[The introduction of technologies in health care systems: from saying to doing]

Health technology assessment (HTA) is a tool based on scientific evidence useful for making decisions about the introduction of technological advances in healthcare systems. However, there are multiple elements that influence the actual use of the results of HTA. These elements are related both to the characteristics of HTA and to the stakeholders involved -health professionals, politicians, and society. The aim of this article was to describe the main elements that influence the applicability of HTA in practice, as well as the use of HTA in clinical practice and health policy.

A literature search was performed in PubMed. The references retrieved, as well as additional bibliography and gray literature dealing with different aspects of HTA practice identified from the references retrieved, were reviewed. The results are presented descriptively, with analysis of the studies grouped according to the various HTA-related topics.

Key elements that could be improved are standardization of the evaluation process, description of the organization's mission, prioritization of the technologies to be assessed, the clarity of the presentation of results, inclusion of values other than scientific evidence, such as social and cost-effectiveness values, and increased international coordination.

For many people, the rationale for HTA is its explicit role in decision making, despite its problems. The immediate future of HTA would seem to include making the assessment process explicit, and the inclusion of HTA in decision making. This entails prioritization of technologies, setting limits on resource allocation and interrelation with political processes.