Fetal imaging and fetal monitoring: finding the ethical issues

Ethical issues are raised in connection with three technologies used to detect abnormalities or distress in the fetus in late pregnancy and during labor: (1) Ultrasound for fetal diagnosis, a technology used with increasing frequency in pregnancy and labor and one which some are advocating for routine use in pregnancy; (2) The newest of the imaging technologies, magnetic resonance imaging (MRI), which is not now commonly used for fetal imaging, but may soon be; (3) The electronic fetal monitors, some of which work by application of the physical principles of ultrasound behavior and raise many of the same ethical issues. This paper argues that women-centered critiques of birthing technologies augment the concern with the health risks posed by those technologies with concerns about the risks that they pose to human relationships.     

Fetal Imaging and Fetal Monitoring

Ethical issues are raised in connection with three technologies used to detect abnormalities or distress in the fetus in late pregnancy and during labor: (1) Ultrasound for fetal diagnosis, a technology used with increasing frequency in pregnancy and labor and one which some are advocating for routine use in pregnancy; (2) The newest of the imaging technologies, magnetic resonance Imaging (MRI), which is not now commonly used for fetal imaging, but may soon be; (3) The electronic fetal monitors, some of which work by application of the physical principles of ultrasound behavior and raise many of the same ethical issues. This paper argues that women-centered critiques of birthing tech- nologies augment the concern with the health risks posed by those technologies with concerns about the risks that they pose to human relationships.     

Exploring digital divides: an examination of eHealth technology use in health information seeking, communication and personal health information management in the USA

Recent government initiatives to deploy health information technology in the USA, coupled with a growing body of scholarly evidence linking online heath information and positive health-related behaviors, indicate a widespread belief that access to health information and health information technologies can help reduce healthcare inequalities. However, it is less clear whether the benefits of greater access to online health information and health information technologies is equitably distributed across population groups, particularly to those who are underserved. To examine this issue, this article employs the 2007 Health Information National Trends Survey (HINTS) to investigate relationships between a variety of socio-economic variables and the use of the web-based technologies for health information seeking, personal health information management and patient-provider communication within the context of the USA. This study reveals interesting patterns in technology adoption, some of which are in line with previous studies, while others are less clear. Whether these patterns indicate early evidence of a narrowing divide in eHealth technology use across population groups as a result of the narrowing divide in Internet access and computer ownership warrants further exploration. In particular, the findings emphasize the need to explore differences in the use of eHealth tools by medically underserved and disadvantaged groups. In so doing, it will be important to explore other psychosocial variables, such as health literacy, that may be better predictors of health consumers' eHealth technology adoption.     

Health care technology in Canada (with special reference to Quebec)

In Canada, all citizens are insured for health services. Health care is a provincial responsibility. The federal role is limited to health care financing, health protection including regulation of pharmaceuticals, and environmental health. The health care system represents a balance among government direction, consumer choice, and provider autonomy. Canada has largely controlled the costs of health care by funding and management mechanisms, the most important of which is the global budget formula used to fund hospitals. This paper discusses the Canadian health care system, with particular emphasis on the province of Quebec. In 1988, the provincial government of Quebec established the first Canadian body dedicated to technology assessment. Since then, a national coordinating office and several other provincial bodies have developed. The work of these and other evaluation efforts has had a growing influence on technology management decisions, particularly those dealing with procurement of capital-intensive technologies. Expanding this influence into the realm of technology use, especially for low-cost, high-volume technologies, remains a challenge.     

Ethical analysis to improve decision-making on health technologies

Health technology assessment (HTA) is the multidisciplinary study of the implications of the development, diffusion and use of health technologies. It supports health-policy decisions by providing a joint knowledge base for decision-makers. To increase its policy relevance, HTA tries to extend beyond effectiveness and costs to also considering the social, organizational and ethical implications of technologies. However, a commonly accepted method for analysing the ethical aspects of health technologies is lacking. This paper describes a model for ethical analysis of health technology that is easy and flexible to use in different organizational settings and cultures. The model is part of the EUnetHTA project, which focuses on the transferability of HTAs between countries. The EUnetHTA ethics model is based on the insight that the whole HTA process is value laden. It is not sufficient to only analyse the ethical consequences of a technology, but also the ethical issues of the whole HTA process must be considered. Selection of assessment topics, methods and outcomes is essentially a value-laden decision. Health technologies may challenge moral or cultural values and beliefs, and their implementation may also have significant impact on people other than the patient. These are essential considerations for health policy. The ethics model is structured around key ethical questions rather than philosophical theories, to be applicable to different cultures and usable by non-philosophers. Integrating ethical considerations into HTA can improve the relevance of technology assessments for health care and health policy in both developed and developing countries.     

