How does technology affect healthcare?
Webster dictionary defines technology as the practical application of knowledge especially in a particular area. The motivating factor underlying all technological activities is the desire to fulfill a need. Health-care technologies have been employed to extend human life, to reduce pain, disease risk, and to improve patient’s quality of life.
The following technologies are considered to be health technology
- Drugs: e.g., antibiotics, ACE inhibitors, aspirin, beta-blockers, antibiotics,
- Biologics: gene therapies, antibodies
- Devices: e.g., pacemakers, CT scanners
- Diagnostic tests: e.g. DNA fecal test for colorectal cancer, genome sequencing
- Medical and surgical procedures: e.g., psychotherapy, coronary angiography, gastric banding operation for weight loss
- Support systems: e.g., electronic patient record systems, telemedicine systems,
- Organizational and managerial systems: e.g., cholesterol management program, billing and accounting.
These technologies can be used to prevent diseases (e.g., immunization, chemoprevention against cancer, nutrigenetics), to screen diseases in asymptomatic people (e.g., mammography, colonoscopy, cholesterol testing), to diagnose (e.g., electrocardiogram, x-ray for broken bones), to treat diseases (e.g., gene therapy, biologics for adjuvant chemotherapy), to rehabilitate (e.g., physical therapy) and to assist, to reduce errors (electronic medical records, computerized order physician entry )
How to evaluate a health technology?
We have to make decisions everyday about how to spend our money, e.g. how much we are going to spend on shoes, on clothes, on food, how much we are going to give away to charity. The same thing happens in health care. The policy makers need to make decisions regarding which health care technologies to fund, drawing from collective resources.
In the U.S., the cost of health technology has skyrocketed in the past few decades. Several novel drugs and procedures cost in the range of hundreds of thousand US dollars routinely prescribed to patients. Obviously, no patients or doctor refuse access to state-of-the-art technology, and although these technologies may improve/prolong survival or improve quality of life for patients, they put a lot of stress on the system and reduce resources that can be spent for other causes, e.g. preventive medicine. Given the limited resource, it is important to give careful considerations to the cost-effectiveness of health technology. The growth of health technology assessment (HTA) in the U.S. reflects this demand.
Health technology assessment is a process designed to “provide decision makers with information about the possible impacts and consequences of a new technology or a significant change in an old technology. It is concerned with both direct and indirect or secondary consequences, both benefits and disbenefits, and with mapping the uncertainties involved in any government or private use or transfer of a technology.
HTA was first developed in U.S., but has gained popularity worldwide. In the United Kingdom, National Institute for Health and Clinical Excellence (NICE) decides whether a new technology will be used in the National Health Service (NHS) based on its cost-effectiveness analysis. The stake-holders of HTAs include
- Regulatory agencies, e.g. about whether a drug, device or technology is permitted for commercial use
- Health care payers, providers, and employers, e.g. about whether a technology should be reimbursed.
- Hospitals, health care networks
- Standards-setting organizations for health technology and health care
- Government health department officials about public health programs
- Lawmakers and other political leaders
- Health care product companies
- Clinicians and patients
Often, several fields of expertise are required to perform HTA. So a HTA may involve a wide range of experts, from physicians, nurses, dentists, managers, technicians, biomedical and clinical engineers, pharmacologists, patients and patient affairs representatives, epidemiologists, biostatisticians, economists, lawyers, to social scientists, computer programmers.
References:
Introduction to Health Technology Assessment
