The devices, treatments, and procedures that will change the delivery—and the business—of healthcare.
Forget flying cars, cities crisscrossed with moving sidewalks, and unisex body suits made of silver lamé. Instead, get ready for an explosion in smart medical devices, infection-fighting nanotechnology, virtual biopsies and colonoscopies, bionic organs, and operating rooms that could serve as a backdrop for a science fiction movie. These and other medical breakthroughs are more than cool. They're going to change the way hospitals provide care to their patients and how they do business. New and emerging technology will dramatically improve outcomes, save money, reduce readmission rates, help hospitals recruit and retain physicians, build your organization's reputation, and more.
OK, they're pretty cool, too.
These days it seems everything is smart. There's the ubiquitous smartphone, of course. But soon there will also be smart bandages that monitor vital signs, smart prescription bottles that remind the patient when to take a pill, and smart pedometers that count the patient's steps and, like smart little tattletales, send the results to the physical therapist. But perhaps the best example of smart technology is the smart OR. Previously found in just a few large academic medical centers, the technology is starting to show up in community hospitals, too.
The array of tools in the smart surgical suite at the 344-licensed-bed Sacred Heart Hospital in Eau Claire, WI, includes a navigational device that's like GPS for the brain and four 57-inch plasma screens that allow the whole team to see what's going on at any stage of the operation—in high-def 3-D. (See "Features of Sacred Heart's Smart OR," below.)
"We're relying on technology much more than we ever have before [with the] singular purpose of making brain and spine surgery more effective," says Kamal Thapar, MD, director of the brain and spine institute and director for tertiary care at Sacred Heart, as well as a neurosurgeon with Marshfield Clinic. "It's had a profound impact on patient care."
The biggest effect is on clinical quality. Navigational tools allow surgeons to make the smallest possible incisions, resulting in faster recovery time and allowing the team to treat sicker, older, and more fragile patients. An intra-operative MRI allows surgeons to examine a patient while he or she is still in the OR to make sure all of the tumor has been removed and helps reduce reoperation rates. The most common question a patient and his or her family asks after surgery is, "Did you get all of the tumor?" Surgeons used to have to say, "I think so," says Thapar. In-suite imaging changes that.
Screw malposition rates are just one example of how the technology is improving outcomes. If medical screws used to stabilize the spine are not positioned correctly, the results can be fatal, so most patients must undergo a second surgery to fix poor placement. The average screw malposition rate is about 5%. Thapar's freehand screw malposition rate was about 2.5%. After the hospital started using the smart technology, the screw malposition rate dropped to less than 0.1%. The reoperating rate went from 15% to 0%.
"This was the first time in my entire career I achieved a zero anything," Thapar says. The technology also aids physician recruitment, says Steve Ronstrom, president and CEO of Sacred Heart. "We made a decision to really get a comprehensive and high-quality neurosurgical program here," he says. "The way we were going to compete is to attract the very best doctors to our community."
But the smart OR didn't just help Sacred Heart attract surgeons in the midst of a specialist shortage, Ronstrom says. It also allowed the organization to hire surgeons who were willing do charity care, perform both complicated and bread-and-butter cases, and even cover the ER.
It's had a ripple effect on the entire organization and its culture, Thapar says. It's changed how the hospital thinks about itself and also how others perceive the organization. "There's no question that this is the way things are going to go. There's just no doubt in my mind," says Thapar. "This technology became the catalyst for change . . . and we just won't be going back."
What's Next: How do you prepare for a project as ambitious as this one? "Plane tickets are the best investment we can make," Ronstrom says. Visiting other organizations with similar technology allowed Sacred Heart to learn from others' mistakes and challenges. Even the smallest details—such as the positioning of a patient headrest—can be a big issue. "The devil's in the details," Ronstrom says.
Nanotechnology itself is not new—it's already being used to make sports equipment lighter and to make computer chips faster, for example. But there are some new medical applications in the pipeline, according to the National Nanotechnology Initiative, which coordinates federal nanotechnology research and development funding. Drugs that use nanoparticles to deliver toxins directly to tumors, minimizing damage to healthy tissue, are now in trials. Nanotechnology could make imaging tools work better and more safely. And gold nanoparticles can be used to detect early stage Alzheimer's.
Researchers at the University of Michigan and Roswell Park Cancer Institute are studying a treatment that uses nanoparticles to better visualize brain tumors during surgery, improve brain tumor resection, and eradicate residual tumor cells. To do this, they are designing tissue-staining nanoparticles that will be selectively internalized by brain cancer cells. The nanoparticles, which specifically target cancer cells, will be linked to both a dye and a therapy agent. The dye will allow surgeons to visualize the tumor during surgery, facilitating more complete resection, according to the National Institute of Biomedical Imaging and Bioengineering. Following removal of the bulk of the tumor, the light-activated therapeutic agent would be stimulated by laser light to kill the remaining tumor cells.
Infection control is another area where nanotechnology shows promise. For example, scrubs and lab coats made by Vestagen Technical Textiles of Orlando, FL, repel liquids as watery as wine or as viscous as ketchup. The fibers are impregnated with nano-sized silicone particles that change the surface area of the fabric, increasing tension and creating a barrier to fluids such as blood and vomit. The material also has antimicrobial properties with a rapid kill time—99.9% of microbes are eradicated in fewer than 10 minutes, compared with consumer-market materials such as those used in athletic gear that can take up to 24 hours to eradicate microbes. The scrubs are in trials at Virginia Commonwealth University's Medical College of Virginia and at Washington Hospital Center. Vestagen is awaiting FDA approval for its efficacy claims.
"There's no question if you culture curtains or ties or coats you find organisms," says Richard Wenzel, MD, professor and former chairman of the department of internal medicine at VCU. "It's not solidly proven yet how much organisms are transferred from a physician's clothes to a patient."
Combining the two mechanisms—the antimicrobial to kill on contact and the nanotechnology to repel liquids—shows promise for protecting healthcare workers from acquiring of nosocomial pathogens, says Thomas J. Walsh, MD, adjunct professor at the University of Maryland School of Medicine who, in collaboration with colleagues Shmuel Shoham, MD, and Matthew Hardwick, PhD, is conducting lab and clinical studies of the product at Washington Hospital Center, a 926-licensed-bed teaching hospital in Washington, DC.
"It's a multipronged approach. No one measure is going to be successful," he says. "Bacteria and fungi are very adherent organisms," he adds, and there could be a "substantial reduction of organism acquisition on the engineered fabric."
What's Next: Scientists are still researching the impact of nanotechnology on infection control, but in the meantime, Wenzel advises hospital leaders to embrace new and emerging infection control measures. "It will save you a lot of money, it will save you lawsuits, it will save you bad publicity, and you'll have bragging rights for low infection rates," he says.
Healthcare organizations are already using wireless technology to remotely monitor patients and transmit large imaging files. But the devices will soon be much smaller, more convenient, and have a higher sampling rate. One emerging wireless technology is the smart or wireless bandage. Patients simply peel off the backing and stick it on their skin like a nicotine replacement patch. The disposable medical device has a processor to monitor vital signs, which are transmitted to a processing service.
Current boxlike models that connect to a phone line send out a patient's vitals once or twice a day—assuming the patient complies. The new technology can take and send thousands of data samples daily. And the devices are passive: The patient's compliance is met just by putting the bandage on.
What's Next:Wireless devices and telehealth are among the most frequently cited examples of technology that will change how healthcare is delivered. Among the benefits: They speed diagnosis, intervention, and therapy; they produce more data and lead to better outcomes; and they're more efficient.