THE TECHNOLOGY SPECTRUM AND ITS APPLICATION TO ORTHOPEDIC TECHNOLOGIES O Mikhail et al International Journal of Technology Assessment in Health Care Vol 15 (Winter 1999) 254-263
Planning for the adoption of new technologies in today's cost-conscious health care environment is important. Premature or delayed adoption can have serious financial consequences. Technology adoption requires certain information, including
* the point at which the technology's evolution will be when it will be adopted,
* the technology's current state of development, and
* the historic and projected rate of its development.
Researchers in this study present a framework describing the evolution of a technology and apply it to 14 orthopedic technologies.
The evolution of medical technologies. Technologies have many origins, which include inspiration, accident, basic research, or a combination of these. After it is conceived, a technology becomes the center of research efforts. Depending on the type of technology, in vitro research is the first phase in which laboratory work is performed to understand the nature of the technology, its purpose, and how it works. Research application is the next stage, and it focuses on how technology affects living organisms. A successful technology then is applied to humans, and research moves from a controlled experimental setting to a clinical environment. Initial studies focus on the technology's safety and the nature and severity of its adverse or untoward effects. Subsequent larger studies address clinical benefits, efficacy rates, and the frequency of adverse effects. Before a medical technology enters clinical practice, its cost-effectiveness and appropriate role must be established.
After technology moves from medical research to routine clinical practice, more physicians and hospital staff members begin to use it. Its adoption accelerates as insurers begin to recognize its cost-effectiveness and approve its adoption. Even as the technology is being used, it may undergo minor evolutionary changes. Eventually, another emergent technology may replace it.
Technology spectrum. The technology spectrum helps visualize the evolution or life cycle of a technology and characterizes its rate of development. Positioning a technology on the spectrum addresses not only the technology's position at a given time, but also the speed at which the technology moves along the spectrum.
The spectrum incorporates several "continua" and terms to describe the developmental states of a technology. Technology moves along the spectrum from research to development and application. Medical research and clinical practice constitute a major dichotomy on the spectrum. Also central to the technology spectrum are the five edges (ie, virtual, cutting, leading, standard, trailing), which describe a technology at any point in its evolution.
As the technology travels the technology spectrum, the nature of the decision to apply it also moves. Several considerations affect the application decision, including
* indications for use, such as cost-effectiveness;
* outcomes (ie, expected clinical results); and
* application or use (ie, the hands-on procedural or technique considerations in actually using the technology).
As a technology matures along the spectrum, uncertainty associated with use, outcomes, and application decreases.
All health care technologies are subject to the same evolutionary process described in the technology spectrum; however, the rate of evolution varies. Several factors affect the rate of a technology's development and adoption, including regulatory (ie, US Food and Drug Administration) requirements, technological challenges, the degree of clinical benefit or severity of complications, the nature of clinical trials needed to prove benefit and lack of complications, reimbursement issues, and ease of use.
Application of the spectrum. The technology spectrum is presented as a useful framework for institutions attempting to formulate policies about adopting a technology based on that technology's maturation. This is particularly important if a technology requires
* substantial capital allocations,
* major facility adaptation, or
* significant training or retraining of technical staff members and users.
The authors apply the technology spectrum to orthopedic medical technologies. This raises several questions, including whether the spectrum could be useful for nurses and nursing. If so, how could it be used and what outcomes would it achieve?
EDWINA A. McCONNELL
RN, PHD, FRCNA
NURSING RESEARCH COMMITTEE