Healthcare providers will continue to face difficult choices among an increasingly complex array of clinical-care technologies in the near and longer term. The challenge for administrative and clinical executives is to hone their skills at pattern recognition to discern which technologies are ripe for adoption now and which types need to be planned for in the foreseeable future.
This challenge differs from planning to adopt a single technology. Deciding whether to buy a surgical robot today requires a different mindset than buying a CT scanner or MRI system did in the 1980s. Piecemeal technology acquisition—acquisitions made without a more contextual understanding of groups of technologies that combine into a strategic direction for the health system—can result in very expensive mistakes. So let's look at some trends that compose an intricate weave for decisionmakers.
- New technologies, less invasive treatments. Roadside billboards for hospitals advertising surgical robots have become commonplace. They tout the claimed benefits of state-of-the-art treatment, such as less pain and disfigurement and a swifter return to being “your old self.” This attracts patients, but that is not enough. Decisionmakers face the larger challenge of creating a care environment that incorporates minimally invasive surgery for everything from needle breast biopsies to image-guided cardiac procedures. They might also be weighing the comparative clinical effectiveness for robotic surgery versus the use of increasingly refined surgical instruments not assisted by robotic controls. While minimally invasive surgery is here to stay, the specific medical devices may not be. The point is illustrated, historically, by laser-assisted cholecystectomy, a technology that helped launch the extensive use of minimally invasive technology in the 1980s. Minimally invasive cholecystectomies endured as a trend, but lasers fell into relative disuse for this procedure.
- Continuum-of-care technologies. These technologies are no longer solely hospital based. A patient leaving the hospital for less intensive institution-based care or home care might receive treatment or monitoring far more frequently than in the past. Remotely programmable pacemakers are one example of a technology for which this is now possible. Emerging delivery systems such as accountable care organizations and bundled payment and outcome-based reimbursement policies will drive the trend and extend the types of technologies considered to be the health system's responsibility. A patient takes his or her orthopedic implant home but may return for treatment of a postoperative infection, for which the hospital will be financially responsible.
- IT-enabled medical devices. As hospitals increasingly implement or enhance their EHRs, they will also capture information from medical devices such as remotely programmable pacemakers.
The U.S. Food and Drug Administration is currently weighing how to address technologies that bypass the physician and report directly into EHRs. But even when a technology remains in the hospital or in remote physician offices, there will be an exchange of data, with great consequences and responsibilities for hospitals. For example, if digital mammographic images are imported into a hospital's EHR, the hospital must ensure that an electronic glitch will not crash the larger EHR.
Our final two trends play hand in hand with one another and with the previous three.
- Personalized technology is often associated with genetically based diagnostic tests and treatment and is often considered a future issue because, while diagnostic tests have been developed, treatments lag. But more pharmaceuticals, such as BiDil for African Americans, and medical devices, such as gender-specific implants, are coming.
- Comparative-effectiveness research, which has been gaining traction, may enjoy an influential place through the work of the well-funded Patient Centered Outcomes Research Institute. Comparisons are not simply between two different drugs or a drug and a medical device. Comparative effectiveness compares how technologies compete, in part, by examining ever-better understood subgroups in patient populations.
While we have discussed some of the technology trends, the universe of medical technology—of pharmaceuticals, medical devices and clinical procedures—continues to expand at an extraordinary rate. The challenge for hospitals is to address the specific technologies that fit with larger technological trends, such as the continuing trend toward minimally invasive surgery, and to match that with the organization's capabilities and strategic directions.
Technological development, changing reimbursement practices and public expectations for safe as well as effective care are leading to a fundamental shift in the purview of clinical and administrative executives. “New-era” hospital executives will need competence in enterprise technology management, not just the ability to decide whether to buy a single expensive technology or suite of technologies.
Jeffrey Lerner is president and CEO of the ECRI Institute, a leading healthcare technology assessment organization.