach to identification, evaluation, and implementation of innovative medical technologies. As in other health care sectors, comprehensive and long-range evaluation of impacts of new medical laboratory technology on both the laboratory and the patient are lacking. It is evident that as questions concerning cost effectiveness are raised, more rigorous evaluation of laboratory technologies must be undertaken. Federal legislation has mandated creation of a National Center for Health Care Technology (NCHCT) with a primary mission to stimulate assessment of health care technologies. This legislation could provide the basis for a more rational approach to technology assessment. Potential implications of technology assessment on laboratory practices and third party reimbursement policy, as well as potential opportunities for laboratory professionals, are discussed.

Government Agencies↗
PubMed1987

An inquiry concerning future health care technology: methods and general results.

New and future health care technology has important implications for the delivery and organization of health care. Furthermore, advances in health care technology are increasingly associated with social, ethical, and economic issues. Effective health planning needs to anticipate future health care technology and take into account such implications. This paper concerns an analysis of future health care technology undertaken in the Netherlands. The study involved: (a) the early identification of future developments in health care technology; and (b) prospective assessments of a number of high-priority technologies. The paper concludes that technology forecasting in health care should become an integral part of overall technology assessment activities in industrialized countries.

Forecasting↗
PubMed1987

Technology assessment for countries in different stages of development.

Technology, in the form of tools, can lead to more effective and less hazardous diagnosis, monitoring and treatment. Criticisms of undue cost and of inhumanity reflect inappropriate use--when a technology is either unnecessary or is bound to be unsuccessful. Strategic objectives for managing technology include determining the limits of appropriate use in the particular country and the level of affordable provisions. Competition between patients for access to a technology should depend on the relative probability of benefit. Competition between technologies for provision should depend on the relative cost of a quality adjusted life year (QALY). Once data on technology assessment is available, steps should be taken to inform providers about appropriate macro-allocation, and clinicians about micro-allocation. There are imperatives to inappropriate use of technologies, especially those that marginally improve or extend the lives of the hopelessly ill. Ethics and economics demand a prior consensus by groups of doctors and others about limiting technological treatment in such circumstances. This should make it easier for individual clinicians to make wise decisions and to minimise inhumanity and waste of resources.

Cost-Benefit Analysis↗
PubMed1995

Evaluation of diffuse technologies: the case of digital imaging networks.

There have been significant developments in recent years in the methodologies and methods for the evaluation of a wide range of health technologies. There remain, though, many technologies which are difficult to evaluate. Often the difficulty stems from the complexity of the technologies themselves, which are in effect hybrids, comprising combinations of several distinct elements. In this paper these are termed 'diffuse' technologies, because the different elements exert different costs and effects, often across several different services. Computer networks are one, increasingly important, example of such technologies in health care. While it is possible to evaluate individual elements of such technologies, it is not clear how to evaluate the technology as a whole, where the whole may be greater (or less) than the sum of the parts. The paper outlines a seven-stage framework for the evaluation of diffuse technologies. The general principles of evaluation are illustrated using the example of picture archiving and communication systems (PACS), which are computer systems designed to capture, store and distribute electronic radiological images within a hospital.

Cost-Benefit Analysis↗
PubMed1983

Psycho-social factors and the technologies of work.

This paper examines the probable association between use of complex technologies in the work setting and psycho-social factors believed to impact upon human health. The analysis is set within two long-standing philosophical perspectives on technology, one which holds that technology controls human choice and action, and the other which sees technology as a useful tool for extending human capabilities. Research evidence linking technologies of work to health are reviewed. On the basis of this literature, the authors conclude that, in general, among blue collar and clerical workers, technology is often a controlling element, to the detriment of health; but among professionals and managers, technology can be an aid to work and may therefore facilitate positive health. Strategies are offered toward the prevention and detection of, and intervention into work environments which, through the use of high technology, may pose a threat to health.

Computers↗