A guide to modernizing clinical and managerial practice in the UK's National Health Service (NHS) was launched by Sir Nigel Crisp, NHS chief executive, at a conference of NHS leaders in Birmingham last month. "The 10 High-Impact Changes for Service Improvement and Delivery," compiled by Professor Helen Bevan of the NHS Modernization Agency, distills into a set of 10 key principles the work the agency has done with hundreds of frontline organizations and thousands of NHS staff over a period of nearly four years. The changes cover areas of critical importance in service delivery such as the role of day surgery, the management of admissions and discharges, support for patients with long-term conditions and the reduction of lines and other bottlenecks. Each principle is backed by practical examples and supported by resources and contacts to help support local implementation.

Crisp said the publication "shows us what we have learned. Now we can move on to make sure they are implemented systematically across the NHS." He said that adherence to the changes should "transform" the experience of millions of patients, should save "hundreds of thousands of clinician hours, appointments and hospital bed days," should "virtually eliminate" patient waiting, and should "significantly improve" both staff satisfaction and clinical quality.

The 10 changes incorporate a number of innovative approaches. They are, according to the NHS, "resolutely patient-centered, seeing an individual's healthcare not as separate episodes or processes but as a single journey, with clinical interventions integrated with emotional, psychological and material support." Saying the 10 changes "are based on hard evidence of what works," Crisp said the document takes a "systems" view of patient care – "not focusing on different sectors, professions or agencies, but emphasizing coordination and teamwork between, for example, primary care, mental health services and acute hospitals."

Bevan said senior clinicians and managers with whom she has previewed "The 10 High-Impact Changes" have warmly welcomed the document. She noted that some frontline organizations already are putting the changes into practice. "I am delighted by the reception the changes have already had from frontline healthcare professionals," Bevan said. "It seems to me that the NHS is more ready than ever to embrace innovative thinking in the drive to improve services and care for patients."

Opportunities seen in mobile medical imaging

The demand for mobile medical imaging equipment in Europe is growing, driven by the high price of fixed-location equipment and an increasing demand for digital modalities, Frost & Sullivan (London) said in a new report, "Strategic Analysis of the Mobile Medical Imaging Equipment Market in Europe." With an increase in procedure volumes and a widening application range, mobile imaging equipment is set to expand from mere diagnosis toward biopsies and surgeries, said Frost & Sullivan research analyst Srividya Badrinarayanan.

"Many small- and medium-sized hospitals that do not have the scale or financial resources to purchase the high-end static diagnostic equipment are turning toward mobile imaging service providers that provide such equipment on hire," she said. For areas with a widely dispersed population lacking access to medical imaging equipment, such service providers employ specially built vehicles that travel from site to site offering patient care that otherwise would be available only by patient travel to fixed sites, Badrinarayanan noted. Hospitals call in these providers on a rental basis once or twice a week, or at times, for an extended period of one or two weeks, she said. Most of the providers are based in the UK, France, Italy and Spain, and have their own trained radiologists and technicians, thus avoiding regulatory issues.

Mobile imaging equipment also presents what she termed "an ideal short-term replacement solution for hospitals." Badrinarayanan noted, however, that as the mobile imaging market matures and the prices of certain fixed imaging modalities fall, mobile service providers "are likely to find it increasingly difficult to maintain their affordability advantage." In fact, she said, mobile computed tomography (CT) scanners are slightly more expensive than their fixed-location counterparts and with the advent of digitization, mobile mammography systems are expected to cost five times that of an analogue system.

"Though mobility is critical, service providers must work toward differentiating their equipment from static modalities," Badrinarayanan said. "Hospitals prefer equipment that incorporates value-added features and the latest technology for improving the accuracy of their diagnosis and increasing patient throughput." In addition to the growing popularity of C-arm systems in minimally invasive surgeries and angiographies, the launch of 3-D interoperability features and introduction of a digital flat detector instead of the conventional image intensifier tube are expected to drive the mobile C-arms market, she said.

