When the finger of blame points to culprits behind healthcare's unrelenting cost spiral, the technology explosion is a prime candidate for a share of the responsibility.
But once the blame is assessed, there's little agreement on how to use limited resources wisely. It's an issue that hospital executives struggle with daily as they try to ratchet down costs and offer added value to their communities.
Efforts to assess and manage the adoption of clinical technology have done little to clarify the question of what types of medical care provide the most bang for the buck.
In some cases, we know which drugs, devices and medical procedures work, but many areas are controversial, and many common procedures have never been examined. Those techniques that have been popular-such as analyzing administrative databases-show how physicians use technologies but don't establish which work best. Clinical trials show effectiveness, but they don't always compare those techniques with alternative technologies.
Clinical practice guidelines being developed to help providers determine the best use of technology can vary widely, and guidelines on the same topic sometimes are in conflict.
That's why we are encouraged by several efforts to clarify the subject of technology assessment. University Hospital Consortium has established 10 criteria critical to successful evaluation of technology. The Leonard Davis Institute of Health Economics at the University of Pennsylvania has established guidelines to help eliminate or minimize real or perceived bias in economic outcomes research conducted as part of pharmaceutical, biotechnological and healthcare device development.
And Medical Alley, an association of Minnesota managed-care organizations, medical device manufacturers and purchasers of healthcare, has established 12 criteria for evaluating cost-effectiveness of technology.
Medical Alley's effort is particularly valuable because it balances divergent views of employers, consumers, hospitals, manufacturers and other parties needed to make evaluation efforts successful.
Such a broad-based approach should be duplicated in establishing a national policy on technology evaluation. A collaborative technique also would pay dividends for insurers that plan to follow the lead of Blue Cross of California in giving preferred treatment to low-cost providers.
The management of technology costs by providers is imperative. But in the final analysis, all parties need to agree that "cost-effective" means more than just "least-expensive."