The hospital industry could probably use a good shrink to deal with its highly conflicted attitude toward medical technology.
On the one hand, everyone wants the newest and greatest. On the other hand, there's the not-so-small problem of paying for it. It's enough to make the most even-keeled decisionmakers schizophrenic.
"Vendors often know what is coming down the pike and they are the ones telling doctors, `This will allow you to do this procedure better,' and we're often playing catch-up with doctors," says Anne Messbarger-Eguia, director of planning and market research for Christus Health in Irving, Texas. Hospital administrators sometimes must feel like parents trying to restrain their children in FAO Schwarz.
Perhaps the next best thing to a psychiatrist is the Health Technology Center in San Francisco. Founded in January 2001 by Molly Coye, the center serves in the multiple roles of counselor, soothsayer and advocate for hospitals that are increasingly desperate to do the right thing when it comes to clinical technology.
Glancing at Coye's curriculum vitae, one would get the idea that she would be an expert resource to help crack the mysteries of healthcare policy, public health or even Chinese dim sum. But what could she possibly know about the intricacies of medical technology? There is little in Coye's background that would suggest a tech nerd.
A healthy resume
Healthcare credentials don't get any more blue-blooded than Coye's. A Johns Hopkins-educated physician, she headed two different state health departments (New Jersey and California) and served as executive vice president of managed care at Good Samaritan Health System in San Jose, Calif., before the organization was acquired by HCA. She is a member of the Institute of Medicine and was part of the groundbreaking IOM Committee on Quality of Health Care in America that produced industry-reforming reports on quality. Last month, she was appointed to the board of trustees of the American Hospital Association. She also is fluent in Spanish and Chinese.
These days Coye, when she isn't flying somewhere to give a presentation or offer consultation, can be found ensconced in a loft space in the South of Market district of San Francisco, the same place countless dot-coms of the 1990s crashed and burned. As chief executive officer of HealthTech, as it's called for short, Coye heads up a unique, not-for-profit think tank focused on medical and information technology (Sept. 16, 2002, p. 6).
HealthTech's home is a brick-walled, airy walk-up with exposed pipes, a skylight and minimalist furnishings. Where there's no brick, the walls are painted green and blue with the exception of Coye's open office, which, much to the wonderment of her staff, was recently redone in a bright burnt orange that seems to please her. The only downside is that the building is not earthquake-proof, which in a way puts HealthTech in the same boat as many California hospitals that are looking squarely at expensive retrofitting costs.
Computers, of course, are everywhere and Coye's staff of 16 works amid colorful poster charts tacked to the walls that look like the creations of mad but brilliant healthcare wonks that also happen to excel in advanced doodling. Technology can be fun.
Coye recently described how she evolved into the technology guru for hospitals. She was speaking on a cell phone as she rushed through San Francisco International Airport on her way to Seattle. (The discussion was interrupted for about 45 seconds at the security check when she dutifully put the cell phone on the conveyor belt to pass through the X-ray machine.)
The germ of the idea for HealthTech was planted while Coye was at Good Samaritan. She recalls sitting through endless planning meetings where she and other executives were trying to decide how best to invest in information technology equipment with "no idea what else was in the pipeline," she says. There was no way of knowing how to compare technologies "unless you spent a small fortune on consultants."
After Good Samaritan and while working for the Lewin Group in San Francisco and serving on the IOM committee, Coye was the recipient of a $1.2 million Robert Wood Johnson Foundation grant to research healthcare quality issues. "The question I was working on was why at the executive level at (healthcare) systems was it so difficult to get traction on quality? One thing that became clear was that there was not at that time a business case for quality," Coye says. The situation, of course, is changing dramatically thanks in part to the IOM reports, she says. "But at that point it was clear if you improved quality in a healthcare system, you risked losing a lot of revenue."
Coye also found that even though some new technologies clearly were "absolutely critical to improving quality," they were being adopted slowly. Other technologies-minimally invasive surgery, for example-"were going to create challenges for quality either temporarily because of the way they were introduced or long term."
