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PubMedDate not supplied

Evaluation of costs and benefits of advances in cytologic technology. International Academy of Cytology Task Force summary. Diagnostic Cytology Towards the 21st Century: An International Expert Conference and Tutorial.

ISSUES: Uterine cervical cytology smears are among the most cost-effective cancer prevention interventions available, but they are not infallible, and new or modified technologies have been and will be proposed to improve diagnostic accuracy. Before these new technologies are accepted, their performance attributes will be carefully studied and defined. Equally important in this era of fiscal constraints are cost/benefit analyses, for which we review certain guidelines. CONSENSUS POSITION: In an effort to control rising costs in the health care sector, there has been a strong incentive to move toward a market system, and a variety of forces are acting to drive down expenditures. These same pressures will continue to be brought to bear on the providers of cervical cytology services. It must be emphasized that the technical knowledge required to define cost-effective medical practice lies within the medical profession itself, which must recognize the following: (a) Resources are finite; (b) Elimination of fraud, abuse and waste is not enough to bring health care expenditures down to levels considered acceptable to government and business; (c) The medical profession must take the responsibility to identify the health and economic consequences of the services it provides and make wise recommendations for allocation of resources to optimize health consequences. The analysis of costs and benefits must be viewed from a societal perspective and presented in terms of the marginal impact on current practice. This does not mean that new technologies must reduce cost; on the contrary, improvements in health can be expected to come at a price, but at a price commensurate with value gained in lives saved or in added quality adjusted life years. To be of value, a new technology for cervical cytology must be more effective in preventing cervical carcinoma. Dysplasia is considered a precursor of carcinoma, and detection of dysplasia has been a surrogate for prevention of cervical carcinoma, but dysplasia does not always lead to carcinoma, least of all mild dysplasia, and policy makers ultimately will insist that a favorable change in health outcome be effected by new technology before it is allocated resources. Alternatively, new technologies may lower cost, perhaps by modifying screening or rescreening procedures according to known risk; by improved cytopreparatory techniques that simplify, improve or speed screening; or by monitoring devices that minimize screening error. In each case the performance attributes of the instrument or human instrument process should be evaluated in the intended use environment. ONGOING ISSUES: While current cervical cytology methodology is one of the most effective means of cancer prevention, there continues to be development of new techniques to increase the sensitivity and specificity of this test. With present fiscal constraints, these will be subject to stringent cost/benefit analyses in which the medical profession must play a key role. Such analyses can be quite complicated, considering the additional costs or cost savings of clinical follow-up procedures and the reliability of dysplasias detected by cytology as a surrogate for cervical carcinoma in calculating quality of life years saved.

Attitude of Health Personnel↗
PubMedDate not supplied

Considerations in change management related to technology.

OBJECTIVE: The authors describe the complexity of social processes for implementing technological change. Once a new technology is available, information about its availability and benefits must be made available to the community of users, with opportunities to try the innovations and find them worthwhile, despite organizational resistances. METHOD: The authors reviewed the literature from psychiatry, psychology, sociology, business, and technology to distill common denominators for success and failure related to implementing technology. RESULTS: Beneficial technological innovations that are simple to use and obviously save everyone time and effort are easy to inaugurate. However, innovations that primarily serve management rather than subordinates or front-line utilizers may fail, despite considerable institutional effort. This article reviews and outlines several of the more prominent theoretical models governing successful institutional change. CONCLUSIONS: Successful implementation of difficult technological changes requires visionary leadership that has carefully considered the benefits, consulted with influence leaders at all organizational levels to spot unintended consequences and sources of resistance, and developed a detailed plan and continuous quality assurance process to foster implementation over time.

Diffusion of Innovation↗
PubMedDate not supplied

Assistive technology for postsecondary students with learning disabilities: an overview.

