Barrett Franklin: I Love Technology, but It Isn’t Always the Answer

Until recently, the daily management of healthcare technology was my core focus, having served as chief clinical engineer for the VA New England Healthcare System. When I stepped into a new role as deputy network director for that system—a position with a more global focus—I was struck by how often I had fallen victim to a “technology first” mindset. Now, I am being called upon to coach others from making my previous errors.

As clinical engineers, we often are quick to recognize a problem, diagnose a situation, and leverage technology to resolve the issue, but what about when technology cannot or perhaps shouldn’t be the answer?

I want to be careful here because using any one technology as an example is perhaps unfair. There is no opportunity to rebut, and I concede that there are many others who might see things differently. So, rather than use a real example, I will use a set of hypotheticals.

Your clinicians need to calculate a data set for patients. This data set has been calculated for patients the same way for years, but a new technology-driven solution can do in three minutes what takes most people five minutes. Now, here is the hitch: it costs $300,000. Still, using a simple ROI calculator proves that it pays for itself in three years. Do you buy it or do you continue to calculate manually? It is, at first, a seemingly simple “yes” decision, offering the chance to improve efficiency with a reasonable ROI.

What if we added that your organization could spend that same $300,000 on a technology that would improve care for a small subset of patients, with an ROI of 10 years—but no impact on reimbursement. If you are like me, you’ll read this and confidently determine you can find a plan ‘c’ that allows you to have both—perhaps a unique purchase model or something to the like.

Now, let’s take a similar hypothetical, but take it one step further. One technology will save one life per year; another technology will allow you to treat 1,000 additional patients per year (to an unknown consequence). Which is the better technology to direct your organization to invest in if they cost the same amount?

I suppose my message here is not asking you to consider the math or challenging you to come up with an algorithm to determine why one solution is better than another. I am asking you to take pause. When you present a new technology, do you think about it from the perspective of “need, want, or would be nice to have”? As healthcare technology managers and clinical technology leaders in our organizations, we’re often recognized as subject matter experts who are called upon to provide guidance on one solution’s merit versus another. It’s important that we understand that sometimes technology is not the answer.

Barrett Franklin, MS, CCE, is deputy network director with the VA New England Healthcare System, VISN 1. He is a member of AAMI’s Technology Management Council.

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2 Comments on “Barrett Franklin: I Love Technology, but It Isn’t Always the Answer”

  1. J Scot Mackeil Cbet Quincy Ma. Says:

    I agree on a similar note, but at the other end of the scale: “over-engineering” driven by marketing is a serious problem in the medical equipment industry. Too many technologies in the hospital environment are burdened with many unnecessary layers of technology that have questionable real value other than to create a revenue stream for the manufacturer’s field service department.

    For example, surgical lights that have remote switch panels and pods of LED emitters controlled and monitored by multiple CPUs and networked bus that lock up and fail. Really? Why not an analog switch and power supply? When we first saw LED surgical lights coming on the market, the expectation was for a light fixture with a near-zero failure rate. Now surgical lights are somewhat less trouble prone than when they had incandescent lamps that failed. But now we have a whole new class of issues and failures. when they do fail, it is a much bigger problem.

    Surgical tables with complex hand controls and micro processor circuits that lock up or have mysterious issues–same deal.

    As an old-school biomed, too often I find myself looking at a new device and asking, “Somebody really built this thing like this? really, what were they thinking?” I could go on and on.

    to the next generation of medical equipment builders I would say: Why not strive to design solutions to healthcare needs that use as few moving parts and as few micro processor control systems as possible? Sometimes less really is more (and better).

    Anyone else feel this way? Or not?

    Reply

  2. William A Hyman Says:

    More broadly, it is often said that risk or cost vs. benefit is being considered, but we actually have little knowledge or methodology of how to do this except when it is a straightforward financial (money vs. money) question.

    Reply

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