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PubMed2005

Technology innovations and experience curves for nitrogen oxides control technologies.

This paper reviews the regulatory history for nitrogen oxides (NOx) pollutant emissions from stationary sources, primarily in coal-fired power plants. Nitrogen dioxide (NO2) is one of the six criteria pollutants regulated by the 1970 Clean Air Act where National Ambient Air Quality Standards were established to protect public health and welfare. We use patent data to show that in the cases of Japan, Germany, and the United States, innovations in NOx control technologies did not occur until stringent government regulations were in place, thus "forcing" innovation. We also demonstrate that reductions in the capital and operation and maintenance (O&M) costs of new generations of high-efficiency NOx control technologies, selective catalytic reduction (SCR), are consistently associated with the increasing adoption of the control technology: the so-called learning-by-doing phenomena. The results show that as cumulative world coal-fired SCR capacity doubles, capital costs decline to approximately 86% and O&M costs to 58% of their original values. The observed changes in SCR technology reflect the impact of technological advance as well as other factors, such as market competition and economies of scale.

Air Pollutants↗
PubMed1993

Premature adoption and resolution of medical technology: illustrations from childbirth technology.

The first part of this article discusses four forces underlying the emergence, adoption, and routinization of medical technology: key societal values, policies of the federal government, reimbursement policies, and economic incentives. It also addresses a set of impacts resulting from increased reliance on medical technology. The second part of the paper assesses three examples of childbirth technology: electronic fetal monitor, obstetric ultrasound, and cesarean birth. The tendency toward premature and excessive use of technology is especially strong in the area of childbirth and technology.

Biomedical Research↗
PubMed2000

Technology assessment and the sociopolitics of health technologies.

In a growing number of countries, health technology assessment (HTA) has come to be seen as a vital component in policy making. Even though the assessment of the social, political, and ethical aspects of health technology is listed as one of its main objectives, in practice, the integration of such dimensions into HTA remains limited. Recent social scientific research on the inherently political nature of technology strongly supports such a comprehensive approach. The growing claims by and on behalf of consumer groups also suggest that HTA should be informed by a broader set of perspectives. Using the example of the cochlear implant in children, this essay compares the professed objectives of HTA with typical practice and explores possible explanations for the discrepancies observed. A second example, home telemonitoring for elderly persons, demonstrates how the types of evidence considered by HTA and the process through which assessments are produced may be reconsidered. We argue for the formal integration of the sociopolitical dimensions of health care technologies into assessments. The ability of HTA to more fully address important issues from a public policy point of view will increase by making explicit the sociopolitical nature of health care technologies.

Aged↗
PubMed2006

Technology, governance and patient safety: systems issues in technology and patient safety.

Technology and equipment are often identified as contributors to adverse medical events, however technology is seldom the focal point of investigation as a source of medical error or adverse event. It is often seen as both a means of reducing error (e.g., automated drug dispensing machines) or as a major contributing factor to adverse events (e.g., through cognitive overload). Here we review literature about the governance of technology in health settings, which is addressed in relation to patient safety. We outline the challenges of addressing technology governance issues in the health sector, provide an overview of governance processes, and suggest that technology related adverse events have been largely conceptualized as device and user problems rather than system or socio-technical problems, which is reflected in governance processes associated with medical devices. A recognition of the situatedness of medical practices implies that new forms of governance may be required that place greater emphasis on socio-technical and systems issues.

Causality↗
PubMed2003

Handheld technologies in a clinical setting: state of the technology and resources.

Handheld or palm-based computing technology, commonly known as personal digital assistants (PDAs), are having a tremendous impact in many personal, educational, and business settings. The potential is particularly compelling for healthcare, specifically in the clinical setting. By exploring the development of the technology, applications, and products, as well as issues regarding its use, a better understanding of this technology can be gained. The rapid acceptance and ongoing swift development of handheld computing technology is leading to an evolution in the way clinical data and information move to and from the bedside and into the patient record. This article focuses on three main areas related to PDAs: the development of the palm technology, its potential in clinical settings, and available specific resources.

Computers, Handheld↗
PubMed1999

[Health technology assessment in the international context: where does Germany stand? For the "German Scientific Working Group Technology Assessment for Health care"].

