Transcript ECRI PRESENTATION

Top 10 Technology Issues: C-Suite Watchlist
WSHMMA Spring Conference
Surviving Healthcare Reform-Bridging the Gap
Vancouver, WA
April 14, 2011
Anthony J. Montagnolo
Executive Vice President and COO
[email protected]
610-825-6000 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
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Outline
Building a Bridge To The Future
 The Forecasting Chasm—Seeing around
corners.
 The Technology Chasm—Where is
technology headed?
Action Steps
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Change Happens
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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
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Setting capital
priorities...
…can cause
headaches.
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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?
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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
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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.
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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
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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 Lithotripsy
Laser Angioplasty
Inhaled Insulin
Cine CT
Autologous bone
marrow transplant for
metastatic breast
cancer
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MARCH 2010| IN VIVO: THE BUSINESS & MEDICINE REPORT| www.ElsevierBI.com
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Outline
Building a Bridge To The Future
 The Forecasting Chasm—Seeing around
corners.
 The Technology Chasm—Where is
technology headed?
Action Steps
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Where is technology
headed?
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Six Macro Technology Trends
Genetic/Molecular Medicine
Computer-related technologies
Home and Self-care
Minimally invasive procedures
Device/drug hybrid products
Organ replacement/assist devices using
hardware and tissue-engineering
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Key Technology Trends
1. Diffusion of electronic medical records and
clinical decision support systems
2. Convergence of medical devices and
information technology
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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?
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Hitting cancer harder…
Protons join the fray.
Roberts Proton Therapy Center (at Penn)
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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?
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Cleveland Clinic’s “Top 10”
Innovations
Molecular imaging for Alzheimer’s
T-cell antibody therapy for melanoma
Prostate cancer vaccine
Statin Jupiter study
Protease inhibitors for Hepatitis C
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Cleveland Clinic’s “Top 10”
Innovations
Heart failure patients use telehealth
technologies
Transoral weight-loss surgery
Nitric oxide analysis for asthma diagnosis
Oral treatment for Multiple Sclerosis
Pediatric capsule endoscopy for GI
disorders
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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
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
Diffusion is slow and
limited to large teaching
and surgery hospitals

Cost remains a major
barrier to adoption (up to
$5.5 million)
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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
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
Increasing use of RF
ablation could burden
treatment centers.

Higher upfront costs
could eliminate longer
term drug costs.
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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



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Endoscopic procedure
uses R/F energy
Reduces smooth muscle in
airway
Received FDA approval in
April 2010
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Therapeutic Vaccines for Colorectal
Cancer



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Designed to harness
body’s immune
response
One compound has
received fast-track
designation from US
FDA
3-5 years until early
adoption
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Drug-eluting Angioplasty Balloons
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
Early adoption in 1-3 years

Could reduce the use of
drug-eluting stents

Several products have
approval from European
Union
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Wearable Artificial Kidney



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Several teams working on
this technology
Mobile “dialysis”
Not yet FDA approved
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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
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Deep Brain Stimulation: A shocking
development
 Brain “pacemaker”
 Current treatment for
Parkinson's
 Potential for depression
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Implantable Eye Telescope:
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
Used to treat
macular
degeneration

Approval by U.S.
FDA in March of
2009
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ECRI’s Radar Screen–
Technology for …

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Advances in
mobility—Bionic
arms,
exoskeletons, and
IBOTs!
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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
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Outline
Building a Bridge To The Future
 The Forecasting Chasm—Seeing around
corners.
 The Technology Chasm—Where is
technology headed?
Action Steps
 What do I do on Monday morning?
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Look past the headlines---get the
full story.
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Intuition and experts can be
misleading…
…(especially when estimating
probabilities)
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Strategies for Success
 Implement evidence-based technology decisionmaking process for medical capital
 Add organized horizon-scanning into your fiveyear strategic capital plan
 Ensure your healthcare strategy includes a
clinical technology strategy
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To thy own
self be true…
where are
you?
D. Berwick,JAMA, April 16, 2003-Vol. 289, No. 15 (Reprinted)
Copyright 2003 American Medical Association. All rights reserved.
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Strategies for Success
Technology Accelerators
Good-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.
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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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