Medical Technology and the Health Care System: A Study of the Diffusion of Equipment-Embodied Technology

316 Pages·1979·6.389 MB·English

by  Committee

MedicalT echnology
andt heH ealth
CareS ystem
A
Studoyf
thDei ffusoifo n
Equipment-Embodied
Technology
A Reportb yt he
CommittoeneT echnologayn dH ealtCahre
AssembolfyE ngineering
NationRaels earcCho uncil
and
InstitoufMt eed icine
NATIONAL ACADEMY OF SCIENCES
WashingtOn, D.C. 1979
Medical Technology and the Health Care System: A Study of the Diffusion of Equipment-Embodied Technology
http://www.nap.edu/catalog.php?record_id=18439
NOTIC:E The porjectt hat tihse s ubjecto ft hisr eportw as
approvbeyd t heGo verninBqo arodf t heN ationReasle archC ouncil,
whosmee mbersa red rawnf romt heC ouncilso ft heN ationAacla demy
ofS cienc,e tsheN ationAacla demyo fE nqineienrq, antdh eI nsti­
tuteo fM ediicn.e Theme mbers oft hec ommitteer esponisblef or
ther eportw erec hsoenf ort hiers pceialco pmetensc aned withr e­
qardf ora ppropriateb alnace.
Thisr eporth asb eenr eviewbeyd a qrouopt hetrh ant hea uthors
accorditnoqp roceduraepsp rovbeyd a ReportRe view Committeceo n­
sisitnqo fm emberso ft heN ationAacald emoy fS cinece,s theN a­
tionaAlc ademyo fE nqieneri,n aqnd tIhnets ituteo fMe dicin.e
Thisr epo rt reprseentwso rkun derC otnracNtS FC -31b0e tweetnh e
NationAacla edmyo fS cienceansd theN ationSacil enceF oundati.o n
Library ofC onrqessCa tlaoqC ardNumbe r 79-81480
InteartinonaSlt andaBorodk Number 0-309-02865-5
Avaaibell
from:
Officeof Pulbicatnis,o NationalA cademoyf Sciecnes
2101Co nstiuttoinA venu,e N.W., Washinq,t Do.n.C 20418
Printeidn t heU ntiedS tateosf Am erica
Copyright © National Academy of Sciences. All rights reserved.
Medical Technology and the Health Care System: A Study of the Diffusion of Equipment-Embodied Technology
http://www.nap.edu/catalog.php?record_id=18439
COMMITTEEO N TECHNOLOYG
AND HEALTHC ARE
CHARLES A. SANDERS (Chariman), Generla Dirceto,r Massachuestts
Generla Hopsital
MORRIS F.C OLLE,N Dirceto,r MedicaMle thodRses earc,h thPee r­
manenteMe dical Group
AMITAIE TZINOI, ProfessoofrS ociogly,o ColumbiaU niversiyt,a nd
Direocrt, Cetnerf orP olicyRe search
CHARLES D. FLAGLE, Professoro fH ealht SevriceAsdm initsrati,o n
Scholo oHfy gienaned PubliHce alt,h theJ ohnHso piknsU ni­
veristy
GE RALD A.GO RDON , Direocrt, Centefro rA ppiledS oicalS cienc,e
BotsonU niversity
ANTHONY A.RO MEO , AssoicateP rofessoofrE coniomc,s theU nievrsiy t
ofC onncetciut
HENNINGE .V ONG IERKE, Direocrt, Biodynacmsia ndB ioncisD iviison,
AerospacMee dcialRe searcLhab orato,r WyrightP-atteornsA ir
ForcBea se
WILLIAM s. YAMAMOTO , Professora ndC hairman, Departmenotf C lniical
Engienreing, GeorgWea shingtUoninve ristyM edicla Center
MICHAEL ZUBKOF,F Profesosra ndC hairman, Departmento fC ommunity
Mediicne, DartmoutMehd ical School
JUDITH L.W AGNER, StduyD irector
JANEK INSMAN, Conslutant
MADALYN POLLITT
DIANE WEAVER
iii
Copyright © National Academy of Sciences. All rights reserved.