The number of postsecondary students with learning disabilities has increased dramatically over the last several years. This increase, coupled with federal legislation mandating "academic adjustments" for students with disabilities, has prompted the development of postsecondary learning disability support service programs. One support service that has begun to attract considerable attention is assistive technology. The purpose of this article is to provide an overview of assistive technology as it relates to postsecondary students with learning disabilities by (a) briefly tracing the development of assistive technology service for postsecondary students with learning disabilities; (b) identifying basic models of assistive technology service delivery and specific services; (c) providing a description of specific assistive technologies; (d) reviewing research on the effectiveness of assistive technology with postsecondary students with learning disabilities, with a focus on the authors' 3-year federally funded study; and (e) concluding with a summary and recommendations.

Adult↗
PubMed2005

Cell membrane array fabrication and assay technology.

BACKGROUND: Microarray technology has been used extensively over the past 10 years for assessing gene expression, and has facilitated precise genetic profiling of everything from tumors to small molecule drugs. By contrast, arraying cell membranes in a manner which preserves their ability to mediate biochemical processes has been considerably more difficult. RESULTS: In this article, we describe a novel technology for generating cell membrane microarrays for performing high throughput biology. Our robotically-arrayed supported membranes are physiologically fluid, a critical property which differentiates this technology from other previous membrane systems and makes it useful for studying cellular processes on an industrialized scale. Membrane array elements consist of a solid substrate, above which resides a fluid supported lipid bilayer containing biologically-active molecules of interest. Incorporation of transmembrane proteins into the arrayed membranes enables the study of ligand/receptor binding, as well as interactions with live intact cells. The fluidity of these molecules in the planar lipid bilayer facilitates dimerization and other higher order interactions necessary for biological signaling events. In order to demonstrate the utility of our fluid membrane array technology to ligand/receptor studies, we investigated the multivalent binding of the cholera toxin B-subunit (CTB) to the membrane ganglioside GM1. We have also displayed a number of bona fide drug targets, including bacterial endotoxin (also referred to as lipopolysaccharide (LPS)) and membrane proteins important in T cell activation. CONCLUSION: We have demonstrated the applicability of our fluid cell membrane array technology to both academic research applications and industrial drug discovery. Our technology facilitates the study of ligand/receptor interactions and cell-cell signaling, providing rich qualitative and quantitative information.

Animals↗
PubMed1985

Medicare coverage, Medicare costs, and medical technology.

One possible approach to containing Medicare costs involves explicit changes in Medicare's coverage policy with respect to medical technology. This paper first describes the development and diffusion of medical technology in general and then describes how technologies are identified, assessed, and approved for payment by Medicare. Currently, cost is neither a criterion nor an explicit issue in coverage decisions, although coverage policy is an integral part of payment policy. A combination of policies to reduce the rates of adoption and use of certain technologies is needed--including cost considerations in technology assessments for coverage decisions, limiting diffusion of technology to certain providers and sites, limiting utilization to certain indications, and tightening administrative processes. Finally, the interaction between coverage policy and DRG payment needs to be explored more thoroughly.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1995

State involvement in medical technology assessment.

State governments are reevaluating their role in the assessment of medical technologies. This paper outlines a range of state technology assessment activities, highlighting programs in Minnesota, Oregon, and Washington, and discusses the issues associated with state government involvement. Clinically oriented activities on the state level can inform efforts to contain costs, educate consumers and providers, and facilitate local consensus on the appropriate uses of new and existing technologies. Although current programs are still in their infancy and their viability remains uncertain, the importance of technology assessment is growing as technology continues to fuel increasing costs. The future of state-level technology assessment may lie in collaborative ventures with other states, the federal government, or private industry.

State Government↗
PubMed1995

Access to hospitals with high-technology cardiac services: how is race important?

OBJECTIVES: Relatively few hospitals in the United States offer high-technology cardiac services (cardiac catheterization, bypass surgery, or angioplasty). This study examined the association between race and admission to a hospital offering those services. METHODS: Records of 11,410 patients admitted with acute myocardial infarction to hospitals in New York State in 1986 were analyzed. RESULTS: Approximately one third of both White and Black patients presented to hospitals offering high-technology cardiac services. However, in a multivariate model adjusting for home-to-hospital distance, the White-to-Black odds ratio for likelihood of presentation to such a hospital was 1.68 (95% confidence interval = 1.42, 1.98). This discrepancy between the observed and "distance-adjusted" probabilities reflected three phenomena: (1) patients presented to nearby hospitals; (2) Blacks were more likely to live near high-technology hospitals; and (3) there were racial differences in travel patterns. For example, when the nearest hospitals did not include a high-technology hospital, Whites were more likely than Blacks to travel beyond those nearest hospitals to a high-technology hospital. CONCLUSIONS: Whites and Blacks present equally to hospitals offering high-technology cardiac services at the time of acute myocardial infarction. However, there are important underlying racial differences in geographic proximity and tendencies to travel to those hospitals.

