This paper offers a theory to explain the diffusion of new medical technologies into local practice. Based on several hundred interviews with community hospital physicians, it anchors technology decisions in the norms and relationships of local practice. Physician descriptions of their use of different types of assessment information provide insight into the way in which local consenses on appropriate practice are formed, guide behavior, and change. To understand new technology adoption, it is necessary to (a) differentiate “formed” (complete) and “dynamic” (still developing) technologies, and (b) appreciate the extent to which medical practice is locally organized. Concepts from organizational literature, then, become useful in explaining the penetration of these medical communities and the circumstances under which a new modality takes hold in them. Within the framework presented, previously puzzling findings regarding variations in local practice and the poor relationship between practice behavior and the published literature become understandable.

Programs that disseminate information to health care practitioners often do so partly to encourage appropriate changes in practice. However, merely providing information is seldom enough to accomplish such changes. If information transfer programs are to influence practice, they must be designed to maximize the conditions facilitating change. Reliance on a diffusion model for thinking about how information reaches practitioners has led researchers to over-emphasize the importance of exposure to information and ignore other factors that determine whether change will occur, such as practitioners' motivation to change, the context in which clinical decisions are made, and how information is presented. The fact that successful dissemination will not necessarily produce change also has implications for how information transfer programs should be monitored and evaluated.

This presentation provides an overview of the process of information transfer in a typical area of the medical device industry, that of medical imaging. The medical device industry must translate technological trends into ideas for new methods for diagnosis and treatment. The feasibility of such ideas has to be evaluated carefully, inasmuch as large amounts of money are sometimes invested in product development. Moreover, the knowhow obtained from research must be protected long enough to enable the industry to complete development and market the product.

Biomedical research plays a great part in promoting not only advances in scientific knowledge but also in the continuous flow of technological innovations in health care. One of the first conditions for the successful transformation of research into an innovation is overcoming the divisions between science and technology, between the researchers and their partners in the innovation process.

Biomedical Research Councils (BMRCs) have an important role in the transfer of information. To improve the chances of successful developments and transfers of scientific breakthroughs, the BMRCs must adopt new, comprehensive strategies for such transfer. They must learn to recognize as early as possible which new opportunities hold promise, at which stage of development information should be transferred to other areas of expertise, and which target groups in which fields should be made partners in the research.

Universities, especially those with medical schools whose academics engage in clinical research, have a vital role in shaping the way in which medical technology is used. Academic clinicians are a bridge between laboratory research, where new technologies are developed, and clinical practice, where these technologies are applied in treating patients. Academic clinicians are particularly suited to doing clinical assessment of medical technologies, and academic clinical departments should devote more time to the assessment and application of technology on a broad scale.

Abstract Professional journals are of great importance in the transfer of information about technology, providing most physicians and medical students with the majority of their new information. Professional journals have mission statements and goals and many editorial categories to help achieve their goals. In addition, news media, books, television, and computerized journals are important methods for changing physician knowledge. Physician behavior is changed by many factors of which poor patient outcome is probably the key. Quality of information and activities is best assured by clear definition, goals, proper peer review, and good management. Appropriate use of technology is best approached by separating wants from needs.

Abstract Despite the quantity of material on medical issues which journalists typically receive, and the tremendous public interest in health news, journalists are only rarely able to provide medical information of any real value to the public. Good news, no matter how tentative, always gets more attention than critical assessment. Deadlines pressure journalists to look only at the surface of the issues that they describe, and few have the expertise necessary to judge the importance of their stories. When accurate, authoritative information is available in a structured format; however, the news media can publicize medical findings rapidly, effecting significant changes in public behavior.

The assessment of medical technologies has to answer several questions ranging from safety and effectiveness to complex economical, social, and health policy issues. The type of data needed to carry out such evaluation depends on the specific questions to be answered, as well as on the stage of development of a technology.

Basically two types of data may be distinguished: (a) general demographic, administrative, or financial data which has been collected not specifically for technology assessment; (b) the data collected with respect either to a specific technology or to a disease or medical problem.

On the basis of a pilot inquiry in Europe and bibliographic research, the following categories of type (b) data bases have been identified: registries, clinical data bases, banks of factual and bibliographic knowledge, and expert systems. Examples of each category are discussed briefly. The following aims for further research and practical goals are proposed: criteria for the minimal data set required, improvement to the registries and clinical data banks, and development of an international clearinghouse to enhance information diffusion on both existing data bases and available reports on medical technology assessments.

Seven consensus development conferences have been held in Sweden since 1982. The conferences, sponsored by the Swedish Medical Research Council and Spri, typically examine social, organizational, and economic aspects of technology, and therefore, generate consensus statements of interest not only to physicians but also to politicians and health administrators.

