Case studies on forecasting for innovative technologies: frequent revisions improve accuracy.

Health technology forecasting is designed to provide reliable predictions about costs, utilization, diffusion, and other market realities before the technologies enter routine clinical use. In this article we address three questions central to forecasting's usefulness: Are early forecasts sufficiently accurate to help providers acquire the most promising technology and payers to set effective coverage policies? What variables contribute to inaccurate forecasts? How can forecasters manage the variables to improve accuracy? We analyzed forecasts published between 2007 and 2010 by the ECRI Institute on four technologies: single-room proton beam radiation therapy for various cancers; digital breast tomosynthesis imaging technology for breast cancer screening; transcatheter aortic valve replacement for serious heart valve disease; and minimally invasive robot-assisted surgery for various cancers. We then examined revised ECRI forecasts published in 2013 (digital breast tomosynthesis) and 2014 (the other three topics) to identify inaccuracies in the earlier forecasts and explore why they occurred. We found that five of twenty early predictions were inaccurate when compared with the updated forecasts. The inaccuracies pertained to two technologies that had more time-sensitive variables to consider. The case studies suggest that frequent revision of forecasts could improve accuracy, especially for complex technologies whose eventual use is governed by multiple interactive factors.

The case for a national patient library.

A national patient library that stored and communicated findings from research on the comparative effectiveness of health services could be a valuable resource for patients and clinicians. It could assist in improving the quality of health care and help reduce inappropriate costs. Public confidence in a national patient library would require that its activities be insulated from government as well as from professional, provider, payer, and commercial groups and advocacy organizations. This article describes why such a library is possible and desirable, what it would do for whom, how it could be governed and financed, and how it could overcome initial challenges.

Top technology issues for ambulatory care facilities this year and beyond.

ECRI Institute medical technology experts (i.e., biomedical engineers, patient safety experts, physicians, and research scientists) compiled a list of important technology-related issues that executives and clinical leaders at ambulatory care facilities should pay close attention to this year. The list presents several high-profile technologies in the context of the convergence of critical economic, patient safety, reimbursement, and regulatory pressures. Guidance is provided about key considerations regarding adoption and implementation of electronic medical records, high-end computed tomography and magnetic resonance imaging technology, the convergence of health information technology and medical technologies highlighting integrated patient alarm systems as a case in point, physician preference items such as cardiac stents, robotic-assisted technology for minimally invasive procedures, image-guided radiation technologies, and the role of radiofrequency identification technology.

The consequence of secret prices: the politics of physician preference items.

This paper assesses the implications for policy of recent aggressive efforts by manufacturers to enforce price-confidentiality clauses in contracts with hospitals for purchases of physician preference items (PPIs) such as implantable medical devices. Secrecy clauses prevent hospitals from revealing prices to third parties that help them negotiate prices and to surgeons who specify which device brands and models hospitals purchase. Litigation focused the attention of journalists and policymakers on problems that result from the asymmetry of information between buyers and sellers in the market for PPIs. Legislation is pending.

The role for leaders of health care organizations in patient safety.

We review what leaders of health care systems, including chief executive officers and board members, need to know to have "patient safety literacy" and do to make their systems safe. High reliability organizations produce reliable results that are not dependent on providers being perfect. Their characteristics include the commitment of leadership to safety as a system responsibility, with a culture of safety that decreases variability with standardized care and does not condone "at-risk behavior." A business case can be made for investing resources into systems that produce good outcomes reliably. Leaders must see patient safety problems as problems with their system, not with their employees. Leaders need to give providers information to make and monitor system progress. All medical errors, including near misses, and processes associated with all adverse events may provide information for system improvement. Improving systems should produce better long-term results than educating workers to be more careful.

Will using evidence-based approaches to a standards development process improve Medicaid policy making? Report on a promising effort.

In theory, evidence-based medical necessity policy in health care utilization review may make resource allocation more equitable. Costs can be managed through the consistent application of standards for approval of only those services deemed medically necessary and by controlling denials and appeals litigation. Additional cost savings may be realized with more efficient utilization review processes and concentration on review standards for the specific items or services that have the greatest financial impact on overall utilization dollars. This article describes a five-step process for evidence-based medical necessity standards development and includes illustrative examples from a state Medicaid agency project. While early results are promising, data are scarce. The authors, nevertheless, believe the approach may prove to be useful on promoting the application of evidence-based decision making.