Adult↗
PubMed2007

Effects of technological interventions on the safety of a medication-use system.

PURPOSE: A study was conducted to assess the effects and outcomes of implementing new technology into the medication-use process. METHODS: A pharmacy computer system, automated dispensing cabinets, and point-of-care products were implemented. The hypotheses of the study were that system errors in each phase of the medication-use process would decrease with the implementation of each technological application and that workload measures, such as staffing and inventory levels, would increase. Using a scripted questionnaire, interviews of participating staff (registered nurses, licensed practical nurses, nursing-unit clerks, pharmacists, pharmacy technicians, physicians, and physician assistants) were conducted to determine their impressions of the safety of the medication-use system before and after the implementation of technology. All hospitalwide errors were reported monthly between November 2002 and July 2005 by the number of errors per 1000 patient days and were categorized by error type. The accuracy of the medication administration record was examined; the pharmacy dispensing process was evaluated for accuracy, timeliness, and system changes; the accuracy of medication administration was observed; and staffing changes were also evaluated. RESULTS: Because of the technology implementation, the accuracy of patient identification was introduced, process changes and technological design identified potential failure modes in the medication administration process, inventory increased, turn-around time to process medication doses in the pharmacy decreased, accuracy of medication administration increased, and the staffing of nurses and pharmacists increased. CONCLUSION: Implementation of new technology into the medication management system standardized the medication administration processes, decreased turnaround time for processing medication orders, and increased accuracy of medication administration to patients.

Diffusion of Innovation↗
PubMed2000

Managing medical technology: lessons for the United States from Quebec and France.

Important modifications to technology assessment, diffusion, adoption, and utilization must take place if the United States is to better employ medical technology and save resources so as to assure access for the uninsured and underinsured. The United States can learn from other health systems that are more successful in achieving these goals. The author selects for comparison the health systems of France and Quebec. The discussion focuses on the differences between the three systems in the management of medical technology on a range of policy-relevant dimensions, including health system structure, attitudes about planning versus market competition, government regulation, the balance between decentralization and centralization, the needs of the individual and those of the society, linkages between technology assessment and policy-making, and the importance of medical technology assessment for medical practice. Seven specific recommendations are made for better managing medical technology in the United States, drawing on what can be observed from the experiences of Quebec and France.

Diffusion of Innovation↗
PubMed2026

Development of a Blockchain-Based Platform to Enable Indigenous Data Sovereignty and Shared Research Participation With Indigenous Communities: Technology Prototyping and Community Engagement Study.

BACKGROUND: Historic and ongoing problematic practices regarding the collection, storage, and use of Indigenous health data have led to the need to ensure principles of Indigenous Data Sovereignty (IDS) are followed in research practices and technology development. OBJECTIVE: This project, a partnership between UC San Diego and the Native BioData Consortium (NativeBio), sought to explore the practical application of blockchain technology and its potential to facilitate Indigenous-led research collaboration. METHODS: This project first undertook purposeful relationship building with NativeBio to form a Community Advisory Board (CAB) for identifying community and technology needs for a blockchain research collaboration platform with an initial focus on genomic data. Over a 2-year project period, a series of public meetings and presentations at Indigenous-led conferences introduced the concept of exploring compatibility between blockchain and IDS principles, followed by iterative prototyping and co-design of a blockchain platform with NativeBio, using Ethereum as the underlying protocol. RESULTS: Direct engagement with NativeBio and the CAB informed the initial design and development of a "b-IDS" proof-of-concept (POC) blockchain platform. The POC consists of three main components: (1) the web front-end layer, (2) the Ethereum network that executes the smart contract and blockchain storage aspects of the framework, and (3) the back-end database that stores off-chain interactions and data for future use with external genomic data repositories. After refinement of the POC, a community-based participatory research (CBPR) use case aligned with IDS principles was identified as a practical workflow and incorporated into the design of the POC for implementation. CONCLUSIONS: The findings from this project demonstrated the potential use of operationalizing IDS through blockchain technology with proactive and sustained engagement with Indigenous partners. Blockchain technology may have certain advantages over other data governance approaches and systems, facilitating timely oversight, shared decision-making and consent structures, and direct involvement of Indigenous communities in technology design, respecting the core principles of IDS and CBPR. Future development of the blockchain-IDS POC will need to incorporate other research practices and ethics frameworks to expand its use to other public health and biomedical research use cases.

