AAMI: Scan horizon for future technology servicesand observe rise of HTMs star
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James P. Keller, Jr., vice president of health technology safety and evaluation for the ECRI Institute, took up his telescope, pointed it horizon-ward and described what he sees approaching during a June 3 session of the 2012 annual conference of AAMI, the Association for the Advancement of Medical Instrumentation. He also suggested ways healthcare technology managers can help shape the future so as to avoid sitting back and getting shaped by it.
The HTM profession’s structure and roles, he said, are and must remain strongly oriented on the life cycles of the fast-changing technologies that HTM supports. “Over the 27-some years that I’ve been with ECRI Institute, working with hospitals on selection of technology, one of the things [I have seen] lacking is accurate and reasonable utilization forecasting,” he stressed. “‘How many times is that laser really going to be used in our hospital?’ You get that doctor who just buys into a sales pitch so strongly that he convinces the administration to bring in that laser, or whatever high-end device it might be, and it’s used a lot for a little while and then just starts collecting a little dust—and then a little more dust.”
By the time people start asking whatever became of the “latest and greatest” thing to hit the hospital, it has become downright dangerous. “The few times you pull it out of the closet, people don’t really know how to use it because they haven’t touched it for months,” said Keller. “And you have to go through the re-training and so forth. Participating in that utilization process can be a very valuable contribution for the HTM department to be making.”
Keller also predicted that, going forward, much technology support for new service lines will not be “building-related. As our healthcare organizations start changing over the next number of years, a lot of the services they’ve traditionally offered within the hospital are going to move outside the traditional setting and into home care and clinics and telemedicine.” He cited Grande Ronde Hospital in rural Oregon, which won ECRI’s 2011 device-achievement award for its use of telehealth robots, as an example of a situation in which HTM can help set up innovative uses of new technology in settings that are no longer building-centric.
Keller next moved on to product selection. “You’ve done your horizon scanning so you kind of know what’s out there, and you’ve done your forecasting to predict what’s probably going to be impacting your organization, and now you do planning for what is going to go into your hospital over the next five years. Now it comes time to pick it.” Here he made a case for HTM—or biomedical/clinical engineering (BE/CE), for those who prefer the established if aging terminology—to be much more engaged in device selection and evaluation than ever.
“We understand the technical issues and the details on how these devices work, and we understand the clinical implications and the safety implications of these devices,” said Keller. “And we have a pretty good perspective on how the cost [of medical equipment] relates to the cost of operations. And if we can do more with that and be more of a player in the evaluation of devices, we can provide a really important service to our institutions.”
Keller spoke briefly but passionately on technical specifications regarding off-the-shelf vs. customized technologies. “A lot of customization can be done on medical devices, and hospitals can get carried away with that unless someone is there with a foot on the brake,” he said. More and more, it will be HTM’s job to help the hospital ask itself if it needs to customize, or if it’s customizing just because it can. “Our profession can provide some sanity,” he added, to counter the “unfettered revision of technologies.”
Turning to reporting structures, Keller encouraged attendees to watch for IT and HTM departments to continue “morphing” as more and more medical devices look and quack like software ducks—and vice versa. “You can already see some of that morphing with infusion pumps, RTLS (real-time location systems) and integration of medical devices with the EMR,” he said, noting that the move of HTM departments to a spot under the IT umbrella seems to be gaining steam.
Meanwhile, “the role of CIO or vice president of HTM may come to look more like the role of a CTO,” he said. “But even if it doesn’t, understanding the IT world is very important” for healthcare technology managers. “Don’t be in position to be told what’s happening,” Keller urged. “Be in a collaborative position so you can help decide what the reporting channel looks like and how you can contribute to your [blended] department, whether it’s IT or not.”
Keller also predicted the continuation of a wide range of related HTM issues and activities, among them implementation planning, wireless challenges, the place of device safety checks in the mix of HTM’s expanding duties (CMS challenges, anyone?), hazards and recalls, incident investigations, clinician training, change management, planning for device decommissioning—and even the wisdom of equipment acquisitions driven by local competition with other provider institutions.
After the session, Healthcare Technology Management asked Keller for his take on why so few healthcare technology managers are rising to fill new and open CTO positions, despite earlier predictions by some that such a development was inevitable if not imminent.
“The CE profession has been a little too heavily mired in technical details and hasn’t stepped back to be more strategic,” Keller replied before quickly suggesting that the doors remain open. “Somebody in the hospital has to take on the CTO role, and the kinds of things that are happening with HTM, and integration in particular, are creating opportunities for the profession—if it’s the right individual with that leadership mindset to take on that role. There are examples of people who are doing it, but it’s a small number right now.”
To hasten the ascent to the C-suite by a wider swath of the HTM profession, current managers and directors must “look for opportunities and start small, and make themselves more of a valuable asset to the institution,” said Keller. “Eventually—if they have the right mix of technical skills, business skills and leadership skills—they’ll become part of the C-suite.”
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.