Intended for healthcare professionals

How Do New Technologies Get Into Practice

Linking health technology assessment to practice

BMJ 1999; 319 doi: (Published 13 November 1999) Cite this as: BMJ 1999;319:1292
  1. Rebecca Rosen, fellow in primary care (,
  2. John Gabbay, professor of public healthb
  1. a King's Fund, London W1M 0AN
  2. b Wessex Institute for Health Research and Development, Community Clinical Sciences Research Division, School of Medicine, Mailpoint 728, University of Southampton, Southampton
  1. Correspondence to R Rosen

    To make best use of scarce healthcare resources the diffusion and adoption of new technologies should be linked to evidence of their clinical and cost effectiveness. 1 2 Yet despite major recent developments in the conduct and dissemination of health technology assessment, 3 4 the diffusion of technologies continues with little reference to research. So why does health technology assessment still have so little impact in the political world of healthcare organisations?

    The answer lies partly in the complexity of the forces (such as clinician enthusiasm, media campaigns, public opinion, manufacturers' inducements, hospital developments, and government regulations) that determine the diffusion of new technologies and the way that health technology assessment interacts with them. For example, government regulations delayed the introduction of lithotripsy in France until French made machines were available, even after its effectiveness was proved in selected patients.5 In contrast, laparoscopic cholecystectomy was in widespread use by 1994 despite there having been only three peer reviewed randomised trials. The reason for this rapid uptake has not been studied in depth, but Hatlie argues that in the United States “a rapid response to the market's demand for new treatment modalities that involve less pain or a shorter recovery period may be wholly appropriate.”6 He admits concern, however, about the additional influences of the revenue interests of surgical centres, surgeons' desires to expand their markets, and manufacturers' desires for equipment sales.

    Summary points

    Reasons for the limited influence of health technology assessment on the use of new technologies include failure to assess the effect of new technologies on the organisations which adopt them, the complex nature of knowledge about new technologies, and the personal and social values through which results are interpreted

    The current focus on clinical and cost effectiveness produces work of limited relevance to managerial decision makers, who …

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