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Up Close 
Up Close
with HealthTech’s research team
Gazing into the crystal ball of
technology trends
by Rick Dana Barlow
L to R: Anil Rao, Ateret Haselkorn, Jason Kell and
Kent Soo Hoo.
For San Francisco-based Health Technology Center (a. k.
a. HealthTech) analyzing past trends, observing and interpreting current
trends and integrating all of that to forecast future trends not only is
a way of life but a lot of fun.
Still, it represents a lot of hard work and painstaking
research and sourcing, which healthcare providers and suppliers
routinely rely on to make business decisions for the good of their
organizations and patients.
Healthcare Purchasing News Senior Editor Rick Dana
Barlow posed a series of thought-provoking questions to HealthTech
research project managers Jennifer Monti, Ateret Haselkorn , Anil Rao,
Katherine Horney and Kent Soo Hoo about technological concepts and
adoption and implementation trends among healthcare providers. As the
quintet stretched their imaginations they offered some valuable insights
about what potentially lies ahead.
HPN: You work with healthcare facilities to help them
make decisions about improving their operations and outcomes through the
use of advanced technology. What are some of the key trends you see in
the technology arena that will impact how hospitals and outpatient care
facilities deliver care and treat patients?
MONTI: Genetic
testing will allow for stratification of patients based on
predisposition to disease; care pathways will be modified based on which
cohort your genetic profile suggests. Pharmacogenomics will allow for
more effective drug treatments. Minimally invasive and non-invasive
surgery will be responsible for a lot of the shift of surgery from
inpatient to outpatient and even medical office building space. We’ll
see improved equipment as well as more control of radiosurgery,
cryoablations, radiofrequency ablations, etc. In the materials sciences
area we’ll see improved biomaterials allowing for devices to be more
compatible with body tissues. Drug-eluting stents are great examples, as
well as LVADs [left ventricular assist devices], bone scaffolds, etc.
If you were to strap on a pair of 3-D goggles and peer
20 years into the future what does the next-generation hospital and
outpatient care facility realistically look like in your mind? How do
they function differently in 2025 than today for maximum effectiveness
and efficiency?
MONTI: Most
care will be given in the outpatient setting, a setting that is
physically and operationally separate from the inpatient space. With
advances in sensing and remote patient management, patients that finally
do end up in the hospital will be highly acute. Outpatient care
facilities will subsequently have much more advanced equipment in them
for performing surgeries and other interventions that were once
conducted in the inpatient space. You can imagine a third space that is
like a ‘command and control center’ – with the IT system being used to
constantly monitor patients. Data flows back in real time, and a
clinician is constantly available to monitor any red flags. This is
already beginning to happen with the eICU – and health delivery systems
will, 20 years from now, be making more concerted efforts to retain the
remote monitoring business.
What are some of the key technological trends you
foresee? Device and equipment miniaturization? Multifunctional devices
and equipment? Patient biosensors (external via clothing, for example,
and implantable)? Micro robotics and nanotechnology? ‘Smart’ instruments
with tactile sensitivity to discern organs and tissues? Adaptive imaging
modalities that track motion for more effective therapy and treatment?
Non-invasive surgery (via lasers, etc.)? Intuitive computers?
Interconnectivity and integration of information? Plug-and-play ease of
use?
HASELKORN: In
the next two to five years, use of sensors for continuous patient
monitoring will allow treatment to be more predictive in nature, often
taking place before the onset of symptoms. This will improve patient
quality of life, decrease length of stay, and reduce morbidity and
mortality. Non-invasive monitors also represent great areas of progress.
For example, in the short-term, non-invasive acoustic brain monitors
will be able to distinguish an ischemic stroke from a hemorrhagic
stroke, avoiding a complicated and invasive procedure. Finally, advances
in smart, implantable pumps will lead to the creation of a closed-loop
insulin pump for diabetes in the five to ten year time frame.
