The Challenge
When deciding whether to acquire a new clinical technology, health systems must consider more than just the expected efficacy of the technology. Factors such as whether the technology will be an appropriate fit for the organization, as well as whether it will be the most effective use of the organization's resources, also need to be considered. Inappropriate choices can lead to soaring healthcare costs and even negative patient outcomes.
To avoid the pitfalls associated with acquiring clinical technologies that didn't align with its standardization practices, that wouldn't provide optimal benefits, or that wouldn't be sufficiently utilized, Geisinger Health System (Danville, PA) determined that it needed a more structured and objective approach for assessing incoming technologies.
The Solution
Responsibility for addressing this challenge rested with Geisinger Health System's Clinical Technology Optimization and Standardization Committee, known as CTOSC. This committee incorporates perspectives from throughout the organization, with representation from clinical engineering, supply chain, nursing, IT, and strategy and business development, as well as medical staff leadership. (Read about the development of this committee.)
To bring a measure of objectivity to capital expenditures, CTOSC developed a technology assessment tool and scoring system. Because of its efforts, Geisinger was chosen as a finalist for the 2014 Health Devices Achievement Award.
The tool is applied when proposals for new clinical technologies are being reviewed, to assess the appropriateness of the technologies. It directs committee members to assess clinical technologies in seven domains by considering the applicability of various dimensions, or aspects, within each domain. The seven domains, with a few sample dimensions, are as follows:
Patient and staff safety—Have any applicable Class I recalls been issued by FDA? Are any high-risk events described in FDA's Manufacturer and User Facility Device Experience (MAUDE) database? Would the technology contribute to patient or staff safety?
Value to patient—Would the technology help the patient recover more quickly? Would it facilitate the expansion of an existing clinical program?
Effective technology—Is the existing technology functionally obsolete? Would the technology under consideration improve effectiveness? Does it offer superior features?
Balanced standardization—Does the technology allow for standardization while meeting clinical needs? Does it do so without limiting clinical outcomes?
Balanced optimization—To what extent would options or features of the technology be used? Could optimization be achieved without limiting clinical outcomes?
Balanced utilization—Does the expected level of use support the addition of the technology? Would the technology be useful for more than one function/department?
Systemic thinking—Would the acquisition help improve operational efficiency, organizational efficiency, or workflow? Would it eliminate duplication or redundancy? Does it advance innovation and improve the organization's standing?
Over the course of multiple meetings, proposals for acquiring new technologies are discussed, adjusted if appropriate, and scored for all applicable dimensions within each domain. The scoring system is built into the tool—each dimension is associated with a score based on its relative importance. If the committee's determination for a particular dimension is positive, the predetermined score for that dimension is added to the total. If the determination is negative, the dimension receives a score of zero. The scores are then totaled to provide a scoring index, which is used to sort the proposals from high to low. Proposals that do not meet a minimum score are excluded from further consideration, as are those that do not meet critical safety-related criteria. The remaining proposals are presented to the Capital Committee for final adjudication.
Lessons Learned
Geisinger Health System reports that this structured assessment methodology helped improve decision making for technology acquisition. By scoring each technology according to a standard set of criteria, the organization was better able to separate the technologies that met clinical needs and organizational goals from those that would likely prove to be inefficient, ineffective, or unnecessary. The organization estimates that this process prevented $33.3 million in unnecessary technology expenditures.
Congratulations and thanks to the people who submitted Geisinger's application for the Health Devices Achievement Award: Kenneth E. Wood, A. Joseph Layon, Joseph A. Hardisky, and Eliezer Kotapuri.
