Survey Reveals Hospital CEO Concerns and Priorities
The technology wish lists included in the HIMSS Leadership Survey is
a vendor's wet dream – so many things, and so many
CIOs want to buy them! Of course reality strikes back by figure 12, “barriers
to adoption.” Here we learn the biggest barrier is a “lack
of financial support” – insufficient funds.
To better learn what's top of mind for hospital CEOs, check out Deloitte's Outlook from the Perspective of Hospital CEO's (press release, study highlights). Here are some choice excerpts:
Reluctance to Close Unprofitable Product Lines: Hospital
bottom lines are being helped by some product lines and hurt by others,
yet there is a tremendous gap between the percentage of CEOs who report
a product line as unprofitable and the percentage willing to close it.
Radiology services, laboratory testing, ambulatory surgery, outpatient
therapy, orthopedics, cardiac care, and rehabilitation were cited by a
majority of CEOs as being profitable. By contrast, some services, such
as emergency room care, pediatrics, and obstetrics, were largely
reported as unprofitable, but the CEOs are reluctant to close
these service lines. For example, while 73 percent of CEOs report that
emergency room (ER) services are unprofitable, only one percent would
be willing to close their ERs. The same is true for pediatrics (78
percent find it unprofitable but only four percent would close) and
obstetrics (64 percent unprofitable, seven percent willing to close).
CEOs feel that they have good reasons for keeping unprofitable lines
open. The most important factor, by far, is community demand for the
service.
Education/Training, Standardization, Technology Seen as Key to Reducing Errors: More than 85 percent of CEOs highlight education/training
and standardization as being in the top five among activities with the
greatest potential to reduce medical errors. Technology clearly has an
important supporting role to play as well, with 75 percent of CEOs
placing it in their top five. Relatively few CEOs believe that medical
errors will be significantly reduced through public reporting of errors
(29 percent) or through increased staffing (25 percent).
Investing Capital to Meet Near-Term Operational Needs: Eighty-six
percent of CEOs highlight purchasing replacement equipment as a major
capital need, while 72 percent cite purchasing new equipment. With the
exception of purchasing IT systems (cited by 68 percent of CEOs), the
majority of hospital CEOs are not planning to make long-term strategic
investments, such as the building and/or renovating of inpatient and
outpatient facilities, or expanding emergency room or operating room
capacity. To the extent that hospitals are investing in IT, most of the
investment to date has focused on security and privacy applications
along with pharmacy systems.
Hospital boards are focused first on financial viability (66%),
information technology infrastructure ranked second (at 22%). Hospital
CEOs are investing in programs to improve quality. Specific programs
are chosen in large part for their ability to generate revenue
enhancements and/or reduce costs.
As a complement to the above, the HFMA just released their third report in the series, Financing the Future II. The report is titled, Essentials of Integrated Strategic Financial Planning and Capital Allocation,
and in it there's lots of good info on aligning capital investment with
strategic planning. Both of these reports are good reading for vendors
who want to make a sale and hospital management that wants to make a
purchase.
New Medical Device Software Platform
What's in your fantasy medical device operating system? Here's mine:
- Royalty free
- A true real time OS
- Connectivity support on par with Windows CE (TCP/IP, wireless, USB, etc.)
- Royalty free
- Something without the hacker appeal of Microsoft Windows (is easy to lock down, and isn't patched every week)
- Approval-ready for up to FDA Class III medical devices
- A full set of developer tools on par with Windows and beyond
- Did I mention royalty free?
An outfit called Green Hills Software announced the introduction
of a new software platform optimized for medical devices. Microsoft's
strengths have always been the built in connectivity support,
development tools, and a ready source of Windows-experienced engineers.
