New medical technologies seem to spring forth constantly, and hardly a day goes by when local news or national morning lifestyle programs don't highlight a state-of-the-art device or technique.
Although it's the business of ECRI Institute to follow these developments, the number of new technologies to keep on the radar is staggering. The drive for innovation in health care technology has slowed down slightly due to the financial crisis, but not much. For a health care leader, it can be bewildering. What works well, what works wonders, what really matters and what should we do first?
As an attempt to find the true signal in this chaotic noise of new developments, ECRI Institute experts published "Top 10 C-Suite Watch List: Hospital Technology Issues for 2012," a white paper that explains 10 developing technologies and technology-related issues to which hospital and system leaders should pay close attention this year. It takes into account the convergence of critical economic, patient safety, reimbursement and regulatory pressures. As in previous years, the effort began with an open call for emerging technology nominations throughout ECRI's staff of nearly 400. This resulted in a list of more than 30 technologies and issues. The list was then circulated among key ECRI Institute thought leaders who individually ranked their top 10 choices.
It is unlikely that any top 10 list for technology will be a perfect reflection of the only true reality. The process of deciding what seems most important helps to provide a better understanding of how to navigate through the myriad choices we face each year. As one can see from the list, the technologies are wide-ranging and the issues complex. Nonetheless, some themes emerge.
Interoperability, Infrastructure
First, everything wants to be connected to everything. Information technology in general and the electronic health record in particular play leading roles in transforming health care. Although progress has occurred in the area of health information technology, it has driven an amazing array of complexity and conundrums. Chief information officers, chief medical officers and clinical engineers must solve a puzzle every day by connecting IT and clinical systems and medical technology systems into a coherent, robust and high-reliability infrastructure.
The push to meet the federal meaningful use threshold now calls for a focus on Stage 2 certification, which requires hospitals to have the necessary IT infrastructure and the ability to transmit patient care data between unaffiliated EHRs. Stage 2 also increases the threshold from some Stage 1 criteria. For example, the threshold for the percentage of patients for which changes to vital signs must be electronically recorded increases from 50 to 80 percent.
Hospitals now need to determine the best and safest way to get this data into their EHR. The latest meaningful use requirements don't specify how this should be done. Technically, manual entry is acceptable, but this negates the efficiency and safety gains achieved with an EHR. A better, safer alternative is the automatic transfer of data from vital signs monitors to the EHR. But that's not easy. Does the organization have the networking — wireless and hardwired — and security infrastructure to put this in place? If your organization hasn't already done so, it's time to start figuring this out.
Clinical Advances
Although the second topic on the list, bariatric surgery techniques, may not surprise too many given their wide play in the media, the newest developments signal more minimally invasive options on the horizon than ever before.
The third item, digital breast tomosynthesis, may not be as familiar. This technology takes digital mammography to a new level, and represents the potential to make mammography images into more CT scan-like images. It uses a rotating X-ray scan around the breast to create an image slice rather than the conventional mammogram view. This imaging technique eliminates the overlapping fog seen on a normal mammogram and provides a crisper view through the breast. One manufacturer already has FDA approval, and several other manufacturers are awaiting approval. While the evidence that this technology results in better patient-centered outcomes is not a foregone conclusion, it certainly seems to be a logical step forward. However, the cost of these new devices is nearly twice that of the conventional digital mammography machines — around $400,000.
An important emerging cardiology topic, the recent availability of a minimally invasive aortic valve replacement for severe aortic stenosis, which affects a significant number of elderly patients, could attract a new patient population to your hospital. The infrastructure requirements for hybrid operating rooms and highly skilled staffing requirements could challenge some budgets for hospitals that want to offer this technology.
Getting Personal
Another theme embedded in ECRI's Top 10 list shows up as the trend toward personalized medicine — in other words, more customized diagnostic and treatment approaches to specific subgroups of patients with the same general condition.
Two of the Top 10 areas touch on it: new cardiac stent and balloon devices and personalized therapeutic cancer vaccines. In the coronary intervention category, developments include fine-tuning existing cardiac stent and balloon angioplasty technology to increase the options available, depending on the specific extent and type of a patient's disease (for example, single vs. multi-vessel disease). The developments encompass new antibody-coated stents, bioabsorbable stents that disappear several months after implantation, multi-vessel Y-shaped stents for complex lesions and drug-eluting angioplasty balloons.
Most of these approaches represent incremental but important developments targeted at preventing treated lesions from reoccluding and obviating the need for the costly, and often risky, dual-antiplatelet therapy required for many months to years after stent implantation.
The second personalized medicine item in the list comes from a potential wave of advances in cancer care — specifically, the development of targeted biologics and therapeutic cancer vaccines. While these new pharmaceuticals have shocking price tags — sometimes $100,000 per patient per year — the promise of changing the blunt war toxicity of conventional chemotherapy to a more targeted, tactical approach has the oncology community hopeful.
In the past year or so, five new chemotherapy agents have been approved in this category, including the first therapeutic cancer vaccine. Initial results have not always lived up to expectations, but the trend in this direction seems clear. In fact, Roche Diagnostics announced plans to spend the majority of its research budget on these personalized cancer treatments. Of course, the costs and the possible severe side-effects may continue to hamper diffusion if substantial benefits do not appear quickly.
The advances in ECRI's 2012 Top 10 list have impressive potential to improve individual health and community well-being. Still, the newest diagnostic techniques and therapies pose an ongoing challenge for those charged with allocating resources within hospitals. It is this Rubik's cube of simultaneously setting priorities, spending strategically and stimulating new growth that challenges even our best thinking and planning. If we are to meet that challenge as individual institutions, systems or even as a nation as a whole, then we all will have to think deliberatively but act quickly. The overarching theme is simple and applies to cell phones and CT scanners alike: today's technology waits for no one. Don't get left behind.
Anthony J. Montagnolo, M.S. (amontagnolo@ecri.org), is executive vice president and chief operating officer at ECRI Institute, Plymouth Meeting, Pa.
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