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PubMed2004

Ethics in technological culture: a programmatic proposal for a pragmatist approach.

Neither traditional philosophy nor current applied ethics seem able to cope adequately with the highly dynamic character of our modern technological culture. This is because they have insufficient insight into the moral significance of technological artifacts and systems. Here, much can be learned from recent science and technology studies (STS). They have opened up the black box of technological developments and have revealed the intimate intertwinement of technology and society in minute detail. However, while applied ethics is characterized by a certain "technology blindness," the most influential approaches within STS show a "normative deficit" and display on agnostic or even antagonistic attitude toward ethics. To repair the blind spots of both applied ethics and STS, the authors sketch the contours of a pragmatist approach. They will explore the tasks and tools of a pragmatist ethics and pay special attention to the exploration of future worlds disclosed and shaped by technology and the management of deep value conflicts inherent in a pluralistic society.

Bioethical Issues↗
PubMed1998

Does new technology increase or decrease health care costs? The treatment of peptic ulceration.

OBJECTIVES: To determine whether new technology increases or decreases formal health care costs, with reference to the diagnosis and treatment of peptic ulcers. METHODS: A costing method has been devised which is designed to investigate directly the way in which the costs to formal health services of diagnosing and treating an individual illness have changed with changes in technology. RESULTS: The cost of diagnosis has increased almost entirely as a result of the high cost of endoscopy compared with X-ray examination. The introduction of H2-receptor antagonist drugs increased the cost of treatment compared with the earlier phases of surgical treatment. Subsequently, Helicobacter pylori eradication treatment has reduced the cost of treatment compared with all earlier phases of technology. CONCLUSIONS: A method has been devised that allows the impact of changes in medical technology on formal health care costs to be investigated for individual illnesses. In the treatment of peptic ulceration, the current technology, H. pylori eradication, has lower treatment costs than all previous technologies. The evidence from previous studies and this study is insufficient to support the assertion that new technology in general leads either to an increase or to a decrease in health care costs.

Anti-Infective Agents↗
PubMedDate not supplied

Meeting the computer technology needs of community faculty: building new models for faculty development.

OBJECTIVE: We aimed to identify the evolving computer technology needs and interests of community faculty in order to design an effective faculty development program focused on computer skills: the Teaching and Learning Through Educational Technology (TeLeTET) program. METHODOLOGY: Repeated surveys were conducted between 1994 and 2002 to assess computer resources and needs in a pool of over 800 primary care physician-educators in community practice in East Texas. Based on the results, we developed and evaluated several models to teach community preceptors about computer technologies that are useful for education. RESULTS: Before 1998, only half of our community faculty identified a strong interest in developing their technology skills. As the revolution in telecommunications advanced, however, preceptors' needs and interests changed, and the use of this technology to support community-based teaching became feasible. In 1998 and 1999, resource surveys showed that many of our community teaching sites had computers and Internet access. By 2001, the desire for teletechnology skills development was strong in a nucleus of community faculty, although lack of infrastructure, time, and skills were identified barriers. The TeLeTET project developed several innovative models for technology workshops and conferences, supplemented by online resources, that were well attended and positively evaluated by 181 community faculty over a 3-year period. CONCLUSIONS: We have identified the evolving needs of community faculty through iterative needs assessments, developed a flexible faculty development curriculum, and used open-ended, formative evaluation techniques to keep the TeLeTET program responsive to a rapidly changing environment for community-based education in computer technology.

Community Health Services↗
PubMed1994

Technology assessment and support of life-sustaining devices in home care. The home care physician perspective.

Practicing physicians are increasingly using life-sustaining devices in the home setting for patients with long-term needs due to chronic conditions. At the same time, public policy focus on technology assessment has broadened from narrow medical concerns about safety and efficacy to considerations of effectiveness, quality of life, patient preferences, and cost/benefit. Around the world high-technology home care (HTHC) features a number of ways to evaluate outcomes. One category of HTHC that requires initial and on-going technology assessment is home mechanical ventilation (HMV). Home MV has developed in nations with a variety of healthcare finance systems: England (national health system), France (national health insurance), and the United States (regulated/market-economy). Approaches to technology assessment differ among nations according to organizational design and evolution. Physician behavior is a major determinant in the application of medical technologies. There are new physician roles that an influence what, when, and how technology is appropriately used in the home--initially and over time. For this reason, it is crucial to consider the role of the practicing physician in home care technology assessment.

England↗
PubMedDate not supplied

[Bioethics and health care technology assessment].

