Join 24×7 Magazine Chief Editor Keri Stephens she talks to Scott Skinner, MBA, FACHE, director of capital equipment planning at Sodexo Healthcare and PhD candidate, who is conducting a survey about evaluating and selecting medical equipment. In the podcast, Skinner defines the health technology assessment (HTA) process and reveals how a hospital-based HTA differs from a “big-picture” HTA. He also divulges why HTA can get a “bad rap” and whether it’s justified.

Moreover, Skinner shares how healthcare technology management professionals can get a better seat at the table when equipment is being evaluated and selected and well as HTA best practices. Finally, Skinner reveals his hopes for how his survey will help advance the conversation about HTM’s involvement in capital equipment purchasing.

Podcast Transcript

Keri Stephens:
Hi, welcome to the MEDQOR Podcast Network. My name is Keri Stephens and I’m the editor of 24×7 and your host. Today I’m here with Scott Skinner, a PhD candidate and well known member of the HTM field who is currently conducting a really interesting survey that we think you all should take part of. So Scott, welcome.

Scott Skinner:
Thanks Keri. Thank you so much for having me on the podcast today.

Keri Stephens:
Of course.

Scott Skinner:
Like you said, I’ve been around a little while, been in the HTM field more than 25 years now. Started off in field service and operations and then went to work for a six hospital system in Kentucky where originally I was in supply chain and oversaw capital procurement and then I moved into HTM, the HTM executive role, and was there for 13 years. And now I’m a director of capital equipment planning where I help analyze medical equipment inventories for client hospitals across the country. But I’m also a PhD candidate working on my dissertation. So because of my background, I’ve just been really interested in how hospitals go about evaluating and selecting medical equipment. I just think it’s a fascinating topic. There’s not a lot of research out there on the topic, surprisingly. So there’s a gap that needs to be filled and I’m working to do that with the survey I’m doing currently and the research is part of my dissertation.

Keri Stephens:
That’s awesome. And congrats on going for a PhD. That’s amazing, especially in this field. So can you talk about the HTA and how it’s defined?

Scott Skinner:
Yeah, so I’m referring to the process that we evaluate and select medical equipment as Health Technology Assessment. So first we have to understand what’s meant by health technology. And it’s actually been defined by the World Health Organization pretty broadly to include devices, drugs, procedures, and even systems that are used to help solve a health problem and improve the quality of people’s lives. Again, it’s an extremely broad definition. But of course in HTM we’re most concerned with electronic medical equipment, which is a subset of the device domain of health technology. So probably the latest definition for Health Technology Assessment, or HTA, is from a couple years ago where it was defined as a multidisciplinary process that uses specific methods to determine the value of a health technology at different points in its lifecycle.

Scott Skinner:
And the purpose of HTA is to really inform the decision making process so we end up with an equitable, efficient and high quality healthcare system. So again, when we say HTA, we’re really talking about all the various processes used to evaluate and select health technologies. Now, just quickly to mention, HTA can occur at varying levels. So HTA seems to be most often associated with policy level decision making. So for example, if we’re deciding if a wound care technology makes sense for Medicare patients, so in that instance we’re talking about the entire Medicare population. Another example might be evaluating a new imaging technology for the National Health Service in the United Kingdom. So in that instance we’re talking about an entire country. But HTA can also be used at the organizational level. And that’s mostly what we’re going to be talking about today. And there’s a good example of HTA being used at a hospital in Canada, for example, to facilitate the choice of smart pumps.

Keri Stephens:
Okay. And how does a hospital based HTA generally differ from big picture HTA?

Scott Skinner:
So where big picture HTA might focus, again, on that broad population. We’re really, when we’re talking about hospital based HTA, we’re concerned mostly on which technologies best fit with our local circumstances. So our hospital might serve special patient populations, for example, such as a children’s hospital that might be 50% NICU patients. Or maybe our hospital is a dedicated heart hospital. Also, there are unique things with the operating environment, if you will, the clinical staffing that might be present in a particular hospital, the culture. All those things must be taken into account to see if we can determine the best fit from a safety, from an efficacy effectiveness and cost effectiveness standpoint. But again, from a local or regional perspective.