The evaluation of medical technologies, Health Technology Assessment (HTA), is gaining more and more importance in Germany. Starting from a comprehensive definition of the term medical technology, this article first describes the development of HTA since the seventies as an instrument for improving decision-making in health policy. HTA is presented as a repetitive cycle of a sequence of steps starting with the prioritization of topics to be evaluated to the analysis of the impact of the results. Current trends in the further improvement of HTA methods are described, such as the formalization of the topic selection. The current situation in Germany is presented with regard to the regulation of licensing/market entry, coverage by the statutory health insurance, and the utilization of medical technologies. Finally, current activities in the field of HTA in Germany as well as the role of the German Scientific Working Group Technology Assessment for Health Care are discussed.

Guidelines as Topic↗
PubMed2000

[Alternative technologies on infectious waste treatment, and guidelines for evaluation on safety and efficacy of the alternative technologies].

Recently, regulations on incinerators have been tightened, the number of incinerators in medical facilities has hastily decreased. Under these circumstances, alternative technologies for medical waste treatments that can be substituted for incinerators have received considerable attention. Many alternative technologies for treating medical wastes have already been installed in many facilities in advanced nations such as United States of America, Europe and Australia. Appropriate guidelines are essential for safe treatment of medical wastes, and hence some guidelines for evaluation of the safety and efficacy of the alternative technologies have been established in advanced nations including Japan. In this chapter, a summary of alternative technologies, recent regulations worldwide on the technology and an outline of the guidelines are described.

Guidelines as Topic↗
PubMed2001

Information technology in medical education: a nationwide project on the opportunities of the new technology.

CONTEXT: The aim of the national "IT Culture in Medical Education" project in Finland is to enhance the opportunities new technology may provide for medical education. The project focuses on attitudes towards information technology (IT) and on its current use among teachers and students. METHOD: This survey was part of a Finnish nationwide project in medical education. Data were collected by means of a questionnaire designed to gather information about IT use in medical education, sent to teachers and students. The questions were 5-point Likert-type. The participants were medical teachers (n=196) and medical students (n=392) at two medical schools. RESULTS: In both universities, it appeared that medical teachers and students had a very positive attitude toward the advances in modern technology. In addition to the favourable attitudes, computer-related technology was also widely applied. Teachers, however, used information technology more in their research work than in teaching. CONCLUSIONS: The results pose challenges to medical education and underline the importance of educational and psychological knowledge in combination with new technical skills.

Attitude to Computers↗
PubMed1992

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↗
PubMedDate not supplied

APA Summit on Medical Student Education Task Force on Informatics and Technology: learning about computers and applying computer technology to education and practice.

OBJECTIVE: This article provides a brief overview of important issues for educators regarding medical education and technology. METHODS: The literature describes key concepts, prototypical technology tools, and model programs. A work group of psychiatric educators was convened three times by phone conference to discuss the literature. Findings were presented to and input was received from the 2005 Summit on Medical Student Education by APA and the American Directors of Medical Student Education in Psychiatry. RESULTS: Knowledge of, skills in, and attitudes toward medical informatics are important to life-long learning and modern medical practice. A needs assessment is a starting place, since student, faculty, institution, and societal factors bear consideration. Technology needs to "fit" into a curriculum in order to facilitate learning and teaching. CONCLUSION: Learning about computers and applying computer technology to education and clinical care are key steps in computer literacy for physicians.

Computer User Training↗
PubMed1998

Ending the technology paradox: healthcare management technologies for clinical decision making.

As this article has shown, advances are beginning to put an end to the technology paradox that has hindered the industry's efforts to manage care better. Whereas in the past the management side of the healthcare industry has been slow to adopt new technologies, recent years have seen an explosion in the development and use of new tools for managing care. Most of these tools have traditionally focused on managing the administrative and financial aspects of providing care; however, that has also begun to change. Software systems incorporating clinical decision support criteria permit healthcare professionals to make clinical decision-making part of the care management process conveniently and efficiently. Clinical decision support criteria are also helping to change the focus of managed care. At the beginning of the managed care era, insurers and managed care companies concentrated primarily on reigning in costs, in many cases by restricting the types and duration of care provided to their members. Although these restrictions succeeded in conserving resources, they also helped foster an uneasy atmosphere between payers and providers, many of whom felt that their clinical judgment was too often overruled by the "bean counters." At the same time, many healthcare consumers grew to distrust both managed care professionals and providers, feeling that medical decisions were often made for the wrong reasons. However, as managed care companies have acknowledged that the most efficient way to provide care is to provide appropriate care, the focus has begun to move toward the clinical side of healthcare. Although healthcare organizations are still relying on financial management tools, they are also looking for systems that can make the clinical decision-making process more efficient and effective. The end result is that the healthcare industry is able to assure the best, most appropriate treatment while conserving resources. With the constant stream of new technologies into the healthcare management arena, healthcare professionals will have access to new tools to make the management process even more efficient. The healthcare industry's technology paradox will soon be a thing of the past.