The demand for mobile systems that incorporate high-level ergonomics and ease of use is necessitating equipment that is technically on par with, if not superior to that of static alternatives, the report said. However, at the same time, Badrinarayanan said service providers need to strike the right balance between image quality, mobility and price to satisfy a wider range of applications. For instance, service providers must reduce the dimensions of mobile ultrasound equipment without compromising on image quality and basic features. That coupled with adequate training to technicians is likely to increase the usage of mobile ultrasound equipment in obstetrics, gynecology, urology and physiotherapy procedures, Badrinarayanan said.

She said mobile equipment also is gaining prominence in the field of magnetic resonance imaging (MRI), where long patient waiting lists are a significant problem in many European countries. For instance, in order to condense the waiting list, the NHS has awarded a five-year contract to mobile service provider Alliance Medical to perform around 635,000 MRI procedures annually.

Mobile positron emission tomography (PET) scanners also are in demand. Use of a PET scanner allows accurate detection and staging of cancer, Badrinarayanan said, but smaller healthcare facilities are skeptical about investing huge amounts in installing a specialized and costly PET scanner, and they prefer the mobile alternatives.

The report said the future of mobile medical imaging equipment holds particular opportunity in Eastern Europe, where countries are looking to mobile systems as means to support their healthcare systems.

Centralized purchasing concerns Eucomed

Europe's major medical technology industry trade association has voiced its concerns about centralized purchasing bodies. Eucomed (Brussels, Belgium) called upon the European Commission to make recommendations to member states about the procedures to be followed by such purchasing bodies, which award public contracts on a nationwide basis. The association said the process followed by these bodies "can distort competition and have a negative impact on innovation."

Eucomed emphasized that centralized purchasing of medical technology can have "negative consequences for the patient," with decisions within a centralized purchasing system being based in many cases solely on product prices. That, it said, "can lead to buying technologically obsolete or technically incompatible products." It added: "Quality criteria in medical care should prevail."

Maurice Wagner, director general of Eucomed, said, "This question is of particular importance to the medical technology industry, as in many cases, well over 90% of sales are generated by public procurement." Therefore, he added, "Eucomed has asked the commission to look into it and provide guidance to the member states on the dos and don'ts in public procurement." The association noted that under the new Public Procurement Directive 2004/18/EC, which is due to be implemented by member states by Jan. 31, 2006, central purchasing bodies have to abide by principles of non-discrimination and equal treatment, and contracting authorities may not use framework agreements in such a way as to prevent, restrict or distort competition.

While saying those provisions "will contribute to improving the situation," Eucomed said they are "insufficient," and recommended adoption of several guidelines, including:

1) A maximum threshold should be fixed with respect to the purchases that can be bundled in each market concerned.

2) The autonomy of the public administrative entities in making purchases should be acknowledged.

3) In healthcare-related sectors, the size and duration of tender contracts should be such as to avoid anticompetitive distortion and to encourage investment in the research and development of new products.

4) Instead of focusing on price only, the tenders in healthcare-related sectors should evaluate the quality and value of medical technology for patient care.

5) The opportunity for end-users to be able to choose from the widest possible range of products should be guaranteed.

Philips in 'Sense, Simplicity' branding effort

In an approach that seems to be aimed in considerable measure at its medical products, Royal Philips Electronics (Amsterdam, the Netherlands) has unveiled a new brand positioning effort built around the concept of "Sense and Simplicity." The company said the new positioning is intended to give its existing and potential customers "a distinctive image of a sharper, more focused enterprise, which – throughout its activities in Healthcare, Lifestyle and Technology – is held together by a common drive to deliver intuitive end-user experiences."

Philips said it would spend EUR 80 million ($97 million) on a new advertising campaign to bring its message to customers around the world.

Gerard Kleisterlee, president and CEO, said, "Philips is not the only technology company to grasp the need for simplicity – but I believe we're the first to put a stake in the ground and declare our intent to take action." Saying that other companies "may aspire to be more fashionable, more cool," Kleisterlee, without acknowledging that Philips' own TV commercials in recent years have taken just such an approach, added: "Our route to innovation isn't about extra complexity – it's about simplicity, which we believe will be the new cool."

He said, for example, "simplicity is what people expect of technology and it is as applicable to a doctor working under pressure in a hospital with advanced medical equipment as it is to a consumer operating a DVD recorder." Kleisterlee said simplicity "is equally relevant to our customers, be it in Healthcare, in Lifestyle or in enabling technologies. In each of these domains, Philips already has many proof points of simplicity and some of these we highlight in our new advertising campaign."