Beyond usability: designing effective technology implementation systems to promote patient safety

Evidence is emerging that certain technologies such as computerized provider order entry may reduce the likelihood of patient harm. However, many technologies that should reduce medical errors have been abandoned because of problems with their design, their impact on workflow, and general dissatisfaction with them by end users. Patient safety researchers have therefore looked to human factors engineering for guidance on how to design technologies to be usable (easy to use) and useful (improving job performance, efficiency, and/or quality). While this is a necessary step towards improving the likelihood of end user satisfaction, it is still not sufficient. Human factors engineering research has shown that the manner in which technologies are implemented also needs to be designed carefully if benefits are to be realized. This paper reviews the theoretical knowledge on what leads to successful technology implementation and how this can be translated into specifically designed processes for successful technology change. The literature on diffusion of innovations, technology acceptance, organisational justice, participative decision making, and organisational change is reviewed and strategies for promoting successful implementation are provided. Given the rapid and ever increasing pace of technology implementation in health care, it is critical for the science of technology implementation to be understood and incorporated into efforts to improve patient safety.     

The 'NICE' Approach to Technology Assessment: An Economics Perspective

The National Institute for Clinical Excellence has published guidelines for economic evaluations for considering whether new health care technologies contribute to the efficient use of National Health Service resources. The analytical basis of the guidelines is a comparison of the costs and consequences of new and existing methods for dealing with particular conditions using the incremental cost-effectiveness ratio (ICER). However, this fails to provide an explicit and systematic basis for addressing the dual objectives of health maximisation and equitable availability of technologies in the context of a fixed NHS budget. We show that information on the costs and consequences of a particular technology is insufficient to address issues of efficiency of resource use. In addition, information is required about the total resources available and the alternative uses of those resources. Moreover, because these factors are unlikely to be identical for all settings, it is unlikely that the efficiency of using resources to support a new technology will be the same for all settings, even if the cost and consequences of the technology are the same across settings. Instead of improving the health outcomes from NHS resources, we show that using NICE guidelines to inform decisions about new technologies may lead to increased resources allocated to new technology, increased local variations in the use of new technologies and concerns about the sustainability and affordability of public funding for new technologies.     

The uses of modern technologies: problems and perspectives for industrialized and developing countries

Medical technology, which holds out the promise of improving public health, is obviously important. Nevertheless, it is also true that in some ways today's medical technology seems out of control. In the US, for example, there has been investment in curative technology even beyond the point where one could hope for small gains, while many possibilities in other areas of health technology have been ignored. Therefore, the important question is how to develop, select, and deploy medical technology that will meet human needs without overtaxing our countries' limited resources. In general, there are 4 types of government policies dealing with medical technology, these being research and development policies, evaluation policies, safety and efficacy policies, and policies governing investments and use. By and large, the nations of Latin America tend to be in need of clearly defined health research policies and of improved coordination and communication between institutions doing applied research. I very important research and development question that has not been clearly answered is whether existing resources can be used to produce a more appropriate technology, for in general the region's limited scientific research effort has not been steered in this direction. Regarding evaluation of medical technology, it appears that no Latin American country has as explicit policy or program concerned with the evaluation of medical technology. In the area of safety and efficacy, the mandatory registration of new pharmaceuticals with the government usually provides a basis for regulation of pharmaceutical technology in Latin America. The nature of this registration process varies greatly from country to country, and in most countries except Brazil, little or no original testing is prformed. Medical devices are not generally regulated for safety of efficacy in Latin America. Regarding investment in medical technologies ad the use of those technologies, a large share of the health services in Latin America is provided through public programs. This means that the decisions to invest in and use certain technologies are not dictated by the individuals who wish to use the services, but rather are made by those controlling the systems, often through explicit policies. Ideally, a well coordinated system for assessing medical technology can be broken down into 4 stages: identification of the technologies to be assessed, testing of those technologies, synthesis of all available information, and dissemination of that information to appropriate properties. At the present time, there is little indication that any of these processes are being preformed in an extensive way in most Latin American countries. However, many cases, it would appear possible to have a program which identified technologies in urgent need of assessment, sought information from various sources, and prepared guidelines for action based on this information. This would not be expensive but could be rather useful.     

