Spending More, but Getting Less: How Hospitals Can Work Together to Reap the Benefits of Increased Spending on New Technologies

Hospitals often buy new technologies without requiring that the technologies communicate with each other, even though this lack of interoperability results in lower physician productivity and an increased likelihood of medical errors occurring. Other hospitals, fearing exactly those inefficiencies, simply avoid buying innovative new technologies. Peter Pronovost and his colleagues at Johns Hopkins Medicine, give some advice on how to avoid these issues in “What Hospitals Can Learn from Airlines About Buying Equipment,” in the Harvard Business Review.

Hospitals’ spending on new technology “has ballooned,” the authors note. “For years, hospitals have invested in sophisticated devices and IT systems that, on their own, can be awe-inspiring,” the authors say. “Yet these technologies rarely share data, let alone leverage it to support better clinical care.”

“Part of the solution must involve hospitals,” the authors state. “If they truly want technologies that save lives and boost productivity, they will need to exert their considerable pressure as purchasers, requiring that manufacturers embrace openness and interoperability, and only purchasing devices that support this.”

“Too often, hospitals treat equipment and IT procurement in a siloed way, focusing on price without looking at how those devices will work as part of a larger system,” the authors say.

“For example, many new hospital beds come with a sophisticated array of sensors that can track such information as whether a patient is at risk of developing a bedsore, based on data about how often they move in bed. Such sensors may be 30% of a bed’s costs. Yet at one of our hospitals [within the Johns Hopkins system], that data is unusable — it’s in a format that our system cannot read.”

The situation is similar for “much of the data that is fed from wireless monitors of patients’ heart rate, blood oxygen levels, blood pressure, and breathing rate: This data doesn’t link to the medical record,” they note.

“The vision of an integrated hospital unit that is much safer and more productive will not be possible without widespread availability of products that share data openly and freely. Just as the U.S. Navy demands that its submarines and ships have interoperable technologies, this change can be driven by those who purchase these technologies,” they say. “Health care leaders that purchase technologies need to do the same.”

However, it is “unrealistic to think that each hospital should go it alone, exerting its purchasing power to move the marketplace,” the article states. “Hospitals could work together, writing specifications and functional requirements for the products that they will purchase and refusing to do business with manufacturers that don’t comply.” There may also be a role here for group purchasing organizations, they say.

As a further step, instead of assembling hospital rooms “one product at a time, hospitals should be able to purchase modules, sets of interoperable products that work together to support an aspect of care,” the authors continue. “This model makes sense, as few if any hospitals have the resources to design and manage all the connections between technologies, or to optimize how the data is used and displayed to support top-quality care. Ultimately, when a hospital is built or renovated, it would have the option to buy modular patient rooms, clinical units or floors — a ‘hospital in a box,’ built to its specifications.”

“We don’t expect airlines to build their own planes. They buy them from experienced system integrators such as Boeing or Airbus,” and hospitals should have a similar model, the authors note. “The question is whether health care leaders will have the resolve to require it.”

On the other hand, “even if digital devices communicate with one another, the lack of standards for health data puts full interoperability and data sharing out of reach,” according to an article in Healthcare Dive highlighting the opinion piece. “While we’ve made progress in the last three to four years and have the promise of FHIR (fast healthcare interoperability resources), the standards in health care from a data exchange standpoint are very weak,” explains Paul Shenenberger, CIO of Summit Health Management.

The lack of interoperability and data standards will be especially challenging as access to health care continues to change in the digital age, as a separate Healthcare Dive article points out. “From alternative care settings to telehealth companies, supply and demand for healthcare services is in flux.”

“Care is actually moving away from the hospitals,” the article quotes Dr. Rasu Shrestha, Chief Innovation Officer at UPMC, as saying during a panel at the National Health Policy Conference (NHPC) earlier this year. “’The brick and mortar hospitals that we know today will not be the focal point of healthcare delivery tomorrow.’ As care moves away from hospitals, whether at large or in part, it will be important to integrate health data from all over the care spectrum to get a full picture of a person’s well-being.”

This points to the persistent challenge related to use of new technologies in health care; in a siloed, non-standardized data world, how do we leverage the massive amounts of data generated in health care every day and facilitate data sharing in a way that actually makes health care more efficient and effective? The Hopkins op-ed authors take a step in the right direction – urging hospitals to leverage their significant purchasing power to demand interoperability. However, in order to do that, the data standards challenges will also need to be resolved. As Healthcare Dive summarizes, “though it may be a painful process, the need for standards and interoperability are desperately needed for innovative care to move forward.”