RAO:
Nanotechnology will have an impact in the clinical setting in three
primary areas: Early detection of disease, improved targeting and
delivery of drugs, and improved biocompatibility of implants. Specific
technologies that we can expect to see in the next fifteen years include
point-of-care biomarker diagnostic devices, and targeted, non-invasive
ablation of cancerous cells that minimizes damage to surrounding healthy
tissue. The emerging field of tissue engineering will also benefit from
nanobiological scaffolds in orthopedic and neural tissue
regeneration. Also, implantable sensing and monitoring devices, for
example in diabetes management, are also expected to have a significant
impact in the coming decade.
In the robotics space, the next generation of surgical
robots will use ‘force-feedback’ instrumentation that allows a robotic
procedure to more closely mimic a conventional procedure. These virtual
surgical environments will reduce physician training time and improve
patient outcomes.
MONTI:
I think it is important to add simulation
technologies to the list because it is just beginning to take off in the
surgical realm, and it is likely that simulation will play an even more
important role in the future education and training of physicians. This
technology has been used in aviation for years; there is growing
recognition of the value of letting surgeons earn their stripes in a
virtual environment before having them work in live patients. There are
some hospitals in Australia that are requiring their surgeons to work in
simulation if they have been away from patients for more than two weeks.
Medical schools are investing in these technologies, and young surgeons
will consider their availability to be a requisite part of surgical
practice.
What technological innovations would you like to see in
place by 2025 that promote efficiency, generate revenue, save time and
ensure patient safety in hospitals and outpatient care facilities?
HORNEY: EMR
would definitely promote efficiency, generate revenue and ensure patient
safety. Obviously, we don’t want to wait until 2025 and the goal is
2010. Looking further out, I think telemedicine can also promote
efficiency, generate revenue, ensure patient safety – even in the
outpatient arena.
Do you foresee next-generation hospitals and outpatient
care facilities incorporating laboratory, oncology and/or radiology
equipment in surgical suites so that more comprehensive patient care is
delivered in a single area and surgical procedure accuracy is achieved?
Why?
MONTI: I think
what we are talking about here is point-of-care testing and imaging
technologies, and yes, I think next-generation facilities will
incorporate these technologies into the surgical suite because there is
growing evidence that these technologies improve patient care.
Point-of-care lab is a good example that our group has studied
extensively. In charting the process from ‘physician request test’ to
‘results received and therapy initiated’ traditional testing took one
hour, 50 minutes. Point-of-care testing achieved similar results in five
minutes. This technology has a very strong bearing on operations when
you think through a lens of time. There are basic point-of-care tests
that are done now, and a few organizations are beginning to consistently
move beyond glucose in their use of point-of-care testing – into enzyme
tests, etc.
Also, thinking about imaging – one of the things that is
evident is that pre-surgical images, while valuable pre-operatively, do
not account for the movements that occur during surgery. Take, for
example, brain surgery – there is bound to be shifting and settling as
surgeons work to get at a lesion. The difference between healthy and
disease tissue is minute and difficult to discern. This has often just
been done with the trained eye of the surgeon. Intraoperative imaging
will remove some of this dependence on qualitative experience, and allow
for a more appropriate flow for the procedure. Operating rooms, even in
the outpatient setting are being built with significant lead shielding
as planners anticipate continued improvement in intraoperative
technology. MRI is the dominant modality in the space, and that will
continue.
Will next-generation surgical suites – both inpatient
and outpatient – be so flexible and utilitarian that a facility may only
need one or two at best when today they might require more? Why?
MONTI: People
are constantly talking about flexible space, and the practical
experiences of hybrid surgical/interventional designs have been recorded
just in the past couple of years. Not everything has been smooth sailing
for these types of designs – for example, if a case is slated as an
interventional procedure, and takes a turn in a different direction, the
space may then be quickly converted for open surgical procedure, but
there is an operational consequence for the procedure that was booked
after that procedure was supposed to be completed. I would be very
skeptical if someone told me I will need less surgical space overall.
There will be different types of space, driven by advances in minimally
invasive surgery as I mention previously. Also, consider the
demographics of a particular area – aging, obesity, etc. – there will be
increasing demand for medical and surgical services overall.
