MEDICALTECHNOLOGY INCLUDES THREE ELEMENTS

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Chapter 5
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MEDICALTECHNOLOGY INCLUDES THREE ELEMENTS

• 1. Application of biomedical discoveries to
  provide more effective medical care
• 2. Adaptation of discoveries in other scientific
  fields (physics, chemistry, engineering, computer
  science) to the delivery of medical care
• 3. Application of technologies to improve the
  structural elements of healthcare delivery
• Information systems
• Facilities and settings
• Organizational arrangements

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INFORMATION TECHNOLOGY

• Considered medical technology when it is used to
  support healthcare delivery functions
• Application of computer technology in
  organizations fall
• in four main areas
• 1. Clinical information systems, for example,
  electronic
• patient charts
• 2. Administrative information systems, for
  example,
• financial management systems
• 3. Decision support systems, for example,
  analytical
• tools for advanced decision making
• 4. The Internetboth physicians and patients are
• increasingly relying on the Internet for clinical
  information.

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INFORMATION TECHNOLOGY

• Benefits
• Increased patient empowerment as patients
  become more actively involved in their own health
  care
• Better efficiency in medical practice by using
  the
• Web to register patients, transmit medical
  results,
• and order pharmaceuticals and other products
• access patient information from physicians homes
• or hospital lounges to get a head start on
  hospital
• rounds and transmit medical records

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INFORMATION TECHNOLOGY

• Concerns
• Privacy issuesthe Health Insurance Portability
  and Accountability Act (HIPAA) of 1996 requires
  protective measures against illegal access to
  personal medical information.
• However, public skepticism remains.
• Little oversight to ensure validity of clinical
  information can result in misinformation
• Potential of conflict between patient and
  physician

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DIFFUSION AND UTILIZATION OF TECHNOLOGY

• Diffusion (spread, availability) and utilization
  (aggregate use) go hand in hand. Both are
  important factors in medical cost escalation
• Technology is a two-edged sword. It can provide
  tremendous health benefits, but it also increases
  costs.
• Once technology becomes available, its use is
  almost guaranteed unless deliberately controlled.

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Why dont wecontrol technology diffusion?

• Because people want it, and physicians want to
  use it.
• Insurance coverage implies a right to access all
  available technology.
• Our belief and value system leads to a continuous
  search for technological advancements.
• We are driven by the technological imperativethe
  desire to use technology regardless of its cost.
• Managed care has been criticized for its efforts
  to control usage because overt supply-side
  rationing is not acceptable to the American
  public.
• Currently, price rationing under the market
  justice system is the only constraining force
  against overutilization.

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Other factors contributing to the growth of
technology in the US

• Specialization, specialty maldistribution,
  specialty training.
• Payment for services, when payment mechanisms
  insulate patients against the cost (moral hazard)
  or contain loopholes for provider-induced demand.
• Competition among hospitals based on acquisition
  of technology has led to duplication.
• Defensive medicine.
• Absence of supply-side rationingnational
  healthcare programs in other countries use health
  planning and global budgets to contain technology
  dissemination.

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Other factors contributing to the growth of
technology in the US

• The governments role in technology diffusion
• Regulation of drugs and devices (FDA).
• Certificate of need to control the growth of new
  construction and acquisition of costly equipment.
  The program had failed to demonstrate its
  effectiveness in cost containment.
• It was criticized for stifling competition.
  Abandoned by some states.
• Research on technologyrole of the Agency for
  Healthcare Research and Quality (AHRQ).
• Research funding.

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IMPACT OF MEDICALTECHNOLOGY

• Quality of careour notion of quality is often
  associated with high technology. Technology has
  improved diagnosis and treatmentmore effective,
  less invasive, safer proceduresresulting in
  greater life expectancy and decreased morbidity
  and disability.
• Quality of lifetechnology enables people to live
  more normal lives than would otherwise be
  possible. Examples include relief of pain and
  suffering, improved mobility, and compensation
  for disabilities.
• Costsgenerally, technology increases costs, but
  some technology has reduced costs. Technology has
  enabled the delivery of care in less costly,
  alternative settings (home health, subacute
  care), and a reduction in hospital average length
  of stay.
• Technology has contributed to economic growth by
  reducing disability, prolonging life, and
  allowing a quicker return to work.

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IMPACT OF MEDICALTECHNOLOGY

• Accessportable technology can be used in small
  towns and rural areas.
• Telemedicineapplication of computer technology
  combined with advanced interactive
  telecommunications
• Access to specialist consultations (radiology,
  dermatology, pathology, cardiology telepresence
  surgery)
• Structure and processesgrowth in home health,
  outpatient, subacute care. Clinical applications
  include lithotripsy, MRI, total parenteral
  nutrition (TPN), outpatient surgery, and home
  kidney dialyzers.

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IMPACT OF MEDICALTECHNOLOGY

• Information systems applicationsbedside
  computers that review and update clinical
  information access to medical data, research
  teleconferencing, continuing education
  organizational networks, managed care
  organizations (MCOs).
• Global practice of medicineadoption by other
  countries of technology developed in the US.
• Bioethicsartificial prolongation of life without
  the capacity to live. Genetic research and its
  implications.
• Creation of life outside the womb.
• Example What to do with frozen embryos?

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TECHNOLOGY ASSESSMENT

• Deals with the assessment of efficacy, safety,
  and cost-effectiveness.
• Together they define how appropriate the
  technology is. Assessment serves as a guide for
  the adoption and diffusion of new technology.
• Efficacy (effectiveness)determination of health
  benefits (outcomes), more accurate diagnosis,
  better treatment, quicker recovery
• Safetynot causing undue harm evaluation of risk
  (negative side effects)
• Cost-effectivenessevaluation of benefits in
  relation to costs

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TECHNOLOGY ASSESSMENT

• Implications of technology assessmenttechnology
  assessment determines whether care delivered is
  appropriate.
• In current practice, it is mostly governed by
  efficacy and safety considerations.
• Cost-effectiveness criteria have been slow to
  enter into the delivery of healthcare. This is
  because patients generally are not satisfied
  until all possible technology is used.
• The providers now have a financial incentive to
  limit the indiscriminate use of technology, but
  conflicts are created between what patients
  demand and what providers and insurers may
  consider appropriate based on cost-effectiveness
  criteria.