Keep an eye on these tech­nolo­gies

ECRI un­veils top 10 C-suite Watch List

Modern Healthcare - - FRONT PAGE - Jaimy Lee

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. 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 pro­ton­beam 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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