Theres a change afoot in healthcare technology management and theres a good chance that a few years from now youll look back and say William Hendee, Ph.D., helped inspire that change.
After spending 20 years in the radiology department at the University of Colorado School of Medicine, Hendee recognized some changes in healthcare technology assessment and wanted to dive deeper. The increasing cost pressures in healthcare were playing against the increasingly complicated technologies to make true technology assessment and purchasing nearly impossible. The economic and technical issues made it extremely difficult for any one person to perform true technology assessment in the hospital.
To get a broader view of those changes, Hendee left Colorado in 1985 to become vice president in charge of science and technology programs at the American Medical Association. It was there that he confirmed his suspicions. There needed to be a new person in the hospital that brought the essential clinical, technical and business sense to make educated recommendations on equipment requirements.
In 1991, Hendee returned to the academic world to become senior associate dean and vice president of the Medical College of Wisconsin. In that position, Hendee has begun the process of creating a new discipline in healthcare technology assessment by spearheading the creation of the Masters program in Healthcare Technologies Management, in cooperation with Marquette University, to create the hospital chief technology officers of tomorrow. The program looks to create a mediator between clinicians and the CFO by giving technology assessment professionals the business skills to evaluate a hospitals clinical technology requirements within the individual facilitys budget. Medical Imaging talked with Hendee about technology management and where we can expect it to be in the future.
When did you see the impetus of the changes that are now eminent in technology management?
It was perfectly clear as far back as 1983 that medicine was transitioning away from a technology-push enterprise where we could accommodate new technologies and charge for them to be reimbursed. It was obvious that by putting a cap on reimbursement through certain legislation that we would be moving from a technology push to a clinical pull so you would have to document the clinical utility of technology before you could actually make it pay for itself. It was clear where things were headed and I wanted to better understand that and be a player on a much larger level than just radiology which was going to be rather captive to the problem rather than helping guide the process. Thats why I moved to the American Medical Association.
What experience could you draw from your work in radiology to bring to the larger role you were seeking to fill?
At Colorado we implemented a rather comprehensive process of trying to make intelligent decisions about the acquisition and deployment of technology in radiology. For example, we implemented micro-costing of clinical procedures in the early 1980s. We were levying charges for procedures based on what it cost us to administer those procedures, rather than being guided by the maximum reimbursement we could acquire. I think what we were doing in the radiology department at that time was really a reflection of my interest and my concern about not only where radiology was going but where all of medicine was headed in terms of trying to cap the reimbursement process and control the spiraling costs of healthcare. Having implemented those things in our department rather successfully, I wanted to learn more about the process outside the boundaries of radiology.
How did the healthcare technologies management program at the University of Wisconsin come about? Was it your effort to address what you saw happening on a broad scale during your work at the AMA?
Thats right and it also reflects some more recent things that have happened since I came here in the entire arena of technology evaluation and deployment and diffusion.
Decisions are being driven more and more by the dilemma that its very hard to justify the purchase of a new technology until you can prove that it really contributes in an effective way to clinical care. Hospitals are increasingly put in a very difficult position with regards to making decisions about the acquisition of new technologies for a number of reasons. First, technologies are becoming more and more sophisticated and difficult to understand. Secondly, the whole issue of cost and cost recovery is an increasing challenge for institutions. Thirdly, and this is a major issue, there are two conflicting forces at work in almost every healthcare institution. There is the clinical side that is demanding the newest and best technologies because they see themselves as advocates for patient care and quality of care. Then there is the business side of the institution which has limited resources and is trying to make intelligent decisions against this pressure of wanting to acquire technology no matter what the cost. Both sides try to work through these kinds of questions, but the problem is neither side has a very good understanding of the others point of view. The clinical side doesnt understand the fiscal constraints and the business side doesnt really understand the technological demands and clinical effectiveness of the issue. So the real question is where is the person in this institution who can serve as a mediator between these conflicting interests? Those people are simply not available.
The masters program coursework emphasizes the business side of technology assessment. Is that an effort to create that fiscally knowledgeable person?
Absolutely. We can take this two steps further. An increasing number of institutions are outsourcing the management of their technologies to outside asset management companies, large and small. The question is, where are these companies getting their people that have this broad, global knowledge of healthcare market the business side of medicine and the clinical side of medicine? These vendors are having the same problem the institutions are and that is there is no place to go to find these people.
