Surveillance of Medical Technologies

Abstract

Technologies from three different medical disciplines are examined in an effort to demonstrate the potential benefit of epidemiologic surveillance of health care technologies. Tubal sterilization is a common surgical procedure done in a healthy population, and a surveillance mechanism is already in place. A surveillance system was instituted for insulin pump therapy in response to a perceived safety problem to demonstrate the need for postmarketing surveillance. Carotid endarterectomy has rapidly diffused into accepted practice in the United States despite the absence of evidence of efficacy and increasing controversy over its safety; no national surveillance is in place to monitor either its use or safety.

Epidemiologic surveillance will provide a mechanism for monitoring the use of a technology, and together with data on morbidity and mortality, will provide an ongoing measure of its effectiveness and safety. Epidemiologic surveillance will also indicate whether an effective technology is being applied to the population which is likely to benefit. For hospital-related technologies, there are available data bases which could facilitate epidemiologic surveillance. In the ambulatory setting, much less information is readily available, and these data needs must be addressed. It is incumbent upon the public health community to recognize the need for improved surveillance of health-care technologies and to take the lead in this endeavor.