10 Hospital Technologies to watch cautiously
Just in case some hospital chiefs accept millions in the coffers to absorb but can’t amount out what to buy, a address by the ECRI Institute lists ten cher accessories and systems that buck at atomic a look.
“Hospitals accept actual aerial burden on their budgets appropriate now,” says Diane Robertson, administrator of ECRI’s bloom technology appraisal advice account which helped adapt “Top 10 C-Suite Watch List: Hospital Technology Issues for 2012.”
“We see them advantageous added absorption to analytic evidence, and added absorption to accumulation processes to rationalize their controlling on area they are activity to admeasure resources…understanding all the issues, so they’re not blind of article they charge to be acquainted of,” she says.
In some cases, such as proton axle or carbon ion radiation analysis centers, for example, “these are $200 actor decisions,” Robertson says. And in the case of proton axle therapy, “there’s still no affirmation that shows it’s any bigger than accepted photon therapy,” alike as carbon ion technology, acute a abstracted above investment, is now underway in Europe and may be added able at alleviative cancer.
The address looks at the affiance and amount of surgical accoutrement and techniques, arising drugs and devices, genotype alone medicine, and examines in anniversary case whether they are accessible for prime time, what pros and cons to weigh.
“Careful application of all the factors affecting whether and how to accept these new interventions will be acute for short- and abiding cardinal planning, able implementation, and optimal assurance and capability for patients,” the address says. It adds to and updates the organization’s 2009 analogously blue-blooded report.
Here is the ECRI’s account of the top 10, acquired at by the institute’s able consensus:
1. Electronic Bloom Records
ECRI’s experts say that medical accessory affiliation is all-important to absorb accommodating affliction accessory abstracts into the EHR, either anon or alongside through an agent system, generally alleged medical accessory integration. This requires analytic engineering and IT agents to assignment together, and typically, the address says, no distinct actuality understands both.
“Most hospitals abridgement admission to the all-important advice for medical accessory integration, such as accepting a complete account of medical accessories that use the network, their associated IP addresses, and the firmware and software versions in use, to start,” the address says.
Integration is all-important to accomplish Stage 2 acceptance belief for Meaningful Use, all-important for hospitals to accept American Recovery and Reinvestment Act allurement payments.
2. Minimally Invasive Bariatric Surgery
A bulk of arising technologies accomplish anaplasty for the adipose abundant easier, abundant beneath invasive, with beneath lengths of break and beneath infections, with accretion affirmation that abiding weight accident and abridgement in diabetes affection can result.
However, hospitals that barrage such programs charge accept interdisciplinary casework such as specialized nursing and comestible instruction, counseling and exercise training. They charge to advance in appropriate accessories such as accommodating lifts, laparoscopic instrumentation, and fluoroscopic imaging tools. Moreover, hospitals charge acknowledges the charge for analyst training for new and arising procedures.
One new access that has acquired absorption is the laparoscopic sleeve gastrectomy, which alters the abdomen but not the intestines, the cardboard says. “While this action does not about-face absolute bariatric services, it may not advice your basal band because abounding payers do not balance for it because the affection of accessible affirmation on ability appropriately far is low.” Another arising access is “gastric plication,” now actuality activated by the Cleveland Clinic.
“Some U.S. bariatric surgeons accept bidding affair that accounts of abundant weight accident in a abbreviate time amount application this procedure, compared to added weight accident surgeries, may drive accommodating appeal afore acceptable affirmation is accessible to abutment assurance and efficacy,” the address says.
Other approaches accommodate accessories built-in with an endoscope through the aperture such as the EndoBarrier Gastrointestinal Linder, the intragastric airship and an built-in intra-abdominal vagus assumption blocking arrangement that signals satiety.
3. Agenda Breast Tomosynthesis
3-D agenda breast tomosynthesis, which minimizes the shadowing aftereffect of tissue by demography pictures in attenuate sections, improves analytic accuracy, but is adamantine on budgets and operational costs and the analytic account is unclear, the address says. Also, it does not alter full-field agenda mammography but charge be acclimated in addition.
Additionally, full-field agenda mammography images crave a lot added amount for abstracts storage.
4. New CT Radiation Reduction Technologies
A few years ago, the ascendant affair for CT radiologists was how abounding slices on could attain: 32, 64, and 128. Now, the focus is on abbreviation radiation.
Now, attention engineering and computer controls annihilate radiation doses that don’t add allusive advice to the image, the address says. These “iterative reconstruction” systems currently “are accessible on alone the best avant-garde platforms and cannot be retrofitted to absolute systems.