We also have been seeing a big need for people with these skills in companies that are manufacturing technologies for healthcare. They have internally within their own organizations the dilemma of trying to bridge the gap between the technical development side of technology and the business and marketing side of technology. Now there are ISO regulations and federal and state regulations that are becoming more and more demanding, so these people also are going to have to have more knowledge of the regulatory side of healthcare as well as the business and clinical sides.
What was the first step in creating the program?
We made it a priority. We had to find a way to get it jump-started because its very difficult to create a new discipline. You have no models. You cant look at what other institutions do and there are no textbooks, so you have to design courses from scratch. You have to convince people to teach these courses, even though they dont have the normal resources to start with.
We also didnt want to start it with a whole bunch of students. We wanted to move into this gradually and decided to limit the number of students to spend more time on the courses to make sure the program works right. So we started the program in the fall [of 1999] with five students and we plan to add about five students each year for the next four years until we have about 20 students. But since thats not enough students to generate enough tuition revenue to offset the cost of running the program, we needed some financial help from the outside and the Whitaker Foundation gave us a special opportunity grant to ramp this program to a level at which it will be self-sustained.
How did you recruit students and what kind of interest have you received in your first year?
We had many people inquire about the program, but many of the inquiries didnt have the appropriate background for the program. They need to have either an engineering background like an undergraduate degree in engineering or something close to it like physics or physical chemistry. We chose the students who had the right background and out of the ones we chose who met our requirements, all five that we offered admission to accepted and are in the program now.
Only one student came right out of an undergraduate degree in engineering, while the others all have experience [working for equipment vendors] and thats where we pitched this program. We will accept people right out of undergraduate school, but we think the major market is going to be individuals who are working or have worked and want to create new opportunities for themselves in terms of career mobility. We teach the courses in the evenings so that people who are working during the day can take the courses.
How do you plan to expand the program?
We have plans to move quite rapidly into distance education, which means electronically mediated instruction materials. Since about a third of the courses are created especially for this program, we obviously dont have those materials online yet. Our goal this year is to offer three of those courses online. Now we dont intend for this to ever be a total distance education program, so what we would like to do is have this program available as a combined distance education and residence program.
What kind of real world experience will the students receive?
Every student has to do an internship. Its a special project students get credit for doing. Its essentially a thesis but we dont put it in the form of a thesis, so its not considered a thesis program.
Each student presents a proposal of a body of work that he or she intends to do in the area of technology management. The student also has to propose co-mentors on the project. One co-mentor will be a member of the faculty and the other co-mentor will be somebody in the real world at a company or an institution.
If a student is working at a company, we encourage them to do a project at their organization with a mentor from that organization because we think that will be more meaningful to the student and make a greater contribution to the company. Every student has to do that and write it up as a project report in a format that a company or an institution would expect, not an academic-type of report. They have to present that report verbally like they would in defending a masters thesis.
How much interest do you see on the academic side of biomedical engineering today?
Biomedical engineering is probably the most rapidly growing scientific discipline in any of the sciences or engineering right now. A lot of this is being stimulated by the Whitaker Foundation, which has put a lot of money into biomedical engineering all over the country. This is going to send a lot of biomedical engineering students into the market.
I believe the onslaught of these very bright and sophisticated students coming out of masters and Ph.D. programs, and even undergraduate programs, is going to force that field to expand. While the number of academic positions is limited, organizations and institutions want people who can come in and solve problems. Thats going to force biomedical engineering to pay attention to the more pragmatic opportunities for placement of students by developing programs that give students the practical skills they need to be of value. Well see more practical training programs in technology assessment or technology management or engineering as it contributes to things like quality improvement, patient safety, and design engineering.
What about the radiology-specific areas do you see those matching up with these trends as well?
Absolutely. Radiology departments of moderate to larger size need to have someone who is a technical expert, yet has a strong business sense to really manage the deployment of technologies as they pertain to radiology or radiation oncology. The technology is so sophisticated so that if your background is in business, administration or hospital management, or even in clinical radiology, you are really handicapped in trying to understand the technology itself, how it functions and how to make good decisions about how much you should really pay for a CT scanner and if you really need it. I think I could make the case that today in most radiology departments, a properly trained technology assessment person with requisite authority to make decisions would improve the quality of care and reduce the costs.