Technology plays a central part in the provision and improvement of healthcare. This technology however comes at a cost which is not only financial, but may also impact on patient safety and satisfaction with possible implications on infrastructure and training. It is therefore imperative for healthcare providers and institutions to be aware of the implications of medical technology right from the onset of the acquisition of the technology (Lyva 2009).
Therefore, the continued advancement of healthcare technology and its subsequent use in healthcare organizations must be strategically evaluated in regard to its cost and effectiveness. The effectiveness of the technology can be measured by its ability to enhance patient and user safety, improve patient health and provide more direct care time (Coy S, 2004). The evaluation of the technology should be aimed at, among other things, providing evidence backed information to healthcare organizations so that they are able to make better purchasing decisions. These are some of the ideals upon which the Center for Evidence-based Purchasing was established (Brown A, 2009).
Established in April 2000, NHS PASA is "an executive agency of the Department of Health". NHS has a huge annual budget (Darzi L, 2008) to spend on the purchase of goods and services. In order to realize value for this budget, there is need for continuous modernization of purchasing and supplies. NHS PASA therefore "works to contract, on a national basis for products and services which are strategically critical to the NHS". The NHS PASA also works with an aim of making purchasing savings that can be used on direct patient care (Department of Health 2007).
THE CENTER FOR EVIDENCE BASED PURCHASING.
The Center for Evidence Purchasing (CEP) was established in September 2005 as part of NHS PASA as a recommendation from the joint government and industry task force (HITF). Building on the foundations of the Device Evaluation Services (DES), CEP was established with the aim of "providing impartial and objective information about medical technology to help the NHS make better purchasing decisions"(Brown A. 2009).
THE ROLE OF CENTER FOR EVIDENCE BASED PURCHSING
Driven by the need to improve the quality of life, continuous improvement in medical technology has made it one of the fastest growing industries in the world today. This implies that there exist different technologies in the market to do the same thing, some probably claiming to be better than others. With such scenarios, health care providers and patients - the main users of these technologies, need to be protected against unscrupulous market influences. The government, among other institutions has to "put in place policies that will address all elements related to medical devices, ranging from access to high quality, affordable products, through to their safe and appropriate use and disposal"(Medical device regulations 2003).
The Center for Evidence Purchasing (CEP) is one such organization set up by the government under NHS PASA to serve the interests of mainly healthcare organizations and patients, but also the manufacturers of medical devices. The main role of CEP is to be the leading source of valuable information regarding healthcare technology. CEP is therefore an "increasingly significant part of NHS PASA and is funded to provide free, independent and impartial evidence to underpin purchasing decisions and to drive the adoption of useful, innovative healthcare technology-based solutions by the NHS and social care sectors" (Public Service Review 2008).
HOW DOES CEP FULFULL THESE ROLES?
In order to get valuable evidence, CEP has to liaise with key customers and all the stakeholders involved. CEP runs projects across the entire range of medical technology aimed at finding evidence about clinical and cost effectiveness so as to enable NHS and policy makers understand technical, clinical, operational, economic and financial data on a range of medical devices.
The projects run by CEP include equipment evaluations, collating product specifications, and summarizing evidence from a wide "supplier base of experts and specialists based in the NHS and academia" (Brown 2009).
However, just like in any institution or organization, the ability to do excellent work is just as important as the ability to make it known. Presentation of evidence is therefore one of the major tasks of CEP. The evidence should be presented in simple understandable way because the final decision makers may sometimes be politicians who may not be necessarily technical in certain fields of expertise. Different reports are therefore tailored to specific interest groups that include clinicians, procurement specialists, financial managers, scientists, and healthcare managers. Therefore CEP presents a number of reports ranging from evidence review reports, evaluation reports, protocol reports to buyer's guides (CEP 2009).
IS CEP FULFILLING ITS ROLES?
The purpose of CEP is to provide evidence that can be used to underpin purchasing decisions. The above question, on one hand, can best be answered by examining whether these reports are actually affecting the decisions of the NHS.
For example CEP has published review reports about imaging modalities available for the diagnosis of stroke. In one report, it specifically looked at CT perfusion imaging and found that it served as a better modality to distinguish between hemorrhagic and ischemic stroke compared to the Non-enhanced CT which was widely preferred as the first line diagnosis and imaging investigation (CEP08039 2008). These reports enabled the NHS to implement the Department of Health stroke strategy. This clearly shows the extent to which evaluation reports by CEP is influencing policies in the NHS and Department of Health (Brown 2009).
