From miniature pacemakers to cybersecurity, healthcare in 2016 will be characterized by a host of important technological advances. HRMR rounds up some of the insights from ECRI Institute’s new report on the subject.
Hospital leaders demand that new technologies and care processes bring higher value, better outcomes, and lower costs to their organizations. To help them sift through the latest healthcare innovations that are molding the landscape of healthcare in 2016 and beyond, ECRI Institute announces the release of its annual Top 10 Hospital C-suite Watch List.
Available as a free public service, the report highlights important new and emerging drugs, devices, procedures, and care processes intended to provide new ways to deliver safe and cost-effective patient care. Each entry includes actionable recommendations in a quick-glance “What to Do” section.
“Taking an evidence-based, ‘just the facts’ approach to assessing new healthcare innovations—from gadgets to drugs to infrastructure issues—that have been on our radar for the last year, we present hospital leaders with unbiased guidance to support informed decision making and help them understand how new innovations will affect care delivery,” says Diane Robertson, director, health technology assessment, ECRI Institute.
"The Watch List draws upon ECRI Institute’s nearly 50 years of experience evaluating and providing technical assistance on the safety, efficacy, and cost-effectiveness of health technologies."
In its 2016 list ECRI Institute, an independent nonprofit that researches the best approaches to improving patient care, examines 10 topics poised to affect care delivery over the next 12 to 18 months.
“Hospital leaders have to deal with a lot of new technology issues—and demands from different departments in their facilities—so this list is intended to assist them in their efforts to update or implement their strategic technology plans,” says Robert Maliff, director, applied solutions group, ECRI Institute.”
Here is a summary of some of the key points.
Mobile stroke units
Summary: A mobile stroke unit (MSU) is a new concept that uses specially outfitted ambulances and a special staff model, telemedicine, and equipment to enable stroke diagnosis and prompt treatment at the patient’s location before transport to the hospital.
What to do: Determine whether your health system’s current approach to treating stroke is meeting desired cost, quality, and patient and institutional outcomes goals. Determine whether your demographics support use of an MSU, and then decide on your staffing model, additional equipment needs, and telemedicine capabilities. Coordinate with your local emergency medical services dispatch services to create a response plan. Develop clinical protocols for use of MSU and how a hospital stroke team will function with an MSU team.
Medical device cyber security
Summary: The hacking of the Hospira Symbiq Infusion in 2015 has many hospital leaders wondering whether they have the risk of medical device cyber hacking under control.
What to do: Include clinical engineering, IT, and risk management staff when creating cybersecurity policies and procedures. Proactively assess medical device cybersecurity risks, working with manufacturers as appropriate, and keep up with the latest updates and patches. Limit network access to medical devices through the use of a firewall or virtual LAN and audit the log-in process to all medical devices to ensure that an access-control method is being followed. Set up a process to monitor and report on cyber security threats and events.
Wireless wearable sensors: data sense or data chaos?
Summary: Health data collection devices such as FitBit and AppleWatch are used daily by consumers to monitor and improve their health. How can health systems put wearable sensors to work to improve cost-effectiveness and safety of patient care throughout the continuum of care?
What to do: Assess situations in which sensor use might enable your facility to decrease length of stay, improve clinical outcomes, reduce ‘never events’, or provide high-quality home care. Don’t rely only on vendor demonstrations; establish several use cases and see the technology in action through site visits where you talk with users (health facility and patient).
Miniature leadless pacemakers
Summary: Next-generation pacemakers in development are less than 10% the size of conventional pacemakers, leadless, and do not require surgery to implant.
What to do: Meet with the interventional cardiovascular team about whether to be an early adopter. Monitor Food and Drug Administration regulatory decisions expected in 2016 and monitor results of ongoing pivotal trials for both devices. If adopting, plan sufficiently for necessary staff training time.
Be alert to individual product warnings regarding patient selection, device repositioning after fixation, and long-term safety.
Blue-violet LED light fixtures
Summary: A new light fixture has recently become available that uses continuous environmental disinfection technology to continuously kill harmful bacteria linked to healthcare-acquired infections, including methicillin-resistant Staphylococcus aureus, Clostridium difficile, and vancomycin-resistant Enterococcus.
