Beyond effectiveness: the evaluation of information systems using a comprehensive health technology assessment framework
Section snippets
Introduction and purpose
Decision-making in health care is increasingly expected to be transparent and accountable. The decision process itself should also be clear and explicit, since otherwise it is unlikely to produce consistent conclusions. Health care administrators consequently need the kind of high-quality information that supports rational and defensible policy choices. Yet decisions on the adoption of emerging health care technologies are often made in the absence of comprehensive (or even general) information
The framework
Building on previous studies on the subject [11], [12], [13], the framework for technology decisions in health care was developed incorporating four key dimensions (see Table 1). The first three dimensions—epidemiological context (population at risk, and population impact), economic context, and broad social context (including ethical, legal, and political concerns)—are descriptive elements of the health issue in question and the social environmental context within which the issue is defined.
Indicators
All the above-mentioned dimensions of the Framework are dependent on appropriate indicators (empirical measures) used to define and accurately describe the specific policy issues of importance to the decision-making team.
The availability and quality of the scientific evidence are therefore important factors for using a critical approach. It should not be supposed, however, that the lack of accurate data will necessarily obstruct the decision-making process, since raising a set of appropriate
Information systems evaluation
What does the Comprehensive Framework offer in the evaluation of health information systems? Other frameworks exist which aim for comprehensiveness, and which acknowledge that systems impact complex social and behavioural processes [14]. Their scope, however, is primarily limited to impacts on the organizational setting of application. Evaluation approaches which do not go beyond organizational interests preclude the consideration of more widespread population or political impacts. Although
Summary
This paper develops and describes a Comprehensive Health Technology Assessment Framework, capable of guiding rational decision-making about the adoption of new health technology. We raise three questions essential to this type of process: Who?; What for?; and How much and for whom? The answers will identify the people influenced by and influencing the decision, ascertain the purpose and value of the new technology, identify the beneficiaries, and quantify the benefit.
The major dimensions of the
Arminée Kazanjian is Associate Director, Centre for Health Services and Policy Research and Associate Professor of Health Care and Epidemiology, Faculty of Medicine, The University of British Columbia, Vancouver, Canada. A sociologist by training, Professor Kazanjian earned her Doctorate from the Sorbonne. She is the principal investigator and director of two programs of research: health technology assessment, and health workforce policy and planning. Current major areas of interest include the
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Arminée Kazanjian is Associate Director, Centre for Health Services and Policy Research and Associate Professor of Health Care and Epidemiology, Faculty of Medicine, The University of British Columbia, Vancouver, Canada. A sociologist by training, Professor Kazanjian earned her Doctorate from the Sorbonne. She is the principal investigator and director of two programs of research: health technology assessment, and health workforce policy and planning. Current major areas of interest include the role of evidence in policy decisions; the quality of information used by decision-makers and its appraisal; the social context of technological diffusion; and the incorporation of evidence-based practice into professional training. Dr. Kazanjian's research draws from a broad range of analytic fields: policy analysis, analysis of large databases and data linkage, and gender-based analysis.
Carolyn J. Green is Research Coordinator with the BC Office of Health Technology Assessment, Centre for Health Services and Policy Research, The University of British Columbia, Vancouver, Canada. Her research interests include research synthesis methodology incorporating critical appraisal, meta-analysis, utilization analysis and decision analysis using data from administrative databases, systematic reviews and clinical trials. She is also a doctoral candidate in Health Information Science at the University of Victoria where she is pursuing her research interest in the application of information technologies to enhance research uptake in health care system evaluation, planning and policy development. As project leader in health technology assessments she has conducted nine major reviews including evaluations of screening and diagnostic testing, as well as pharmaceutical, surgical and complementary medicine interventions. Carolyn Green has an M.Sc. from the Department of Health Care and Epidemiology at UBC and a B.H.Sc. (Physiotherapy) from McMaster.