The simultaneous existence of a biotechnoscientific paradigm (which emphasizes technological incorporation) and a culture of limits (which selects technologies) challenges current health systems, raising ethical and political discussions as to the choices to be made. Health care technology assessment is mainly concerned with the consequences of health care and health care policies. Thus, there is significant overlap between this activity and bioethics, even though they are different fields of knowledge. Although the importance of ethical and social issues arising in technology assessment has been recognized, most publications emphasize only methodological and scientific aspects. There are different interests involved in technological incorporation, and many value conflicts arise. Ethical implications include those related to clinical trials, medical care assessment, incorporation of technology, resource allocation, equity, and the effectiveness gap. Incorporating the ethical dimension into technology assessment will foster a better understanding of health care practice and progress in its improvement.

Bioethics↗
PubMed1998

A model of cost-outcome analysis for assistive technology.

During the CERTAIN study (research carried out in 1994-96 within the Technology Initiative for Disabled and Elderly (TIDE) programme of the European Union), a number of real life case studies of provision of assistive technology to disabled persons were investigated in order to assess the applicability of socio-economic principles, methods and techniques already available from Health Care Technology Assessment studies. A retrospective study on cost, effectiveness and utility resulting from the implementation of assistive technology was carried out over a sample of disabled persons who had adopted technical aids before the start of the project. The sample was selected in such a way to include different pathologies (steady or progressive), impairments, ages, technology and social environment. Each case was described by considering all clinical, technical and social aspects; a common structure for case reporting was developed and tested; attempts were carried out to apply and refine concept and tools derived from health technology assessment studies; on the grounds of such experience a decision support model was elaborated for the choice between different alternatives in order to maximize the client's quality of life while making efficient use of scarce resources. A computer implementation of such a model was also developed, along with a mathematical structure of cost analysis. Within a national research programme such findings were further exploited, leading to the development of a prototype cost-outcome instrument designed for use in clinical practice in the provision of assistive technology to individual cases.

Activities of Daily Living↗
PubMed2005

Understanding the interrelationship of instructional technology use and organizational culture: a case study of a veterinary medical college.

Many predicted that in the latter part of the twentieth century modern technology would revolutionize higher education and "create a second Renaissance" (Sculley J. The relationship between business and higher education: A perspective on the 21st century. Commun ACM32:1056-1061, 1989 p1061). However, as the reality of the twenty-first century has set in, it is apparent that these revolutionary prophecies have fallen short. Using the lens of Douglas's Typology of Grid and Group, this case study examines (1) the organizational context of a veterinary medical college at a large Midwestern university; (2) individual faculty members' preferences toward instructional technology use; and (3) the interrelationship of culture and the decision process to implement instructional technology use in curricula. The study has several implications for instructional technology use in veterinary medical educational settings that help explain how cultural context can guide leadership decisions as well as influence faculty motivation and preference. The findings suggest that a key mitigating factor to instructional technology implementation is conflict or concord between the cultural biases of faculty members and actual cultural identity of the college (Stansberry S, Harris EL. Understanding why faculty use (or don't use) IT: Implementation of instructional technology from an organizational culture perspective. In Simonson M, Crawford M, eds. 25th Annual Proceedings: Selected Research and Development Papers Presented at the 2002 National Convention of the Association for Educational Communications and Technology, vol. 1. North Miami Beach, FL: Nova Southeastern University:viii, 507).

Computer-Assisted Instruction↗
PubMed2005

Web-based technology: its effects on small group "problem-based learning" interactions in a professional veterinary medical program.

The objective of this investigation was to ascertain whether and how the introduction of a new technology (WebCT) influenced faculty teaching styles while facilitating small group problem-based learning (PBL) sessions in a professional veterinary medical (PVM) program. The following questions guided the study: (1) How does the use of technology affect faculty teaching behaviors? (2) Do the facilitators' interactions with WebCT technology change over the course of one semester? (3) What is the perceived impact of WebCT on facilitators' role in PBL? The study employed a combination of qualitative (case study) and semi-quantitative (survey) methods to explore these issues. Nine clinical sciences faculty members, leading a total of six PBL groups, were observed over the course of an academic semester for a total of 20 instructional sessions. The qualitative data gathered by observing faculty as they facilitated PBL sessions yielded three major themes: (1) How do PBL facilitators adapt to the addition of WebCT technology? (2) Does this technology affect teaching? and (3) How do PBL facilitators interact with their students and each other over the course of a semester? No direct evidence was found to suggest that use of WebCT affected teaching behaviors (e.g., student-centered vs. teacher-centered instruction). However, all facilitators showed a moderate increase in comfort with the technology during the semester, and one participant showed remarkable gains in technology skills. The teaching theme provided insight into how facilitators foster learning in a PBL setting as compared to a traditional lecture. A high degree of variability in teaching styles was observed, but individuals' styles tended to remain stable over the course of the semester. Nevertheless, all facilitators interacted similarly with students, in a more caring and approachable manner, when compared to the classroom or clinic atmospheres.