What to do: Consult with infection control specialists in your organization to weigh the cost-effectiveness of adopting this technology broadly and the patient areas that might benefit most. Test lights in a few patient rooms before wide implementation. Monitor results of ongoing trials at facilities enrolled in the company’s clinical partners program.
New high-cost cardiovascular drugs
Summary: With growing trends to hold health systems responsible for patient care in and out of the hospital and to prevent readmissions, several newly approved cardiovascular drugs intended for use in homecare settings should be on your radar.
What to do: Because of the high costs of these drugs, be careful about patient selection and possible financial impact on patients. Cardiac care staff will need to teach patients self-injection techniques and appropriate disposal of injectors. Warn patients to seek immediate medical attention if they experience symptoms of a serious allergic reaction. Watch for results of multiple ongoing trials assessing long-term safety and effectiveness of these agents.
Changing landscape of robotic surgery
Summary: With the upcoming decommissioning of the da Vinci S model and the fact that numerous hospitals’ Si models are reaching the end of their useful life, C-suite and surgery leaders are assessing their robotic surgery programs and planning for future growth and technology platforms.
What to do: If you have the da Vinci S model, decide whether and when you want to replace it with another da Vinci model or whether to wait for new developments. Because of the significant capital investment, C-suite and surgery leaders must ensure that costs are managed with a nuanced analysis of the cost-effectiveness of procedures and processes, robotic-specific consumables, staff efficiency, and operating room time optimization.
Spectral computed tomography
Summary: Spectral computed tomography (CT) is not new, but people are talking about it more these days because vendors have recently developed specific spectral technology and tools and have often heavily marketed such developments. The technology does not yet have a solid foundation of evidence demonstrating its purported benefits for various clinical applications that lead to improved diagnosis and patient management, despite more than 10 years of availability.
What to do: Healthcare organizations considering acquiring spectral CT scanners should ensure that the configuration they choose will support a broad range of general CT applications because those other scans may help defray the high procurement and maintenance costs of spectral CT scanners.
Injected bioabsorbable hydrogel
Summary: Many patients with prostate cancer undergo radiation therapy, which can damage adjacent tissue and healthy organs, causing lifelong complications. For many years, clinicians have used hydrogel products as sealants and adhesion barriers to protect the most sensitive body parts. A new bioabsorbable hydrogel technology called the SpaceOAR System is available and intended to protect the rectum of patients with prostate cancer who are receiving radiation therapy.
What to do: Cancer centers adopting this technology will need to create protocols for spacer use and to include patient education materials about this option. The SpaceOAR application procedure may require an ultrasound technologist and anesthesia professional.
Warm donor organ perfusion systems
Summary: About two-thirds of donor lungs and hearts obtained in hospitals are never used because the process of harvesting, preserving, and transporting donor organs can damage organ suitability for transplantation. New technology—the Xvivo Perfusion™ system and the Organ Care™ system—offers the promise of increasing the viability of donated lungs and hearts, and eventually other organs such as the liver, for transplantation. The technology uses machines that provide warm perfusion of donated organs rather than conventional cold storage.
What to do: The perfusion system costs are high. Consider rental or cost-sharing strategies with other transplant centers. Plan for costs associated with training and ongoing field support.
Professionals are also encouraged to join ECRI Institute’s new LinkedIn Group, “Emerging Healthcare Technologies in Patient Care,” for further discussion of these topics.
The Watch List draws upon ECRI Institute’s nearly 50 years of experience evaluating and providing technical assistance on the safety, efficacy, and cost-effectiveness of health technologies. It reflects the unbiased, independent judgment of the institute’s multidisciplinary staff of clinical and technical researchers, engineers, risk management specialists, and healthcare planners and consultants.
It is also informed by the work that ECRI Institute performs as a contractor to the US Agency for Healthcare Research and Quality for the National Healthcare Horizon Scanning System.
The full version of ECRI Institute’s 2016 Top 10 Hospital C-Suite Watch List is available for download here.
ECRI Institute, Diane Robertson, Robert Maliff, US