The weaknesses have included royalty cost, overhead, and the fact that
it's not a true real time embedded operating system. Green Hills cut
their teeth on the “other” high reliability embedded device market,
aerospace, and have extended their products to meet medical market
requirements. From the press release:
- Significantly reduced product approval cost and risk with
faster time-to-market. Medical device manufacturers can take advantage
of an RTOS that is approval-ready to minimize the quantity of software
and documentation that they must develop for product approval. In
addition, by utilizing the available Rhapsody Model Driven Development
environment, it is possible to link requirements to model elements and
to generated code, facilitating the process of proving that all
requirements are met. Rhapsody also automatically produces
documentation needed to support the approval effort. - Absolute
information security. Strict patient information protection dictated by
regulations like HIPPA requires medical devices that collect and
distribute patient information to be absolutely tamper proof and
secure. The INTEGRITY architecture was designed to prevent hackers’
access to this personal information. And the integrated support for
leading networking security protocols and crypto algorithms provides a
secure path for untethered transfer of this information to the central
hospital systems. - Reduced hardware costs, power and heat
dissipation requirements. Green Hills leading compiler and linker
technology allows the end user to develop smaller, faster application
code allowing the designer to reduce the memory requirements and
processor demands to execute this code. In addition, INTEGRITY’s
support for processor-unique power management API’s allow better
battery management for hand-held devices.
This platform seems well worth the look for wireless sensors and
gateways; portable medical devices requiring connectivity like
infustion pumps, ventilators, and vital signs monitors; and point of
care diagnostics.
New FDA Risk Notification on Medical Telemetry
The FDA issued a public health notification
on the risk of electromagnetic interference (EMI) with medical
telemetry systems still operating in the 460-470 Mhz frequency bands.
operating in the 460-470 MHz frequency bands will be at increased risk for interference,
which could compromise patient safety. In January 2006 the Federal Communications
Commission (FCC) will begin issuing new licenses for mobile radio transmitters
to operate in the 460-470 MHz band.
The feds have delayed the issuance of new land mobile licenses a number of times since
2000 when WMTS was created and the 460-470 MHz band was designated for
commercial use in dispatch and field service applications. Based on
recent posts to the Biomed Listserv,
there's still plenty of hospitals out there running on the old
frequency – some of them appear (from their posts) to be seriously
considering delaying their move off 460-470 until some time after the
FCC lifts their freeze.
Here's my take on the FDA recommendations:
- Identify if your telemetry is on the old frequencies (you know who you are)
- Move
off the 460-470 MHz band by December 31, 2005 – either get your system
re crystaled to WMTS (the quickest and cheapest, although I believe
that Philips – and maybe others – have discontinued selling upgrades)
or get a completely new system - You have two main alternatives: a proprietary infrastructure based on WMTS, or a system using ISM (more on that here)
- If you use WMTS, you should register your WMTS equipment with the
American Society for Healthcare Engineering (ASHE) – ISM requires no
registration - Be sure to check which digital TV channels are in your local markets (there's a list here) as they can impact any use of WMTS. Last summer the FCC ordered most major commercial broadcasters in
the top 100 markets to operate their Digital TV (DTV) transmitters at their
maximum licensed power. (You can read more on WMTS/TV station interference here.)
[Hat tip: Tom Quinn on the Biomed Listserv]
New Report on Clinical IT Market
The latest study from Kalorama Information
pegs health care IT market growth at about 11 percent over the next 5
years. They estimate the market for clinical IT to exceed $25 billion
by 2009. The current clinical IT market is estimated at $23 billion,
with about $15.4 billion being spent on hospital systems. A surprising
“feature” of the market research study appears to include some
political perspective:
The government can have a major influence in encouraging or
discouraging investment in health IT, the report states. Despite the
federal government spending more than $900 million on health IT in
fiscal 2004, it describes government programs as too diffuse. A “true
leadership role requires that federal efforts be brought together into
a coherent program of support,” the report states.
The
report also questions the often-touted links between the use of health
IT and improvements in health care quality. “Further research is needed
to better document and understand the link between IT and quality,” the
report states.
Describing actual and potential federal
programs to promote health IT use, the report says federal actions can
also discourage implementation. One example is the Health Insurance
Portability and Accountability Act of 1996, which is a set of rules to
be followed by health plans, doctors, hospitals and other healthcare
providers.