Decision Support Systems, Clinical↗
PubMed2005

Time-trends in health technology assessments: an analysis of developments in composition of international health technology assessments from 1989 to 2002.

OBJECTIVES: Health Technology Assessment (HTA) as a method for producing evidence in the health-care sector has been used for more than 25 years but has grown in extent during the past years. The objective of this study is to explore a possible evolution in these HTAs, in type of assessed technologies, in type of assessors, and in its methods. METHODS: A structured literature review was conducted of 433 HTA reports from the period 1989 to 2002 by eleven leading HTA institutions worldwide. The review focused on the methodology used, the assessors, and the assessed technologies and was designed to elucidate general time-trends in the practical application of HTA. RESULTS: The study shows that literature reviews are still the most often used method of assessment and accounts for a relatively stable fraction of assessments. The fraction of economic evaluations shows a slightly decreasing trend in contrast to randomized controlled trials and modeling/evaluations, which are applied more frequently. The data also demonstrate a more frequent use of external partners as assessors and a shift between devices and pharmaceuticals as assessed technologies. CONCLUSIONS: The study shows an increase in the number of HTAs but no major developments in assessment methods used and, therefore, no widespread spillover from the development in research methods in general to the field of HTA methodology.

Denmark↗
PubMed2006

What influences the choice of assessment methods in health technology assessments? Statistical analysis of international health technology assessments from 1989 to 2002.

OBJECTIVES: Health technology assessment (HTA) has been used as input in decision making worldwide for more than 25 years. However, no uniform definition of HTA or agreement on assessment methods exists, leaving open the question of what influences the choice of assessment methods in HTAs. The objective of this study is to analyze statistically a possible relationship between methods of assessment used in practical HTAs, type of assessed technology, type of assessors, and year of publication. METHODS: A sample of 433 HTAs published by eleven leading institutions or agencies in nine countries was reviewed and analyzed by multiple logistic regression. RESULTS: The study shows that outsourcing of HTA reports to external partners is associated with a higher likelihood of using assessment methods, such as meta-analysis, surveys, economic evaluations, and randomized controlled trials; and with a lower likelihood of using assessment methods, such as literature reviews and "other methods". The year of publication was statistically related to the inclusion of economic evaluations and shows a decreasing likelihood during the year span. The type of assessed technology was related to economic evaluations with a decreasing likelihood, to surveys, and to "other methods" with a decreasing likelihood when pharmaceuticals were the assessed type of technology. CONCLUSIONS: During the period from 1989 to 2002, no major developments in assessment methods used in practical HTAs were shown statistically in a sample of 433 HTAs worldwide. Outsourcing to external assessors has a statistically significant influence on choice of assessment methods.

Choice Behavior↗
PubMed2000

Information technology adoption in health care: when organisations and technology collide.

The implementation of advanced information systems is enabling great social and organisational changes. However, health care has been one of the slowest sectors to adopt and implement information technology (IT). This paper investigates why this is so, reviewing innovation diffusion theory and its application to both health organisations and information technology. Innovation diffusion theory identifies variables that influence the 'innovativeness' of organisations and the rate at which a technology diffuses. When analysed, these variables show why IT implementation has progressed at a slower rate in health compared with other industry sectors. The complexity of health organisations and their fragmented internal structure constrain their ability to adopt organisation wide IT. This is further impacted upon by the relative immaturity of strategic health IT which is complicated and unable to show quantifiable benefits. Both organisational and technological factors lead to the slow adoption of strategic IT. On the other hand, localised IT solutions and those providing measurable cost reductions have diffused well.

