Top 10 Technology Issues: C-Suite Watchlist WSHMMA Spring Conference Surviving Healthcare...

Top 10 Technology Issues: C-Suite Watchlist

WSHMMA Spring ConferenceSurviving Healthcare Reform-Bridging the Gap

Vancouver, WA

April 14, 2011

Anthony J. MontagnoloExecutive Vice President and [email protected] ext. 5175 ©ECRIInstitute.Montagnolo.2011

Nonprofit healthcare information organization Collaborating Center, World Health Organization Evidence-based Practice Center, Agency for Health Care Policy

and Research now known as the Agency for Healthcare Research and Quality (AHRQ)

Interdisciplinary staff of over 300 Stringent conflict-of-interest regulations Largest information provider worldwide for healthcare technology

—its assessment, planning, selection, procurement, management, and risk and quality assessment.

Consulting support and technical assistance worldwide

2 ©ECRIInstitute.Montagnolo.2011

Outline

Building a Bridge To The FutureThe Forecasting Chasm—Seeing around

corners.The Technology Chasm—Where is

technology headed?

Action Steps


©Montagnolo.ECRI Institute.2011

Change Happens

4

©Montagnolo.ECRI Institute.2011©ECRIInstitute.Montagnolo.20115


Today’s technology decisions are a bridge to our future (like it or not)

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“Prediction is very hard…

especially when it’s about the future.”

Yogi Berra

©ECRIInstitute.Montagnolo.20107

…can cause headaches.

Setting capital priorities...


The Forecasting Chasm

Trends are often clear but timing isn’t.

Ergo… Changing too soon and/or changing too late are deadly.

Will intraoperative MRI become a standard of care at every hospital?

Will hospitals be in the genetic medicine business?


Outline: The Forecasting Chasm

Expert opinions often conflict.

Forecasting technology is a lot like forecasting economics.

“I wish I could find a one-handed economist.”—Harry Truman


Outline: The Forecasting Chasm

Trends are easier to predict than breakthroughs and are often evolutionary in nature.

The timing of a revolution is incredibly hard to predict…but a little planning goes a long way.

The tipping point –Malcolm Gladwell.



How many people take Lipitor?

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When it comes to new technology, if you are not part of the steam roller, you are part of the road.

--Stewart Brand



The robots are breeding like rabbits!

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Will intra-operative MRI or CT become standard of care?

Courtesy, Brainlab, Inc.

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The Medical Arms Race:Victims, Wounded, Missing-in-action

Biliary LithotripsyLaser AngioplastyInhaled InsulinCine CTAutologous bone

marrow transplant for metastatic breast cancer


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MARCH 2010| IN VIVO: THE BUSINESS & MEDICINE REPORT| www.ElsevierBI.com


Outline



technology headed?

Action Steps



Where is technology headed?

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Six Macro Technology Trends

Genetic/Molecular Medicine Computer-related technologiesHome and Self-careMinimally invasive proceduresDevice/drug hybrid productsOrgan replacement/assist devices using

hardware and tissue-engineering


Key Technology Trends

1. Diffusion of electronic medical records and clinical decision support systems

2. Convergence of medical devices and information technology



Everything wants to be connected to everything

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ECRI TOP 10 Technologies (2009)1.Electronic Medical Records: What Should You Be Doing Now?

2.Ultrahigh-Field-Strength MRI and Premium Performance CT: Do You Really Need Them? Now?

3.Physician Preference Items: Do Your Docs Know the Costs?

4.Robotic-Assisted Systems for Surgery and Endovascular Catheterization: How Many Should You Have?

5.Radiation Oncology: Will Proton Centers Fulfill Their Promise?



Hitting cancer harder… Protons join the fray.

Roberts Proton Therapy Center (at Penn)24 ©ECRIInstitute.Montagnolo.201

ECRI TOP 10 Technologies (2009)

6.Radio-Frequency Identification Technology: What Problems Can It Really Solve?

7.Alarm Integration Technologies: How Best to Monitor All Those Alarms?

8.Hybrid Operating Rooms: How Many of Your ORs Should Have Imaging Capability?

9.Therapeutic Hypothermia after Heart Attack, Stroke, Spinal Cord Injury: Dawn of a New Era in Emergency Medicine?

10.Rapid Tests for Deadly Infections: Where Do They Fit in Infection Control Protocols?


