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9/4/2000

Keeping Pace with Medical Technology

Katherine M. Bennett

Health care decision-makers have plenty of medical technologies to ponder. However, they have little information on how to make the best use of these options, commented the director of the Agency for Healthcare Research and Quality recently in the Journal of the American Medical Association. 

According to John M. Eisenberg, M.D., whose group was previously named Agency for Health Care Policy and Research, most technology assessments rely on a simple, but inaccurate, model of clinical practice. At the same time, there are limitations on the capacity of clinicians and organizational decision-makers to use technology assessments. 

The challenge to evidence-based health technology assessment, wrote Eisenberg in his Nov. 17, 1999, article, is to determine when in the course of an illness the technology will be effective, for whom it enhances outcomes, and how it will be used in practice. From his agency's 10-year involvement with technology assessment, Eisenberg offered 10 lessons to the medical community. 

  • Innovation and flexibility should guide assessment. 
  • Technology is more than devices. 
  • Research and assessments should be linked with coverage. 
  • Technology assessment is not a one-time exercise. 
  • New measures of outcome, based on value and disease, should be developed. 
  • The community of practice is a laboratory for technology assessment. 
  • Training and capacity building in technology assessment should be emphasized. 
  • Better international collaboration will result in global synergy. 
  • National resources on technology assessments should be linked. 
  • Technology assessments should be translated into improved practice. 
  • With the enormous benefit provided by continued development of health technologies comes a responsibility to ensure that these technologies are used appropriately.

Appropriate use of medical technologies poses a problem overseas as well. Half a week before publication of Eisenberg's article in an issue JAMA devoted to technology, BMJ came forth with its theme issue "New Technologies in Medicine and Medical Journals." Eisenberg's British counterpart, John Gabbay, with the NHS National Coordinating Centre for Health Technology Assessment, described how new technologies get into practice. 

To view the two articles, go to http://jama.ama-assn.org/issues/v282n19/full/jco90121.html and http://www.bmj.com/cgi/content/full/319/7220/1292.