Abstract

Assessment of health care technologies should be an iterative process, not a single event. In the United States there are an increasing number of organized attempts at reassessment of technologies by the health industry, professional societies, and national government agencies, such as the Medical Necessity Project of Blue Cross/Blue Shield, the Clinical Efficacy Assessment Project of the American College of Physicians, and the work of the US Preventive Services Task Force. We examine four clinical practices--electronic fetal monitoring, episiotomy, electroencephalography, and hysterectomy--to illustrate the need to continuously reassess existing technologies and to challenge our current inertia in this critical arena of health practice.

KIE:

The authors emphasize the need to consider continuous reassessment of health care technologies already in use in the face of rising health care costs and of questions about quality and effectiveness. Among the issues covered by Banta and Thacker are the definition and history of technology assessment, the life cycle of a health care technology, and examples of attempts at technology reassessment. They make a case for reassessing four technologies currently in use: electronic fetal monitoring, episiotomy, electroencephalography, and hysterectomy. These technologies are offered as examples of technologies already in place whose introduction into health care was preceded by an initial, nonsystematic assessment. Technologies that are being applied in ways for which they were not intended originally are also candidates for reevaluation and reassessment.