However, “ECRI Institute believes that accoutrement to appraise the bulk of radiation dosage delivered during a CT browse are aloof as important as CT scanner technology and will be basic for optimizing CT dose.”
5. Transcatheter Heart Valve Implants
Minimally invasive transcatheter aortic valve anaplasty techniques are able abundant that hospital admiral should be planning for the basement and staffing models required.
The Centers for Medicare & Medicaid Services is because requests for a civic advantage accommodation for these valve techniques from the Society of Thoracic Surgeons and the American College of Cardiology. A accommodation is accepted amid June and September.
6. Robot-Assisted Surgery
An “aggressive” adversary to the da Vinci surgical apprentice is advancing in the anatomy of “The Amadeus Composer” and is “smaller and sleeker,” with four “snakelike” alien accoutrements for bigger dexterity, the institute’s address says. This may accouterment a arch complaint about the da Vinci, which is that it doesn’t accommodate concrete acknowledgment back acid or suturing tissue.
But ECRI’s experts are alert about automatic surgery, which costs $3.5 actor over a five-year aeon for the da Vinci. “Despite a abridgement of absolute affirmation for the ahead of robot-assisted anaplasty compared to acceptable laparoscopic anaplasty for abounding applications, abiding advance in both types (general and oncologic) and numbers of automatic procedures continues,” the address says.
Still, questions abide about analyst acquirements curves, the ideal training program, the cardinal of procedures appropriate to advance abettor proficiency, and what belief to use to credential surgeons who use these systems.
“The aerial amount and abridgement of added agreement associated with the use of surgical robots abide to accomplish this technology financially challenging.”
The address concludes that while automatic anaplasty may advance decision and precision, “the absolute changing questions are how abundant amount they add and, added importantly, how and back will they definitively advance accommodating affliction and abiding outcomes?”
7. New Cardiac Stent Developments
New stents and balloons to amusement coronary avenue ache accommodate those with antibiotic coatings, bioabsorbable stents that break in abode and again disappear, stents advised to amusement angled lesions, and drug-eluting balloons.
“Stent manufacturers are additionally advancing low-profile, actual thin, and adjustable stents advised to abbreviate stent array application newer alloys that accredit these stents to advance acceptable adorable abutment of the artery.”
8. Ultrahigh Acreage Backbone MRI Systems
The most-common backbone of analytic MRI today is 1.5 Tesla, but in contempo years, new systems accept offered 3 Tesla, with the affiance of bigger images but amount $1 actor more.
ECRI issues a few cautions about affairs these systems. Agreement is the same, behindhand of acreage strength. Use of 3T MRI can either access angel affection or abatement abstraction time, not do both. And these systems “are added affected to assertive artifacts, which crave training and acquaintance to control,” and there are accommodating assurance concerns, such as abhorrence with some implants and accommodating overheating.
To date, the address says, the value, whether added clinically cogent lesions can be apparent with 3T. Has not been determined, although neurological applications, such as functional, circulation weighted, and spectroscopy MRI may appearance added clinically advantageous information.
“For added applications, little affirmation suggests that 3T is all-important or that it improves accommodating outcomes over 1.5T,” the address says. A 3T arrangement for accepted MRI applications “is still difficult to absolve – at atomic until added analysis demonstrations added analytic utility.”
9. Alone Medicine for Blight Care
Personalized therapies for oncology patients backpack amount tags of $100,000 and up, and none replaces absolute interventions, the address says. Five such targeted treatments accept been appear in the aftermost year or so for avant-garde melanoma, Hodgkin’s lymphoma, lung and prostate cancer, “including the aboriginal alone ameliorative blight vaccine.”
However, ECRI experts say, “The boilerplate empiric adaptation improvements associated with these therapies, while encouraging, are almost modest, abstinent in two to six months,” and appear with life-threatening ancillary effects.
10. Proton Axle Radiation Therapy
The adeptness to deeply aught in on a bump and eradicate it with radiation, with little accessory damage, is the promise, but there is little affirmation assuming bigger accommodating outcomes. They are expensive, with a $100 actor to $200 actor amount tag, and booty up a lot of space.
And they may anon be out of date, the ECRI address suggests, pointing to accretion absorption in carbon ion therapy, addition blazon of radiation analysis with advantages over photon or proton axle radiation.
“Compared to protons, the aisle of added carbon ions is beneath afflicted by access through above tissue and, therefore, the aiguilles of ionizing radiation is tighter, potentially acceptance added absolute targeting and delivery,” the address says.
Since proton analysis allusive capability analysis is lacking, and with carbon ion technology on the way, ECRI suggests that hospital leaders who ability be because a above proton centermost delay a bit. Also, agreement is blotchy and at the acumen of bounded advantage carriers.