Apps for addiction, direct-to-consumer genetic testing, acuity-adaptable rooms, and virtual reality for pediatric patients are among the topics poised to affect healthcare during the next 12 to 18 months, according to the ECRI Institute's 2018 Top 10 Hospital C-suite Watch List.
"This year we selected a range of technologies and infrastructure issues hospital leaders and their teams are facing, will be facing, or should consider," Diane C. Robertson, director of health technology assessment at the ECRI Institute, said in a statement.
Topping the list is the first US Food and Drug Administration (FDA)–approved prescription mobile medical app to help treat substance use disorders (SUDs) involving alcohol, cocaine, marijuana, and stimulants, but not opioid dependence.
As previously reported by Medscape Medical News, the reSET app, from Pear Therapeutics, should be used in conjunction with both outpatient therapy and a contingency management system, a widely used program for treating SUDs that utilizes a series of incentives to reward patients for adherence to their treatment.
In a 12-week clinical trial of 299 patients diagnosed with an SUD, use of the reSET app nearly doubled the rate of abstinence and increased retention in treatment compared to standard face-to-face therapy.
Pear Therapeutics is also developing a version of the reSET app for treating opioid use disorder. Clinical trials with the reSET-O app have demonstrated improved abstinence and increased program retention when used in combination with opioid replacement therapy, according to the company.
The reSET-O app has received the FDA's expedited review and is expected to reach the market sometime in 2018.
Coming in at number 2 on the ECRI Institute's latest watch list is direct-to-consumer genetic testing, which is changing how clinicians interact with patients who pursue tests on their own.
"Direct-to-consumer (DTC) genetic testing accelerated in 2017 and shows no signs of abating in the months and years ahead. Many of the latest DTC genetic tests entering the market are more likely to have implications for healthcare provider and health system interactions with, and care for, their patients. Patients who receive unexpected results with healthcare implications or uncertain results that generate anxiety may increase patient demand for follow-up services," the report notes.
"Hospital leaders often are not aware how much lab budgets are being blown by genetic testing, inappropriate use from lack of evidence-based information, and unreimbursed testing," Robertson said in the statement. "Now that direct-to-consumer testing provides health information to patients, it will drive them to seek attention to understand the implications of their test results."
The report recommends tht healthcare providers designate someone in each clinical service line to monitor new entrants into the DTC genetic testing market, as well as changes to existing tests in the DTC landscape. They also suggest that frontline staff gather information that patients who use DTC tests bring to their attention and that they ask patients for follow-up after receiving results.
Number 3 on the list is acuity-adaptable care delivery models, wherein a hospital keeps a patient in the same room from admission to discharge, regardless of acuity level. Some hospitals are experimenting with acuity-adaptable rooms with an eye toward improving workflows, continuity of care, and patient safety and decreasing length of stay and costs, the report notes.
"While acuity-adaptable models make intuitive sense, many challenges exist in staffing, infrastructure, and workflow to actually improve patient outcomes. Just ensuring and maintaining staff competencies across all care levels requires a major rethink of nursing and hospitalist support models," the report notes.
The report recommends that facilities form a steering committee of multidisciplinary members to address training, room design, and patient charges and that nursing staff be included early in the process. A visit to hospitals that have implemented acuity-adaptable care models is also recommended.
Number 4 on the list is Abbot Labs' Confirm Rx, an implantable loop recorder cardiac monitor. This insertable cardiac monitor is the first of its type to interface directly with a patient's smartphone. With Confirm Rx, the patient's smartphone proactively transmits data to the patient's physician, eliminating the need for the patient to use a bedside telephone transmitter, the report notes. At intervals programmed by the treating physician, the smartphone app automatically uploads patient data to the Merlin.net Patient Care Network for clinician access.
Rounding Out the 2018 Watch List
5. Distraction-based virtual reality (VR) for pediatrics: Several children's hospitals and companies are working together to develop software that provides three-dimensional VR experiences to help children overcome or be distracted from the fear and pain caused by repeated injections and infusions needed for chronic conditions. Recent studies have shown significant declines in pain and anxiety scores in children and a decrease in the anxiety of parents helping their child through difficult and numerous medical procedures with the use of VR technology.
6. NeuroAD Therapy System (Neuronix Ltd) for Alzheimer's disease: "The technology purportedly delivers sustained cognitive improvement by combining noninvasive transcranial magnetic stimulation (TMS) with computer-based cognitive training, added to existing pharmacologic therapy," the ECRI Institute notes. NeuroAD is the first device-based treatment for AD to receive the CE (Conformité Européene) mark for clinical use in the European Union. The device is currently under review at the FDA and could receive clearance this year.
7. Microneedle blood-collection devices: The touch-activated phlebotomy device from Seventh Sense Biosystems extracts blood quickly and virtually painlessly and was recently approved by the FDA. The single-use device, which is about the size of a golf ball, adheres to the patient's upper arm. A push of a button activates 30 microneedles and a small vacuum to collect 100 microliters of capillary blood over 2 to 3 minutes. An indicator signals that the collection is complete. Another company, Tasso, Inc, is close behind in developing its HemoLink device for simplified blood sample collection.
8. Neonatal MRI system: The Embrace Neonatal MRI System (Aspect Imaging), approved by the FDA in 2017, as reported by Medscape Medical News, is designed for point-of-care imaging in the neonatal intensive care unit of the neonatal brain and head. The system reduces risks associated with patient transport and enables staff to rapidly perform emergency care, the report notes.
9. GammaTile cesium-131 (Cs-131) brachytherapy in neuro-oncology: The GammaTile Radiation Therapy System (GT Medical Technologies), currently under review at the FDA, incorporates cesium-131 Cs-131 brachytherapy seeds, which are embedded into a bioabsorbable collagen mesh that is sutured or stapled into place in the cavity left by an excised brain tumor at the time of the surgery. The Cs-131 brachytherapy seeds purportedly deliver their radiation dose to the target tissue more quickly and more directly than either external-beam radiation therapy or other forms of brachytherapy that use different radioisotopes, potentially improving outcomes and reducing injury to adjacent healthy tissue.
10. Microhospitals: Many health systems and investors are pursuing microhospitals as a way to distribute care throughout a system's service region, to brand the health system, and to extend healthcare by positioning such hospitals in fast-growing suburban areas.
Available as a public service, the ECRI Institute watch list provides hospital leaders evidence-based perspectives on innovations and care delivery trends that have the potential to affect cost, quality, and patient outcomes, the institute notes.
"Nobody pays us to produce our C-suite watch list — it's built on our deep, independent expertise for how to address today's and tomorrow's healthcare challenges. Many healthcare leaders use this as a springboard for informed decision making in their capital planning programs and strategic initiatives," says Robert P. Maliff, director, strategic growth and business development, ECRI Institute.
ECRI Institute's 2018 Top 10 Hospital C-suite Watch List is available for download.
Medscape Medical News © 2018
Cite this: Top 10 List of 2018 Healthcare Innovations Released - Medscape - Jan 24, 2018.