The ECRI Institute, a nonprofit research firm based in Plymouth Meeting, Penn., has released its top 10 list of health technologies for hospital c-suite executives for 2009.

ECRI compiled the list taking into account the convergence of critical economic, patient safety, reimbursement, and regulatory pressures that hospitals face today.

“Prioritizing is a tough but essential job for executives who face a squeeze on their capital budgets, insistent demand from clinicians concerned with patient care and personal income and the well-being and strategic directions of their institutions,” said Jeffrey C. Lerner, president and CEO of the ECRI Institute. “This difficult-to-compile ranking of 10 critical technologies will help them to pay close attention to technologies and issues that have a significant impact.”

The top 10 technologies are:

1. Electronic Medical Records. ECRI researchers urge hospital CIOs and administers to figure out what they need to do to prepare for an EMR or, if they have already implemented one, how best to continue the adoption path so they will not face penalties.
2. Ultrahigh-field strength (3.0 T) and MRI and premium-slice CT. “With limited access to capital funds in 2009, we believe that most hospitals that need a new or replacement MRI system will not be able to consider 3.0 T or open HFS systems in 2009,” researchers said. One alternative is to purchase a refurbished 1.5 T system. ECRI researchers also believe many hospitals will put off buying CT scanners unless absolutely necessary, and if they do, their best option would be to purchase a basic or refurbished system.
3. Physician preference items (PPI) implantable items, including cardiac stents, pacemakers, orthopedic implants and orthobiologics. Researchers recommend that hospital executives be educated about pricing: “The resulting lack of transparency of pricing often leaves hospitals holding the bag for the high cost of implants, but all too often in the dark about what it should pay for the devices.”
4. Robotic assisted systems for surgeries and endovascular catheterization. “Hospital leaders will need to carefully assess the high capital and consumable costs of a second or possibly third robot against the possible growth of surgical volumes, the ability to accommodate the robots in OR suites, the resultant OR scheduling issues and the market advantage of providing robot-assisted surgery,” said ECRI researchers.
5. Radiation oncology (proton therapy systems). “Medicare has listed proton therapy as one of its top 10 priorities this year, an indicator that they will be taking a close look at the evidence for the burgeoning indications with an eye toward coverage policies.” Given the uncertain reimbursement climate, researchers recommend monitoring this technology to support improved clinical outcomes.
6. Radio-frequency identification technology. The cost of RFID systems is high, so researchers recommend hospital executives examine the return on investment carefully. One promising application they highlight for this technology is its ability to track medical devices.
7. Alarm integration technologies. The effective management of alarms is a serious problem – according to FDA’s MAUDE database, 150 deaths related to physiologic monitoring alarms occurred between 2002 and 2004. One recommendation is to implement a complex alarm integration system that can incorporate many alarms (e.g., physiologic monitors, ventilators, infusion devices and medical telemetry) and notify a clinician’s wireless device. Researchers say this is a big incentive for hospital executives to consider because it can alert the clinician to alarms while the clinician is not near the patient. 
8. Hybrid operating rooms. “Hybrid ORs require larger space and typically have to be dedicated to only those procedures requiring that equipment,” researchers said.  Whether a hospital  has sufficient cardiovascular and neurosurgical procedures to justify purchase should be considered, as well as the potential to introduce “unwanted competition between clinical service lines within the hospital.”
9. Therapeutic hypothermia (TH). ECRI researchers say implications for this technology are promising. They recommend having a TH protocol in place as a standard of care for out-of-hospital cardiac arrest in patients who have an initial rhythm of ventricular fibrillation, such as taking the patient to a hospital that offers therapeutic hypothermia services.
10. Rapid tests for deadly infections. “Hospitals should refer to published evidence reports on these topics and consider how to integrate rapid tests in their infection control protocols and measure outcomes regarding impact on healthcare-acquired infections (HAI) rates with the understanding that protocols may need to be  adjusted in light of the evidence they collect,” researchers said.