Second moment method for evaluating human health risks from groundwater contaminated by trichloroethylene.

Pollutants in groundwater aquifers may constitute a significant human health risk. A large variation in response may result among human populations experiencing the same level and duration of exposure to pollutants. Variability in response, as a result of exposure to a carcinogenic contaminant such as trichloroethylene (TCE), can be represented by a distribution function of safe doses. Spatial variability in aquifer characteristics and contaminant transport parameters requires the use of stochastic transport models to quantify variability in exposure concentrations. A second moment method is used to evaluate the probability of exceeding safe dose levels for a contaminated aquifer. The name of this method stems from the fact that the formulation is based on the first and second moments of the random variables. With this method, the probability is a function of the variability of contaminant concentration (which incorporates variability in hydrogeologic parameters such as hydraulic conductivity) and the variability in response in the human population. In this manner, the severity of the health risk posed by a contaminated aquifer and the evaluation of appropriate strategies and technologies for aquifer remediation are a function of contaminant concentrations and human health risks. The applicability and limitations of this method are demonstrated with data on groundwater contaminated by TCE at Hill Air Force Base, Utah.     

Health care technologies in The Netherlands. Assessment and policy.

This article argues that while health care and government authorities in the Netherlands in the last decades have attempted to rationalize the diffusion of medical technology, much work remains to be done. The authors contend that though a mix of direct government regulation and economic incentives will be needed, regulation by incentive is more effective than regulation by directive in achieving cost effective use of technology. Generally, bureaucratic structures provide only limited opportunities for tight control of the diffusion of medical technologies. The article offers possible future strategies for directing the adoption and use of medical technologies and stresses the importance of reliable information culled from comprehensive technology assessments.     

Science and technology for wealth and health in developing countries

Abstract

It is now widely accepted that the developing world needs to invest in science and technology or risk falling behind as the technology gap between the North and South widens. However, these investments must be balanced by continued investment in basic population-wide services, such as healthcare and water supply and sanitation. Achieving this balance is a matter of ongoing debate in policy circles, and leaders and policy-makers in developing countries often have to make difficult decisions that pit investment in new technologies and capacity-building in science and technology against basic population-wide services such as healthcare and water supply and sanitation. The tension is underscored by evidence which suggests that rapidly industrializing economies, like in China, India and Brazil, are actually experiencing a rise in economic and health disparities among their populations. The fact that poor people in an industrializing country must fall behind while the rest of the country marches ahead does not have to be an inevitable outcome of industrialization. This article shows that science and technology can make an important and vital contribution to development, using public health as an example. It suggests the need to focus investments in science and technology in such a way that they can have a positive impact on public health. For instance, the use of simple, hand-held molecular diagnostic tools can help unskilled health workers rapidly and accurately diagnose diseases, thus helping to reduce healthcare costs due to delayed or incorrect diagnoses. Recombinant vaccines can mitigate the risk of infection associated with live or attenuated vaccines, while needle-less delivery methods can help contain the spread of blood-borne infections.

Critical to making technology investments work for population health are government policies and strategies that align public health goals and technology priorities. Such policies can include cross-sectoral training programs to improve dialogue between the technology and health sectors, setting up technology transfer cells to increase commercialization of health research relevant to local needs, and leveraging the phenomenon of low-margin high-volume marketing for health products.     