Medical Technology and the Health Care System: A Study of the Diffusion of Equipment-Embodied Technology
http://www.nap.edu/catalog.php?record_id=18439
PREFACE
Thisr eporte xamniest hepo liyc anrdes earcihs uses baisct ot he
relationshbiepwt eenn ewm edicatle cholnoyg andt he effiicency
ande fefcitvenesosf t he healh tcares yst.e mTheN ationRae­l
serachC oucni'lsC ommitteeo nT echnloogy andH ealh tCar,e org­a
niezdj onitlyi n1 97b6y theA ssemblyo fE ngineerainndtg h e
Instuitteo fM ediicn,e hasa ssesstehdep rocesbsy w hicht ech­
noloyg fidnsi tsw ayi not theh eatlh care tseyms,i denitfyinga nd
analiynzgs uccsesesan d iflaruesi nt hep rcoesso ft echonlogcial
chan.g eIdeally, themo re effectei avnde fifcinett echonlogies
shoulbde intorduceqdui ckly:o therss houldn ot. The ciotmmtee
hasa ttemptetdo d etemrinet he extentto w hich thseei dearle ­
sutlsa cutalyl doo ccura nd, whent heyd on',t whyn ot. Ino ur
revieowf t hee videnbceea rinong itshq uestoin,w eh avei denitfeid
areawsh eremo re reserachi sn eeedd.
SCOPEA ND LIMITATIONS
The committeel imiteidt si nquriyt oa ne xaminatioonf " equipemnt­
embodeidt ehcnolo,g"yw hichi st hee quipment,p rocedsu,rs eervcie,s
ors ystmse thatd epenpdr imarliyu ponc apitaelq uiepnmt. Fetal
monitorinegq uiepnmt, coornayr caer units,f iber-potice nodsocpic
procuerdse,a ndm edicailnf ormatiosny tsemsd,i verstheo ugthh ey
are, allf allw ihtint hes tduy'sp urveiw. Thes tudye xcldued
otheri mportantt echonlogiciannlo vaitonsi n heha clatres,u cha s
newt hreapeiuctd rugosr n ew sguircaplr ocuerdse forw hich par­
ticuleaqru ipmewnats n otr euqierd.
Asa fisrta pporximatioonf t he issuest o baed drsesde,t he
committeei denitfieda serieosf q uesiton:s
v
Copyright © National Academy of Sciences. All rights reserved.
Medical Technology and the Health Care System: A Study of the Diffusion of Equipment-Embodied Technology
http://www.nap.edu/catalog.php?record_id=18439
vi
What isk nownab outt her elatinoshpi ofe quipment-embodied
•
technolotogh ye lathc arec ostasn ds oicalb enfeits?A ret here
cateogrieosf sutcechh nloogyt hata rew ortthh eirc osta nd
othertsh ata ren ot?
What facotrsd eterminteh ew ayd eciisonsa rema de about the
•
acecptancoef n ewe quipmeenmbto-diedt echnoloigyn toh elathc aer?
Aret here patriculacart eogreiso ft echnolotghya ta rel ikelyt o
bea doptetdo or apidlayn du ncriticya olrlt oos lowly?T ow hat
extentd o currnetp ublicpo liciecso tnrbiutet o suchp rolbems?
How iisnf ormaitonab outt hee ffecteinvsesa nde ffiicencyo f
•
newt ehcnolyo gdevleopeadn du sed? At whats tagien t hep rcoess
oft echnicaclh angies i nformationg enreated?To whate xtent
doest hed evleopmenta ndd issmienatioonf i nformatiaobonu tme d­
icalt echnologyn eedt ob e improved?
