Each year at ECRI Institute, we check our collective technology pulse and identify the top 10 technologies to watch. We go through an extensive polling of our technology experts and then rate the current technology advances we think health care leaders should be watching carefully for the next year.
In many ways, today's top health care technology trends build on the past rather than deliver revolutionary breakthroughs to a new horizon. I am reminded of the quote by Isaac Newton: "If I have seen further [than others], it is by standing on the shoulders of giants." Likewise, this year's issues build on the technology themes we all know: health care information technology, imaging, cancer care and pacemaker advances, to name a few examples.
Make no mistake; these advances will change care, just as the evolution of cellphones to smartphones changed communication. And the cellphone analogy leads us to the top two trends in our list that deal with communication: health IT patient safety and mobile health technology advances.
The first technology issue is not the emergence and diffusion of health IT but rather the unintended patient safety consequences of electronic health record use. In late 2011, the Institute of Medicine published "Health IT and Patient Safety: Building Safer Systems for Better Care." While this report noted some of the gains in patient safety from health IT, it also highlighted some of the new, somewhat less-understood dangers to patients that now exist.
At ECRI Institute, our hospital members have begun letting us know about some of the new safety issues cropping up, such as data corruption, data entry errors, inadequate data transfer between systems, data entry into the wrong patient record, and clinician failure to save entered data (something to which many us can relate). Health care leaders and clinicians alike should begin thinking through these new patient safety issues and whether they are being adequately addressed in their organizations.
The second communication trend is the rapid development and expansion of a wide variety of mobile health technologies, also known as mHealth. In short, the smartphone revolution has hit health care. Add to that the amazing tablet devices being used in health care, and it does not take a stretch of the imagination to begin seeing clinician workflow and patient engagement dramatically changing in the next five years. Whether it's clinician access to key test results from virtually anywhere or patients' using apps to better manage their chronic diseases, the flexibility of having powerful applications and data sets in all of our back pockets presents an obvious opportunity to make the wheels of care roll a bit easier and maybe even faster, too. ECRI Institute's advice to leaders: Get ahead of this curve by creating an enterprise mHealth strategy for your organization.
Moving on to machines: We are used to seeing hybrid cars on the street and now we have hybrid technology pushing medical imaging forward. The first major hybrid imaging technology, PET/CT (positron emission tomography scanning combined with CT scanning), already is fairly common. The next hybrid entry is the PET/MR hybrid scanner, which provides a theoretical advantage over PET/CT in that magnetic resonance imaging provides better soft tissue imaging than does computed tomography.
Specifically, that advantage may give physicians an edge in locating and precisely defining tumors, which, in turn, may give physicians more precision in diagnosing and designing effective treatments for cancer. Furthermore, using MR instead of CT eliminates a significant amount of patient exposure to ionizing radiation, which is especially advantageous for pediatric patients who should receive the least amount of ionizing radiation possible. Naturally, marrying two already costly technologies has a hefty price tag — about $7 million. Despite its price, PET/MR seems like a logical next step forward from PET/CT, so health care leaders should keep this on their radar if not quite their capital budget.
Another critical advance comes in the area of cardiac care with a technology that has been around for years — the pacemaker. Medtronic last year launched a pacemaker that is MR-conditional, meaning it has been demonstrated to pose no known hazards in certain magnetic resonance environments.
Until now, imaging a pacemaker patient has been complicated and risky. The Medtronic pacemaker purports to reduce those risks. Although it's more expensive than a conventional pacemaker, it provides an advantage as the use of MRI continues to expand. It is not hard to imagine that as we continue to implant pacemakers and patients live longer that the odds of those patients needing an MRI will increase.
The challenge for providers is to decide which patients get the more expensive MR-conditional pacemaker and then to deal with the potentially higher overall implant costs. Implant costs, in general, are already straining supply budgets, and this device just makes that problem worse.
To round out our list, we selected the potential expansion of low-dose CT screening of patients at high risk of lung cancer. In 2011, the National Cancer Institute halted the National Lung Cancer Screening Trial because early results showed that low-dose CT screening of these patients lowered mortality by 20 percent compared with conventional chest X-rays. Further, organizations such as the American College of Chest Physicians now have released guidelines and recommendations for CT-based lung cancer screening. Though low-dose CT scanning is still in its infancy, it is increasingly important for providers to develop a systematic, evidence-based approach to screening that balances patient benefits vs. risk and cost.
Striking a balance is appropriate when it comes to acquiring and adopting new clinical technology. Too much, too soon may turn out as badly as too little, too late. Finding the right balance means thoughtfully seeking to see over the horizon to what is possible, and that means keeping our eyes peeled for these technological developments and trends. With a little vision, a little luck and a great deal of hard work, we should continue to enjoy the benefits of new technology, even in an era of system transformation.
Anthony J. Montagnolo, M.S. (firstname.lastname@example.org), is executive vice president and chief operating officer of ECRI Institute, Plymouth Meeting, Pa.
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