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HSA 3111: Medical Technology
1Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Topics
• Technology Defined• Medical Technology• Medical Informatics• Technology Innovation and Diffusion• Government Regulation of Technology• Impacts of Medical Technology• Assessing Medical Technology
“We live in a society exquisitely dependent on science and technology, in which hardly anyone knows anything about science and technology.”
Carl Sagan
HSA 3111: Medical Technology
2Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Technology
• From the Greek techne meaning Art and logia meaning the study of something.
• Merriam Webster’s Definitions:– The practical application of knowledge, especially
in a particular area– A capability given by the practical application of
knowledge– A manner of accomplishing a task especially using
new technical processes, methods, or knowledge
HSA 3111: Medical Technology
3Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Technology (cont.)
• None of the definitions require the presence of a physical artifact, machine or device
• All of the definitions incorporated “knowledge”• All contained or implied the “application” of
knowledge• Are any of the following not technologies?
– Fire ‒ A spear– The wheel ‒ A Boeing 747– The U.S. Congress ‒ My shirt– An electric drill ‒ A flint hide scraper
HSA 3111: Medical Technology
4Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Technology (cont.)
• What are the economic benefits of technology?– Who pays, who benefits?
• Technology embedded in an artifact (machine or other physical object)
• Technology not requiring an artifact– How do we benefit?
• Technologies that are productive• Technologies that we consume for comfort,
pleasure, enhanced quality of life
HSA 3111: Medical Technology
5Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Technology (cont.)
• Can you name a technology that accomplishes something we could not do some other way?
HSA 3111: Medical Technology
6Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Medical Technology
• Technology applied to healthcare• “…the practical application of the scientific body
of knowledge produced by biomedical research.” (p. 163)
• What has been the result of– The growing body of scientific knowledge
biomedicine?– Its application in healthcare?
HSA 3111: Medical Technology
7Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Medical Technology (cont.)
• Some benefits– More precise diagnosis– More effective procedures– Less invasive procedures– Less expensive production– Better pharmaceuticals– Better information management
• Clinical• Managerial
HSA 3111: Medical Technology
8Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Medical Technology (cont.)
• Seven consequences (p. 162) – Raised consumer expectations– Changed the organization of medical services– Changed medical training and practice and
resulted in increased specialization– Changed status of practitioners– Driven costs upward (inflation)– Resulted in assessment activities– Created complex social dilemmas
HSA 3111: Medical Technology
9Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Medical Informatics
• What information problems are raised by:– Increasing specialization in healthcare?– The nature of the physician-hospital-patient
relationship in the U.S. healthcare system?– Third (and fourth) party payers?– A mobile population?– More complex procedures?
• (Including multi-step procedures applied over a period of time)?
HSA 3111: Medical Technology
10Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Medical Informatics (cont.)
• Medical Informatics is the application of computer technologies to improve outcomes and reduce the costs of healthcare– Clinical information systems focus on information
related to patient care delivery– Administrative IS support financial and
administrative support– Decision Support Systems assist in decision
making• Clinical• Administrative
HSA 3111: Medical Technology
11Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Medical Informatics (cont.)
• Electronic Health Records (EHR)– What are the problems with paper-based health
records?– What are the advantages to moving these records
into a networked electronic format?• Available to any authorized user on the network• Support clinical analysis & decision making
– Integrate information from multiple providers– Perform patient-oriented longitudinal
analysis• Easily integrated for population-level analysis
HSA 3111: Medical Technology
12Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Medical Informatics (cont.)
• Electronic Health Record (cont.)– What impedes EHR implementation?
• Huge inventory of existing incompatible systems
• Privacy and legal constraints• Patient concerns• Costs—estimated at $37 - $64,000 per
physician/PA/NP– Only 15-20% of physician offices using EHR– Only 20-25% of hospitals using them
HSA 3111: Medical Technology
13Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Medical Informatics (cont.)
• The Internet and e-Health– Why do patients seek the care of physicians (or
attorneys or auto mechanics)?– The Internet makes copious amounts of
information available to the public– Patients are using this information to help with
their medical decision making• Researching illnesses and treatments• Researching providers• Sometimes changing the patient-doctor
relationship
HSA 3111: Medical Technology
14Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Medical Informatics (cont.)
• Telemedicine– Supporting or providing healthcare from a distant
location• Sending imagery to be read in a distant city (or
country)• Specialist consultation to primary care
providers in underserved locations• Patient consultation via communication
technologies
HSA 3111: Medical Technology
15Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Medical Informatics (cont.)
