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PubMed2004

Designing your office for technology.

BACKGROUND: To practice efficiently, dentists need to consider the successful integration of technologies, which can benefit their practice of dentistry. The physical environment of the office must be developed to accommodate not only the appropriate placement of computer hardware and high-tech dental devices, but their interconnectivity, as well. CONCLUSION: Dentists need to make appropriate decisions regarding the types of technology they choose to integrate into their offices, and they need to understand how the technology will be installed and integrated. An office designed to optimize the use of technology will produce ongoing benefits for dentists, their staff members and their patients throughout the lives of their practices. PRACTICE IMPLICATIONS: A dentist's practice must be planned to accommodate networks of systems hidden below floors, above ceilings and within walls, as well as to support and connect diverse technology items throughout the office.

Computer Systems↗

PubMed2004

Putting technology in place successfully.

BACKGROUND: This article discusses how to integrate clinical and administrative workstations into your dental practice from the planning phase to the implementation phase. The author discusses the costs that are associated with integrating technology, as well as the hardware components and configuration. He then discusses in greater detail the core clinical technologies and how they tie in together to facilitate building a cohesive digital patient record. CONCLUSIONS: There are no shortcuts to successfully integrating technology into a dental practice. A significant commitment of time, energy and money is a prerequisite to building a secure and reliable computer network that incorporates all clinical and administrative applications. PRACTICE IMPLICATIONS: Technology is reinventing the world, and dentists need to keep pace with the people they serve. These new and not-so-new technologies will enhance dental services and productivity, which ultimately will raise the bar for the standard of care in dentistry.

Computer Systems↗

PubMed1986

Medical technology and developing countries: the case of Brazil.

Developing countries, faced with severe resource limitations, are trying to develop modern health care services that deliver sensible medical technologies. Because of their lack of development, these countries must import much technology, while often lacking the expertise to make wise choices. In this article, the case of Brazil is examined. Brazil has shared many of the problems of other developing countries, including inadequate access of the population to health services, maldistribution and excessive use of technology, a relatively weak national industry for production of drugs and medical devices, a weak policy structure for dealing with medical technology, and little tradition of using research or policy analysis as a guide to action. Since the election in 1985 that returned Brazil to democratic rule, the government has taken active steps to address many of these problems. The example of Brazil is important for all of the developing world to examine and follow, where applicable. In addition, North American and European aid programs could play a much more constructive role in helping less developed countries develop their health care services. International organizations such as the World Health Organization must also be active in assisting such countries to improve their decisions concerning medical technology.

Brazil↗

PubMed1998

Comprehensive, technology-based clinical education: the "virtual practicum".

This article discusses the application of technology to promote more comprehensive clinical education in the biopsychosocial aspects of primary care. Comprehensive refers to the inclusion, in addition to scientific and technical knowledge, of knowledge that is less easily characterized, quantified, and taught: empathy, intuition, the demonstration of artistry. Clinical education will be increasingly facilitated by the proliferation of computers capable of displaying combinations of text, graphics, video, and sound; broadband networks capable of delivering these multiple media to the home or office; and new methods for using these technologies for education and training. However, current models for technology-based learning are limiting, lagging behind the rapid technological evolution driving our entry into the Information Age. Some recent educational models (Schon's reflection-in-action and reflective practicums [1], Boisot's E-space [2], Kolb's learning cycle [3]) provide for a more comprehensive and complete view of health professional education. This article describes these models in depth and proposes a new model for technology-based clinical training, the "Virtual Practicum," based on them. The Virtual Practicum is illustrated with a new interactive CD-ROM program, dealing with primary care of patients with HIV/AIDS. The concepts presented here are generally useful in thinking about clinical education, regardless of the means used.

CD-ROM↗

PubMed2026

The Impact of Chatbot Type and Normative Messaging on Chatbot Usage Intention Based on the Health Technology Acceptance Model: Randomized Controlled Trial.