Fromt heo utsett hec ommittedee icdedn ott or eveiwt hes tatoef
thea rti nd evleoipng patriculakrin dso fme dicalt ecnhologyn or
didi ta ttemptt oi denitfys ingificanto pportuintiefso rR &Do f
newt echlnooyg--althougthh ec ommitteies qu itec erta�sn ucha
studcyo ulbde u sefutlo t hosef ederaagle nicest hata rer espon­
siblef or supoprtingR &Da ctitviie.s Thec ommittedei dn ota n­a
lyzet hes ubstnatianlumb er ofi ssuesa ssocitaedw ithb imeodical
resaerhc policy, sucha st her elatiev meritso ft argedt veersus
untargeteidn evstgiationosro f larggrena tso vers mall gratns,
thec onitnuiy t orfe serachf udnin,g thep eerr evieowf r eserach
prpoosal,s andt he orgainztaionasltr ucturoer p roecssmo st con­
ducivet o innovaitonsi nm edicatle chnoogly.T hesew erer uled
outf ort wor easo:n sThei sseus dh ajustb eenc onisdreed btyh e
Presiednt'sB iomedicalRe searchP aenl, and tthieem availablef or
thes tudy moedfi catlec hnloogyd idn ota llowf ore xpnadintgh e
scopeo ft hec ommittee'sw or.k
Thec ommitteiem psoeds everala didtionallim itatiounposn it­
selfi nr ecognitoifot nh ec onstraionftt sim e andt hea besnceo f
objectiev stduieso nc etraint opics.T hu,s itd idn otd eliberate
the technicailss ues aisastoecdw iht deevloipng equipmte-nmbeodied
technloog,y inclduingt hen eedfo rt rainetdec hincamla npoweorr f or
R&Ds etitngsi nw hich thec ollaboratioofnme dicine ande ngineer­
ingc anb emo st prodtuciev.*I td idn ote xaminfeu llyt hei nful­
ence tohfe b iomedicaell etcroincsa nde quipmenti ndusiterso nt he
procesosf t echincalc hnagei nh elathc aren�o rd idi te vaulate
thee xtentto w hich thei ndustrdye teirnmest hed ierctionosf
*Onec ommittemeemb er,W ililam Yamamoto , hast akene xceptiotno
the limitesdc opeo ft hes tudiyn t hisc onnecitona sw ella ss ome
oft hei mplciatioonfst he conclsuionsa ndr ecommendtaion.s His
dissentivnige wa ppaersa sA ppnedixA .
Copyright © National Academy of Sciences. All rights reserved.
Medical Technology and the Health Care System: A Study of the Diffusion of Equipment-Embodied Technology
http://www.nap.edu/catalog.php?record_id=18439
vii
deevlpoment and distbruitioonf nemwe dicalt echnoloyg ors ipmly
respondst o thdee mandsa nd neeodfst heh ealth cares ytsem,
mainlyb ecuaser eliabled ataab outt hea ctviitieosf e quipment
makersa rev itruallyun attainlabe. Indee,d thec ommitteea ssumed
ini tsd eliberatiotnhsa tn ewm edicalt echlnoogyr eslutsl argely
from tdheeman d exrpessedi nt he" marke,t"w hic,h int hec aseo f
theh ealht cares yst,e mmeanpsh yiscian,s hospitsal,o thre proivd­
ers, and tphubel i.c Conseqtuley,n thec ommitteea ssessedt he
nature tohfema rkets ingalsi ns omed epthan d nott hee xtentto
whicthhe bimoedicaleq uipmeinntd ustmaryy bea powe rfulf orce
inc reatinga marketf ori tsp rodusc.t
Fianlyl,t hes tuddyi dn otd ealw iht thei suseso fe thicaaln d
soicalc hoicensow made possibleb y the availabiiltyo fm edical
equipmetnotp rolongl ief ort hef innaciaclo stosf s ucht echnlo­
ogyo ne ither thei ndiivduapla tienatn dt hei mmediatfea imlyo r
the rest soocfi ety. Medicalt echlnooyg rasiesman y fundmeantal
questionsabo ut previoluysun contorlleda spectosf life. Itpo s­
sesessan implicti powert or edsitriubtew ealthi nt hes oicetya nd
to confebre nfeitsupo n some tohfe mo st underpriilveegd. Ietn ­
dowsh elathp ractitiownietrhsn ewpo werso verl ief andd eat.h It
cretaes newj obsan d dipslcaeso ldj obs. While tchoemm itteree cgo­
nizetsh ed iffeernitali mpactso ft echonlogiccahla ngoen soicety
that mediicnen owpo ssess,e ssuche thicaaln ds oicalq uestoins
haven otb eena drdessedi nt hes tudy.Th e committ'eesma in focus
hasb eeno nt hec ostasn de ffecteinvseso ft hep rcoesso ft echno­
logiccahla ng,e noto nt hee quitoyf itcso nesquecnes.
