The assessment process: a microscopic view.

Abstract

A medical technology evolves through several stages in its path towards development, clinical utilization and eventual obsolescence. These stages include Invention, Evaluation of Safety and Efficacy, Implementation, Marketing, General Evaluation, Comparison to Existing Technologies, Evaluation of Long-Term Effects, Modification and Replacement. At each stage the impact of the technology on health care quality and cost should be evaluated according to methods most suitable for the particular stage. The development of a technology, and its assessment at various stages, can be illustrated by the example of electronic fetal monitoring (EFM). This technology was introduced in 1968 with considerable enthusiasm, and several opinions were published that it was unethical to deliver any baby without EFM. However, the ongoing assessment process for EFM resulted eventually in guidelines from the American College of Obstetrics and Gynecology that EFM is not indicated in low-risk pregnancies. As a consequence, the medical profession has reconsidered the wholesale use of EFM during deliveries.