BACKGROUND: Digital health tools, such as health chatbots, may improve access to scalable health support, but adoption remains inconsistent. Existing models do not fully integrate technology acceptance factors with health motivation factors relevant to digital health use. OBJECTIVE: This study proposed and tested the health technology acceptance model and examined whether normative message framing and chatbot type were associated with health motivation, technology acceptance, and intention to use a health chatbot. METHODS: In October 2025, we conducted a 4 × 2 between-participants online experiment with 1000 US adults recruited from a nationally representative YouGov panel. Participants were randomized to 1 of 8 conditions varying norm message type (self-oriented, peer-oriented, expert-oriented, or family-oriented) and chatbot type (AI-powered or rule-based) in a cancer prevention and genetic risk information scenario. Outcomes included descriptive norms, injunctive norms, perceived susceptibility, perceived severity, perceived benefits, self-efficacy, perceived ease of use, trust, privacy concerns, and usage intention. Data were analyzed using a multivariate ANOVA with Bonferroni-adjusted post hoc tests and multiple linear regression. RESULTS: Peer-oriented and family-oriented messages produced higher usage intention than expert-oriented messages, and peer-oriented messages also increased descriptive norms, injunctive norms, self-efficacy, and trust. AI-powered chatbots were associated with higher usage intention (P=.02) and greater trust (P=.008) than rule-based chatbots. In regression analyses, the model explained 50.8% of the variance in usage intention. Usage intention was positively associated with descriptive norms (β=0.087; P=.003), injunctive norms (β=0.078; P=.009), perceived susceptibility (β=0.051; P=.03), perceived benefits (β=0.253; P<.001), and trust (β=0.33; P<.001), and negatively associated with perceived severity (β=-0.047; P=.049) and privacy concerns (β=-0.11; P<.001). Perceived ease of use and self-efficacy were not significant predictors. CONCLUSIONS: The health technology acceptance model was a useful framework for explaining the intention to use a health chatbot by combining technology acceptance and health motivation constructs. Both social design features and chatbot design features shaped adoption-related beliefs, with peer-oriented and family-oriented framing and AI-powered chatbots showing particular promise. Trust and privacy concerns remained central determinants of intended use.

Humans↗

PubMed1981

Engineering design and appropriate technology.

A new type of engineering degree course, entitled Engineering Design and Appropriate Technology (EDAT), at the University of Warwick, is described. After explaining the term 'appropriate technology' and its relationship to 'alternative and intermediate technology', the need for a new approach to teaching engineering design is developed. The reasons why present engineering undergraduates receive an education ill-suited to work in appropriate technology are examined. Implicit assumptions underlying all the teaching are claimed to produce graduates unfitted for work in many important fields, such as small firms, job creation, and overseas development. A new set of assumptions to underlie the teaching of appropriate technology are put forward and the resulting implications for the engineering design curriculum are examined. The development of the EDAT course is then described, and finally the course structure and teaching methods are outlined.

Education↗

PubMed2003

Can randomised trials rely on existing electronic data? A feasibility study to explore the value of routine data in health technology assessment.

OBJECTIVES: To estimate the feasibility, utility and resource implications of electronically captured routine data for health technology assessment by randomised controlled trials (RCTs), and to recommend how routinely collected data could be made more effective for this purpose. DATA SOURCES: Four health technology assessments that involved patients under care at five district general hospitals in the UK using four conditions from distinct classical specialties: inflammatory bowel disease, obstructive sleep apnoea, female urinary incontinence, and total knee replacement. Patient-identifiable, electronically stored routine data were sought from the administration and clinical database to provide the routine data. REVIEW METHODS: Four RCTs were replicated using routine data in place of the data already collected for the specific purpose of the assessments. This was done by modelling the research process from conception to final writing up and substituting routine for designed data activities at appropriate points. This allowed a direct comparison to be made of the costs and outcomes of the two approaches to health technology assessment. The trial designs were a two-centre randomised trial of outpatient follow-up; a single-centre randomised trial of two investigation techniques; a three-centre randomised trial of two surgical operations; and a single-centre randomised trial of perioperative anaesthetic intervention. RESULTS: Generally two-thirds of the research questions posed by health technology assessment through RCTs could be answered using routinely collected data. Where these questions required analysis of NHS resource use, data could usually be identified. Clinical effectiveness could also be judged, using proxy measures for quality of life, provided clinical symptoms and signs were collected in sufficient detail. Patient and professional preferences could not be identified from routine data but could be collected routinely by adapting existing instruments. Routine data were found potentially to be cheaper to extract and analyse than designed data, and they also facilitate recruitment as well as have the potential to identify patient outcomes captured in remote systems that may be missed in designed data collection. The study confirmed previous evidence that the validity of routinely collected data is suspect, particularly in systems that are not under clinical and professional control. Potential difficulties were also found in identifying, accessing and extracting data, as well as in the lack of uniformity in data structures, coding systems and definitions. CONCLUSIONS: Routine data have the potential to support health technology assessment by RCTs. The cost of data collection and analysis is likely to fall, although further work is required to improve the validity of routine data, particularly in central returns. Better knowledge of the capability of local systems and access to the data held on them is also essential. Routinely captured clinical data have real potential to measure patient outcomes, particularly if the detail and precision of the data could be improved.