The study presented here examines the influence of the first five consensus development conferences on politicians and health administrators. Data was obtained via a mail questionnaire and personal interviews with leading individuals in these groups. More than half of the respondents indicated that they had found the statements from one or more conferences to be of practical value as a basis for discussing specific technologies with medical staffs. In some cases the statements directly influenced political decisions.

The impact of consensus conferences on physicians was studied in 1985 for the first four conferences Sweden held in 1982–1985. For each conference a main target group was defined as hospital-based physicians in supervisory positions within relevant clinics. Data were collected through a postal survey of all 1,668 members of the four different target groups. The total response rate was 86%. Reported awareness of a particular consensus conference as well as professed knowledge of a single conference statement was high—roughly 90%—for all four conferences. The consensus statement evoked changes in clinical practice according to 7%–10% of the respondents and changes were proportionally higher for physicians in smaller hospitals. Most of the respondents (61%–83%) reported no change, claiming that the consensus statement reflected clinical practices established prior to the conference. The validity of self-reported data is discussed.

The purpose of this paper is to present an update on biomedical technology assessment activities from a United States perspective. In 1985, I described in detail (a) a primary vehicle for technology assessment—the Consensus Development Program (CDP) of the National Institutes of Health (NIH)— and also discussed, in a second paper, (b) the transfer of consensus-enhanced scientific information and some of its impact on U.S. medical practice. Here, I focus on what has transpired during the past year: the changes in the climate in which U.S. technology assessment efforts are being conducted, the consequences of these changes, and the challenges that they pose for all concerned with the provision of quality health care. The first part of this paper centers on the broader framework within which technology assessment plays a role ir the United States. Later, it addresses the specific technology assessment and transfer activities in which the NIH is engaged.

Professional societies in general are designed to support and raise the prestige of the professions they represent, and the most overt way in which they do this is by attempting to keep the level of information concerning their profession as high as possible.

Traditionally, the predominant type of transfer of information has been scientific papers presented at meetings for the memebership, and this it still so in many cases. The large amount of information communication in this way, and its significance, is beyoned doubt.

Technology assessment in its broadest sense is essential if the highest quality of health care is to be matched to available resources. The results of technology assessment will be meaningful only if they can be transferred in a manner that affects practice as well as policy. Therefore, although we are still far short of an effective system for technology assessment, it is not too early to begin grappling with the problems of transferring the results of such a system when it exists.

In considering future developments in information transfer, it is important to keep several caveats in mind.

Prior to the nationwide diffusion of a new technology, evidence must be assembled to demonstrate that a new technology is, in the terminology of WHO, appropriate. Not everything that is new in health technology is good; not all that is good is needed. It is by no means unethical to demand adequate assessment of new technology before it is diffused. On the contrary, it is unethical to squander resources on hazardous and uneffective treatment. Of the methods available for assessment, the randomized clinical trial is among the most valuable. Randomized clinical trials cannot, however, solve all problems. Speed is a critical element. It is not ethical to permit excessive delay. Balanced, relevant, and informative studies must be conducted as quickly as possible and with a maximum of international collaboration. WHO has a valuable role to play in advising on, coordinating, supporting, and disseminating the findings of such studies.

It should be pointed out that during the interviews most of the experts had positive expectations of ESM. The developers are more generally enthusiastic than the prospective users and affected parties who, especially in respect of the diffusion of ESM into practical application, only show a limited optimism.

However, the representatives of the medical profession and the health insurance industry were convinced that ESM might contribute to cost-neutral increases of quality in out-patient and in-patient medicine. But we also understood them to say that they consider other developments in medicine to be overriding, for example, a tendency of general medicine towards a more family-oriented medicine and a reduced emphasis on technology-oriented medicine. In respect of the conception shared by developers as well as potential users that over-enthusiastic expectations should rather be restrained, we consider such a balanced expectation of positive effects of ESM to be adequate to the actual knowledge of the subject.

The third King's Fund Forum was held in London from 8 to 10 April 1987. A panel of 12 from a range of backgrounds listened to evidence from experts in public sessions attended by 200 people, including representatives from many consumer and voluntary organizations as well as health care and social service professionals. After closed sessions the panel discussed its report with the audience; the agreed consensus statement was then presented at a press conference.

May and June were busy months in Europe for technology assessors. Following the International Society meeting in Rotterdam, many people went on to the quality assurance meeting at WHO in Copenhagen and the International Hospital Federation Congress in Helsinki. “Modern Technology—How Much and for Whom,” was one of the main themes of the congress; with an attendance of about 400 there was an opportunity to get the ideas about technology assessment across to a large group of health care managers and professionals. For those of us who spoke it was also a chance to meet members of the Finnish Society for Technology Assessment. This may be the only national society for health technology assessment, and with 70 members, it is clearly going to be influential.