The impact of medical technology on healthcare …

1 Hong Kong Journal of Emergency MedicineThe impact of medical technology on healthcare todayLTH Tan and KL OngCorrespondence to:Ong Kim Lian, FRCSEd, FHKCEM, FHKAM(Emergency Medicine)Prince of Wales Hospital, Accident and Emergency Department,30-32 Ngan Shing Street, Shatin, , Hong KongEmail: Thuan Heng, Lawrence, FRCR, FHKCR, FHKAM(Radiology)Hong Kong Baptist Hospital, Department of Radiology, 222 Waterloo Road, Kowloon, Hong KongIntroductionRapidly changing medical technology and availabilityof high technology diagnostic and therapeuticequipment together with changing practice pattern ofdoctors has revolutionized the way health care is beingdelivered doubt, medical technology is indispensablefor people's health and better quality of life in someareas.

2 And contributes billions of dollars to would go so far to say that the practice ofmedicine these days is inherently dependent uponhealth technology . This is probably based on theobservations that clinicians use a wide variety oftechnologies in diagnosing, treating and assessing thecare of their 's medical technology is more advanced, moreeffective, and in many cases, more costly than everbefore. Furthermore there is an ever increasing demandfor high technology diagnostic and therapeutic healthcare facilities and their availability may come intoconflict with medical necessity, social justice and is increasing pressure on health care resourcesthat is driving more explicit and public decisionsregarding the best use of these resources.

3 Thecomplexity of modern technology and its highmarginal cost suggest to us that testimonial reviewsof new technologies are no longer Currenttrends in health care decision making favour a transitionfrom a rationale based primarily on resources and opinionto a rationale derived from developing a new health care technology it isimportant to recognize its potential impact . Theimportant question would be whether the newtechnology provides information that was notpreviously available and the new information mayresult in the cure of a common and otherwise fataldisease.

4 technology assessment helps physician bydetermining which technologies are most apt tobenefit the patient, allowing the physician torecommend a prudent course of action. Technologyassessment should encourage skepticism of newtechnology, causing the clinician to be more rigorousabout accepting the latest invention. It willsubstantially contribute to better utilization of thescare health care for increased productivity despite cuts infinancial resources have renewed the discussion of costeffectiveness in medical care.

5 Important parametersthat should be considered include the incidence andprevalence of the disease, the cost and success oftreatment, the cost and success of diagnosis, and thecost and success of preventive treatment. Onefundamental issue of health care economics is the studyof cost versus benefit analysis. It is often difficult toplace a dollar value on a person's life, as is commonlydone in the Kong j. emerg. med. Vol. 9(4) Oct 2002232 BenefitsAny new technology , process, innovation or productwill have a certain level of risk associated with it as,contrary to the wistful utterances of many politicians,there are no such thing as 'zero risk'.

6 In fact there canbe no innovation at all without an element of technology industry's point of view is thatthey have to identify the appropriate hazards for aproduct or process, estimate the risks associated withthem, reduce risks by appropriate risk control measuresin an iterative process, taking care that we do notinadvertently introduce new risks by such actions, andconsider the overall residual risks remaining after riskcontrol measures have been implemented. Thedecision on the acceptability of that residual risk musttake into account the benefit to the people inherently believe that the Americanhealthcare system is safe and some countries use it asa yardstick.

7 While this assumption is valid, it is also afact that between 44,000 and 98,000 Americans dieeach year as a result of medical errors in hospitals, anumber greater than the number of people killedannually from car accidents, breast cancer or studies have estimated that medication errorsalone account for over 7,000 deaths Thetotal national cost (including lost income, disabilityand medical expenses) of preventable adverse medicalevents is running between $17-$29 billion medical technology has in this instance helpreduce morbidity and mortality from medial errorsby providing electronic prescriptions that allowphysicians to know if there is drug-drug or drug-foodinteraction.

8 Some systems goes as far as providinginformation on physician profiling and diseasemanagement but also monitoring and assessing thecare delivered to every member in the health examplesThree examples are provided to exemplify the complexissues of advances made in medical technology in thelast few decades and to the extent in which theirbenefits have outweighted their and treating breast cancerDespite the fact that breast cancers are being detectedearlier, it has also been recognized that most breastcancers progress slowly and many occur in olderwomen who may die from other causes before theircancer becomes symptomatic.

9 It has been estimatedthat survival after breast cancer increased by fourmonths during the period and average cost to treatbreast cancer rose by about US$20,000. This wasobserved from innovations in treatment from 1985to 1996 using data from Medicare claims records inthe US matched to the National Cancer Institute'sSurveillance, Epidemiology and End Results for heart attacksHeart attack treatment is a compelling example of thebenefits of new technology . Treatment of heart attackhas changed to include the use of bypass surgery, clotdissolving drugs, angioplasty, angioplasty with stentsand long-term drug therapies that reduce the chanceof additional heart attacks.

10 Spending on heart attackpatients covered by Medicare in the US increased from$3 billion in 1984 to $5 billion in 1998, despite thefact that the number of heart attacks declined. Theseincreased costs were due more to the use of intensivetechnologies rather than to the increase in the cost oftreatment. In 1984 nearly 90% of heart attack patientswere managed medically. By 1998 more than half ofpatients received surgical treatment. It is found thatthe use of new technology treatment helped to increasethe average heart attack patient's life expectancy byone year.