Healthcare Technology Is on the Move

Abstract

This past fall, I had the pleasure of attending the AAMI/FDA Summit on Healthcare Technology in Nonclinical Settings. I attended not because I am an expert on the subject. Quite the opposite: I attended because I wanted to learn more about a subject that was largely foreign to me. What I learned tells me that the healthcare technology management (HTM) community needs to better appreciate the opportunities we have and the challenges all stakeholders face as healthcare moves increasingly outside the walls of hospitals.One measure of the summit's importance was the fact that 17 other organizations signed up as supporters. One of them, The Joint Commission (TJC) published a 2011 paper “Home—The Best Place for Health Care,” which summarizes the many advantages of caring for patients at home, such as more comfort and fewer costs when compared to hospitalization. “In the United States, the home care industry serves about 8.6 million patients, with needs ranging along a continuum that includes primary care, pre-acute care intervention, post-acute care service, and hospice and palliative care,” according to the paper. It went on to say there are new incentives and opportunities for hospitals to work with home health agencies.While many hospital systems are exploring such collaborations, my suspicion is that not all HTM organizations are participating in these efforts. They may not even be aware of the trends. If so, they are missing an enormous opportunity. I encourage all of my HTM colleagues to learn more about this growing area, especially because the technology being used in these nonclinical settings is rapidly becoming much more varied and complex.What follows are summaries are some of the presentations I heard at the summit. I've focused on those that I consider to be the most valuable to the HTM community.As was pointed out by multiple speakers, the term “home,” as it relates to how healthcare is evolving, is very limiting. Many of the patients being cared for outside of hospitals, nursing homes, and physician offices are extremely active and take their medical devices with them in the course of their daily activities. These activities may include shopping or engaging in sports, such as swimming or even mountain climbing. Because of such activities and because the home environment varies so widely, device designers have a difficult time knowing where their products will be used.James Keller, vice president of health technology evaluation and safety with ECRI Institute, discussed the challenge of ensuring “that the right technology is being used in the right environment.” In 2012, ECRI cited “poor usability of home-use medical devices” as one of its top 10 health technology hazards because of the rapid growth in that area, the “uncontrolled use environment,” the “lack of ‘home-care’ focused design,” and the “failure to manage ‘home-based’ technologies.”ECRI and the Healthcare Technology Foundation have jointly published three short safety pamphlets targeted at patients and their caregivers on home infusion, home dialysis, fire safety and oxygen, and home ventilation. Electronic copies of these brochures are available for free, in both English and Spanish, at www.ecri.org/Patients/Pages/Patient_Resources.aspx.To function effectively and safely in nonclinical settings, device designers must consider a host of new factors. Lane Desborough, a product strategist with Medtronic, made several interesting points that nicely framed the discussion. Desborough spoke not simply as a medical device expert. He spoke as a father who deals with healthcare technology. His son has type 1 diabetes. Desborough's points included:Johann Becker, director of clinical operations at Wellspan VNA Home Care and a caregiver herself, focused on the needs of users in her presentation. Her points emphasized the following:Tobey Clark, director of instrumentation and technical services at the University of Vermont, spoke as the president of HealthCare Technology Foundation. He made many important recommendations about how to communicate safe practices to patients and caregivers. They include the following points for medical device manufacturers:He included this bit of advice for all stakeholders: “Respect culture, social, economic, and environmental differences.”Bridget Moorman, a healthcare technology consultant, described her experiences in Europe working on a truly integrated data system covering hospitals, physician offices, and the home environment. In the system she was involved with, a regional center operator receives multiple data streams from patients and their equipment, and makes decisions as to which caregiver, if any, should be notified based on the data. The United States is just beginning this kind of integration; in general, she said, Europe makes much greater use of this technology.Neil Charness, a professor of psychology at Florida State University who has written extensively about the role of human factors in home health care, said that the growing interconnectivity of medical devices is generally a good thing, but there are serious issues to keep in mind. They include:Reginald Cyrus, a certified biomedical equipment technician (BMET), outlined the opportunities available to healthcare technology professionals. Cyrus went from being a military BMET, to a civilian BMET manager in a hospital, to managing the biomedical equipment for the home care services company that is part of a hospital system. In the home-care environment, biomedical equipment is also referred to as durable medical equipment (DME) or home medical equipment (HME).In a 2010 article for AAMI's Horizons, Cyrus reported “seeing more—and more complex—medical device technology migrating into the home care environment. Examples include alternating pressure and low-air-loss mattresses (a.k.a., powered support surfaces), apnea monitors, power wheelchairs and other assistive technology devices, continuous positive airway pressure (CPAP) machines, enteral feeding pumps, oxygen concentrators, neonatal phototherapy systems, pulse oximeters, semi- and full-electric hospital beds, telehealth systems and e-health networks for managing diseases and promoting wellness remotely, and ventilators.“ He said that a DME technician functions very much as a BMET does (acceptance testing, installation & maintenance), but that the DME technicians usually don't have the training or leadership to do the full range of BMET activities.There is a certification program for those professionals responsible for medical equipment delivery and set up. I'm not endorsing the Delivery Technician Certification Program, but you can learn more about it at www.rentrain.com/dtcp.Also in the 2010 Horizons, Nestor Damasco and Chris Abe from Rady Children's Hospital in San Diego published an article on how their biomedical engineering group assumed responsibility for managing all of the equipment in the home-care division beginning in 2004 “in an effort to control or eliminate some of the expenses.” They soon learned that while the home-care business had much in common with their hospital experience, there were major differences. There were substantial opportunities for cost savings and reduction in turnaround time when they began servicing the home-care equipment. An onsite equipment specialist at the home-care site opened up opportunities to spot equipment problems that had been there for some time, but had not been recognized as solvable problems.My point in sharing what I learned from Cyrus and the Horizons articles is to emphasize that HTM professionals have a crucial role to play in the evolution of healthcare in nontraditional settings.The future will bring a greater emphasis on home healthcare in the United States because it can be better for patients and their families, and much more economical. The financial incentives have changed and will change even further to reward organizations that keep patients out of the hospital. Technology associated with home healthcare will continue to increase in sophistication and be developed specifically for that market. Hospital systems are recognizing that they need to partner with home-health organizations to provide integrated and complete care, and receive the financial incentives.Hospital-based HTM groups need to be aware of these trends. They should be asking questions in their own organization to ensure that they are leading the way to accommodate these changes—and not simply reacting to them. The future will be bright for those who see what is happening and step out front. I encourage those HTM groups who are already leading the way in home-care technology to publicize their experiences so that others might learn.