Competing technologies and convincing advertisements sometimes leaves no room for healthcare providers to make better decisions. CEP is clearly making sure that these impressive advertisements do not cloud NHS' ability to make the right decision. Again as an example, buyer's guides published by CEP about different imaging modalities are helping NHS to select the most suitable imaging equipment. One such guide looks at the Diffusion-Weighted magnetic resonance imaging (DWI). It suggests that DWI applications may benefit from high gradient performance although gradients systems may not improve much in the near future compared to the high specific MRI systems. It goes ahead to state that there is no evidence on the cost effectiveness of DWI systems. Therefore NHS may have to think twice before implementing such systems (CEP08011 2008).
However, since CEP together with NHS does this to improve on patients' health and safety, the question is not fully answered without considering improvements in patients care. It is common knowledge that patient care is improved by provision of better services. Better service provision is enhanced by, among others, availability of equipment. CEP produces annual reports that aim at providing evidence of availability of different models of equipment.
Without going into the details of the causes of unavailability, the analyzer monitoring program run my CEP gives a summary of the downtime of different analyser equipment. One such report shows that Olympus AU640 and Ortho 5,1FS analyser units show improved reliability. The NHS can therefore procure these models to improve patients care in this area (CEP 09006).
Improving Equipment Life Cycle Management Process
In the 2008/2009 budget, NHS received over 100billion pounds with about 20% of this budget split between buildings, equipment and training costs. This shows that a big sum of money is spent on equipment and the management of equipment life cycle is very important in ensuring that this large sum is not wasted (NHS Choices, 2009).
Management of equipment life cycle means managing all the eight major components of the equipment life cycle right from evaluation of needs to disposal of equipment (Thompson lecture 2, 2009). However, CEP is most concerned with providing evidence so as NHS can make better purchasing decisions. Whereas this improves the management of equipment lifecycle, this is just at the beginning of the process. It is thus evident that the contribution of CEP in the management of equipment lifecycle is therefore minimal (NHS CEP 2009).
The process could be very much improved if CEP monitored the whole process of the equipment lifecycle. Apart from just buying the right equipment based on the evidence, training of users and technicians, equipment maintenance, human factors and operating environments, safety and acceptance testing all have considerable implications on the management of equipment lifecycle (Thompson lecture 2, 2009).
Although mandated to give evidence, CEP is part of NHS PASA which does not have legal powers to force the different NHS trusts to take these evidence in consideration when making purchases. There is therefore a possibility that evidence can be disregarded. Giving CEP legal status would help it to follow up and make sure that the evidence is put into consideration (Brown A. 2009).
According to Andrew Brown, CEP concentrates on projects which "make an impact upon the uptake of new technology". This would imply that the evidence available is mainly on high value equipment. However, some of the equipment which may not be considered to make high impact (like syringe pumps) with time accumulate and will have a high impact in the healthcare system. CEP can improve equipment management system by considering these systems as well (Brown A. 2009).
Benefits to Clinical Risk Management
Clinical risks are any factors that have the potential to harm patients in a hospital set up. The factors are avoidable and this is the context of clinical risk management. Clinical risk management therefore "is an approach to improving the quality and safe delivery of health care by placing special emphasis on identifying circumstances that put patients at risk of harm, and acting to prevent or control those risks" (The Royal Children's Hospital, Melbourne, 2008).
In providing evidence, CEP collects data about equipment from different NHS trusts. This data include, among others, the risks associated with using a particular device and all the adverse incidences that occurred when using such a device. Based on the evidence, the purchasing institution is thus aware of the safety implications of using such a device and has to put in necessary measures to prevent such risks. Evidence based purchasing is therefore beneficial in the management of risk for the benefit of not only the patient, but the users of the equipment as well (Brown A, 2009).
It is evident that Evidence Based Purchasing is of enormous benefit to the UK NHS. Like in any other venture, the history of reliability about the type of equipment one is to buy is very important in decision making. The reliability if this history in itself is as important as the history. That is why it has to be provided by an impartial neutral person or organization. The CEP has been this impartial organization and as it concludes its services, having published over 160 different reports, it can be said that the CEP has served its purpose (Burke R, 2009).
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