A. Health Technology

Technology is the practical application of knowledge. Health technology is the practical application of knowledge to improve or maintain individual and population health. Three ways to describe health technology include its physical nature, its purpose, and its stage of diffusion.

1. Physical Nature

For many people, the term “technology” connotes mechanical devices or instrumentation; to others, it is a short form of “information technology,” such as computers, networking, software, and other equipment and processes to manage information. However, the practical application of knowledge in health care is quite broad. Main categories of health technology include the following.

  • Drugs: e.g., aspirin, beta-blockers, antibiotics, cancer chemotherapy
  • Biologics: e.g., vaccines, blood products, cellular and gene therapies
  • Devices, equipment and supplies: e.g., cardiac pacemaker, magnetic resonance imaging (MRI) scanner, surgical gloves, diagnostic test kits, mosquito netting
  • Medical and surgical procedures: e.g., acupuncture, nutrition counseling, psychotherapy, coronary angiography, gall bladder removal, bariatric surgery, cesarean section
  • Public health programs: e.g., water purification system, immunization program, smoking prevention program
  • Support systems: e.g., clinical laboratory, blood bank, electronic health record system, telemedicine systems, drug formulary,
  • Organizational and managerial systems: e.g., medication adherence program, prospective payment using diagnosis-related groups, alternative health care delivery configurations

Certainly, these categories are interdependent; for example, vaccines are biologics that are used in immunization programs, and screening tests for pathogens in donated blood are used by blood banks.

2. Purpose or Application

Technologies can also be grouped according to their health care purpose, i.e.:

  • Prevention: protect against disease by preventing it from occurring, reducing the risk of its occurrence, or limiting its extent or sequelae (e.g., immunization, hospital infection control program, fluoridated water supply)
  • Screening: detect a disease, abnormality, or associated risk factors in asymptomatic people (e.g., Pap smear, tuberculin test, screening mammography, serum cholesterol testing)
  • Diagnosis: identify the cause and nature or extent of disease in a person with clinical signs or symptoms (e.g., electrocardiogram, serological test for typhoid, x-ray for possible broken bone)
  • Treatment: intended to improve or maintain health status or avoid further deterioration (e.g., antiviral therapy, coronary artery bypass graft surgery, psychotherapy)
  • Rehabilitation: restore, maintain or improve a physically or mentally disabled person's function and well-being (e.g., exercise program for post-stroke patients, assistive device for severe speech impairment, incontinence aid)
  • Palliation: improve the quality of life of patients, particularly for relief of pain, symptoms, discomfort, and stress of serious illness, as well as psychological, social, and spiritual problems. (Although often provided for progressive, incurable disease, palliation can be provided at any point in illness and with treatment, e.g., patient-controlled analgesia, medication for depression or insomnia, caregiver support.)

Not all technologies fall neatly into single categories. Many tests and other technologies used for diagnosis also are used for screening. (The probability that a patient who has a positive test result for a particular disease or condition truly has that disease or condition is greatly affected by whether the test was used for screening asymptomatic patients or diagnosing symptomatic patients. See discussion of “predictive value positive,” below.) Some technologies are used for diagnosis as well as treatment, e.g., coronary angiography to diagnose heart disease and to guide percutaneous coronary interventions. Implantable cardioverter defibrillators detect potentially life-threatening heart arrhythmias and deliver electrical pulses to restore normal heart rhythm. Electronic health record systems can support all of these technological purposes or applications.

Certain “hybrid” or “combination” technologies combine characteristics of drugs, devices or other major categories of technology (Goodman 1993; Lewin Group 2001; Lauritsen 2009). Among the many examples of these are: photodynamic therapy, in which drugs are laser-activated (e.g., for targeted destruction of cancer cells); local drug delivery technologies (e.g., antibiotic bone cement, drug patches, drug inhalers, implantable drug pumps, and drug-eluting coronary artery stents); spermicidal condoms; and bioartificial organs that combine natural tissues and artificial components. Examples of hybrid technologies that have complicated regulatory approval and coverage decisions are positron-emission tomography (PET, used with radiopharmaceuticals) (Coleman 1992), metered-dose inhalers (Massa 2002), and certain targeted drugs that are developed in combination with pharmacogenomic tests that are predictive of patient response to those therapies. These pharmacogenomic test-drug combinations may require clinical trials demonstrating the clinical utility of the tests as well as the safety and efficacy of the accompanying drug (US Food and Drug Administration 2007; Hudson 2011).

3. Stage of Diffusion

Technologies may be assessed at different stages of diffusion and maturity. In general, health care technologies may be described as being:

  • Future: in a conceptual stage, anticipated, or in the earliest stages of development
  • Experimental: undergoing bench or laboratory testing using animals or other models
  • Investigational: undergoing initial clinical (i.e., in humans) evaluation for a particular condition or indication
  • Established: considered by clinicians to be a standard approach to a particular condition or indication and diffused into general use
  • Obsolete/outmoded/abandoned: superseded by other technologies or demonstrated to be ineffective or harmful

Often, these stages are not clearly delineated, and technologies do not necessarily mature through them in a linear fashion. A technology may be investigational for certain indications, established for others, and outmoded or abandoned for still others, such as autologous bone marrow transplantation with high-dose chemotherapy for certain types of cancers (Rettig 2007). Many technologies undergo multiple incremental innovations after their initial acceptance into general practice (Gelijns 1994; Reiser 1994). A technology that was once considered obsolete may return to established use for a better-defined or entirely different clinical purpose. A prominent example is thalidomide, whose use as a sedative during pregnancy was halted 50 years ago when it was found to induce severe fetal malformation, but which is now used to treat such conditions as leprosy, advanced multiple myeloma, chronic graft vs. host disease, and certain complications of HIV infection (Breitkreutz 2008; Zhou 2013).

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