Like most healthcare organizations, Geisinger Health System (Danville, PA) faces the constant challenge of making the most effective use of limited resources. Based on a self-assessment, the health system had determined that, although its current approach to technology planning and prioritization was robust, there were several areas where it could be improved.
In 2012, Geisinger supplemented its existing technology planning program with a new, integrated approach to clinical capital assessment, planning, and optimization. According to Geisinger, the new approach ensures thorough, objective analyses, establishes patient-centered standards, and makes use of optimal-deployment roadmaps (including multidisciplinary use management). This new model positively affects patient safety, clinical quality, technology selection, resource allocation, and operational efficiency.
The organization’s previous technology plan included several beneficial features, which remain a part of its current program. These include:
- Annual horizon scans for the devices in the organization’s inventory; these show the estimated life and expected replacement costs for each device.
- A requirement that requests for large purchases (>$100,000) be scored, ranked, and approved according to defined criteria by a designated capital allocation committee.
- A program to repair, refurbish, and/or resell retired devices; this program, run by Geisinger-owned ISS Solutions, generates approximately $2 million in annual cost savings.
Nevertheless, Geisinger’s analysis of its technology program and the input it received from clinical and operational leaders and staff revealed several challenges. Geisinger estimates that the financial implications of these challenges could be measured in millions of dollars, considering factors such as clinical capital purchases that have resulted in excess capacity, suboptimal use, and unrealized return on investment.
Below are the challenges Geisinger identified, and the corresponding solutions the health system developed to address them:
Challenge #1: If a clinician wished to adopt a new clinical technology, Geisinger lacked the means to perform an objective clinical, operational, and financial assessment.
The solution: Technology Insights—Reports to analyze the potential impact of new technology. When a clinical service line wishes to implement a new technology, the organization’s strategy and business development (SBD) office can develop a Technology Insight report to facilitate the assessment. These reports are structured to provide an objective, fact-based analysis, thus preventing decisions on new and potentially disruptive technologies from being based solely on factors such as a clinician’s previous exposure to the technology, vendor influence, or competitive pressures. The reports “provide the information that service lines need to make informed decisions,” notes Scott Davis, vice president, business development, Geisinger Health System.
Geisinger’s Technology Insight reports include an overview of the technology, a clinical benefit summary (using information provided by ECRI Institute and other sources), a market assessment, and a financial summary. The financial summary includes information such as cost per case, reimbursement details, estimation of investment break-even point, and impact on operations (e.g., OR case times, staff training, IT integration). Each report concludes with a recommendation that either endorses or opposes further consideration.
One of these reports, for example, identified the need for particular purchasing contract language and targeted marketing initiatives to help a robot-assisted spine surgery program yield a positive return on investment. Another report recommended forgoing a technology acquisition that would require a $600,000 capital expenditure because the projected patient volume did not justify the expense; the technology could be used for only a narrow range of approved therapies, and it was already established in several competing hospitals within the large geographic region that Geisinger serves.
Challenge #2: The health system lacked a venue and process to manage clinical technology standardization, capacity management, and cross-functional (i.e., multidisciplinary) use.
The solution: The Clinical Technology Optimization and Standardization Committee (CTOSC)—Managing technology standards, assessments, capacity, and multidisciplinary use. Geisinger established this committee to improve the management of increasingly complex and expensive new clinical technologies. The committee’s responsibilities include:
- Establishing clinical technology standards, including implementation and periodic review.
- Managing cross-functional use, including protocols, policies, and procedures.
- Determining technology specifications to meet defined clinical needs, with corresponding vendor communication and quotations that meet those specifications.
- Outlining the implications associated with implementing a given clinical technology, including impact on patient and clinician safety, clinical outcomes, and information security.
- Linking clinical technology considerations to Geisinger’s IT infrastructure.
- Leveraging the ISS Solutions annual clinical technology inventory and horizon scan of existing devices (over 40,000) to identify optimization opportunities.
CTOSC, for example, facilitated enterprise-wide standardization of telemetry monitoring, a process that involved determining monitoring performance criteria and unit specifications, evaluating vendors, selecting a single source, and developing a process for phased migration/replacement. Geisinger notes that benefits have included improvements to communication, patient flow, responsiveness, and clinical analytics, as well as substantial cost savings.
Challenge #3: Decisions on significant capital equipment investments—those totaling $1 million or more—were not always based on comprehensive information; that is, the clinical capital business plans reviewed by the capital allocation committee did not always address issues such as reimbursement, optimal use, patient safety, or alignment to system standards.
The solution: Technology Assessments—Ensuring comprehensive evaluation of clinical investments over $1 million. For complex, big-ticket capital requests, the organization felt that an additional vetting process—beyond the standard business plans that were already required for capital requests that exceed $100,000—was necessary to help ensure that capital allocation committee members have the information they need to make informed decisions. Each Technology Assessment, as these analyses are called, addresses domains such as patient safety, clinical program development or expansion, meeting system standards, likelihood of being fully optimized, and contributing to system goals for healthcare reengineering; these domains are weighted based on their importance. The result is a numeric score, which the CTOSC team uses to offer a nonbinding recommendation to the capital allocation committee.
According to Deborah Templeton, chief, care support services, “These robust assessments have allowed us to look at requests for capital from several different aspects, ensuring that we are applying rational, evidence-based decision making to make the most prudent decisions for allocation of capital monies.”
As Geisinger outlined in its Health Devices Achievement Award submission, the combination of existing and new solutions described above enables the health system to deploy a comprehensive, “360 degree” approach to clinical technology assessment, planning, standardization, implementation, optimization, and retirement.
The organization estimates that over the course of 2012, these new solutions helped improve patient care and produced over $2.1 million in savings.
To help other organizations develop a successful clinical capital technology assessment program, Geisinger shared the following lessons learned.
For Technology Insight reports:
- Refer to multiple sources for clinical summaries; do not rely solely on vendor-provided information.
- Provide a robust market assessment, with realistic volume and revenue estimates.
- Capture all costs, including installation, training, disposables, and marketing.
- Acknowledge risks, and offer specific recommendations.
- Disseminate findings and recommendations to clinical and administrative leadership.
For a committee like CTOSC:
- Employ a multidisciplinary approach. Geisinger included representatives from several departments—Supply Chain, Clinical Engineering, IT, Strategy and Business Development, Lifecycle Management, and Nursing—as well as medical staff leadership.
- Facilitate objective, data-centric decision making and transparency (e.g., committee members at Geisinger are required to complete conflict-of-interest documents).
- Develop a committee charter that establishes governance, roles, activities, and responsibilities.
- Obtain the support of executive leadership.
For Technology Assessments:
- Take the time to assess large, complex, clinical technology business plans.
- Make sure assessments are physician-led.
- Link assessments to the planning calendar.
- Provide specific feedback for plans that do not receive favorable recommendations.
Congratulations and thanks to the people who submitted Geisinger’s application for the Health Devices Achievement Award: Scott Davis, Joseph Hardisky, Deborah Templeton, and Dr. Kenneth Wood.