Some of the technologies that hospital executives should be keeping an eye on this year include computerized tomography radiation reduction technologies, proton-beam radiation therapy and ultra-high-field strength magnetic resonance imaging systems, according to a list compiled by the ECRI Institute.
ECRI unveils top 10 C-suite Watch List
The not-for-profit organization, which studies patient safety, released its second Top 10 C-suite Watch List this week. About half of the technologies that appeared on the 2012 list—electronic health records, robotic-assisted surgery, ultra-high-field strength MRI systems and proton-beam radiation therapy—also appeared on the 2009 list, the most recent version.
Other technologies to make the list include minimally invasive bariatric surgery, digital breast tomosynthesis (which creates a three-dimensional image of the breast using X-rays), transcatheter heart valve implantation, development of new cardiac stents and personalized therapeutic vaccines for cancer.
“The price tag for these technologies is going up, and the real question and one of the points we needed to make with this list is that hospitals need to be very selective about where they spend their money,” said Robert Bense, a clinical manager at ECRI. “They don't have the option to buy it all as they may have done many years ago.”
The development of three-dimensional digital breast tomosynthesis has improved diagnostic accuracy but also requires a costly capital purchase and higher operational costs, according to ECRI. In addition, the Food and Drug Administration requires it to be used in addition to full-field digital mammography, not as a replacement.
“Digital breast tomosynthesis is still very new and probably suitable only for sites at the leading edge of technology use and that have considerable capital and operational resources,” according to the ECRI. “Even some early adopters are taking a ‘wait and see' stance to determine whether the clinical utility provides a benefit that is worth the investment.”
For hospitals looking at new CT radiation-reduction technologies, attention to dose-reduction technologies and protocols continues to grow, according to ECRI. Along with the Joint Commission's Sentinel Event alert last year recommending that providers increase efforts to reduce radiation dose, all CT manufacturers offer iterative reconstruction technology, a newer technique that reduces dose but requires additional computing hardware and longer image processing times.
While a replacement CT machine may cost upward of $800,000, the cost of a retrofitted CT machine ranges between $100,000 and $200,000, said Thomas Skorup, ECRI's vice president of applied solutions. The issue for providers is that the life cycle of CT scanner technology is no longer than 10 years.
“Depending where they are in the life cycle of a system, it can be a very difficult decision,” Skorup said.
The ECRI list reported that dose monitoring and measuring are critical elements in radiation dose-reduction and CT manufacturers and third-party organizations offer software to monitor dose. “These tools are just as important as CT scanner technology and will be vital for optimizing dose,” ECRI said.
Ultra-high-field strength MRI systems—also known as 3T systems—and premium performance CT were recognized as the No. 2 technology for hospital executives to pay attention to in 2009. The higher-field-strength MR system is still a priority issue for hospital executives. The cost of the 3T system is, on average, $2.4 million and the clinical value remains difficult to discern, according to ECRI.
“At many sites that may have multiple MRs, whether it is for marketing reasons or other (reasons), we are seeing a slight uptick in the adoption of 3T in systems,” Skorup said. “Sometimes it's hard to tell if that's based on clinical and other forces such as competition.”
Price is also an issue with the development of proton-beam therapy sites. In 2009, ECRI said that hospitals with large radiation oncology programs should monitor the clinical evidence and reimbursement for proton-beam radiation therapy.
This year's list found that reimbursement for centers that offer proton therapy has risen over the last year and a half and the technology continues to interest oncologist, hospitals and patients. In the second half of 2011, Scripps Health announced that it had hired a chief medical physicist for a proton therapy center it plans to open in 2013. Also, Baylor Health Enterprises, US Oncology and Texas Oncology confirmed that they were in discussions to open a proton therapy center in north Texas, and the Mayo Clinic started construction on proton-beam therapy facilities in Phoenix and Rochester, Minn.
What has changed is the interest in carbon ion therapy, which may allow for improved administration of radiation therapy compared to protons and photons, according to ECRI. The costs to build a proton beam or carbon ion therapy facility are similar, about $200 million.
“One of the most significant issues is the increased interest in carbon ion therapy and how that could emerge as a disruptive force to proton-beam therapy, whose efficacy is still unclear,” said Diane Robertson, ECRI's director of health technology assessment information services.
Dr. Steven Schilds, chairman of Mayo Clinic's radiation oncology department in Arizona, said the 20-hospital system may look at building a carbon ion therapy facility but noted that there are some obstacles for carbon ion therapy adoption, including the fact that the therapy is not yet approved in the U.S. and the gantry, which is used to deliver the therapy, can weigh six times as much as the 100-ton gantry used by in proton-beam therapy.
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