Ethics and technological advances: contributions of social work practice

Rapid technological advances in biomedicine have created ethical dilemmas for social workers and other health professionals. This article reviews three areas in which advances have been most dramatic; life support for terminally ill and elderly persons, reproductive technologies and services to severely impaired newborns. It presents principles and processes that can help structure decision making when choices are many and difficult to make. Finally, it suggests ways that social work can use its own technology to help humanize and demystify sophisticated medical technology.     

Biases and imperatives in handling medical technology

ObjectivesFor a long time key actors in health care have conceived of medical technology as a rational science-based means to obtain specific human goals, such as reducing suffering and increasing health. However, this appears paradoxical as medical technologies are handled in ways that appear non-rational by the standards of the field itself, e.g., by implementing non-efficient technologies and by not abandoning harmful or low-value technologies. The objective of this article is to investigate this apparent paradox. How can it be explained? Accordingly, the research question is: What biases and imperatives are involved in the handling of medical technology that counter and hamper what is conceived of as rational handling of such technology in medicine and health care?MethodsKahneman's framework of System 1 and 2 modes of thinking from cognitive psychology is applied and combined with Mazarr's analysis of imperatives in order to study and develop a typology of irrational implementation of technology. Examples from health care are found by targeted searches in PubMed.ResultsHealth policy on technology assessment and implementation is based on measures, such as safety, effectiveness, and efficiency. Nevertheless, a range of technologies are implemented and used without obtaining such goals. This can be explained by, a range of affective biases, such as the Identifiability Effect, Affective Forecasting, and Impact bias, as well as cognitive biases, such as the Focusing Illusion, Prominence Effect, Status Quo Bias, Endowment Effect, Availability Heuristics, Anchoring Effect and others. Various imperatives also contribute to this, such as Positive feedback loops, Imperative of Action, Technology Placebo Effect, Imperative of Knowledge, the Boys and Toys Effect and others. Examples illustrate how all of these effects can distort rational technology implementation and policy.ConclusionWe need to include biases and imperatives in our theories and our strategies to handle medical technologies. Believing and acting as if we implement and use technology in health care as external means to our internal goals may be treacherous. Understanding technology indeed includes understanding of ourselves.     

The diffusion of information technology among health maintenance organizations

This article examines the information technology functions, staffing and cost, services provided, and advanced technologies among health maintenance organizations (HMOs) using a national sample of HMOs from mid-1995. HMOs have a well-developed capability to use data from administrative functions, such as claims processing. Nationally affiliated HMOs and HMOs in markets with greater HMO penetration support more IT functions. Relatively little work has been completed integrating clinical with administrative systems.     

The great escape? Prospects for regulating access to technology through health technology assessment

OBJECTIVE: Health technology assessment (HTA) can be used both to promote access to safe, efficacious, and cost-effective technologies, and to discourage access to undesirable ones. Yet HTA has had less success than might be hoped in pursuing the latter goal. This paper examines the scope of HTA as currently practiced to contribute to regulation of access to undesirable technologies. DESIGN: The study design is a critical analysis of HTA's methods, based on an exposition of the normative issues involved in restriction of access to health technologies. The paper classifies technologies that might figure as potential candidates for exclusion into five categories and underscores the key social and ethical dilemmas associated with limiting their use. RESULTS: For four of the five categories of technology outlined, limitation of access necessarily involves denial of benefit. Limitation of access thus inevitably raises difficult normative issues. We show that these are ill-addressed by the range of "evidence" typically considered in technology assessments, which centers predominantly on clinical and technical features such as efficacy, safety, and costs. CONCLUSIONS: If HTA is to enhance our ability to make reasonable decisions concerning the use and diffusion of health technologies, it must better integrate consideration of the social, political, and ethical dimensions of health technologies into the process of technology assessment. We suggest a framework within which to approach this goal.     

Mobile and Traditional Modes of Communication Among Male Latino Farmworkers: Implications for Health Communication and Dissemination

This analysis describes (1) cell phone and smartphone ownership, (2) continuity of phone numbers, (3) use of specific technologies while inside and outside the U.S., and (4) perceived adequacy of specific formats to receive health research results among Latino farmworkers. Telecommunications questionnaires were administered to 165 and 102 farmworkers in North Carolina in 2012 and 2013, respectively. Univariate and bivariate analyses were completed. Increasing numbers of Latino farmworkers own cell phones and smartphones. Talk and text functions are used frequently. Relatively few farmworkers maintain consistent phone numbers. They prefer to receive study results through low technology formats. Strategies to use cell phones to improve health or to share research findings will face obstacles in this population. Public health officials who identify and implement effective strategies to overcome these barriers may be able to harness mobile technologies to address the needs of Latino farmworkers.     

