Integrating New Clinical Technologies

Academic medical centers are often among the first to adopt new technologies. Historically, these initiatives have been relatively straightforward, like installing new X-ray or CT equipment. Major challenges arise with transformational technology: something that is being done, often for the first time, which entails re-training, hiring new technicians and clinicians, adding space, or changing routines.

Kevin B. Mahoney, senior vice president and chief administrative officer for the University of Pennsylvania Health System, and Erik Mollo-Christensen, principal with Tsoi/Kobus & Associates, recently collaborated on the new $142-million Roberts Proton Therapy Center at Penn Medicine’s Perelman Center for Advanced Medicine in Philadelphia. Using this experience as a springboard, they have formulated several guidelines that identify and address the major integration questions that arise when adopting new clinical technologies.

According to Mollo-Christensen and Mahoney, these integration issues fall into three categories: strategic, financial, and physical.

Strategic Considerations

Strategic considerations are driven by three questions: What is the institution’s overall approach to technology? What new areas would attract and retain top talent? How will the new technology affect the delivery of care?

Trying to compete with community hospitals on technology alone is nearly impossible, Mahoney advises.

“In the past, technology purchases would give Penn a five- to seven-year advantage in the market place. Now, nearly as soon as we buy new technology, another institution also acquires it,” he says. “The best course is to be very selective about pushing technology for technology’s sake as a competitive advantage.”

For the Penn Health System, the decision was to focus on transformational technology, with the goal of building superb clinical programs that distinguish Penn medicine in the marketplace. One example is a cell vaccine production facility, in which a patient’s cells are removed, genetically altered, and then reintroduced into the body as a personalized vaccine against the disease. The first application at Penn was ovarian cancer. Now, the treatment is being used in heart surgery, with some significant implications for facility location.

As for attracting and retaining gifted physicians, Penn is emphasizing preventable mortalities and improved outcomes.

“For example, we are trying to meld laboratory and radiology data into an integrated diagnostics platform. New technology that can increase the speed and accuracy of a patient diagnosis is sorely needed and a research interest at leading academic medical centers across the country,” Mahoney says.

Focusing on technology that markedly improves patient outcomes is also key. For example, comparing robotic surgery to the traditional “open” method, Mahoney points out that the robot often costs about four times more than the conventional approach.

“Is the patient four times better off?” he asks.

Mahoney also points out that most patients choose a hospital for inpatient stay according to their primary doctor’s recommendation, with technology about “dead last” on the list of influences.

Financial Considerations

Financial issues relate primarily to payback terms and funding sources.

Calculating the payback of a new technology investment is not a difficult task, but Mollo-Christensen cautions that costs beyond equipment acquisition and installation must be factored into the equation. For instance, data storage requirements for images from digital microscopy add significant sums to the budget.

It is also important to base ROI calculations on stable reimbursement rates, a challenge as competition, insurance pressures, and health care reform continue to drive those numbers down. Penn’s computations are based on the assumption that all new technology must operate within Medicare reimbursement rates, Mahoney says.

Donor funding frequently pays for new initiatives, but opportunities exist elsewhere as well. Sharing space or equipment, like coordinated clinical and research use, creates possibilities for internal collaboration.

“Also look for regional clinical or financial partners, or develop a program with community doctors to help support the patient load the technology requires,” Mollo-Christensen says.

Sometimes, a facility is built by a third party, like an outside developer, who obtains his own financing and then enters into a long-term operating agreement. Manufacturers of cutting-edge technology may be willing to invest, either directly or through a discount in the equipment.

Mollo-Christensen also advises that the cost equation for technology is quite different from a normal hospital project.

“With typical clinical work, for every $100 spent on construction, another $50 to $75 goes to design fees, medical equipment, legal costs, etc. But with some of the larger or more complex technologies, like proton facilities, the equipment cost is twice the building cost, and the building cost winds up being one-quarter of the total.”

Physical Considerations

Physical concerns range from finding an appropriate location to providing the right site conditions and infrastructure to support the new equipment or facility. It takes a larger-than-normal crane resting on exceptionally stable ground to install a 200-ton cyclotron, for example.

Not to be overlooked is the patient experience.

“Good healthcare design is paramount, after providing the actual clinical care,” Mollo-Christensen says.

Finally, prepare for the evolution of technology. At some point, the equipment will need to be removed and replaced. Plans for access and future construction are imperative.

By Nicole Stahl

This report was based on a presentation given by Mahoney and Mollo-Christensen at Tradeline’s Academic Medical and Health Science Centers conference in October 2009.

Project Teams

Roberts Proton Therapy Center & Perelman Center for Advanced Medicine

Owner: University of Pennsylvania Health System
Prime Architect: Tsoi/Kobus & Associates (Roberts Proton Therapy Center)
Architects: Rafael Viñoly Architects, Perkins Eastman (Perelman Center for Advanced Medicine)
Construction Manager: L. F. Driscoll Co., McKissack
Structural Engineers: Thornton Tomasetti, Goldstein-Milano, LLC
Civil Engineers: Hunt Engineering Company
MEP Engineers: Bard, Rao + Athanas Consulting Engineers, LLC

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ISSN: 1096-4894