June 25, 2012
Debates about the productivity yield of IT are new to health care but not to other sectors of the economy. During the 1970s and 1980s, the computing capacity of the U.S. economy increased more than a hundredfold while the rate of productivity growth fell dramatically to less than half the rate of the preceding 25 years.1 The relationship between the rapid increase in IT use and the simultaneous slowdown in productivity became widely known as the “IT productivity paradox,” and economists debated whether investing billions of dollars in IT was worthwhile. The Nobel laureate economist Robert Solow observed in 1987 that “you can see the computer age everywhere but in the productivity statistics.”
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May 9, 2012
“Background: Finding measures to enhance the dissemination and implementation of their recommendations has become part of most health technology assessment (HTA) bodies’ preoccupations. The Quebec government HTA organization in Canada observed that some of its projects relied on innovative practices in knowledge production and dissemination. A research was commissioned in order to identify what characterized these practices and to establish whether they could be systematized.
Methods: An exploratory case study was conducted during summer and fall 2010 in the HTA agency in order to determine what made the specificity of its context, and to conceptualize an approach to knowledge production and dissemination that was adapted to the mandate and nature of this form of HTA organization. Six projects were selected. For each, the HTA report and complementary documents were analyzed, and semi-structured interviews were carried out. A narrative literature review of the most recent literature reviews of the principal knowledge into practice frameworks (2005-2010) and of articles describing such frameworks (2000-2010) was undertaken.
Results and discussion: Our observations highlighted an inherent difficulty as regards applying the dominant knowledge translation models to HTA and clinical guidance practices. For the latter, the whole process starts with an evaluation question asked in a problematic situation for which an actionable answer is expected. The objective is to produce the evidence necessary to respond to the decision-maker’s request. The practices we have analyzed revealed an approach to knowledge production and dissemination, which was multidimensional, organic, multidirectional, dynamic, and dependent on interactions with stakeholders. Thus, HTA could be considered as a knowledge mobilization process per se.
Conclusions: HTA’s purpose is to solve a problem by mobilizing the types of evidence required and the concerned actors, in order to support political, organizational or clinical decision-making. HTA relies on the mediation between contextual, colloquial and scientific evidence, as well as on interactions with stakeholders for recommendation making. Defining HTA as a knowledge mobilization process might contribute to consider the different orders of knowledge, the social, political and ethical dimensions, and the interactions with stakeholders, among the essential components required to respond to the preoccupations, needs and contexts of all actors concerned with the evaluation question’s issues.”
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March 7, 2012
This TED talk looks at how crowdsourcing can be used to help improve service to patients. Crowdsourcing is “the practice of obtaining needed services, ideas, or content by soliciting contributions from a large group of people and especially from the online community rather than from traditional employees or suppliers (crowdsourcing, 2011. In Merriam-Webster.com. Retrieved May 8, 2011, from http://www.merriam-webster.com/dictionary/crowdsourcing.).”
According to Lucien Engelen (“a technologist and innovator who is working to put patients into the healthcare team”), “you can use your smartphone to find a local ATM, but what if you need a defibrillator? At TEDxMaastricht, Lucien Engelen shows us online innovations that are changing the way we save lives, including a crowdsourced map of local defibrillators.”
To watch the video visit: http://www.ted.com/talks/lucien_engelen_crowdsource_your_health.html.
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February 24, 2012
KEY MESSAGES:
- Health technology assessment (HTA) is a multidisciplinary area of applied research that produces high quality information about health technologies—drugs, medical technologies and health interventions. The HTA produces recommendations on whether a health technology should be considered, funded and adopted into practice. The goal is to use the research and recommendations from the HTA to inform decisions that will improve quality and cost-effectiveness of healthcare.
- In Canada, there are several well-established agencies at the national and provincial levels that successfully perform HTA. More and more, however, HTA units are being implemented in a local/ hospital-based setting, based on a growing awareness that the local context needs to be taken into account when assessing health technologies.
- Four different models for performing local/hospital-based HTA have been identified and are currently in use world-wide: the ambassador model; mini-HTA; internal committee; and HTA unit. Each has its own strengths and weaknesses. There is insufficient evidence available to adequately assess which of these models would be the best for Canadian hospitals.
- Research shows that local/hospital-based HTA may influence decision-making. There are reports from isolated experiences related to local/hospital-based HTA on hospital decisions and budgets, as well as positive perceptions from managers and clinicians.
- It is difficult to evaluate the overall impacts of HTA on the various levels of healthcare delivery, largely because most hospital-based HTA experiences are recent and there is a paucity of data. Further research is necessary to explore the conditions under which local/hospital-based HTA results and recommendations can have an impact on hospital policies, clinical decisions and quality of patient care.
- The potential exists to share expertise and methodologies between local/hospital-based HTA units. However, there are challenges in directly transferring research knowledge from one organization to another, given the specificity of the context from hospital to hospital.
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February 13, 2012
“If implemented appropriately, health IT can help improve health care providers’ performance, better communication between patients and providers, and enhance patient safety, which ultimately may lead to better care for Americans. Health IT is designed to help improve the performance of health professionals, reduce costs, and enhance patient safety. For example, the number of patients who receive the correct medication in hospitals increases when these hospitals implement well-planned, robust computerized prescribing mechanisms and use barcoding systems. However, poorly designed health IT can create new hazards in the already complex delivery of care.