Computer-Assisted Instruction↗
PubMed1993

Addressing assistive technology needs in special education.

Assistive technology is critical to maximize the functional skills of the person with a physical disability at home, work, and school. As assistive devices become increasingly complex and expensive and more options are available, the need for an assistive technology specialist is enhanced. Recent regulations and advances in technology are affecting the type, quality, and comprehensiveness of assistive technology service provision and need for assistive technology specialists. The occupational therapist's role as an assistive technology specialist is illustrated in an example of an assistive technology program within a special education setting.

Adolescent↗
PubMedDate not supplied

Current trends in assistive technology education in entry-level occupational therapy curricula.

OBJECTIVE: This replication study investigated what changes, if any, occurred in the education of entry-level occupational therapy students relative to assistive technology between 1989 and 1994-1995. METHOD: A questionnaire was mailed to all entry-level occupational therapy programs in the United States (N = 79). The response rate was 88.6% (n = 70). Results were compared with those of a similar survey that examined the same issues in 1989. RESULTS: Assistive technology education had increased from 1989 to 1994-1995 in 11 identified areas. The highest increases were found in environmental access and robotics, sensory aids, augmentative communication, and prosthetics and orthotics. Only 10% of the respondent programs had less than 20 hours of assistive technology education compared with 50% in the earlier study. Thirty (43%) programs included one or more technology courses in the curriculum compared with 17 (29%) in 1989, and 62 (89%) programs included assistive technology content in lectures or units throughout the curriculum compared with 32 (54%) in 1989. CONCLUSION: Occupational therapy educators are placing more emphasis on assistive technology education than they did in 1989 and are learning the skills to teach this content. If this trend continues, we will see assistive technology content taught in all occupational therapy programs in the next millennium.

Computer Literacy↗
PubMed2006

The evolving relationship of technology and nursing practice: negotiating the provision of care in a high tech environment.

Nurses proudly espouse that they provide 'care' in highly technological environments that focus on 'cure'. How care is achieved in such environments continues to be debated: There is evidence that care is dominated by the management of technology. The literature identifies that the nature of care provision by nurses is largely dependant on nurses' experience with complex technologies. More specifically, nurses familiar with the technology integral to the care environment are more likely to 'engage' with the patient in their care. There is evidence that nurses do provide patient-centred care in a technologically dominant world. The nature of such care is invariably dependant on the specific context of the user and the technology. This means nurses require highly developed capabilities to 'situate' themselves within these specific contexts to focus on the particular needs of the patient. Experienced nurses are able to articulate and demonstrate opportunities whereby they situate themselves with patients to learn about them and their needs. It is important that this knowledge and practice pertinent to this domain is articulated to assist in the development of capabilities for nurses to 'care' for patients' direct or indirect expressed needs in a highly technological environment.

Nursing↗
PubMed2005

High and rising health care costs. Part 2: technologic innovation.

Technologic innovation, in combination with weak cost-containment measures, is a major factor in high and rising health care costs. Evidence suggests that improved health care technologies generally increase rather than reduce health care expenditures. Greater availability of such technologies as magnetic resonance imaging, computed tomography, coronary artery bypass graft, angioplasty, cardiac and neonatal intensive care units, positron emission tomography, and radiation oncology facilities is associated with greater per capita use and higher spending on these services. Because the spread of new technologies is relatively unrestrained in the United States, many of these technologies are used to a greater extent than in other nations, and the United States thereby incurs higher health care costs. Nations with a greater degree of health system integration have relied on expenditure controls and global budgets to control costs. Although diffusion of technology takes place more slowly in more tightly budgeted systems, the use of innovative technologies in those systems tends to catch up over time.

Budgets↗
PubMedDate not supplied

Health care technology. Evolution toward revolution.

The assessment process has a significant effect on the development and diffusion of any new technology. An assessment during the infancy of a new technology may have to be updated as more experience and data accumulate and change the analysis of the technology's safety and effectiveness. An outdated assessment can result in inappropriate utilization either by hindering diffusion of a valuable technology or by promoting utilization of an inappropriate technology. Those who conduct technology assessments must recognize that technologies have life cycles of their own.

Methods↗
PubMedDate not supplied

Technology framework. A system's five-phase approach integrates values with vision.

