Waves of research and technical innovation pose challenges to health-care organizations trying to line up the right tools before the next ones roll in.
Since 2001, the number of medical device patents has soared from fewer than 6,000 in the U.S. to nearly 14,000 by 2014, and to nearly 20,000 worldwide. Where is that leading us? To an age of 3D printing of replacement rib cages and cranial bones made out of titanium, of nanomachines that can be injected into humans to seek out and destroy cancer cells, to wireless technology that will allow “smart” pills to track biometrics and reactions to medications.
Now, consider that level of innovation with what’s happening on the research side, where health-care officials estimate that 1,500 medical research papers are being published every day, and you begin to see the enormity of accommodating innovation and new knowledge into a massive health-care system.
According to the National Center for Bio-technology Information, more than 514,000 research papers were published in 2014, triple the output as recently as 1990. That output was 100 times more than in 1950, and an astonishing 3,000 times the publication level from 1940, roughly one human lifespan ago.
The challenge for accommodating all of that innovation, and turning it into programs and practices that allow physicians to provide hands-on treatment for patients, is an operational burden for administrators trying to assess the viability of new technologies, which are rarely cheap, and whether they’ll provide sufficient return on the capital budgeting spend to justify acquisition before some other innovation renders it obsolete.
At this point, though, it’s manageable, administrators say.
“First of all, there is sometimes a misunderstanding of how the arrival of a new protocol or technology seems to be evidence of dramatic exponential change, when in fact more often than not, the arrival of that technology is evidence of incremental change,” said David Westbrook senior vice president for innovation strategy at Children’s Mercy Hospitals and Clinics. “Research progress takes place in increments, not in bold leaps that cross deep chasms, and the reason is that we can’t move from A to D without going to B and C to get there.”
The deep, broad foundation of knowledge, he says, helps make the task of managing all the new academic research possible—as does technology designed just for that task. “The bad news about 1,500 papers a day is there is a lot of information to be processed,” he said. “The good news is that with our high-speed data processing technology today, we can consolidate that knowledge rather quickly, and because of the technical capability enabling that consolidation, we can make some insightful decision about precise areas of research where we think we can make the greatest contribution to progress.”
Lee Norman, chief medical officer at the University of Kansas Hospital, said he’s seen innovation move through a variety of cycles over his career, but in the final analysis, innovation changes the game somewhat, but the game remains the same. Often, he said, “the greatest thing since sliced bread by way of new technological advancement that took off like a rocket in eyes of the public and even the health-care community quickly flamed out, despite significant capital investment.”
More often than not, new technology has a “me-too” aspect, rather than being a truly major departure from past practice, he said. Given that, prudent organization will be patient enough to see if breakthroughs truly are breakthroughs. Among the factors that go into assessing the utility and effectiveness of such devices, he said, were examinations of the evidence that it truly works better, whether there will be regulatory issues with implementation, effectiveness in actual treatment as opposed to lab-based research, and cost factors.
“If one assumes that the economics are something of a zero sum, that is, if bringing some new technology in means you’re not doing something else, that new technology is typically more expensive than the old,” Norman said. But just because something is approved by the FDA doesn’t mean that insurance companies will cover its adoption, which gets back into the cost calculus. “So the whole cost and affordability issue is a big one.” If a procedure isn’t covered, he said, “we use that device at our own peril.”
The real challenge, Norman said, is finding the financial benefit from in-creased efficiencies. All of it, he said, “is like an equation with about seven variables. From my perspective, it’s often hard to come up with just the right answer if there’s more than one variable.”
Generally, Westbrook said, prudent early adoption will withstand the changes that follow.
“The technology and number of new devices coming on stream are astounding,” he said, “but as they come on stream, some become extinct almost as quickly as they arrived, but their extinction is not a problem because what replaces them is so much improved.” The investment in prior technologies, he said, is thus not wasted, because it has taken the organization to a new plateau from which to build.
“We do eye surgery with lasers,” he noted. “I’m fond of saying that beams of light are replacing blades of steel. Those beams allow procedures that once required anesthetics, surgery, 10 days in the hospital. Today, kids can go in to surgery at 11 a.m., they’re out the door at 1:00 p.m. and in school the next day.We did surgery in the past that couldn’t save them but now can, because it’s so precise, guided by a combination of human talent and technological resources, so we can be profoundly more successful.”
At the practice level, the experience of Midwest Neurosurgery Associates ex-emplifies the benefits, and challenges, of first-in-the-market technology. In 1994, the neurosurgical practice, a part of Health Midwest, obtained a gamma knife, a highly advanced surgical tool to treat brain tumors and other intracranial abnormalities. At the time, it was the region’s first and only such device—and still is.
The application of that tool set that practice apart from all others with its precise delivery of radiation, sparing more of the healthy tissue, reaching cancers inaccessible to surgery, and doing it all on an outpatient basis.
Jonathan Chilton, a neurosurgeon with that group, recalled that after a few years of putting the device to good use, “other technologies came into use to do that, using linear accelerators to provide radiation to treat cancer in other areas of the body. As they became adapted to similar brain radiosurgery, it was less expensive to adopt that technology, rather than install this.”
That, however, doesn’t mean the gamma knife became obsolete—quite the opposite. The next big thing, Chilton said, would be acquisition of a new, sixth-generation knife, a process now under way. The biggest improvement in that technology, he said, is that “it now has a CAT scan attached that allows us to do 3D imaging of the patient’s skull and register that image with MRI scan and other images to treat the intra-cranial area.”
The process of bringing that on board 22 years ago entails some of the same dir-ectives that shape capital purchases today, Chilton said. “I personally rely on scientific information that is in neurosurgical scientific literature that is peer-reviewed, then critically evaluate the tests that are done, early prototypes and results and determine whether I feel that it is a technology that adds value to me and to my patients, whether early evaluations have been done in reliable ways that are meaningful, and moving beyond that.”
If all else fails, Westbrook said, there’s always the option not to buy.
“A lot of times we borrow from the computer industry, where we’ve leased the hardware and software,” he said. “So in-stead of buying and paying for something for 10 years, we trade in the old model, put in the new one and keep paying. One of the ways we manage a budget is by understanding that because of rapid change in technology, from a standpoint of business principles, it’s better to understand you are going to have a certain amount of money each year deployed to lease technology when it becomes obsolete and is replaced by new innovation, and you continue to lease it. Some of the stuff we used to buy, we just don’t buy anymore.”