Analyzing the Human Rights Impact of Increased Digital Public Health Surveillance during the COVID-19 Crisis

The COVID-19 pandemic has led policy makers to expand traditional public health surveillance to take advantage of new technologies, such as tracking apps, to control the spread of SARS-CoV-2. This article explores the human rights dimensions of how these new surveillance technologies are being used and assesses the extent to which they entail legitimate restrictions to a range of human rights, including the rights to health, life, and privacy. We argue that human rights offer a crucial framework for protecting the public from regulatory overreach by ensuring that digital health surveillance does not undermine fundamental features of democratic society. First, we describe the surveillance technologies being used to address COVID-19 and reposition these technologies within the evolution of public health surveillance tools and the emergence of discussions concerning the compatibility of such tools with human rights. We then evaluate the potential human rights implications of the surveillance tools being used today by analyzing the extent to which they pass the tests of necessity and proportionality enshrined in international human rights law. We conclude by recommending ways in which the harmful human rights effects associated with these technologies might be reduced and public trust in their use enhanced.     

Improving primary health care through technological innovation.

As a result of policy changes and developments on the demand side, the importance of technology in primary health care will grow fast. An approach to the implementation of new technologies in primary health care is presented in this article. First we describe the main problems in Dutch primary health care. The second step is to identify new technologies which are becoming available. Subsequently, the interface between these problems and their possible technological resolution has to be found. The fact that a technological innovation appears to be a solution is not sufficient reason for introducing it. There are all kinds of reasons why an innovation that has proved useful in the hospital situation, for example, might be of doubtful use in primary health care. Accordingly, the next step is to assess whether a technological solution to a problem in primary health care is indeed an improvement. To acknowledge the particular situation of primary health care, a scheme has been developed that may be used to determine criteria of evaluation.     

“互联网+”背景下如何做好卫生监督工作

随着我国城市化进程的加快,卫生监督监管工作技术含量日益提高,全面性、突发性公共卫生事件的应急管理、处置显得更加重要。这些都意味着卫生监督工作需要面临全新的挑战和接受新任务,在信息技术不断发展的今天,如何在数字卫监的基础上进一步发展,融合新技术、新理念,将信息技术与卫生监督工作有效衔接。“互联网+”背景下,卫生监督工作应该不断提升信息技术融合能力,在监督执法的过程中加强事中、事后的监督和管理,推动卫生监督工作从信息化向智能化转变,从而提升科学管理能力,在提升卫生监督工作质量的同时还可以运用大数据计算,提高管理科学化水平。所以现阶段要做的是推动卫生监督工作信息化水平向智能化发展,将信息技术的作用在工作中进一步凸显出来,促进卫生监督工作的开展。该文就“互联网+”背景下进行卫生监督工作的优势和所存在的问题展开分析,提出“互联网+”背景下做好卫生监督工作的策略。     

Concerning technology: thinking with Heidegger

Abstract  In human lives, technology holds sway in mundane and extraordinary ways, such as in the ways we work, entertain, transport, and feed ourselves, and importantly in the ways we encounter and manage health, disease, illness, and death. A significant area of Heidegger's later work is questioning technology. Unlike many current inquiries that centre on contemporary technology's function, utility, and positive transformations, Heidegger offers a radical way of thinking about technology through developing an inquiry that uncovers technology's essence of revealing. In this article, Heidegger's thinking about technological modes of revealing in regard to bodies, health, and illness is explored. In Heidegger's view, the ordered revealing of modern technology has overshadowed other modes of revealing. This article highlights how remembering concealment and unconcealment in its many modes can be relevant to nurses and others involved in health care. Through tracing Heidegger's thinking about technology, a more critical approach to the effects and outcomes of modern technologies within health care systems can be generated.