Medical technology can be an important contributor to ending hallway medicine

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By Pippa Wysong

When it comes to improving efficiencies in hospitals, reducing costs and getting patients home sooner, an important part of the equation lies with technology.

Indeed, technologies already have a solid track record for speeding up diagnoses, leading to shorter procedures and improving outcomes. And, as new technologies are adopted, can help alleviate some of the issues that contribute to the overcrowding in hospitals and so-called hallway medicine.

“If you want better patient outcomes and want to be able to address hallway medicine, you need innovation and technology,” says Nicole DeKort, Vice-President, Ontario and Marketing at MEDEC.

But Canada has sometimes been slow to adopt new technologies, she said. This is especially true for medical technologies, yet they help get patients out of hospital and help support them in the community and in their homes. To improve this, MEDEC created the Hospital to Community Collaborative (HCC) that brings together industry along with healthcare and government partners to address barriers hindering the adoption of technologies that support chronic disease management and post-acute care patients in the community. MEDEC is the national association representing Canada’s medical technology industry, and represents approximately 100 medical technology companies.

“While the issues around overcrowding in hospitals are complex, technology can provide solutions,” adds DeKort. In fact, new technologies are constantly being developed with this mind. Canada is host to more than 1,500 medical technology companies which employ more than 35,000 people.

Historic examples of technologies that have improved patient flow and better outcomes include keyhole surgeries that allow for minimally invasive surgical procedures; devices that allow for diabetes and heart patients to be monitored at home instead of having to go to a hospital clinic; detailed imaging technologies which improve diagnoses or targeted therapies and devices that offer greater mobility to older or injured patients, and more.

A glimpse of the future of what hospitals across Canada could be like is illustrated by Ontario’s new Humber River Hospital which opened in 2014. It is the first fully digitized hospital. Everything from its architectural design to an intricate system of roving robots, telecommunications, integration of data items with physician smartphones, electronic charts, use of barcode systems to track materials and tests, and more, help ease the patient journey through care, as well as making tasks and procedures more streamlined and easier for staff. General Electric was the company behind developing a novel centralized command centre for this.

TECHNOLOGIES THAT ARE PROVIDING RAPID DIAGONOSES, BETTER OUTCOMES

Hospitals are seeing an increase in the use of various rapid diagnostic systems. Some are used in hospital labs, while others are in the form of a portable, hand-held point-of-care (POC) devices. One example is Roche’s Elecsys Troponin T-high sensitive assay, a highly sensitive laboratory test that can let doctors know within an hour whether heart attack has occurred.

All patients with chest pain admitted to the ER have blood samples taken and sent to the lab to test for troponin levels — an indicator of heart tissue damage. Testing often requires a second test conducted about three hours later to determine a change in troponin levels from baseline admission value.

However, the highly sensitive test provides a quicker and more accurate result. “If a patient test is undetectable for troponin at admission, the vast majority don’t need the second test, freeing up an ER bed more quickly,” says François Drolet, a spokesperson for Roche Diagnostics, Canada and a participant on the HCC.

In fact, he notes, in Denmark a POC troponin test is used by EMS professionals. “The test is done in the ambulance as a patient is being transported, giving a quicker idea of what treatment patients should get before they even get to the hospital, improving efficiency,” he says. Roche Diagnostics is one of several companies developing and manufacturing rapid diagnostics for a variety of medical conditions.

Drolet notes that when evaluating new technologies, big-picture economics need to be taken into account, something the HCC is aiming to address. A new technology sometimes may appear costly on the surface, but if it reduces hospital stays, speeds up diagnoses, improves patient outcomes, reduces the need for additional tests or treatments, reduces readmissions and other related benefits, it saves the healthcare system in overall expenditures.

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“Another game-changing technology is transcatheter aortic valve implantation (TAVI) which is replacing surgical replacement of the aortic valve,” says Dr. Natarajan, Director of Catheterization laboratories at Hamilton Health Sciences. It is less invasive than chest-opening surgery, doesn’t require a bypass machine, and more recently, can be done with conscious sedation without putting patients on a breathing machine.

Each year, one-in-ten to one-in-twelve Ontarians develop aortic stenosis, a narrowing of the aortic valve in which the valve thickens, gets calcified and degenerates. Some people develop severe aortic stenosis needing intervention, but until recently 40 per cent of these patients were not eligible for surgery and half died within two years.

In these high-risk patients, TAVI leads to a 50 per cent drop in mortality, Dr. Natarajan said. Now, 2,000 patients per year get aortic valve surgery and about 800 patients get TAVI. Work is now underway to investigate whether TAVI should be used in earlier disease.

After standard aortic valve surgery hospital length of stay is at least five days. TAVI patients are ambulatory within six hours, and studies show discharge within 24 to 48 hours of the procedure is feasible and safe. “This early discharge pathway could probably apply to about 75 per cent of TAVI patients,” he says.

The ability to monitor TAVI patients remotely would give them even more independence, Dr. Natarajan said. A clinical study, funded by Ontario’s Health Technologies Fund, is now exploring use of the mobile cardiac arrhythmia diagnostics (m-CARDSTM) from Burlington, Ontario-based m-Health Solutions. Before undergoing TAVI, patients are monitored real-time from a central monitoring station and the clinical team is alerted if a rhythm abnormality is discovered. Similarly, stable post-TAVI patients are fitted with a monitor for a minimum of two weeks. This early warning system enhances collaboration between various health care providers, maintains continuity of care, and may reduce emergency department visits.

“We are incredibly excited to partner with such innovative organizations such as Hamilton Health Sciences and Sunnybrook Hospital on this project,” says Sandy Schwenger, CEO of m-Health Solutions. “Partnerships like these, with the involvement of the Government of Ontario, allow us to bring technology like the mobile Cardiac Arrhythmia Diagnostics Service forward faster and save the lives of more Canadians.”

“These are only a couple of examples of how technology is transforming hospitals and the health care system,” says DeKort. Along with technologies that are already in use, there are also numerous technologies under development, as well as various products currently being evaluated for use the healthcare system.

Pippa Wysong is a freelance writer.