Healthcare providers must assess how a technology can benefit patients and how it relates to existing technology. They must also look at a new technology's expense, quality, efficacy, and appropriateness. In March 1990 Mercy Health Services (MHS), Farmington Hills, MI, developed a five-phase technology assessment approach to help each hospital division balance its resources with the needs of its community. A technology assessment approach should: Be apolitical, unbiased, and objective Examine the relationship between existing, new, and emerging technologies Balance the community's needs with the healthcare organization's resources The five phases of MHS's technology assessment approach are as follows: Baseline assessment Regional vision Coordination and implementation Measurement and analysis Report results

Catholicism↗
PubMed1988

Pros and cons of marketing technology.

For years, high technologies have provided hospitals with marketing advantages. Hospitals used them to recruit and keep physicians and to lure patients and purchasers. Having the latest technology in a given field provided hospitals with status and prestige and enabled smaller facilities to compete with major medical centers. From a marketing point of view, technologies can produce four distinct effects that benefit the hospital: halo, monopoly, opportunity, and momentum effects. The best technology, from a competitive marketing viewpoint, meets the following criteria: The hospital can operate it at acceptable and, hopefully, competitive quality levels. The hospital can offer it at acceptable and, hopefully, competitive cost. It is sufficiently accessible to patients who need it. It gives the hospital a distinct competence in its market that can be preserved for a long time. But technology can become a risky business if: The hospital cannot attract the volume of patients needed to maintain quality. The low-volume hospital prices itself out of the competitive market. The new technology has undisclosed or undiscovered side effects. The technology is recruited by a competitor. Hospitals place more value on it than do their customers.

Economic Competition↗
PubMed2000

The use of information technology in improving medical performance. Part I. Information systems for medical transactions.

Investment in medical information technologies reached $15 billion in 1996. However, these technologies have not had the wide impact predicted in streamlining bureaucracy, improving communications, and raising the effectiveness of care. In this series, we identify how such technologies are being used to improve quality and performance, the future directions for advancement, and the policy and research developments required to maximize public benefit from these technologies. Each of these articles focuses on a different type of information technology: (1) information systems to manage medical transactions; (2) physician-support technologies to improve medical practice; and (3) patient-focused technologies designed to change how people manage their own care. This first article of a 3-part series examines the successes of and opportunities for using advanced information systems that track and manage medical transactions for large populations to improve performance. Examples of such systems include: HEDIS, which gathers standardized data from health plans on quality of care; the USQA Health Services Research Program, which tracks treatment patterns and outcomes for 14 million insurance members; Ford's program to collect medical data for over 600,000 employees; and Harvard Pilgrim Health Care's system of computerized laboratory, pharmacy, ambulatory, and hospital admission records for its 1.5 million members. Data from these systems have led to modest improvements in knowledge and practice patterns for some diseases. Significant barriers are slowing efforts to add outcomes data to these databases and broaden the databases to cover larger populations. Nonetheless, existing data in currently evolving systems could be used to greater benefit in tracking public health and in identifying more effective treatments and causes of diseases.

Biomedical Technology↗
PubMed2003

Building support for health information technologies.

Despite the increasing role of information technology in health care, its use still lags behind that occurring in other sectors. Factors contributing to this include the complex health care environment and conflicting political agendas. Building political support for information technology in health care depends on understanding the importance of stakeholders and the environment in which they operate. It is important to involve stakeholders early in the process of implementing new information technology in order to identify needs, barriers, and non-starters. Understanding the historical experience of the community and its past attempts at using information technology is also important. Quality of care issues, nursing shortages, cost control concerns, health insurance costs and coverage rates, institutional solvency, and overwhelming paperwork are current problems in the healthcare environment that can hinder willingness to invest in information technology. Ironically, information technology can also help remedy these problems. Impact on workflow, privacy of personal health information, and system reliability, interoperability, and the ease of updating the system can all have political ramifications with regard to acceptance and implementation of information technology.

Medical Informatics↗
PubMed2005

Instructional technology adoption of medical faculty in teaching.

Despite large investment by higher education institutions in technology for faculty and student use, instructional technology is not being integrated into instructions in the higher education institutions, including medical education institutions. While diffusion of instructional technologies has been reached a saturation point with early adopters of technology, it has remained limited among mainstream faculty. This study explored technology adoption patterns and perceptions of medical faculty about barriers and incentives to technology adoption in teaching.Complete data was obtained from 155 participants by using survey methodology and analyzed on the basis of theories of diffusion of innovation.Findings provided evidence for limited adoption of relatively new tools associated with instruction into mainstream faculty. Inadequate hardware for students and faculty, lack of reward structure, insufficient traing oppurtunites were identified as major barriers to faculty technology adoption.

Education, Medical↗