Out with the Old, In with the New

Knowing When to Upgrade Technology in Health Care

How do health care professionals decide when it’s time to ditch some innovation in medical technology in favor of the latest upgrade or advice from the medical community?

Researchers from the University of Maryland’s Robert H. Smith School of Business took a close look at how health care professionals abandoned their use of coronary stents, in response to either the emergence of a technology upgrade or in light of new information questioning the efficacy of the existing technology.

The study, “The When and Why of Abandonment,” by the University of Minnesota’s Brad N. Greenwood and the Smith School’s Ritu Agarwal, Rajshree Agarwal and Anandasivam Gopal, was published by the journal Management Science.

While there is a huge literature on adoption of new technologies, less is known about technology abandonment, the researchers said. This is not a trivial issue — if physicians and medical professionals do not keep up with what's state-of-the art in medical knowledge, the downside can be very severe. What drives some professionals to shift to new practices while others don’t is not clear, but it is highly likely that the workplace has some role in encouraging this shift. In this paper, the authors look at features of the hospital where physicians work to see if that influences how soon they abandon older practices for newer ones.

Their research examined coronary stents across three technological upgrades, with data that covered about two million Florida patients over a 12-year period, from 1995 to 2007.

They found striking differences in how quickly physicians in certain hospitals abandoned older technology in favor of a newer upgrade, based on whether the medical center was for-profit, not-for-profit or academic in nature.

Physicians in for-profit hospitals abandoned earlier generation stents in favor of newer stents faster than physicians in not-for-profit hospitals, thereby adopting newer and more expensive stents. But that difference was erased in cases when the efficacy of the technology was questioned.

Academic medical centers, meanwhile, demonstrated the highest rates of abandonment, regardless of the efficacy findings.

“Importantly,” the researchers explained, “we find that organizational factors dominate physician differences as explanatory factors for abandonment.”

Their research identifies which factors play into an organization’s decision to ditch older technology in favor of the new. And it underscores the importance of the organization’s mission in determining how readily it abandons obsolete technology.

Read more: The When and Why of Abandonment: The Role of Organizational Differences In Medical Technology Life Cycles is featured in Management Science.