Blockchain↗
PubMed1987

Health technology assessment: problems and challenges.

From a national perspective, the central prerequisite of the proper application of medical technology is the timely determination of efficacy, cost, safety, and societal impact. This applies to both the introduction of the new methods and the retirement of older methods that may have outlived their usefulness. Within that framework, the rapid diffusion of innovative methods of great value must be balanced against the cost of premature enthusiasm for techniques with little or no incremental diagnostic or therapeutic gain. A nongovernmental Council on Health Care Technology Assessment of the Institute of Medicine-National Academy of Sciences was established by the Congress in 1986. The Council was charged to serve as an information clearing-house, a center to promote research and education, and a stimulus to establish better methods of assessment and more prompt identification of potentially important technologies. It represents virtually all of the constituencies concerned with adequate evaluation of new and existing methods. The Council confronts the critical problems of timing, bias, the quality of primary data collection, new methods of secondary data analysis, the nature of the "laboratory" in which technology assessment is best accomplished, the "exploitative" character of technology assessment research, appropriate diffusion, and ethnical issues. The appropriate use of technology in modern health care depends on the resolution of these issues.

Organizations↗
PubMed1995

Consumer concerns about modern technology in agriculture: considerations for undergraduate and graduate teaching.

A number of events over the last several decades have sensitized society to the possible negative impacts of technology. The majority of our population is one or more generations removed from direct experience on farms and ranches. Thus, few individuals are aware of the dramatic changes that have occurred in agriculture. Since the establishment of the land-grant university system, agriculture in the United States has changed from a system employing 10 million farmers and farm workers each feeding five people to a system in which 2.1 million farmers feed more than 100 people each and support exports of more than $35 billion annually. There are perceptions, as well as survey data, indicating society is concerned about the use and impacts of technology in the food and agriculture system. Survey data indicate 87% of people disagreed that "economic growth is more important than environmental protection." In addition, the survey data indicate society is concerned about how technology is used and who decides which applications are to be pursued. More than 8 out of 10 people (85%) surveyed believed "citizens deserve a greater role in decisions about science and technology." There seems to be concern regarding the use of technology and resultant impacts on the environment, food safety, animal well-being, and the size and numbers of farms in the United States. Education, both formal and informal, is the key to helping the public make informed decisions regarding the role of science and technology in the food and agriculture system. The colleges of agriculture need to carefully evaluate their research, teaching, and extension portfolios to "rediscover" their mission.(ABSTRACT TRUNCATED AT 250 WORDS)

Agriculture↗
PubMed1997

Evaluation of electronic technology to assess lamb carcass composition.