In the wake of more widespread use of health IT, the Department of Health and Human Services asked the IOM to evaluate health IT safety concerns and to recommend ways that both government and the private sector can make patient care safer using health IT. The IOM finds that safe use of health IT relies on several factors, clinicians and patients among them. Safety analyses should not look for a single cause of problems but should consider the system as a whole when looking for ways to make a safer system. Vendors, users, government, and the private sector all have roles to play. The IOM’s recommendations include improving transparency in the reporting of health IT safety incidents and enhancing monitoring of health IT products.”
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February 1, 2012
“Making decisions about the appropriate allocation of scarce healthcare resources is a necessary but difficult task. It involves consideration of a number of decision criteria, processing disparate streams of information and balancing individual and group/jurisdictional perspectives, not to mention ethical principles. This complex process demands transparency, consistency, and accountability to be perceived as legitimate by the public and healthcare providers and to increase the likelihood of making good decisions…
Consistent healthcare decisionmaking requires systematic consideration of decision criteria and evidence available to inform them. This can be tackled by combining multicriteria decision analysis (MCDA) and Health Technology Assessment (HTA). The objective of this study was to field-test a decision support framework (EVIDEM), explore its utility to a drug advisory committee and test its reliability over time. (The study found that by) promoting systematic consideration of all decision criteria and the underlying evidence, the framework allows a consistent approach to appraising healthcare interventions. Further testing and validation are needed to advance MCDA approaches in healthcare decision-making.”
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January 31, 2012
“This report sets out a strategic vision for how the healthcare system in the UK – and particularly in the NHS – can benefit from the mainstream adoption of genomic technology. It also provides specific recommendations on the steps that need to be taken to realise this vision.
Genomic technologies have the potential to transform the delivery of healthcare in the UK, providing vital insights to support more accurate diagnosis of disease and inform therapeutic decisions – so that more patients get the right treatment at the right time. They can enhance preventive care and enrich our understanding of disease risk, as well as enabling outbreaks of infectious diseases to be controlled faster. Indeed, as the report shows, genomic technologies are already beginning to deliver these benefits within the NHS and UK public health.
Our report looks at how the achievements to date can be built upon, moving towards a world-class system for adopting innovation and spreading the application of genomic technologies within the NHS and through public health programmes, aiming to improve patient outcomes and overall population health. More importantly, it considers the challenges that need to be addressed if the UK is to realise these benefits.”
Posted in READ Portal, Reports & Papers | Tagged with Health care reform, Health technology | No Comments
January 25, 2012
“Ms. H. is a 35-year-old woman from Japan who has had a cough for 3 weeks. Her physician sends her for an x-ray and CT scan that reveal an advanced lesion, which a biopsy confirms to be non–small-cell lung cancer. She has never smoked. Can anything be done for her?
Had Ms. H.’s cancer been diagnosed before 2004, her oncologist might have offered her a treatment to which about 10% of patients have a response, with the remainder gaining a negligible survival benefit and experiencing clinically significant side effects. But her diagnosis was made in 2011, when her biopsy tissue could be analyzed for a panel of genetic variants that can reliably predict whether the disease will respond to treatment. Her tumor was shown to be responsive to a specific targeted agent, whose administration led to a remission lasting almost a year; her only side effect was a rash.
This scenario illustrates the fundamental idea behind personalized medicine: coupling established clinical–pathological indexes with state-of-the-art molecular profiling to create diagnostic, prognostic, and therapeutic strategies precisely tailored to each patient’s requirements — hence the term “precision medicine.” Recent biotechnological advances have led to an explosion of disease-relevant molecular information, with the potential for greatly advancing patient care. However, progress brings new challenges, and the success of precision medicine will depend on establishing frameworks for regulating, compiling, and interpreting the influx of information that can keep pace with rapid scientific developments. In addition, we must make health care stakeholders aware that precision medicine is no longer just a blip on the horizon — and ensure that it lives up to its promise.”
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January 20, 2012
“This article describes the judgements used to interpret evidence in evidence-based medicine (EBM) and health technology assessment (HTA). It outlines the methods and processes of EBM and HTA. Respectively, EBM and HTA are approaches to medical clinical decision making and efficient allocation of scarce health resources. At the heart of both is a concern to review and synthesise evidence, especially evidence derived from randomised controlled trials (RCTs) of clinical effectiveness. The driver of the approach of both is a desire to eliminate, or at least reduce, bias. The hierarchy of evidence, which is used as an indicator of the likelihood of bias, features heavily in the process and methods of EBM and HTA. The epistemological underpinnings of EBM and HTA are explored with particular reference to the distinction between rationalism and empiricism, developed by the philosopher David Hume and elaborated by Immanuel Kant in the Critique of Pure Reason. The importance of Humian and Kantian principles for understanding the projects of EBM and HTA is considered and the ways in which decisions are made in both, within a judgemental framework originally outlined by Kant, are explored.”
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January 17, 2012
To determine whether the services they provide are meeting population needs, local health departments (LHDs) use a variety of formal and informal assessments, including community health assessments and communitywide health-improvement plans. Despite these efforts, the services do not always meet the needs, for a variety of reasons, including competing funding priorities, political mandates, and natural shifts in population makeup and health concerns. Geographic information system (GIS) mapping software provides a promising tool to enhance priority-setting and resource allocation for LHDs by displaying complex geospatial information in an integrated and visual way, enabling staff to compare the geographic distribution of population health in a community (i.e., where services are needed) with the geographic distribution of LHD programs and expenditures (i.e., where services are provided). Using such an approach, LHDs can identify gaps between program services and community health needs. This report presents findings from interviews with 65 staff at four LHDs and three case studies to test potential solutions for how maps can be used to address the gaps between public health needs and LHD services. It describes options for accessing easy-to-use, no-cost GIS data and tools and suggests ways in which LHDs can integrate new GIS approaches into their activities.
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