Journal of health care technology最新文献

Therapeutic drug monitoring (TDM), a clinical laboratory technology that measures drug concentrations to regulate drug dosage, has become an important treatment aid in both inpatient and ambulatory care. TDM laboratory methods, including immunoassay (EIA, FIA, and RIA) and chromatographic techniques, are used to assay blood, urine, and saliva samples of patients taking therapeutic drugs; TDM is also useful in identifying abused drugs. This assessment describes specific drug assay techniques, their respective advantages and disadvantages, and costs. TDM's contribution to treatment outcomes, its impact on existing services, implications for laboratory personnel, and the extent of the TDM marketplace are discussed. Future techniques and TDM's contribution to reducing the length of patient stays are also reviewed.

The diffusion of medical technology, the process by which new clinical procedures and devices come into use in the health care system, is an historical topic, as old as medicine itself. Hospitals, physicians, manufacturers, third-party payers, and patients all are factors in the demand for, and adoption and diffusion of, new medical technologies. The federal government also plays a role both in furthering technology diffusion through federally financed health programs and in attempting to control diffusion by stimulating state certificate of need and other regulatory programs. The history of the CT scanner's diffusion illustrates the problems that can result from the lack of a coherent strategy to control the diffusion of major medical technologies. Some of these same problems are now appearing in the diffusion of magnetic resonance imaging (MRI) devices. In the current health care environment, prospective payment and the continuing period of remarkable technological innovation are major influences on technology diffusion and on initiatives for technology assessment. The diffusion of technology can be made more rational by instituting a formal process to identify technologies (both old and new) that require assessment, by financial support for assessment efforts, by selective reimbursement for clinical trials, and by regionalization of costly procedures.

Hospitals and physicians play pivotal roles in the diffusion of health care technology because they, for the most part, are the owners and operators of medical equipment. At the same time, the way in which technology spreads through the health care community has an impact on the number of patients seen, and revenue earned, by hospitals and physicians. This synergistic relationship has been subjected to new forces with the ongoing development of new technologies and the reduction of insurers' generous cost reimbursements. "Competition" is the rallying cry about which much of this change has grown. Medicare's prospective payment system, federal and state cost-containment activities, and an increase in the number of alternative health care providers continue to incite competitive activities among hospitals and physicians as they vie for patients. To survive financially today, hospitals and physicians must have a clear understanding of the health care technology environment in which they function. Only then can a strategic plan be designed that identifies the tactics that would enable the hospital or physician not only to compete, but to succeed, in the battle to offer high-quality services that attract patients.

Because of health care's special status, society has an ethical obligation to ensure that all people have access to an adequate level of health care (including access to new technologies as well as existing ones), without facing excessive burdens in obtaining such care. Society's recognition and implementation of this obligation is all the more important because market forces, alone, will not produce appropriate distribution of health care resources. For those making decisions about resource allocation, ethical pitfalls can best be avoided if policy formulation is differentiated from clinical decisions about specific patients' access to care. The latter can and should be made by each patient's physician, but, to be effective, the former must be accomplished in broadly based political processes by both health care professionals and others. Further, decision making about access to new technologies should begin early in the research and development process, and should involve Medicare and other insurance carriers that will be called upon to pay for the technology. This course is highly preferable to waiting until the technology is ready for wide use--as is now common--and only then deciding whether to pay for it.

The current status of digital imaging storage and retrieval is described, as applied to both digitally created images and those converted from conventional films. Technologies that are beginning to play a role in digital image management--particularly, different configurations of Picture Archiving and Communications Systems (PACS)--are examined in terms of their stage of development, equipment, and operating costs. This assessment finds that the future success and diffusion of these systems will depend upon the diagnostic adequacy of digital images, improvements in image digitizing processes, and the availability of optical disk or other low-cost mass storage. In addition, the paper concludes that Medicare's prospective payment system will greatly influence the spread of this technology because of both the cost-saving incentives the system will place on health care professionals and the still-undetermined method of capital cost reimbursement.