Academic journal article Journal of Research Administration

Crossing the Great Divide: Adoption of New Technologies, Therapeutics and Diagnostics at Academic Medical Centers

Academic journal article Journal of Research Administration

Crossing the Great Divide: Adoption of New Technologies, Therapeutics and Diagnostics at Academic Medical Centers

Article excerpt

"Technology is dominated by two types of people: those who understand what they do not manage, and those who manage what they do not understand."--Putt's Law

Introduction

At many academic medical centers, adoption of new technologies can be a chaotic and ill-defined process. Traditionally, stakeholder physicians have decided whether to use new medical technologies on the basis of their patients' best interests and wishes. Technologic advances in medicine have the capability to enhance diagnostic and therapeutic options, but in doing so will likely increase the cost of health care. In the era of cost-based charging for medical services, the direct costs of new technologies were not borne by physicians or academic institutions, but simply passed on to payers. Fiscal constraints in health care now increasingly force institutions to assess the absolute and comparative costs of what they do, and to balance these costs against their academic and community missions. If adequate means are not available for evaluating outcomes, diagnostic and therapeutic techniques may be used with little outcome benefit and, in some cases, with high cost and harmful impact.

Today, what is best for an individual patient must be considered relative to what is best for other patients, the institution, and society at large. The competition between physicians' allegiance to their patients and the financial realities confronting society and institutions is increasingly apparent. This tension will likely be amplified by smaller and smaller operating margins in academic medical centers and is already affecting clinical research activities. The unwillingness or inability of premier clinical research facilities to accept technology tested locally may negatively impact the willingness of manufacturers to seek out these institutions as test sites.

A major barrier to a systematic institutional approach to the adoption of innovative technologies and therapeutic methods is what Folland (1997) terms "asymmetry of information." Folland defines "asymmetric information" as "situations in which the parties on the opposite sides of a transaction have different amounts of relevant information." Physicians often lack knowledge and understanding of the financial health of the academic institution and of the impact of new technology. Hospital administrators are usually not well versed in patient management issues or in the technologies themselves. This asymmetry of information leads many academic institutions to make decisions about new technologies in a relative vacuum. Politics, emotion, and the eminence of the physician stakeholder commonly replace an appropriate value-based assessment. Much of the tension around institutional adoption of new technology stems from this asymmetry of information.

Discussions concerning asymmetry of information in healthcare decision-making have traditionally been confined to economists. We believe that this lack of discussion in academic medical centers is counterproductive. Effective technology assessment and adoption requires a balanced and thoughtful review process with information transparency, but such systematic approaches are unfortunately rare.

How then should academic medical institutions contend with new diagnostic or therapeutic technologies? One approach is perhaps best exemplified by a case report concerning new technologies designed to control patient body temperature.

Case Example

Clinicians involved in the care of patients who have suffered a form of acute brain injury called subarachnoid hemorrhage (SAH) have known for some time that fever is a prognostic indicator of a poor outcome. SAH involves the abrupt rupture of blood vessels in the brain, usually from a ruptured aneurysm, and bleeding into the space between the membrane covering the brain and the brain itself. Some 10 to 15% of patients suffering from SAH will die before reaching the hospital. …

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