Arthroplasty, Replacement, Knee↗

PubMed2005

Using simulation technology for undergraduate nursing education.

As simulation technology is rapidly expanding, nursing programs are making large investments in this technology, which has great potential for undergraduate nursing programs. Unfortunately, this potential is underestimated and underused. With simulation technology, undergraduate students can gain and improve skills in a safe, non-threatening, experiential environment that also provides opportunities for decision making, critical thinking, and team building. This article describes how to use simulation technology to enhance undergraduate nursing education. The process for simulation technology instruction, leveling content from simple to complex, and faculty resources are discussed. An example of a simulation program is included.

Attitude of Health Personnel↗

PubMed1990

Impact of technology in health care and health administration: hospitals and alternative care delivery systems.

Applications as outlined above and many more that have not yet even been identified--but that will be invented and developed--will have an enormous impact on the health care industry. Clearly, capital requirements to purchase this technology will go up and thus exert further pressure for the reduction of personnel. Computers and robots will replace a significant percentage of health care personnel; overall health care costs as a percent of gross national product will nevertheless probably continue to rise in spite of improvements in productivity. Added costs will be offset in part by the use of technology in areas that will impact efficiency. Because of these accelerating uses of sophisticated technology, future administrators will have a greater appreciation for what technology can offer. Practical uses of robotics, expert systems, and artificial intelligence will require administrators to be technologically proficient.

Delivery of Health Care↗

PubMed1992

Technology: life's salvation or costly sin?

Technology assessment will be the methodology of choice; it will provide the information necessary to make tough investment decisions. It will be a vital tool when analyzing healthcare investments. Technology assessment is probably one of the planks in the process of ensuring better outcomes research, which can be applied after having selected and used the technology. Even if you find technology assessment tougher to learn and more complicated than product evaluation, hopefully you'll recognize its inevitability and be on the cutting edge to adopt it. Make your research go beyond a comparison of acquisition cost and usage. Look at technology assessment as a deterrent to the accelerating cost of operating a hospital--as an investment in more cost-effective health care.

Evaluation Studies as Topic↗

PubMed1992

Forecasting the adoption of new medical technology using the Bass model.

A mathematical model, the Bass model, was used to forecast the adoption of new medical technology based on durable equipment. When the model was applied to five successful medical technologies, actual unit sales were predicted for three. The technologies investigated are computed tomography (CT scan), magnetic resonance imaging (MRI), ultrasound, hemodialysis, and lithotripsy. Because unit sales data for dialysis and ultrasound could not be obtained or estimated from secondary sources for the years immediately after market entry, application of the Bass model produced questionable results for those technologies. However, results for CT scan, MRI, and lithotripsy suggest that this model can be used to predict the adoption of new medical technology based on durable equipment when annual unit sales data can be estimated for the period immediately after market entry.

Data Collection↗

PubMedDate not supplied

Medical technology meets managed competition.

Medical technology is an integral part of health care, not an expensive add-on or afterthought. Therefore, technology policy must be consistent with the approach to health care reform. Our present market has failed to generate adequate information on new technologies and perverse economic incentives have led to overutilization. In managed competition, health plans, not government, are best suited to make most technology decisions. The federal government can provide a safety valve for specific coverage decisions and can facilitate the acquisition, evaluation, and dissemination of information on new technologies.

Community Participation↗

PubMedDate not supplied

Technology assessment and coverage decision making.

In the health care decision-making cascade, technology assessment renders the initial evaluative judgement about the contribution of a technology to patient care. As such, it has a major impact on coverage policy, clinical guidelines and utilization management. This impact necessitates that technology assessment have a scientific, defensible process. There are four basic components of a scientific, defensible process for both clinical and coverage decision making. These are: 1. Outcomes data that are derived preferably from controlled clinical trials and that support the safety and effectiveness of a specific indication 2. Evidence of acceptance by the practicing medical community of specific applications of a technology 3. A rigorous, evaluative process that synthesizes and analyzes outcomes data and expert opinion 4. Consistency in the use of terminology, as it is translated from the technology assessment process to coverage policy The process must be designed to assure scientific and methodological defensibility. Also, it must be designed to facilitate and substantiate the medical and coverage decision-making processes. Finally, it must be designed to enable and expedite the implementation of the managed care philosophy (i.e., outcomes-based decision making) within a particular health plan.

