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