METHODOLOGY
The committee, conisstnigo fs peciailstsi ne ngienrein,g meidcnie,
economcis, soicolgoy, andh ealthc area dminisattiron, met four
timest o deliberatteh ei ssue,s reaccho nlcuisons, andd evleop a
seto fr ecommendatifoonrpos l icya ndr esaercht hatb earo nm edi­
calt ecnholoyg. Ina dditino,t hec ommitteer eviweeda serieosf
studpya perst hati tc ommissione.d Fouro ft hep aperwse rec ase
stduieso fp atricurl eaquimepnt-embodied technloog.y Theo ther
papersi nlcudeda na nalsyiso fp roperrtiyg htspo licierse ltaed
to the introdtuiocno fn ewme dicatle chlnoogy, ane xaminationo f
thei mpacto fs tatea ndl ocarle gultaionosn me dicalte chnloog,y
anda n assessmento ft hee conoimcc osto fe quimepnt-emboditeedc h­
nology. Whileth e cmmiossionepda presp rovided oofin tes p rin­
cipal srocueso fi nformatio,n thec ommittedei dn ota lways accpet
ora grewei th theirf indingasn dc onclsuinos. Some of thpea pres
arei nlcudedh ere( pApenidxesB -G)s ot hatr eaders mayh avea ccess
to thesoeth erwisunep ublishedd ocumnets.
Copyright © National Academy of Sciences. All rights reserved.
Medical Technology and the Health Care System: A Study of the Diffusion of Equipment-Embodied Technology
http://www.nap.edu/catalog.php?record_id=18439
viii
Thec ommitteeh elda no penm eetingt oc olletchte v iweso fc on­
cernedc itizeonnst hec ritcialp rolbemso ft echnloogiccahla nge
int heh ealht cares ysetm. Thep ublic'svi wesw eret hes ubject
ofa ntoherd eilbreaitve meetinbgy t hec ommittee.
ORGANIZATIOONF TH E REPORT
Thisr eprotc ontaiannsi ntordutcionan d summary, fours ubseuqent
chapetr,s anda ppendsix.e Chpater2 reveiwsw hati sk nownab out
thee conomci costosf t hev ariousp esto yfm edicatlec hnloogy.
Chpater3 analzyes thea dpotioann du seo fn ewt ehcnolyo gint he
healht cares ytsem, identifyings pecfiicf atcosr thatma y tendt o
eihteri nhibito re ncouratgheep roecs.s Chpater4 exploretsh e
poliyc otpiontso d ealw iht thper olbems int hea dopitona ndu se
ofme dicailn novaitons.C hpater5 disucssetsh ec ritailcq uestino
ofh owe vaulaitve inofrmatioins g enerataenddd isseminatetdh rough­
outt hep roecsso ft echonlogiccahlan gean d howt hatp rcoessc an
bei mproved.
There aree ighta ppnedixetso t he rretpo. AppenidxA is the
disesntign opniiono fc ommittemee mberW illiam s. Yamamoto. Ap­
penidxesB througGh a res ixc ommissionepdap erst oa ssistth ec om­
mitteei ni tsa naliysso ft hep ertineinstus es andt op rovidcea se
studieso fp aritculatre cnholgoie.s AppnedixH isa lisitngo f
indivaidlusw hoa tetndetdh eo penm eetinogn t hep rocesosf t ech­
nologiccahla nge.
ANOTHERW ORD
Whent hiss tudyw as undertake,n thec ommitteec hairman wasJ ordan
J.B aurch, ProfessoofrE nigneeirnga ndB uisnessA dminitsratni o
atD artmouthC ollege.D r.B arcuha nda ntohero riginmeamble r,
KareDna viso ft heB rookingsI nstuittio,n letf thec ommitteea
fewmo nthsa ftearwrdw hen etyhw erea ppointetdop ositoinsi n
Presdietn Carte'rsA dmniitsratoin. Threeo thre membersl etf the
committeea fetrp atriicpatingi ni tsi nitidaelil berationTsh.e y
areE dwarBdur ge,r ClinicaAlss itsantP rofessoart G eortgoewnU ni­
veristy MedicaCle ntre;A laiGn. E nthov,e nthMaer rinesr. Eccles
ProfessoofrP ublicand PriavteM anagemeanttS tanfordU nivesrit;y
andW alteAr. Rosenbliht,P roovsto ft heM assachuesttsI nstuitte
of Thencology.