Diffusion of Innovation↗
PubMed1998

Universal design and assistive technology in communication and information technologies: alternatives or complements?

Universal design and assistive technology present advantages and disadvantages in accommodating the needs of people with disabilities. The best solution may be a combination of the two, using universal design wherever possible and commercially practical and using assistive technologies wherever it is necessary or provides sufficient additional advantage to the user. Three approaches are discussed for the individual who is unable to interact with their world: change the individual, provide them with tools they can use, or change the environment. Examples of each are illustrated using personal workstations and shared, public, and encountered systems. The final decision may rest on commercial practicality, and several new technologies are explored. Ultimately, we need to continue to move forward both on the universal design and the assistive technology fronts if we are to address the needs of people with disabilities and those who are aging.

Aging↗
PubMed1993

A model for technology assessment applied to pulse oximetry. The Technology Assessment Task Force of the Society of Critical Care Medicine.

OBJECTIVES: To test a model for the assessment of critical care technology. To develop practice guidelines for the use of pulse oximetry. DATA SOURCES: A computer-assisted search of the English language literature and interviews with recognized experts in the field of pulse oximetry. STUDY SELECTION: Those studies that addressed one or more of the seven questions contained in our technology assessment template were analyzed. Study design was not a factor in article selection. However, the lack of well-designed clinical outcome studies was an important factor in determining the method of practice policy development we utilized. DATA EXTRACTION: A focus person summarized the data from the selected studies that related to each of the seven assessment questions. The preliminary data summary developed by the focus person was further analyzed and refined by the task force and then sent to 16 expert reviewers for comment. These expert comments were considered by the task force, and this final consensus report was developed. DATA SYNTHESIS: Pulse oximetry combines the principles of spectrophotometry and plethysmography to noninvasively measure oxygen saturation with a high degree of accuracy over the range of 80% to 100% saturation, assuming the device is being used according to the manufacturer's instructions and without any adverse operating conditions. The appropriate clinical uses of pulse oximetry fall into one of two broad categories: as a warning system based on continuous real-time measurement of arterial desaturation, or as an end-point for titration of therapeutic interventions. There are no published studies that allow for definitive, outcome-based conclusions concerning either the clinical impact or cost-benefit ratio of pulse oximetry. CONCLUSIONS: The model developed for technology assessment proved to be appropriate for assessing pulse oximetry. The available data have allowed us to develop an evidence-based practice policy for the use of pulse oximetry in critical care. Critical care clinicians, researchers, and industry have a shared responsibility to provide valid outcome and efficacy studies of new technologies.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1992

Technology anxiety as a potential mediating factor in response to medical technology.

Technology anxiety, defined as a fear of working with medical equipment, was measured via the use of the Technology Response Questionnaire. Nurses (N = 414) working on nine types of nursing units at two hospitals participated in the study. Nurses working on psychiatric units were found to be most anxious about working with medical equipment, while nurses working on surgical and adult intensive care units were least anxious. A comparison of the nurses who were highest and lowest on technology anxiety indicated that those who were most anxious about technology were less positive toward computers, felt more stressed by their work, were lower on job satisfaction, less positive toward the physicians they worked with, lower on personality scales of autonomy and adaptability, were less likely to do care planning regularly or to use nursing diagnoses, and tended to be older than less anxious nurses.

Analysis of Variance↗
PubMed2004

Technology insight: Identification of biomarkers with tissue microarray technology.

High-throughput technologies have been developed in the hope of increasing the pace of biomedical research, and accelerating the rate of translation from bench to bedside. Using such technology in target discovery has resulted in the need for systematic validation of the targets in an equally rapid manner. For example, gene expression microarrays have highlighted many potential targets in cancer, and tissue microarrays have emerged as a powerful tool to validate these targets by measuring tumor-specific protein expression and linking it to clinical outcome. Automated quantitative analysis of the tissue microarray 'spots' is beginning to take the technology a step further, removing observer bias, and providing standards for quality control and the potential for high-throughput analysis. The validation required for translation of tissue biomarkers from the research lab to the clinical lab will probably rely heavily on the combination of tissue microarray technology with automated quantitative analysis.

Biomarkers, Tumor↗