While the primary reason hospitals adopt new technology is to increase patient care and produce better outcomes, there are many other factors that also affect purchasing decisions. These include how the healthcare system is funded (CMS, insurance companies), the effect of a large aging population, chronic diseases, the rise of consumerism, government regulations, shrinking hospital budget and the need to increase efficiency to compensate for less staff, standardization of equipment and the need to increase patient and staff safety. Purchasing new medical technology also has an element of predicting the future, because a new network, piece of software or new devices may be used for the next 10-15 years before it is replaced. “This is not one of those industries that has a lot of turnover of new equipment, most hospitals keep their equipment for seven to 10 years,” said Steve Menet, Draeger’s director of enterprise patient monitoring and IT. An example would be purchasing a new WiFi computer network and choosing a system that can be expanded to accommodate new technologies for wireless patient monitoring telemetry, voice communications systems, increased data volumes, encryption, RFID, transferring of large DICOM images and interfacing with casual Internet use for patients and their families. Hospitals that only wired for one of these uses have found they needed expensive, invasive wiring upgrades later on to add other uses without overloading the WiFi system. Clinicians who sit on hospital evaluation committees that look at new technologies also have competing forces influencing their decisions — whether the technology will help patients versus the financial realities of being able to making the purchase and recover the investment cost. This has led to the buzz term “ROI” (return on investment), which frequently accompanies marketing literature for new medical technology. As vice president of healthcare solutions for GE Healthcare integrated information technology, Mark Dente, M.D., has responsibilities that include strategic evaluation of emerging technologies. He said the key reasons hospitals adopt new technology are patient safety, a need to report for quality measures and improvement, a reporting need for reimbursements, research, the need to share information with regional health networks and consumerism. “It really focuses on patient safety,” he said. Dr. Dente said new technologies help increase patient safety, which in turn, helps prevent deaths and saves hospitals, Medicare and insurance companies money. EHRs increase efficiency and safety Electronic health record (EHR) adoption is viewed as the key tool to increase safety and save money, Dr. Dente explained. This is driving the purchase of new software, hardware and medical devices that connect together to feed information into a patient's EHR. Parts of the EHR include computerized physician order entry (CPOE) and bar-code medication management, which Dr. Dente said are big drivers to reduce medical error. But, he said these systems also help hospitals manage inventory, ensure patients are charged for all the medications they receive, help track measures used by CMS and insurance companies to increase pay for performance, and the data can be used to compare a hospital's staff performance to that of national standards. EHRs can also double check clinicians to help them improve safety elsewhere, such as at discharge. Dr. Dente said only about 55 percent of hospitals meet core, national standards for providing all the appropriate medications a patient needs upon discharge. Hospitals using EHRs can drive that compliance level up to 95 percent, which can help cut the number of readmissions. “Communication and hand-offs are often a failure point in hospitals, but the EMR is greatly helping in these hand-offs,” said Mary Beth Navarra-Sirio, RN, MBA, vice president and patient safety officer at McKesson. “Electronics very much decrease the error in the hand-offs." She explained when patients are sent from various units for different tests, procedures or recovery, specific information about what was done to the patient, medications administered and other pieces of information from doctors or nurses were not always translated into the paper medical record. However, with an EMR the majority of the information is transferred automatically. “Patient safety is definitely No. 1 and looking at improving productivity for clinicians is No. 2,” Navarra-Sirio said of the reasons to adopt new technology. Menet said he has seen a particular interest in technology that helps increase patient care and helps save clinician time, because both factors translate into saving money for a hospital in the long run. “A lot of facilities are asking how to make the jobs of their clinicians more efficient,” he said. He said most hospitals today are basing IT improvements around EHR implementation. Menet said many clients ask Draeger how its software systems and equipment will support their EHR goals. He said they also demand an increasing ability to interconnect equipment and software with other systems. He said many older hospitals have electronic systems, but they cannot be accessed through a common network or cannot automatically dump information into a patient's EHR. He pointed out that patient monitoring today has gone way beyond vital signs monitors and now includes information from computerized ventilators, anesthesiology information systems, medication management systems, lab reports, image archive systems and even beds that measure patient head elevation. He said all this information is power when combined into one location, such as a patient’s EHR. “It provides clinicians with a more complete picture of the patient to help make better decisions,” Menet said. “With a paper system the clinicians only have part of the picture.” Hand in hand with patient safety and staff efficiency is the need for standardization. Menet has seen a move in the industry toward standardizing equipment, because it leads to better patient safety and allows more flexibility in staffing. “It gets difficult to have a nurse trained with four or five types of monitors,” Menet said. Patients as Consumers Hospitals are buying state-of-the-art equipment today partly to attract new patient customers. An increase in radio and newspaper advertising for hospitals in recent years clearly shows an effort to highlight their latest technology, safety records and numbers of procedures performed in an attempt to draw new patients who have choices between hospitals, especially in large metropolitan areas. “Patients are beginning to view themselves as consumers,” Navarra-Sirio said. “As consumers they begin to have expectations of safety and convenience and they begin to drive new electronic adoption.” Dr. Dente said statistics show about 15 million people a day access the Internet to search for healthcare-related topics. He said these information savvy patients shop around to find the hospitals they feel most comfortable with that offer the most cutting-edge technology. “Consumerism is already a driving factor in healthcare today,” Dr. Dente said. The Computer Generation As baby-boomers begin retiring in increasing numbers hospitals are finding it more difficult to recruit and retain quality medical staff. Hospitals that want to attract the new, younger generation of clinicians need to upgrade to EHRs and other computerized systems. Navarra-Sirio argues this younger generation is demanding hospitals they work at have these computer systems or they will seek employment elsewhere. “This next generation has grown up with computers, as opposed to the other end of the workforce that is nearing retirement and did not have computers when they entered the profession and in some cases have resisted the change to using computers,” she said. Dr. Dente agreed EHRs help attract and retain new staff. “Why would you want to work someplace where it will create more work for you?” Dr. Dente questioned. Financial Pressures Beyond competition from other hospitals, one of the biggest financial incentives for hospitals to adopt new technology is to ensure they receive reimbursements from the Centers for Medicare and Medicaid Services (CMS). To complicate this and force hospitals to adopt new safety mechanisms, starting in October CMS will no longer reimburse hospitals for medication errors, pressure ulcers, hospital-acquired infections and other “never events.” CMS views these issues, which can greatly increase hospital bills, as hospital mistakes for which the hospitals should bear the financial responsibility. “Hospitals are beginning to believe they need to make dramatic changes to make dramatic improvements in patient safety,” Navarra-Sirio said. She said an example is new point-of-care MRSA tests and asking more admissions questions to screen patients who may have a predisposition for infections. These measures help increase infection control and ensure hospitals get reimbursed for treatment of infections if a patient is already a carrier. While numerous factors drive hospitals to adopt new technology, that demand for new technology is also driving the healthcare manufacturers to make new technology as well, Menet said.
What Drives New Technology Adoption?
Many factors go beyond patient safety.
Dynamic ECG waveforms displayed on an iPad using McKesson's mobile ECG viewer, which directly connects to the hospital's cardiovascular information system or ECG management system. This technology can help speed triage of STEMI patients, allowing diagnosis anywhere, rather than requiring cardiologists to walk down to an emergency department or drive into the hospital to view the ECG.