Chief Technology Officer: Let ‘Clinical Need’ Be Your Guide in Purchasing Decisions

Posted June 12, 2017

Using systems engineering principles to take a hard look at the clinical needs, processes, and workflow factors involved with the deployment of clinical technology can result in substantial cost savings for healthcare facilities, said Eliezer Kotapuri, chief clinical technology officer for Mass Technologies, during a presentation Monday at the AAMI 2017 Conference & Expo.

Kotapuri cited an Institute of Medicine report that stated the healthcare system wasted an estimated $765 billion in 2009, which was more than the entire budget of the Department of Defense. Although many factors contribute to this waste, including fraud and duplication of efforts, ineffective deployment of clinical technology also plays a significant role.

Care of patients—and how the technology will affect the quality of care—should be the primary force underlying all capital purchases, according to Kotapuri.

"The clinical need should drive technology rather than the technology itself or cost," he said.

Striking the proper balance between operational and organizational efficiencies is vital to effective capital purchases. To achieve this balance, Kotapuri said the facility must start by asking the right questions. For example: Is there enough space to execute the project? Can the current ceiling height accommodate the technology? How is the real estate in the ceiling or floor used, and what takes precedence (e.g., determining whether surgical lights will reach the area of interest)? Are the correct utilities available?

He also warned against placing a heavy emphasis on whether the space and the technology within it "looks nice." The primary concern should be whether the space and equipment are functioning to benefit the patient. Rather than trying to "shoe horn" a technology into a given space, the clinical need should guide decision making.

Although it's important to listen closely to architects, the decisions that are made ultimately should be based on what works best from a clinical perspective. Kotapuri also recommended reading regulations, instead of relying on the interpretation of architects or engineers, and to ask for a proof of concept. By getting these details correct from the outset, he said, the facility can avoid costly renovations over the years that follow.

Other tips from Kotapuri included:

  • Avoid technology that may change processes and introduce inefficiency. "Just because it rides and has four wheels does not mean that it can be driven on the interstate," said Kotapuri. "The technology should fit the application."
  • Ask how, where, and when the device will be used. In addition, how other equipment will interact with the incoming device requires careful review.
  • Ask for clarification on the actual functioning of the device if medical equipment planners are helping with a task.

Kotapuri offered the following guarantee: "If the right technology is not selected, then the application and use of the technology will never be right."

On a similar note, Kotapuri emphasized that technology and technique are two different things. "You can't ask for a technique to be perfect if the technology is not perfect," he said. "I can't stress this point enough."

To further illustrate this point, he described the differences in applying process engineering concepts in the automotive industry versus in healthcare. A statement such as, "If performing a certain job takes six minutes, then 10 cars can be processed in an hour," can work for the automotive industry because the variables involved are more or less fixed. However, because of the myriad of human factors in healthcare, a statement such as,"If performing a certain job takes six minutes, processing 10 patients in an hour," would be irresponsible, as it discounts the elusive "human element."

Our thinking, said Kotapuri, has to evolve commensurate with the technology itself. We must challenge conventional thinking and adopt innovative designs. By taking an approach of "impacting the impact before the impact impacts you," said Kotapuri, we can benefit patients, reduce waste, and save money.