Accurate price signals are essential for producers of American lamb to ensure production of uniformly lean animals. Development of carcass merit-pricing systems will require the use of objective technology for assessing carcass composition or lean distribution. The objective of this study was to evaluate electronic technologies for accurate determination of lamb carcass composition. Lambs (n = 106) were selected as a representation of U.S. market lambs that transcended geographic location, sex, breed, carcass weight, yield grade, and production system. The independent variables used to predict lamb composition varied with the technology. The electronic technologies tested included realtime ultrasound, optical reflectance probe, bioelectrical impedance analysis, and electromagnetic scanning (TOBEC). All technologies, except realtime ultrasound, were tested on warm (prerigor) carcasses and repeated after a 24-h chill. Longitudinal ultrasonic scans of fat and muscle tissue depth and grading probe fat depths were marginal predictors of proportional carcass yield. The TOBEC measurements often accounted for more variability associated with kilograms of dissected lean and percentage of carcass lean than did carcass weight. Equations from TOBEC measurements were the most accurate predictors of weight and percentage of dissected and fat-free lean. Bioelectrical impedance measurements of resistance and reactance combined with carcass weight were also good predictors of carcass composition. Prediction of carcass lean distribution by measures of TOBEC were the most accurate for prediction of leg lean. The implications of usefulness of these technologies will depend on the commitment of the U. S. sheep industry in development of a lamb price discovery system based on carcass composition.

Animals↗
PubMedDate not supplied

Health activities of the U.S. Office of Technology Assessment.

The Office of Technology Assessment (OTA) was formed as part of the US Congress of 1972. The 'Health Program' was established in 1975. The purpose of the OTA is to advise Congress on the positive and negative implications of technological change. Since its beginning, the Health Program has spent most of its effort in describing technology assessment in health care and federal policies toward such assessment. A number of specific medical technologies have also been evaluated. Reports on health-care topics by the OTA have had some specific effects in Congress, but the more important impact is probably on the broader climate of opinion concerning medical technology and its benefits, risks, and costs. Technology assessment has become an established part of the Congressional decision-making process and is being used increasingly in countries other than the United States.

Government Agencies↗
PubMed2005

Potential use of routine databases in health technology assessment.

OBJECTIVES: To develop criteria for classifying databases in relation to their potential use in health technology (HT) assessment and to apply them to a list of databases of relevance in the UK. To explore the extent to which prioritized databases could pick up those HTs being assessed by the National Coordinating Centre for Health Technology Assessment (NCCHTA) and the extent to which these databases have been used in HT assessment. To explore the validation of the databases and their cost. DATA SOURCES: Electronic databases. Key literature sources. Experienced users of routine databases. REVIEW METHODS: A 'first principles' examination of the data necessary for each type of HT assessment was carried out, supplemented by literature searches and a historical review. The principal investigators applied the criteria to the databases. Comments of the 'keepers' of the prioritized databases were incorporated. Details of 161 topics funded by the NHS R&D Health Technology Assessment (HTA) programme were reviewed iteratively by the principal investigators. Uses of databases in HTAs were identified by literature searches, which included the title of each prioritized database as a keyword. Annual reports of databases were examined and 'keepers' queried. The validity of each database was assessed using criteria based on a literature search and involvement by the authors in a national academic network. The costs of databases were established from annual reports, enquiries to 'keepers' of databases and 'guesstimates' based on cost per record. For assessing effectiveness, equity and diffusion, routine databases were classified into three broad groups: (1) group I databases, identifying both HTs and health states, (2) group II databases, identifying the HTs, but not a health state, and (3) group III databases, identifying health states, but not an HT. Group I datasets were disaggregated into clinical registries, clinical administrative databases and population-oriented databases. Group III were disaggregated into adverse event reporting, confidential enquiries, disease-only registers and health surveys. RESULTS: Databases in group I can be used not only to assess effectiveness but also to assess diffusion and equity. Databases in group II can only assess diffusion. Group III has restricted scope for assessing HTs, except for analysis of adverse events. For use in costing, databases need to include unit costs or prices. Some databases included unit cost as well as a specific HT. A list of around 270 databases was identified at the level of UK, England and Wales or England (over 1000 including Scotland, Wales and Northern Ireland). Allocation of these to the above groups identified around 60 databases with some potential for HT assessment, roughly half to group I. Eighteen clinical registers were identified as having the greatest potential although the clinical administrative datasets had potential mainly owing to their inclusion of a wide range of technologies. Only two databases were identified that could directly be used in costing. The review of the potential capture of HTs prioritized by the UK's NHS R&D HTA programme showed that only 10% would be captured in these databases, mainly drugs prescribed in primary care. The review of the use of routine databases in any form of HT assessment indicated that clinical registers were mainly used for national comparative audit. Some databases have only been used in annual reports, usually time trend analysis. A few peer-reviewed papers used a clinical register to assess the effectiveness of a technology. Accessibility is suggested as a barrier to using most databases. Clinical administrative databases (group Ib) have mainly been used to build population needs indices and performance indicators. A review of the validity of used databases showed that although internal consistency checks were common, relatively few had any form of external audit. Some comparative audit databases have data scrutinised by participating units. Issues around coverage and coding have, in general, received little attention. NHS funding of databases has been mainly for 'Central Returns' for management purposes, which excludes those databases with the greatest potential for HT assessment. Funding for databases was various, but some are unfunded, relying on goodwill. The estimated total cost of databases in group I plus selected databases from groups II and III has been estimated at pound 50 million or around 0.1% of annual NHS spend. A few databases with limited potential for HT assessment account for the bulk of spending. CONCLUSIONS: Suggestions for policy include clarification of responsibility for the strategic development of databases, improved resourcing, and issues around coding, confidentiality, ownership and access, maintenance of clinical support, optimal use of information technology, filling gaps and remedying deficiencies. Recommendations for researchers include closer policy links between routine data and R&D, and selective investment in the more promising databases. Recommended research topics include optimal capture and coding of the range of HTs, international comparisons of the role, funding and use of routine data in healthcare systems and use of routine database in trials and in modelling. Independent evaluations are recommended for information strategies (such as those around the National Service Frameworks and various collaborations) and for electronic patient and health records.