Cleveland Clinic’s “Top 10” Innovations

Molecular imaging for Alzheimer’s T-cell antibody therapy for melanomaProstate cancer vaccineStatin Jupiter studyProtease inhibitors for Hepatitis C


Cleveland Clinic’s “Top 10” Innovations

Heart failure patients use telehealth technologies

Transoral weight-loss surgery Nitric oxide analysis for asthma diagnosisOral treatment for Multiple SclerosisPediatric capsule endoscopy for GI

disorders



Ultrahigh-Field-Strength Magnetic Resonance Imaging (MRI) 3.0 Tesla systems slowly

diffusing

Provides higher resolution images

Primary application is neuro studies for right now

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Dual-Source and 256-Slice Computed Tomography

This technology may be used for cardiac scanning

May provide lower dose and improved resolution

25-50% more expensive than single source CT

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Multislice Computed Tomography Angiography to Detect Coronary Artery Disease

Rapid diffusion

Will replace some cardiac cath

May act as gatekeeper to cardiac cath

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Intraoperative Magnetic Resonance Imaging

Diffusion is slow and limited to large teaching and surgery hospitals

Cost remains a major barrier to adoption (up to $5.5 million)



Digital Breast Tomosynthesis

Provides tomographic view –reduces overlapping tissue blurring

May cost 20-60% more than digital mammo

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Radiofrequency (RF) Catheter Ablation for Atrial Fibrillation

Increasing use of RF ablation could burden treatment centers.

Higher upfront costs could eliminate longer term drug costs.



Bioabsorbable Stents

Bare metal and drug eluting in development

Stents “disappear” over time after implantation

May reduce thrombus

3-5 years away

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Artificial Heart as Bridge to Transplantation

Very slow diffusion

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Artificial Intervertebral Disc Replacement for Lumbar Degenerative Disc Disease

Diffusion slow so far

Poor reimbursement

Limited long-term evidence

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Robot-assisted Surgery for all Applications

Currently being used in cardiology, urology, and gynecology

Diffusion seems to be accelerating as applications expand

Robotic neurosurgery on the horizon

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Bronchial Thermoplasty for the Treatment of Asthma

Endoscopic procedure uses R/F energy

Reduces smooth muscle in airway

Received FDA approval in April 2010


Therapeutic Vaccines for Colorectal Cancer

Designed to harness body’s immune response

One compound has received fast-track designation from US FDA

3-5 years until early adoption


Drug-eluting Angioplasty Balloons

Early adoption in 1-3 years

Could reduce the use of drug-eluting stents

Several products have approval from European Union


Wearable Artificial Kidney

Several teams working on this technology

Mobile “dialysis” Not yet FDA approved


Natural Orifice Transluminal Endoscopic Surgery

Speed recovery and reduce pain

E.g. gall bladder removed through the mouth!

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Image-guided Radiation Therapy


Deep Brain Stimulation: A shocking development

Brain “pacemaker”

Current treatment for Parkinson's

Potential for depression



Implantable Eye Telescope:

Used to treat macular degeneration

Approval by U.S. FDA in March of 2009


ECRI’s Radar Screen– Technology for …

Advances in mobility—Bionic arms, exoskeletons, and IBOTs!


Human Genome Project: Or Baby Needs a New Pair of Genes.

Understanding genetic variations and impact on disease

What is the vision for a provider today?

For example, BRCA1/BRCA2 for breast cancer

www.genome.gov

48

http://www.genome.gov/

Outline



technology headed?

Action StepsWhat do I do on Monday morning?



Look past the headlines---get the full story.

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Intuition and experts can be misleading…


…(especially when estimating probabilities)

Strategies for Success

Implement evidence-based technology decision-making process for medical capital

Add organized horizon-scanning into your five-year strategic capital plan

Ensure your healthcare strategy includes a clinical technology strategy



D. Berwick,JAMA, April 16, 2003-Vol. 289, No. 15 (Reprinted)

Copyright 2003 American Medical Association. All rights reserved.

To thy own self be true…

where are you?

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Strategies for Success

Technology AcceleratorsGood-to-great organizations think differently

about technology and technological change than mediocre ones.

Good-to-great organizations avoid technology fads and bandwagons, yet they become pioneers in the application of carefully selected technologies.

Jim Collins, Good to Great (New York: HarperCollins Publishers Inc. 2001), 162.


In short, do your homework.

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Build your bridge to a bright future

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Thank You


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