But if it does occur to some degree, will that blur the
line between acute care facilities and freestanding outpatient care
facilities so much that outpatient care will become the new acute care?
MONTI: As I
mentioned previously, technology is driving more complex cases,
particularly surgery, into the outpatient space. Outpatient spaces are
taking in more acute patients, but it is highly unlikely that the
hospital as we think of it now will no longer exist. There will continue
to be hospital stays for very acute, complex cases, absolutely. The
anesthesia and monitoring needs in some cases are so complex that this
will continue to be required.
One argument we consistently hear is that hospitals and
outpatient care facilities fail to take full advantage of all the
capabilities that their IT systems offer. Realistically, do they even
need to do it? If so, what’s it going to take for them to maximize their
use of IT capabilities?
SOO HOO: Yes,
taking full advantage of IT systems is important, but the focus should
be on obtaining the greatest return on investment in IT systems. An
organization need only utilize those capabilities in their IT systems
that provide the greatest benefit to their business processes. Since
every business is different, their utilization of a given IT system will
vary according to their particular situation. The issues to consider in
getting the greatest ROI are:
• Get buy-in from all stakeholders (Executives, users of
the system, IT department).
• Choose clear goals for the IT system – are you
re-engineering a clinical process or simply streamlining an existing
one? Choose goals that can be measured to evaluate the success of the
project.
• Choose the right vendor – there are many vendors in
the market which sell quality systems; the challenege is to choose the
one which support your needs best, so the first step is to determine
what business processes you want to change/improve. Knowing what you
want to get out of a system is the key here. You may want to think about
"What’s possible" rather than "How can we replicate what we’ve always
done?" An IT system can serve as a catalyst for change, but you have to
be clear that this is your goal and communicate it to the stakeholders.
• Establish a good implementation plan – You have to
carefully consider how the IT system will complement and/or change your
business processes, taking into account the capabilities of the system.
You have to do your research into the realities of implementation; just
because a vendor claims to support certain functions doesn’t mean that
utilizing those functions are easy – for example, all VCR manufacturers
claimed to support programmed recording, but most consumers never used
it because the user interface was so difficult to master, on the other
hand, TiVo’s revolutionary user interface has made programming
accessible to almost everyone.
Major barriers to good implementation involve poor
project management and control, lack of communication, incomplete goal
specifications and an underestimation of project complexity.
Another common complaint we also typically hear by
hospitals and outpatient care facilities is that their information
systems don’t talk to one another, or more accurately, they don’t
communicate effectively through interfacing or integration.
Realistically, how can they overcome this challenge? Are standards
enough or do you somehow have to influence facility behavioral changes?
SOO HOO:
Systems integration is a vexing challenge, which has no easy solution.
The key to integration is to take small steps at a time instead of
trying to do everything at once. Standards need to be developed which
solve interfacing issues on a smaller scale (e.g., DICOM in radiology
PACS), and then creating broader standards to integrate on larger scales
(e.g., HL7 for enterprise integration of PACS, RIS and HIS). The new
regional healthcare information organization (RHIO) projects are
following this strategy by building small clusters of integrated systems
around the country. Integration on a national level will only be
possible after these regional RHIO efforts succeed.
Healthcare is notorious for being so far behind in
information technology adoption and implementation. To what do you
attribute the slow progression? What’s it going to take for hospitals
and outpatient care facilities to at least catch up to the manufacturing
and retail segments?
HASELKORN: Most
healthcare delivery systems attribute slow adoption to one of four
problematic areas: Strategy, resources, organizational culture and
process. Strategy issues, for example, include the lack of firmly
established firm wide priorities or a coherent technology plan. Resource
problems entail competition for capital and budget constraints. Cultural
barriers to speedy adoption stem from fear of change or loss of
autonomy, and process-related problems typically pertain to the lack of
a fair, understood, and system-wide decision-making process.
HPN
Editor’s Note: For more information on the Health
Technology Center visit its Web site at www.healthtech.org.
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August
2005
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