Læknablaðið - 15.09.1982, Page 32

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LÆKNABLADID
peutic action, hospital curative services and
sophisticated technology, many of these acti-
vities have now moved to preventive and
promotive services at primary health self,
home and community care. This necessitated a
shift in resources, responsibilities, technology
and training programmes. More appropriate
technology at every health care level, proper
utilization of the techniques and an orientated
development have now been part and parcei
of national health care services.
6. Control of Health Technologies
6.1 Development of appropriate assessment
procedures. The performance of technical
equipment is governed by the quality of both
the hardware and the human operator compo-
nent, the latter being involved in several
activities such as preparation, monitoring and
interpretation. Thus the reliability of results
depends on the technical capability and accu-
racy of the device and, similarly, on the skills
and the conscientiousness of the different
persons engaged in handling the process.
While the human factor is a technico-manage-
rial question, the appropriateness of the in-
strument for the task required has to be
assessed. The testing of instrument perfor-
mance is at present rather limited, the main
reason being the absence of international and
national recommendations for evaluation. The
necessity of coordinating attempts is univer-
sally recognized; such coordination would
obviate unnecessary duplication of work, en-
sure optimal use of expert and financial
resources, provide valuable information to
potential users and ensure comparable results.
Because of the extensive availability of instru-
ments and devices and the rapid introduction
of new ones, certain guiding principles for
assessment methodology and priority testing
must be developed at national and internatio-
nal levels.
With regard to new technologies, those
which are likely to have a considerable impact
should be selected for assessment, especially if
an improved performance is expected, or if
the machines and devices in question possess
further advantages such as economy, reliabili-
ty, speed or precision. Machines already in use
have generally already known features, even if
they have not been evaluated by protocols.
The testing laboratory carrying out the evalu-
ation must be financially independent of the
supplier, and the testing itself may require
several types of laboratory, e.g. physical and
clinical. A comprehensive assessment with
various alternatives is shown in the following
table:
Comprehensive technology assessment
Rating Technical efficacy Clinical efficacy Cost
Ideal High High Low
Acceptable Acceptable High High High
under conditions High Low Low
Not acceptable Low Low High or low
NB: A prerequisite for any assessment is the
relevance of the technology.
It is important for scientists and managers in
the health care services to have factual
information on the operational characteristics
of an instrument and to possess the results of
its evaluation during use before envisaging its
purchase. The ideal situation would be one
where a network of specialized, well coordinat-
ed laboratories could carry out the evaluation
of the equipment, after a study of literature
provided by the manufacturer, e.g. on the
design of the electrical circuit, a manual of
methods and instructions for maintenance and
routine repair. The main features of the
technical evaluation to be considered could be
summarized as follows:
— electrical and mechanical safety,
— precision of the different units of the
equipment,
— accuracy,
— speed,
— reagent and spare parts demand,
— built-in quality control device, to ensure
that the various components are operating
effectively,
— cost of performance,
— maintenance.
The technical evaluation should be followed
by an appropriate clinical assessment includ-
ing comparison with alternative technologies.
As a further part of the assessment activi-
ties, utilization must be considered. It is there-
fore extremely useful to obtain a series of data
which include mainly the local organization of
the health care services in the area to be
served by the medical technology or technolo-
gies, together with demographic, geographic,