Cost-Benefit Analysis↗

PubMed1996

Modern health care depends on technology, Part 2.

The first article in this series presented the principles and vocabulary of technology assessment and described the process used at St. Luke's, a tertiary care hospital in Bethlehem, Pennsylvania. This second article will describe the resources needed to support a technology assessment program. Technology planning, acquisition, and management will also be discussed. Historically, the health care marketplace has welcomed new technologies. In a future in which providers will be accountable for the outcomes of the care they provide, the ability to evaluate new and existing technologies will be essential for success.

Databases, Factual↗

PubMed1998

Role of technology assessment in health benefits coverage for medical devices.

With the profusion of new medical technology, managed care organizations are faced with the challenge of determining which medical devices and services warrant health benefits coverage. To aid in this decision-making process, managed care companies turn to technology assessment, a process that differs from the Food and Drug Administration's review of medical devices. Health plans typically use a structured approach to implementing coverage requirements in employer group benefits contracts and use technology assessment to evaluate the scientific evidence of effectiveness to support coverage decisions. Also important is the societal context for decisions regarding coverage for new technologies and the options being considered by policy makers for accountability in technology assessment by private insurers and health plans.

Cost-Benefit Analysis↗

PubMed1986

Technology as an occasion for structuring: evidence from observations of CT scanners and the social order of radiology departments.

New medical imaging devices, such as the CT scanner, have begun to challenge traditional role relations among radiologists and radiological technologists. Under some conditions, these technologies may actually alter the organizational and occupational structure of radiological work. However, current theories of technology and organizational form are insensitive to the potential number of structural variations implicit in role-based change. This paper expands recent sociological thought on the link between institution and action to outline a theory of how technology might occasion different organizational structures by altering institutionalized roles and patterns of interaction. In so doing, technology is treated as a social rather than a physical object, and structure is conceptualized as a process rather than an entity. The implications of the theory are illustrated by showing how identical CT scanners occasioned similar structuring processes in two radiology departments and yet led to divergent forms of organization. The data suggest that to understand how technologies alter organizational structures researchers may need to integrate the study of social action and the study of social form.

Communication↗

PubMed1984

The process of evaluating medical technologies for third-party coverage.

A detailed review of records and documentation considered more than 100 technology evaluations performed in conjunction with coverage decisions by the Medicare program and by a major Blue Cross/blue Shield plan. Medicare evaluations were highly structured, synthesizing thorough literature reviews, recommendations from the National Institutes of Health and other governmental agencies, and information solicited from medical specialty societies and independent practitioners; however, the material supplied by nongovernmental sources seldom influenced the coverage recommendations. In contrast, the Blue plan's evaluations were based largely on presentations and discussions at advisory committee meetings, after receiving informational inputs that were more limited than those used in Medicare evaluations. The fraction of technologies recommended for coverage was slightly over 50% for each carrier. If information was strongly positive about either a technology's safety, its effectiveness, or both, then coverage was nearly always recommended. Still, the carriers differed significantly in the stage of development of the practices evaluated and in their willingness to make a coverage decision in the face of both safety and effectiveness data that were regarded as tentative. Because coverage decisions, and the speed with which they are conducted, may be crucial to the rate of a technology's diffusion--and possibly even to the rate of innovation--the authors conclude that it is important to understand clearly the process by which this type of technology assessment is performed.

Blue Cross Blue Shield Insurance Plans↗

PubMed1985

Program planning in the Office of Technology Assessment's Health Program.

This paper describes the Congressional Office of Technology Assessment's Health Program and the role that its process of program planning has played in the selection of studies and the allocation of Program resources. It discusses the primary areas in which studies have been conducted--assessment methods, specific technologies, environmental health, information technologies, and financing/structural aspects of health care--and examines the changes in relative emphasis placed on the areas over time and the factors that lead to changed emphasis. Internal factors--e.g., judgments of whether a topic is of national importance, fiscal and staff resources available, and whether the issue is appropriate for OTA--and thus program planning have played their strongest role in the areas of assessment methods and of specific technologies. Activities in the financing/structural areas and some types of studies in the environmental health areas are being driven more by external factors--e.g., expressed needs of Congress, availability of data, and developments in science and technology.

Government Agencies↗