Technology assessments and their applications

Technology Assessments

Prior to launching into an assignment to create a Technology Assessment Committee, it is prudent to offer an in-depth description of a TAC, and the need therein.

Introduction to Technology Assessment in Hospitals

Technology Assessment Committee should be "incorporated into the strategic management of a hospital," according to Uphoff & Krane, and perhaps that is an understatement. Why? For two critical reasons: 1) Given the pivotal need for constant upgrading of technologies which hospitals rely upon for the delivery of maximum health care to patients, and the fact that financial resources are scarce in many hospitals, a TAC is vital; and 2) Given the fact that stress and burnout are being reported as widespread among health care professionals - and that there are key decisions to be made as to whether to spend money to bring in new technology or spend money to upgrade working conditions and pay for employees - a TAC makes logical and reasonable sense.

Meantime, Uphoff & Krane add fuel to the fire of the vital need for TACs with their shocking revelation that about 2,000 MRI scanners were recently in place in hospitals around America - at an average cost of $1.5 million each - and yet, "not a single study examining the effect on patient outcomes" of MRIs was to be found. This situation cries out for pre-purchasing evaluation by hospital administrators, doctors, and staff - which is why the Uphoff & Krane piece is highly germane to the issue.

Technically, TA is "a systematic process to develop evidence by which to form a conclusion as to the merits of a particular technology." The key word in use here is "systematic" - the exact opposite of a seat-of-the-pants process where so-called decision-makers huddle at irregular sessions to hastily give the green - or red - light to a proposed purchase of technology.

The Approach to Creating a TAC

First, the selection of decision-makers must be finalized. "Successful TACs have ranged in size from 5 to 32 members," according to the Uphoff and Krane piece, but they add, and I concur, "a group of 12 members..." is more workable. Thirty-two people in one room trying to make decisions on spending for technology would be totally absurd. Hours would be spent haggling, as many of those 32 would likely be in the dark about the proposed technology, and would need enlightening, thus dragging the meeting down.

And what departments should be included? The article suggests representation from all major clinical groups, plus an administration person and staff from nursing, pharmacy, allied health, marketing, risk management, biomedical engineering and ethics, and of course, doctors. And, in the event that regular TAC members do not have the knowledge to make solid decisions, "ad hoc members can be called in." This makes perfect sense, and that is how I would build a streamlined, cohesive TAC in my hospital.

The authors emphasize that the following questions must be asked, in preparation for TAC members to make intelligent, informed choices, and the authors also raise fundamental issues with their questions, all of which I agree are absolutely essential: Does the technology work? Is it safe? Does it improve existing technology? How will it impact the hospital in the big picture? How much does it cost and how urgently is it needed? How does it fit the hospital's strategic plan? How will patients be effected; are there risks associated with it? Are there regulatory constraints and ethical considerations?

As to the composition of the TAC, I believe that before the 12-member group is chosen from the myriad departments of the hospital, that a very open and inclusive selection process should be initiated. My suggestion is that first, prior to establishing the TAC, a 6-member sub-committee of technologically and fiscally knowledgeable professionals - from six decisive areas of the hospital - should be put in place to make assessments in advance of the whole TAC. Call this a Pre-TAC Committee, if you will.

One of the most important jobs of the Pre-TAC Committee will be to research how effective or ineffective the proposed technology has been in other hospital environments, and how solid the company is that is manufacturing the technology. Does that company have a good record when it comes to long-term performance? How viable is the company with reference to its competition in the marketplace? What about the highly critical customer service and technical support that will be needed? The Pre-TAC Committee will then make an exhaustive report to the TAC prior to each decision-making session which the TAC will hold.