Identification of obsolete health technologies is difficult because there are no existing data sources specifically dedicated to locating them. Moreover, scientific literature always reports the outcomes of new technologies from the standpoint of the benefit to be afforded by these new techniques versus the best alternatives, and furnishes no information on the possible loss of benefit currently resulting from the use of out-of-date technologies. Another additional confounding factor is that, for most conditions or diseases, there tend to be more than one or two technologies used in their diagnosis or treatment, and it is therefore complicated to have a single standard of reference for comparing the effectiveness of a new versus another potentially obsolete technology.
There is no one common term that encompasses obsolete technologies, something that renders their detection enormously difficult. Hence, while not being exactly synonyms, in English an obsolete technology may be called “old-fashioned”, “out of model”, “disinvested”, “obsolete”, “superseded” and many more. Goodman has defined obsolete technology (obsolete/outmoded/abandoned) as that which is “superseded by other technologies or demonstrated to be ineffective or harmful” (32). Albeit very broad, this is nevertheless an interesting concept and also highlights the fact that it is extremely difficult to draw up generic search strategies which enable such potentially obsolete technologies to be detected. Indeed, search engines such as PubMed contain none of these terms as a MeSH term. This is why it would seem more reasonable for specific obsolete technologies to be designated before proceeding to consult general databases and search for indeterminate obsolete technologies. To this end, the use of networks of experts who report potentially obsolete technologies is extremely useful. Direct contact with clinicians can furnish specific information about obsolete technologies connected with their specialist areas and, what is more, complete with a certain degree of contextualisation and detail. This will depend, both on the availability of the professional for providing the feedback and on the specialisation, since the number of potentially obsolete technologies will be variable. Accessing a large pool of obsolete technologies would call for contact with specialists engaged in all types of specialisations. These reports may well be influenced by the interest felt in incorporating new health technologies in a department, in order to renew those already in place.
Examining data sources that deal with new technologies and possibly indicate which technology can be superseded, as is the case of EuroScan, or examining requests for the incorporation of new technologies in the respective hospitals and health services, both regional and national, may prove useful. However, the information to be completed (technology to be replaced or supplemented) is not always covered, and sometimes, when such information is completed, this is not done with the degree of comprehensiveness required for being able to make use of it, since it is not felt that the field in question could serve for the detection of potentially obsolete technologies. In fact, the use of the prevailing legislation may not be all that useful because, when the incorporation of a new technology is proposed, available studies tend to compare the new technology to other already existing technologies, and, rather than being obsolete technologies as per our definition, such existing technologies tend to have been good treatment standards up to that point in time.
The proposed systematization for the identification would allow creating a database of potentially obsolete technologies and therefore generating alarms for users or health managers on certain technologies in use. This database could be accessible for the public and those organizations interested in obsolete technologies would feed it. Maybe this database would be more cost-effective than doing the prioritisation followed by a rigorous assessment, since many technologies would be detectable employing few resources.
In brief, the most appropriate way to identify potentially obsolete health technologies would be to make direct use of detection networks made up of specialists. These specialists can furnish information about potentially obsolete technologies, though it is likely that such technologies might not be very widely used in clinical practice, and so the impact generated by their assessment and subsequent exclusion from clinical practice would be low. Arguably, a more interesting strategy would be based on examining top-quality systematic reviews or assessment reports, and there identifying potential, apparently superseded technologies. This would have two advantages: on the one hand, the potential technology identified would still be in use in clinical practice and so, in all probability, the impact of its withdrawal would be high; and on the other hand, the quality methodology of the review on which its identification were based would enable many of the questions possibly surrounding the obsolete technology and its characteristics to be answered.