Keri Stephens:
Great. And what are some of the best practices used in hospitals?

Scott Skinner:
So I’m going to use an analogy here, the classic iceberg example where you know have the iceberg floating in the sea and you see part of the iceberg. It’s obvious, you can characterize it. But then a significant part of the iceberg is below the waterline and we can’t see it. So really, HTA in hospitals is attempting to evaluate what that entire iceberg looks like. So some of the things that are looked at include clinical evidence. Are there peer reviewed publications that support the idea of the technology or one technology over another? Technical analysis can be another aspect. So HTM or IT might look at serviceability, supportability, security, things that are more technical in nature. From a clinical perspective, we might look at doing demonstrations where a vendor or potential vendors bring in technology and they show us how it might be used. We may decide to carry that a step forward and actually do simulations.

Scott Skinner:
So, develop some standard clinical scenarios that occur in the hospital, bring in some of the technology and actually have some of the users go through and emulate those practices and see how they would work in that technology. And then probably the most advanced, sometimes it makes sense to bring things in for actual trials, clinical trials. If, for example, we get down to a couple of options and both of them are viewed as safe and effective, let’s bring both of those options in and use them in a controlled way to see if we can determine which one might be the best fit among both potentially acceptable fits. So some other things are gathering feedback from other hospitals. It’s always good to know what others have experienced who have gone before us, where we can learn some things without having the effort of sometimes a failed implementation on our own. We might look at history of problems and recalls that have been associated with technologies.

Scott Skinner:
And a big one, which sometimes HTA gets a little chastised for, is focusing on total cost of ownership. So sometimes HTAs are chastised for being a little bit too financially focused. But as we know in today’s environment, the total cost of ownership, understanding the full cost going in can be very important. And I draw an example to buying a car. Most of us go to buy a car, we are probably focused on the color of the car, the feature, does it have a heated steering wheel, is it comfortable to ride in? We’re probably not thinking a whole lot about what the ongoing support cost of that car is going to be, or we assume they’re all going to be roughly equivalent to each other.

Scott Skinner:
And those of us in HTM know that that definitely is not always the case. Serviceability and supportability varies widely. The ability to partner with vendors in different ways varies quite a bit. But at the end, all of that is taken into consideration. And typically we have a multidisciplinary team that’s been assembled to wrestle with all these different questions and then basically debate. Here’s all the evidence we gathered. Based on all this, do we think we would achieve certain outcomes with one technology over another? And again, which might be the best fit for our organization given all those circumstances?

Keri Stephens:
Great. So what’s the prevalence of these different practices?

Scott Skinner:
Yeah, surprisingly we don’t know. I’ve been looking into this for a period of time now. There’s very little prior research on the state of HTA in US hospitals. In 2003 there was a small informal study done of West Coast VHA hospitals, that was 19 hospitals, that was published in some supply chain literature. In 2007 and 2008 there was an international survey done, but it only had a single US based organization participate in it. So most of the research that you look at is out of Europe and out of the international space, not so much in the US. And of course, generally when you’re looking to study a situation, you really need to understand the current state before you can suggest future steps. And that’s really where I think we are as an industry right now. We really need to better understand what’s going on with the current state before we try to look at some jumping off points and how we advance the conversation nationally.

Keri Stephens:
I want to switch gears a little bit. Something we’re always talking about in the magazine and even on the podcast is how biomeds can get a better seat at the table for these important discussions. So how can a biomed be part of the discussion when medical equipment is being evaluated and selected?

Scott Skinner:
Yeah, great question. So pretty much everybody in HTM has had the following scenario happen. The first time you find out a new technology is coming in the hospital is when it shows up on the back dock.

Keri Stephens:
Right.