About this time, hospital alliance VHA approached Coye about the very same issues. "I said to VHA, `How come you don't have an early warning system for technology in the pipeline?' and they said, `Great idea. Let's develop one.' "
VHA soon realized that "this was a bigger idea than we thought," says Stuart Baker, VHA's executive vice president of clinical affairs. Working together, Coye and VHA decided to build an early warning system that could benefit the entire industry, establishing HealthTech as a not-for-profit organization. It's grown today to 27 partners, which typically commit for three years and pay annual subscription fees based primarily on size or affiliation with hospital alliances VHA and Premier. The Centers for Medicare and Medicaid Services is a federal liaison, and the Veterans Health Administration is a partner in the same way that hospitals are.
"Hospitals are so engaged in their present crises and pressures. They are in survival mode, really. We're really interested in thinking of migrating pathways to the future-how we are going to get where we need to be from a clinical quality point of view," Baker says.
A growing library
To date, HealthTech has published 17 rigorously researched technology forecast reports, typically 60 pages long, completed by a panel of experts, and it's also developed some technology-planning tools that are available on the HealthTech's Web site, www.healthtech.org. Working groups are exploring what healthcare facilities of the future will look like and tackling the daunting challenges of information technology. HealthTech regularly examines how key technology topics will affect health plans. This year, HealthTech is updating seven technology reports, developing five new ones and working on another half-dozen shorter reports on high-impact technologies such as point-of-care laboratory testing, Coye says. The members have a hand in setting the research agenda and co-designing the strategic planning tools.
Hospitals need not bother looking to the reports for advice on which competing technology to buy from which vendor. Unlike HealthTech partner ECRI, a Plymouth Meeting, Pa.-based not-for-profit health-services research agency modeled after Consumers Union, HealthTech is forecasting more along the lines of what the impact of a specific technology will be on the business of hospitals and other healthcare organizations. ECRI's evidence-based research will "tell you how well a technology works," looking at most perhaps three years down the line, says Jeffrey Lerner, president and CEO of ECRI who also sits on HealthTech's board and co-chairs its methodology committee. HealthTech does more forecasting, which is a riskier type of business.
"Weather forecasting doesn't always get it right, but you're better off with it. No one is advocating abolishing it," Lerner says.
John Doyle, senior vice president of strategic business development and innovation for Ascension Health, St. Louis, says he especially recommends HealthTech's Web-based planning tools. Through computer modeling, hospitals can use their own data to help determine the effects new technology will have on their business.
"HealthTech put together the best minds and best thinking to determine what investments will make sense and what will be the impact on how we operate," Doyle says.
Messbarger-Eguia of Christus Health says the system's membership in HealthTech grew out of an 18-month scenario-planning project, which she led in 2000. Administrators were trying to determine what healthcare delivery systems would look like in 2010 and beyond and they decided there were some major unknowns to determine that: finance and regulation as well as technology.
"Nobody questioned that technology would be advancing quickly, but there was no given as to how quickly and how evenly distributed it would be," she says. It's a tough subject for one hospital system to get its arms around, but HealthTech breaks it down into four digest- ible pieces: how a technology will affect patient care, the facility, the workforce and the cost of providing the technology.
Noting the increasing threat of specialty hospitals on wide-ranging integrated delivery networks, Messbarger-Eguia says, "I think not understanding new technology puts us at an even worse disadvantage." A member of HealthTech for seven months, Christus has decided initially to focus on HealthTech's research on minimally invasive surgery, cardiovascular services, imaging and diagnostics. "We believe what is going on in those areas today is radically changing how we provide care," Messbarger-Eguia says.
MediSys Health Network, a HealthTech member since 2002, is in a slightly different situation. David Rosen, president and CEO of the New York-based system, is trying to figure out ways to invest in technology while "burdened by the cumulative difficulties" of its three financially distressed hospitals. Capital for new technology generally comes out of his operating budget, he says. So Rosen is hoping HealthTech will lead an effort to encourage government agencies to help finance technology in the same way that public-private ventures have helped some hospitals finance construction costs (June 2, p. 17).
"Bricks and mortar don't do it. We need to stay ahead of the game and from my perspective, everything we do is hand to mouth," Rosen says. "Unless there is a mechanism to continue to roll out technology and stay abreast of the field, we will become dinosaurs."