1. Technology and Its Effects
Chapter 5
Technology and Its Effects

2. © 2010 Jones and Bartlett Publishers
Introduction
Technology raises consumer expectations and creates increased demand for its use.
It influences the organization and financing of health services.
It has moved the practice of medicine toward specialization.
It has fueled cost escalation.
It has raised complex medical and ethical issues.
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3. What is Medical Technology?
The practical application of the scientific body of knowledge to improve the delivery of medical care.
Medical technology has benefited from other applied sciences: physics, chemistry, engineering, etc.
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4. What is Medical Technology?
Medical technology includes:
Sophisticated machines
Pharmaceuticals
Biologicals
In a broad sense, it also includes
Procedures
Facilities
Information systems
Management and operational systems
See Exhibit 5.1
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6. Information Technology
Main categories:
Clinical information systems
Administrative information systems
Decision support systems
Internet and e-health
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7. Electronic Health Records
Four basic components:
Collection and storage of health information on individual patients
Access to information by authorized users.
Knowledge and decision-support to enhance quality, safety, and efficiency.
Improve the efficiency of health care processes.
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8. Electronic Health Records
HIPAA 1996:
Addresses access to and transfer of personal medical information.
Legitimate use: care delivery, operations, reimbursement.
Patient rights: inspect, obtain copies, request corrections, restrict use.

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Internet and E-health
E-health: All forms of electronic health care delivered over the Internet.
Information, education, products, services
The Internet has made patients more active participants in their own health care.
Other applications:
Register patients
Order pharmaceuticals
Physicians can get a head start on hospital rounds
Virtual visits
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10. Telemedicine and Remote Health Services
Distance medicine
Issues:
Licensure across state lines.
Who is legally liable.
Lack of reimbursement.
Unsubstantiated cost effectiveness .
Remote in-home monitoring is proving to be cost-effective.

11. Utilization of Medical Technology
High-tech procedures are
More readily-available in the United States than they are in most other countries.
Little is done to limit the expansion of new medical technology.

12. Utilization of Medical Technology
To control medical cost, other nations limit the availability and use of technology through supply-side rationing.
Implementing these measures would be contrary to the fundamental beliefs and values of Americans.
The US spends more on medical R&D than any other country in the world.

13. Cultural Beliefs and Values
Capitalism and lack of government intervention promotes innovation.
Americans have high expectations of finding cures through science and technology.
Americans demand that the most advanced technology be made available to them.
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14. Cultural Beliefs and Values
The technological imperative
The desire to have state-of-the-art technology available and to use it despite its cost.

15. Medical Training and Practice
Specialists use more technology than primary care physicians.
American medical graduates increasingly choose specialization over primary care.

16. Insurance Coverage
Insurance insulates both patients and providers from the utilization and cost of health care.
Lack of checks and balances in the U.S. to determine the appropriateness of high-cost services.

17. Insurance Coverage
Evidence from other countries to curtail the use of high-tech procedures:
Fixed payments to providers (e.g., salary).
Limited payments to hospitals .

18. Competition
Specialization has been used as an enticement to attract insured patients and to recruit specialists.
Such practices have resulted in duplication of services.

19. Mechanisms to Control the Growth of Technology
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20. Role of the Government in Technology Diffusion
The development and dissemination of technology is called technology diffusion.
It addresses when technology will be made available for use, and where it can be accessed.

21. Regulation of Drugs and Devices
The Food and Drug Administration (FDA) is
An agency of the US Department of Health and Human Services (DHHS).
The FDA is responsible for
Ensuring that drugs and medical devices are safe and effective for their intended use.
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22. Regulation of Drugs and Devices
Three classes of devices:
Class I: Pose the lowest risk. Require general controls regarding fraudulent claims.
Class II: Subject to labeling and performance standards, and post-market surveillance.
Class III: Devices that support life, or present a potential risk of illness or injury. Require premarket approval regarding safety and effectiveness.

23. Safe Medical Devices Act of 1990
The law requires reporting of all injuries and deaths resulting from medical devices.

24. Research on Technology
Both AHRQ and NIH provide financial support to private and public institutions for biomedical research.
The AHRQ also supports research on quality, cost, and access.

25. Impact of Medical Technology
The effects of advanced scientific knowledge and medical technology have been far-reaching and pervasive.
The effects often overlap
It is difficult to pinpoint accurately the impact of technology on the delivery of health care.

26. Impact on Quality of Care
Technology does not always lead to high quality of care.
Technology produces quality care only when certain outcomes are achieved.
Innovations may actually be wasteful if they do not improve quality.
Some innovations may actually cause harm.

28. Impact on Quality of Life
Quality of life indicates
A patient’s overall satisfaction with life during and after medical treatment.
Examples:
Ability to do things in spite of disablement.
Ability to manage chronic conditions.
Relief from pain and suffering.
Fast recovery and return to normal life.

29. Impact on Health Care Costs
Technology may be the single most important factor in medical cost inflation.
Factors that contribute to cost escalation
Three main areas in which technology has saved health care costs.

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31. Impact on Access Geographic access can be improved
With new mobile equipment or communication technologies that allow remote access to centralized equipment and specialized personnel.

32. Impact on Structures and Processes
Transformation of hospitals into medical centers.
Development of outpatient services.
Technology available in patients’ homes.

33. Impact on Global Medical Practice
The U.S. is the world leader in R&D.
Other countries benefit because they do not incur the high R&D costs.
Telemedicine can be taken to other countries.

34. Impact on Bioethics Ethical and moral challenges posed by:
Gene mapping of humans,
Genetic cloning,
Stem cell research,
Genetic engineering
Genetic testing
Life-support technologies

35. Assessment of Medical Technology
Health technology assessment (HTA):
The evaluation of medical technology to determine:
Efficacy
Safety
Cost-effectiveness
The objective of HTA is to establish the appropriateness of medical technology for widespread use.
Efficacy and safety are the basic starting points.
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36. © 2010 Jones and Bartlett Publishers
Efficacy
Efficacy is:
The health benefit to be derived from technology.
How effective technology is in diagnosing or treating a condition.
If a product or service actually produces some health benefits,
It can be considered efficacious or effective.
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37. Safety Safety considerations are designed to: Primary benchmark:
Protect patients against unnecessary harm from the use of technology.
Primary benchmark:
Benefits must outweigh any negative consequences.

38. Cost-Effectiveness
Cost-effectiveness or cost-efficiency:
It evaluates the safety and efficacy of a technology in relation to its cost.

39. Cost-Effectiveness
Initial medical treatment – benefits generally exceed costs.
Additional treatments begin to lower the benefits in relation to costs.
At some point (optimal point), additional benefits equal the additional costs.
Beyond the optimal point, additional interventions become wasteful.

40. Benefits of Technology Assessment
Delivering Value
Improved benefits at lower cost
Value is enhanced by
Improving quality,
Reducing cost, or
Doing both
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41. Benefits of Technology Assessment
Cost Containment
Arbitrary restraints would be misdirected.
Technological change should be influenced by reducing cost without sacrificing quality.

42. Benefits of Technology Assessment
Standardized Practice Protocols
Medical practice guideline are protocols to assist practitioners in delivering appropriate health care for specific clinical circumstances.
HTA plays a significant role in the development of protocols.
Cost effectiveness has not taken center stage in U.S. health care.