ECRI: C-suite's top health care technologies to watch in 2012

January 05, 2012
by Brendon Nafziger, DOTmed News Associate Editor
High-powered MRIs, dose-lowering software for CT scanners and a possibly cheaper surgical robot. All these are among the technologies health care executives should keep an eye on in the coming year, according to a new list put out by the ECRI Institute.

The health care research nonprofit's top 10 technologies for the C-Suite in 2012, released Tuesday, examines the areas high-level executives should learn more about.

Here are a few highlights:

Mammography goes 3-D

Last year, Hologic's Selenia Dimensions 3-D became the first breast tomosynthesis unit to be cleared by the Food and Drug Administration. This technology, previously available in Europe, involves sweeping an X-ray scanner in an arc over the breast, taking over a dozen scans, which are then reconstructed into a 3-D image.

Some researchers think the 3-D images could help radiologists spot masses that on 2-D slides would be shadowed by overlapping folds of flesh. Industry studies cited by ECRI suggest reading performance increased 7 percent with the technology, while patient callbacks dropped 30 to 40 percent.

But the technology is fairly expensive -- ECRI says Hologic's scanner costs over $400,000. It also could increase burdens on imaging servers, as the scan files are larger, and it requires staff to get extra training. Also, there's no additional reimbursement for tomosynthesis -- at least, not yet.

"Digital breast tomosynthesis is still very new and probably suitable only for sites at the leading edge of technology use and that have considerable capital and operational resources," ECRI noted. That said, other companies will probably release tomosynthesis devices in the U.S. in the next year or so. One vendor, GE Healthcare, has already announced it's seeking FDA approval for a 3-D capable add-on for its Senographe Essential equipment.

Electronic health records get more meaningful

A lot of hospitals and doctors are already going digital. According to the Centers for Disease Control and Prevention, over the past three years the percentage of doctors who have adopted electronic health records has doubled, jumping from 17 percent to 34 percent. Likely, many of these doctors were lured on by federal incentives, offered to practices that show "meaningful use" of EHR technology.

So far though, the early adopters have only had to meet so-called Stage 1 requirements. But Stage 2 is coming down the line, and providers that want to qualify for Medicare incentive payments will have to meet these more stringent criteria by 2014. For now, the final shape of these rules isn't entirely certain (they're expected to be released this summer), but ECRI warns that hospitals should do all they can now to make sure they're on track to meet these tougher standards.

One notable difficulty will be the likely need to better integrate medical device data into a patient's medical record. What this means is getting the clinical engineering department and IT staff to work together to make sure the EHR draws its data from the life-saving devices. This, however, could present a "cultural challenge," ECRI notes. "(Clinical engineering) often doesn't understand IT's project management processes, and IT often doesn't understand CE's critical role," ECRI said in the report.

Minimally invasive bariatric surgery

Currently, one-third of Americans are obese, according to the CDC. And our heftier public is investing in fat-fighting treatments, close to $150 billion worth every year, according to ECRI. Many are going the surgical route, opting for gastric bypass surgeries.

Hospitals hoping to capitalize on the upswings in patient demand will need specialized staff, as well as specialized equipment -- bariatric-grade beds and other devices. But the field is changing. Right now, the gold standard procedure, open gastric bypass, is giving way to laparoscopic ones, ECRI said, which have shorter hospital stays. Also, a reversible technique, using lap-band technologies, has proliferated since its introduction almost a decade ago.

But more experimental techniques are in the offing, including "gastric plication" (potentially reversible stomach folding, now being studied at Cleveland Clinic), as well as a new implant that can block certain nerve signals. Some new technologies could also shift patient load from inpatient to outpatient facilities, ECRI said, particularly devices that can be inserted endoscopically through the mouth, such as the EndoBarrier liner and an in-the-works saline-filled balloon.

Dose-reducing CT technologies

For computed tomography, radiation dose worries have dominated the headlines (just check out the cover story for the January 2012 issue of DOTmed Business News, hitting your mailbox soon). In fact, medical radiation made a list put out by ECRI a few months ago, on the top technology hazards for the year. But ECRI said a technology is making an impact in the field: iterative reconstruction techniques. These are processes that reduce noise so images can be taken at much lower doses.

Most of the big OEMs make equipment with this technology, and ECRI said independent testing has shown that the "overall effectiveness of the techniques is similar." But oftentimes, getting this technology means upgrading to more expensive, newer equipment. ECRI said the Food and Drug Administration has been slow at clearing the technology for cheaper scanners (64-slice and under).

In the meantime, though, providers can buy some third-party iterative reconstruction products that can be used with their current system, such as "SafeCT," made by the Israeli company Medic Vision, which received FDA clearance about a year ago.

Hybrid ORs and the transcatheter heart valve

Hybrid catheter lab or hybrid operating room? Hospitals will have to decide where to put their resources as they look to perform transcatheter heart valve procedures, according to ECRI.

Instead of open heart surgery, transcatheter heart valve procedures let doctors replace or repair defective valves by making a small incision in the chest or groin and threading up a device through the blood vessels using a catheter. The technology has a head start in Europe, where thousands of the procedures have been performed, as it has been available there for several years. But it has just reached U.S. markets. Edwards Lifesciences' SAPIEN transcatheter aortic heart valve, for instance, was approved by the FDA in early November.

Other products are coming down the road, though (Medtronic also has an aortic heart valve in the works). Plus, a national coverage decision from Medicare is expected later next year. For hospitals hoping to performing these procedures, canny investment now is key, ECRI notes.

"Patient volumes for transcatheter valve procedures may be relatively low from the onset, which may favor a hybrid cath lab, which could be used for routine cath lab procedures," the group said in the report. "However, this migration may occur only after procedures mature and proficiencies improve. The hybrid OR provides the opportunity for simultaneous hybrid procedures such as open surgery in conjunction with transcatheter procedures."

Want to learn about cheaper surgical robots and other technologies? To read the full report, go here (note: registration required):