Scott Skinner:
And that’s the issue that we want to address. And I have a pretty strong opinion here. I do believe HTM does need to be taking a leadership role in HTA in hospitals. Now that doesn’t necessarily mean that we are taking the leadership role, but HTM folks, we are great at being objective scientist who approach things methodically and without bias. And that’s exactly the sort of approach that HTA needs. We obviously are experts on service and support. We have so much more to offer. Many people in our field have advanced engineering degrees and can help conduct things like human factors analyses, failure modes and effects analyses, things that help determine the degree of fit or lack thereof with technologies in our hospitals. I think the challenge is you don’t just decide one day that you want to be more involved in HTA and walk up to administration and say you want in.

Scott Skinner:
I think first, HTM certainly has to be well positioned within the organization, on a steady foundation and having a history of driving value for the organization. I do think it’s always helpful to be able to tell a story though. If you have some internal examples that you can point to, maybe some external case studies, when you have those available, of things that didn’t go so well and what we can do to address it. Certainly we want to be careful, we don’t want to throw people under the bus, but if we can carefully cite an example where HTM wasn’t involved and how it negatively impacted the organization. Particularly where we can point out things like metrics, like safety concerns, down time or cost, that can help build a case upfront to help ensure our involvement in the process.

Keri Stephens:
Perfect. Okay. Let’s talk best practices now. What are some possible next steps with hospital based HTA?

Scott Skinner:
Yeah, so up until now I don’t think there’s really been a formal name for the processes we use in hospitals to evaluate and select medical equipment. Perhaps the closest term is something called value analysis, which is a term that typically is used by supply chain and purchasing people. I certainly imagine that the processes used in hospitals across the country are quite varied and sometimes they’re not based on evidence, which would put them in the anecdotal category. I think we should consider these processes, again, that we used to evaluate and select technology as HTA. And HTA is a science. Things that are a science, they get researched, they get studied, people have discourse about the practices within them. Consensuses are formed on what makes up a best practice that should be considered for uptake amongst other organizations.

Scott Skinner:
So I will be honest though, sometimes HTA gets a bad rap as being overly bureaucratic and a process that adds too much time. But taking it back to basics, I mean, we’re making critical decisions for the friends, family, and neighbors that we serve in our hospitals. I’m not saying that we need to spend months evaluating every new or replacement technology in hospitals. None of us have the resources for that. And it doesn’t make sense to send every single little thing through an extraordinary amount of vetting. But our friends and families and neighbors, they do deserve a robust process that selects the best technologies possible given the resources we have available. We owe that to the patients that we serve. And an HTA applied, where possible, again with the resources that we have available, I think has an opportunity to continue to improve what we’re selecting and putting into our hospitals.

Keri Stephens:
Great. So how can 24×7 and others in the HTM industry help advance the conversation about HTMs involvement in the process?

Scott Skinner:
So again, I do have the research underway including a survey that’s really seeking to capture what those current practices are in the US. And the survey’s specifically designed for HTM folks. I’m not looking to survey administrators or supply chain purchasing professionals. Great perspectives there, but I’m really coming at this from an HTM centric standpoint. That survey is going on over the next month or so. So the results from all of my research should be published and presented next year, and I’m hoping that that work will serve to ignite a bit of a national discussion among the HTM community about a more active role in HTA and one that involves us being leaders and getting us another way of getting us out of the basement, if you will.

Keri Stephens:
That’s awesome. So anything else? How can people find you particularly?

Scott Skinner:
Yeah, well I’m on LinkedIn, certainly. People are more than happy to track me down there. And I’ve been on some of the AME committees in the past, so my information is also in AME. If you follow the AME blogs, I recently posted one of the links to my survey under that blog. So yeah, I am more than happy to speak with anyone who wants to talk with me a little bit more about HTA in their hospital. That’s actually another aspect of my research is doing some interviews. So if people have some special concerns or considerations that they think are unique or they’re struggling with something at their hospital, definitely more than willing to talk with them and we’ll see if we can’t get that perspective added to my research.

Keri Stephens:
Wonderful. Thank you Scott. It was so great talking to you. And to our listeners, thank you as always. And please be sure to visit us at www.24x7mag.com. Take care. Thank you everyone.