Thec ommitteei sg ratfeult ot hseep epolef or thieri nciisve
ideaisn t hee arlmyo nths tohifs s tudy.
Copyright © National Academy of Sciences. All rights reserved.
Medical Technology and the Health Care System: A Study of the Diffusion of Equipment-Embodied Technology
http://www.nap.edu/catalog.php?record_id=18439
CONTENTS
1 INTROCDTIUON AND SUMMARY 1
The Proecsso fT echnicaClh ang,e 3
Summaryo fF indinsg nadR ecommendatio,n 1s1
2 ECONOIMCC OSTS 14
ConcepotfsE conmoicC ost,s 14
The DierctC ostosf Eq uipmnet-Embodied
Technoloyg,1 5
The Impacto fM edicaTelc hnlooyg onT oatlH ealht
CareC ost,s 17
TheS ociaBle nfeitasn dC ostso fN ewM edical
Tehcnoloyg, 19
The DistirbutioonfC ostansd Benfeitosf N ew
Equipment-Embo diedT echonlogy, 20
Conlcuison,s 21
3 PROBLEMS INAD OPTINO AND USE 23
Theroieso fH opsitaBle hvaio,r 24
� EmpiriaclEv idencoen t heD iffuison of
Equimepnt-EmbodieTde cnhoolgy, 27
xTheI mpacto ft he Healht CareF innacnigS ytsem
ont heA dotpino andU seo fEq uipment­
Embod iedT echnoolgy, 33
The Impact ofD efenisveM edicineo nAd optino and
Useo fN ewT echnloogy, 39
TheI mpcato fO rgainzatni oofH ealthCa re
Sevriceso nA dpotino andU se, 39
�Concluison,s 44
ix
Copyright © National Academy of Sciences. All rights reserved.
Medical Technology and the Health Care System: A Study of the Diffusion of Equipment-Embodied Technology
http://www.nap.edu/catalog.php?record_id=18439
4 ALTERNATIVE APPRTOO ATCEHCEHSN OLOGY MANAGEMENT 46
IF unidngo fD evleopmentaElf fort,s 47
· DirecRteg ulatni oofI ntordcutiono fN ew
Equiepnm-tEmbodiedT echnlooyg,4 8
.1D irecRteg ulaitono ft heA dotpiona ndU seo f
Equimepnt-EmbodiedT echnology, 52
tP aymenPtol iceis, 56
Healh tManpowPeroi lcie,s 62
Informtaino DissemiinoantS traegtise,6 3
A Cavaeto nt heE xpansiono fRe gulatoyr Program,s 64
'\S ummary, 6 7
5 THEEV ALUATION OQFU IPEMENT-EMBOD IED TECHNOLOGY 68
What ShoulPdot entiUasle rosf E quipment-Embodied
TehcnologyKn ow AboutT ecnhoolgy,? 68
� To What ExtenAtr eE xsitingP rocdeurse for
Genreatinagn dU singI nfomratino on
Equiepnmt-EmbodieTde cnholoyg Inadequat,e ?75
PropsoedS olutiotnost heP rbole,m 79
GLOSSARY 85
REFERENCES 87
APPENIDXES
A AD ISSNETINGO PININO
Willima s. Yamamoto 99
B A CASES TUDOYF MAMM OGRAPHY
MorrisF .C ollen 101
C ACA SE STUDOYF MULTIHAPSICHE ALTH TESTIGN
Morris F.C ollen 124
D GASTRIFCRE EZIGN--A STUDYO FD IFFUISON OF A
MEDICAL INNOVIAOTN
Harvevy. Finbeegr 173
X
Copyright © National Academy of Sciences. All rights reserved.