The challenge before Philips, he said, "is to further realign our company to deliver on our new brand positioning in each and every aspect of what we do and make." The "Sense and Simplicity" motto replaces "Let's Make Things Better," which Philips has used for almost a decade. "While it is not very specific, it expresses commitment to both excellence and improvement," Kleisterlee said.

He said the rebranding initiative is part of Philips' management agenda to make the company truly market-driven and get it back on track to "sustained, profitable growth." He said the company will see more and accelerated change, adding: "We have clear ideas about how to consistently fill in empty spaces around our core competencies, often in the overlaps of the Healthcare, Lifestyle and Technology domains."

The advertising campaign, developed in concert with DDB, the company's global advertising agency, and media buyers Carat, features existing products that fit the new brand positioning. It will run via broadcast, print and online in the Netherlands, Germany, France, Italy, the UK, North America and China, with just under $100 million scheduled to be spent between now and year-end.

Among the high-tech medical products being featured in the campaign are the HeartStart Home Defibrillator, which is available by prescription and has just been approved by the FDA for over-the-counter sales as an aid for use on those struck with sudden cardiac arrest, and the Brilliance CT (computed tomography) scanner, which is able to do comprehensive organ assessment within seconds.

Healthcare fraud conference set

With a focus on dealing with healthcare fraud across Europe, the first European Healthcare Fraud and Corruption Conference will be held in London this month. The Counter Fraud and Security Management Service (CFSMS), the organization with responsibility for tackling fraud in the UK's National Health Service, has opened discussions with similar organizations in Europe. Those initial contacts have led to the development of strong working relations.

The aim of the conference, set for Oct. 18-19, is to cultivate these new beginnings and develop tough new systems to stop fraud and corruption in healthcare across the European Union (EU). The organizers hope the conference will mark the start of a multilateral approach to tackling healthcare fraud in the EU states. Speakers will address topics ranging from tackling health tourism and ID fraud to issues in the pharmaceutical industry. Persons involved in dealing with healthcare fraud in Spain, Germany, the Netherlands, Poland and the UK will be sharing their knowledge with healthcare officials from throughout the EU.

Conference organizers noted that healthcare fraud is a cross-border problem. "With the enlargement of Europe comes a greater freedom to live and work in other EU states," they said in announcing the gathering. "Although this is a positive step for a better, more productive Europe, it also means an increased risk from fraud. Whether they are individuals or organized crime cartels, fraudsters will be able to duplicate their crimes throughout the EU due to the unrestricted passage from state to state of people, capital and the provision of services."

Along with the short-term aim to share current best practices in dealing with healthcare fraud – the efforts by the CFSMS in tackling fraud in the NHS have saved more than half a billion pounds over the last five years – the conference is seen as helping with the development of stronger relationships among those charged with such responsibilities across the EU.

First implantations of new cervical disc

Pearsalls Ltd. (Taunton, UK) last month reported the first successful implantations of their novel artificial cervical disc in three patients at the Royal Orthopaedic Hospital (Birmingham, UK). Also known as the NeoDisc, the Pearsalls Cervical Disc is a composite of an elastomeric core encapsulated by a textile structure, and is designed to mimic the biomechanical properties of the natural disc.

The surgeries were performed by Dr. Andre Jackowski, a co-inventor of the device. Citing his satisfaction with how the implantations had gone, he said, "All three patients were doing extremely well following the implantations. The device behaved at surgery very much like a natural disc. It was quite a contrast to mechanical disc replacements that I have performed. The operations were straightforward, quick and required no complex or virtuoso techniques."

Lawson Lyon, managing director of Pearsalls, said, "The achievement of this milestone in the development of the Pearsalls Cervical Disc represents the culmination of years of research, resulting in a superior technology for the patient and surgeon." He said the company would continue clinical trials in Europe while preparing for pivotal trials in the U.S.

The cervical disc is the first of a series of products enabled by Pearsalls' platform technology, which is focused on highly engineered matrices of fibers positioned with computer-controlled embroidery that encourage the propagation of biological tissue. The company said future products include an artificial lumbar disc and a family of non-fusion devices developed from the same core technology.

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