Biomedical Technology↗
PubMed1999

Technology-based nursing education: overview and call for further dialogue.

With the rapid growth of technology has come increasing reliance among health science disciplines to integrate technology into many courses. It is apparent that this reliance on technology in nursing education is increasing rapidly regardless of any guiding philosophy of education or pedagogy. The two-fold purpose of this article is to review the development of technology-based nursing education and to identify areas requiring further dialogue among nurse educators. It is becoming clear that nurse educators need to analyze values, communication, and social processes when deciding, judging, and assessing technological use within curricula. Nurse educators need to reflect on the tidal wave of change brought by technology and begin an earnest dialogue regarding its impact on the discipline.

Communication↗
PubMed1998

Health care technology in public health institutions in Kenya.

OBJECTIVE: To highlight the role of technology in the practice of medicine and the delivery of health care in public hospitals, the problems encountered and suggested solutions. DESIGN: The article reviews the process of technology planning, acquisition, management and assessment. Analysis of results and observations leads to recommendation and suggestions. SETTING: Health care technology assessment in hospitals in Kenya and South Africa 1998. INSTITUTIONS: Twenty four hospitals in Kenya and 54 hospitals in South Africa. RESULTS: Technology assessment as a health policy instrument and planning tool has not gained recognition in Kenya; acquisition of health care equipment is not done on the basis of evidence from relative advantage outcome, cost of ownership or returns on investment; tender boards lack the technical expertise to make clinical and technical evaluations of health care equipment and; health care is compromised due to poor equipment acquisition. CONCLUSION: The planning, deployment, management and assessment of technology should be fully integrated into health policy and planning. Policy guidelines should include the regulation, control and utilisation of health care technologies.

Delivery of Health Care↗
PubMed1992

Estimating the effect of new technology on Medicare Part B expenditure and volume growth: do related procedures matter?

The new Medicare Part B physician reimbursement system requires the Health Care Financing Administration to consider how medical technology contributes to growth in service volume. One estimate of this effect has been made by the Physician Payment Review Commission (PPRC), which estimated how individual new technologies have influenced volume growth. This paper extends the PPRC analysis to include both new technology services and those services that are complementary, or related to, the new technology services. The results show that adjusting for related procedures can increase the estimated cost of new technology by as much as 50 percent. In addition, related procedures can increase the estimated share of volume growth attributable to new technology by as much as 42 percent. This implies that both new and related procedures should be used when implementing physician payment reforms.

Diagnostic Imaging↗