If acquiring new health-IT technology is on your blueprint for the New Year, the critical factors for success are less about acquisition decisions than implementation, says Molly Coye, founder and CEO of the Health Technology Center (HealthTech), a non-profit education and research organization. HealthTech provides technology forecasts and decision-making tools for nearly 25 percent of the nation’s hospitals, as well as nonprofit health plans and the Centers for Medicare and Medicaid. As a member of the Institute of Medicine, Coye co-authored major reports such as “Crossing the Quality Chasm” and is on the board of trustees of the American Hospital Association and the Program for Appropriate Technology in Health (PATH), among other credentials. She serves on Google Health’s advisory board.

DHP: How can organizations make the right technology decisions in such a complex and rapidly changing environment?

Coye: There are a few pieces that can be helpful. One of them is a clear understanding of the integration of your technology strategy with your overall business strategy. Very often health care provider organizations, unfortunately, make decisions around clinical technologies separately from the information technologies. It is important to integrate and relate both of them very closely into the overall business strategy of organization.

Another issue is that most organizations never consider are some of the relatively less expensive investments that cross over between IT and clinical. Because they’re not expensive enough, they don’t hit the threshold for capital planning to kick them into the strategic system-like decision process. So decisions around, for example, an IT productivity management and communication system, video interpretation system, or clinical technologies — technologies that are not as expensive as, say, large imaging systems just simply don’t get addressed and opportunities are missed.

Another issue is the process within a health provider system. In many cases it’s highly fragmented and there is very little consistency across the pieces of the large or small hospital system. You need to have a process that is relatively clearly understood and there needs to be a high degree of transparency so that clinicians and staff in the system can understand why some technologies are advanced and others are not. This is a cultural goal. It often takes several years to develop a process and have it be widely understood within the organization so real traction can be had.

 DHP: What decision-making steps should large health systems go through in order to determine which high-value technologies to invest in?

Coye: Start with business strategy, do an environmental scan to see what technologies are available or on the near or immediate term horizon, and determine to what extent they will enable strategies you’re interested in. Or some cases if they’re very disruptive, they may suggest a strategy or modification of a strategy that you wouldn’t have been aware of.

With this under your belt, you can then go a through more detailed review. If you decide that a particular technology is likely to be useful in advancing or enabling a strategic purpose you have, then you want to understand not only factors like the acquisition cost, the impact on volumes, the ROI and the services delivered, but you also need to understand the whole series of ripple effects, including ongoing operating cost, operating impact, and the burden on IT and other departments. You need to include complexities in terms of facilities, work force, and the impact on patient and provider experience within the hospital. And as you determine how much of a change this will present to current work processes and goals of workforce, you can start to design the kind of transition and education you’re going to need in order to make a cultural change, as well as direct training with the technology.

The steps are fairly clear, what’s interesting to note is how many organizations are perfectly aware of steps and still manage to skip important pieces of this process.

DHP: Let’s go to a specific example, such as tele-ICU and it’s potential to transform acute care. What are some evolving business models for tele-ICU?

Coye: In many cases, the adopters combine several elements in their business models in terms of strategic objectives that they are meeting. So for most of them, an improvement in quality, meaning a reduction in the death rate, mortality, and complication rate in ICU patients, is a significant part of the business objective.

When you look at the financial analysis of the impact of the eICU, you find there are also several strategic objectives: one to speed the throughput in the ICU by the user so that you reduce length of stay. A second is the ability to reduce length of stay for relatively low margin medical cases so that you free up cases for space for high-margin elective surgery.

Thirdly, you reduce re-admission, so that you improve the finances for a particular admission because you’re not dealing with the need to incorporate the cost for a re-admission within 30 days. Fourthly, in a substantial number of cases, for many hospitals, the ICU admissions are uncompensated so if you reduce the length of stay and the complications and the overall cost, you’re also alleviating that as an uncompensated care burden.

Another business case is nurse satisfaction. If you interview nurses in many of the adopting hospital systems, the nurses say that they never would want to practice again without that support. So it’s a key factor in nurse satisfaction and retention.

Most of the current installations are focused initially on the hospital or local set of affiliated hospitals, but the capability of the actual technology itself is usually to manage many more ICUs than are currently managed per installation. And so more hospital systems are seeing this as an opportunity to offer these services to unaffiliated hospitals more remote to their core hub and bring in revenues for offering this service. It is useful way to generate revenue but is even more important in terms of the referral relationship.

DHP: What clinical and information technologies do you see as having the biggest impact on health care delivery in the next few years?

Coye: Clearly imaging leads the list, not just in terms in terms of the expense of the technology but also in terms of many of the potential beneficial impacts. We’re beginning to see virtual colonoscopies, CT scans for evaluation, a number of ways that existing imagery capabilities are applied in ways are very important.

Equally important is the remote management of acute care, which is led by eICU system; it also has some interesting applications with the remote video system. Remote ICU management as well as remote management of chronic care is going to be very important -- the impact on quality is quite beneficial and makes it worth pursing.

We believe that RFID will be very important, not only for asset tracking which is the application best understood today, but in terms of managing clinical care processes and improving productivity. RFID’s potential that has been demonstrated in a few institutions but is still largely untapped. It has tremendous potential in terms of improving quality of care by tracking compliance with evidence-based medicine.

We will also see biotechnology beginning to accelerate as a contributor to overall improvement in care and cost. Today what was we see mostly is pharmacogenomics, genetic analysis contributing to an understanding of the appropriateness use of particular pharmaceuticals, but this will grow with the application of more biomarkers to track and diagnosis the course of disease and treatment and the use of genetically targeted therapies.

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