• Telemedicine (cont.)– Issues with telemedicine
• Ambiguity regarding physician licensing• Uncertain reimbursement from insurance
companies• Uncertain liability
HSA 3111: Medical Technology
16Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Technology Innovation & Diffusion
• Technologies diffuse through well understand patterns
• Diffusion influenced by– Usefulness and perception of usefulness– Cultural beliefs and values– Competition– Financing– Policy and Controls
HSA 3111: Medical Technology
17Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Technology Innovation & Diffusion (cont.)
• Usefulness and Perception– Users may under- or over-appreciate the
usefulness of an innovation– Everything else being equal more useful
innovations will diffuse more rapidly
HSA 3111: Medical Technology
18Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Technology Innovation & Diffusion (cont.)
• Cultural Attitudes– Cultural and social attitudes may enhance or
detract from development and diffusion– Some cultures value tradition while others value
innovation and modern developments
HSA 3111: Medical Technology
19Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Technology Innovation & Diffusion (cont.)
• Financing– Both the development and diffusion of healthcare
technology are affected by funding sources– R&D support increases likelihood of new
technology development• Q: Why is nearly 50% of biomedical research
funding from governments?– Insurance company willingness to reimburse
increases development and diffusion
HSA 3111: Medical Technology
20Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Technology Innovation & Diffusion (cont.)
• Perverse Healthcare Technology Diffusion– Unlike most technologies, healthcare technology
can increase costs and prices– New technologies create their own demand – Use must recover costs– New technologies also often need specialized
staff, facilities, and management• Technology accounts for half of the rise in
healthcare spending from 1950-2000• Managed Care Organizations tend to dampen
technology adoption
HSA 3111: Medical Technology
21Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Government Regulation of Technology
• See the history of FDA authority in the 20th Century (Table 5-2)
• Regulation creates tension between innovation and safety– 27 month approval time for new drugs in 1993– Charging fees to applicants sharply dropped
approval time– 1997 FDA Modernization Act allowed fast-tracking
some drugs and devices
HSA 3111: Medical Technology
22Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Impact of Medical Technology
• Changing cost structures– Increasing costs discussed earlier– May reduce overall costs
• Better diagnosis• Less invasive procedures• Shorter recovery time
– Reduced hospitalization– Quicker return to work
• Enable non-hospital delivery
HSA 3111: Medical Technology
23Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Impact of Medical Technology (cont.)
• Mobile technology can reach rural areas• Technology has created capital-intensive
organizations• Information technologies support managed care
– Decision making• U.S. has been leader in technology development
– Rest of world often benefits from U.S. innovations
HSA 3111: Medical Technology
24Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Impact of Medical Technology (cont.)
• Modern technologies create new ethical issues– Testing safety– Genetic testing– Fertilized and unneeded embryos– Stem cell research
HSA 3111: Medical Technology
25Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Assessing Medical Technology
• Technologies assessed along multiple dimensions– Efficacy or effectiveness– Safety– Cost
• Some assessments must be made before development begins
HSA 3111: Medical Technology
26Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Assessing Medical Technology (cont.)
• Efficacy– Evaluated with staged trials– Animal testing in some cases– Clinical trials of increasing breadth and duration– Follow-up monitoring
• Efficacy must be compared to alternatives, especially existing alternatives
HSA 3111: Medical Technology
27Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Assessing Medical Technology (cont.)
• Safety– Identify risks– Weigh known risks with benefits– Continue follow-up monitoring
HSA 3111: Medical Technology
28Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Assessing Medical Technology (cont.)
• Cost-Effectiveness and Cost Benefit Analysis– Point A is where
we realize declining marginalrates of improvement
– What are theunits of the y-axis?
HSA 3111: Medical Technology
29Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Assessing Medical Technology (cont.)
• Assessing medical technology is a massively complex process– Many probabilistic elements– Dissimilar units of measure of components and
outcomes
HSA 3111: Medical Technology
30Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Assessing Medical Technology (cont.)
• Assessment takes place at several levels– Developer
• Prior to development• Interim• Completion
– Regulators ‒ Adopters– Insurance companies ‒ Patients
• A value must be determined for a life or for quality of life– Planning figure of $100,000 / year is used for
valuing years of life
HSA 3111: Medical Technology
31Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Assessing Medical Technology (cont.)
• Trends and Issues– U.S. does most assessment in the private sector
• Thousands of individuals and organizations make decisions about adopting technologies
• If efforts are coordinated or centralized will we lose anything? Gain anything?
– Most other developed countries have centralized assessment and controls on adoption
HSA 3111: Medical Technology
32Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest
Assessing Medical Technology (cont.)
• Issues and Trends (cont.)– Americans expect all available resources to be
applied to their illnesses– Consumers place little consideration on
cost/benefit• Consumers are not paying much of the cost
– Can we change our patterns of adoption?• Clinical practice guidelines implicitly incorporate
assessment– See last week’s discussion