Top 10 Watch List for the Health Care C-Suite

The ECRI Institute has compiled a list of 10 technologies and business issues that health care executives need to keep an eye on in 2014. Read on ...

1. Will Benefits of Computer-Assisted Sedation Head Off Turf Wars? 1. Will Benefits of Computer-Assisted Sedation Head Off Turf Wars?

Consider the new Sedasys® computer-assisted personalized sedation system (Ethicon Endo-Surgery, Inc., Somerville, NJ). If health systems adopt it, the system could theoretically be used during millions of endoscopic gastrointestinal (GI) procedures (esophagogastroduodenoscopy and colonoscopy) performed on adults and reduce use of nurse anesthetists and anesthesiologists (and thereby lower costs).

Executives need to be mindful of the patient safety implications as well as medical turf wars when considering the adoption of the potentially game-changing technology.

2. A New Cash Cow, or Fuel for the Fire? 2. A New Cash Cow, or Fuel for the Fire?

Catheter-based renal denervation is an emerging treatment for a pervasive problem affecting millions of Americans: uncontrolled or treatment-resistant hypertension. The technology was expected to become available in the U.S. market by mid-2015, but hit a snag in January 2014 when the pivotal trial showed mixed results.

Plan now, analysts advise, because if approved it will herald a paradigm shift in care from medical therapy to a hospital-based minimally invasive procedure. Executives also will have to clarify what physician specialties can perform the procedure to avoid internal strife.

3. EDs Just for the Elderly: Fad or Wise Planning? 3. EDs Just for the Elderly: Fad or Wise Planning?

CDC estimates that between 2010 and 2050, the number of adults aged 65 years or older will double, reaching 89 million. Older adults average 45.4 emergency department (ED) visits per 100 individuals per year compared with 38 ED visits per 100 individuals per year for younger patients. Overall, older adults account for 12% to 25% of all ED attendances worldwide.

Leaders will have to address the issue of whether to operate senior-specific EDs and analyze two approaches used by leading organizations: 1) infrastructure/structural redesign of EDs, and 2) new protocols/care processes for ED services to geriatric patients, including training ED staff in geriatric patient care.

4. How Many Copper Surfaces Are Needed to Prevent HAIs? 4. How Many Copper Surfaces Are Needed to Prevent HAIs?

Copper’s antimicrobial properties have been known for a couple thousand years. The idea of using them in healthcare settings to reduce infection is not new.

However, the conversation has evolved given the very high stakes today for reducing healthcare-associated infections (HAIs), costs of treating infections, costs of copper, and concern about reducing risks for the most vulnerable hospitalized patients. The conversation also focuses on how many copper surfaces need to be installed in a patient room to achieve desired effects.

5. Should You Offer Wearable Powered Exoskeleton Rehabilitation for Individuals with Paraplegia? 5. Should You Offer Wearable Powered Exoskeleton Rehabilitation for Individuals with Paraplegia?

Wearable powered exoskeletons are a new $100,000+ ticket to standing upright for patients who are paraplegic from a spinal cord injury (SCI), but less expensive options are also on the horizon. The devices are used in two ways: rehabilitation after SCI and personal, at-home use as an assistive device.

Will getting wheelchair-bound patients up on their feet help reduce morbidity and improve overall survival after SCI? Is this a technology your health system should use in its rehabilitation facilities? Will you need specialized technical expertise to maintain the computerized devices?

6. Magnetic Resonance-guided Focused Ultrasound for Cancer Pain 6. Magnetic Resonance-guided Focused Ultrasound for Cancer Pain

The most common cause of cancer pain is from bone metastases, so effective pain management is critical to improving patient quality of life and functioning. Magnetic resonance-guided focused ultrasound (MRgFUS) has been available in the United States since 2004 for and is now an FDA-approved option for bone metastases pain and is under study for treating certain cancers.

Should you take the plunge to offer this new option now or at all? Should you wait until more evidence accumulates or until more than one player is in the market to decide?

7. NanoKnife System: Real or False Hope for Cancer Patients? 7. NanoKnife System: Real or False Hope for Cancer Patients?

Oncology clinics of several dozen health systems are promoting the NanoKnife® irreversible electroporation system (AngioDynamics, Latham, NY) for treating delicate, inoperable malignant tumors.

The technology involves a major capital investment, has no approved indications for specifically treating cancer (FDA approval is for soft-tissue ablation only), and is not without potentially serious risks to patients. Should you jump on the bandwagon to be an early adopter, or wait for evidence to accumulate and for health insurers to develop coverage policies?

8. Real-time MRI Adaptive Radiation Therapy: A Ray of Hope or Hype? 8. Real-time MRI Adaptive Radiation Therapy: A Ray of Hope or Hype?

One of the latest developments is the integration of MR images (rather than CT images) that are obtained coincidentally during the radiation treatment, which then allows “on-the-fly” changes to target size and dose. This “MR-adaptive radiation therapy” technique theoretically holds promise.

What do you need to know to plan long-term to offer the best in image-guided radiation therapy (IGRT) services that produce optimal patient outcomes? Should you invest in the newest, multimillion-dollar real-time IGRT technology or adopt a wait-and-see approach?

9. Will Intelligent Pills Magically Improve Medication Adherence and Prevent Readmissions? 9. Will Intelligent Pills Magically Improve Medication Adherence and Prevent Readmissions?

Proteus Digital Health Feedback System (Proteus Digital Health, Inc., Redwood City, CA) is a new technology that uses a sensor integrated into solid oral medications to track ingestion and feed information to the patient, caregivers, and prescribing clinicians. The developer calls it “digital medicine.”

Should your pharmacy and therapeutics committee plan to use oral digital medicines for patients discharged with chronic disease medication regimens, especially if it shows promise to reduce readmission rates?

10. Big Data: Does It Signify Big Decisions? 10. Big Data: Does It Signify Big Decisions?

Big data analytics have been used to improve baseball team performance, giving smaller-market Major League Baseball teams the ability to find and hire players—at a bargain price—who were previously undervalued and often overlooked by larger-market teams. By studying statistics of undervalued players, recruiters analytically evaluated and quantified each player’s potential.

Is this a model that healthcare can employ successfully to fix the system, improve access, lower costs, and improve patient outcomes? Just maybe.

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