Kaiser Permanente Southern California Regional Technology Management Process: Evidence-Based Medicine Operationalized

Kaiser Permanente (KP) has a robust process for evaluating, deploying, and monitoring new types of medical technology, including devices, equipment, diagnostics, and procedures. This process provides guidance and management of new and existing medical technology to ensure that physicians of the Southern California Permanente Medical Group (SCPMG) can provide state-of-the art care. The success of the process depends on participation of a variety of internal professional and physician experts as well as other internal groups, such as the Interregional New Technologies Committee, Laboratory Committees, and Pharmacy Committees. The process of managing medical technology uses three teams of physicians and support staff: the Medical Technology Assessment Team (MTAT), the Medical Technology Deployment Strategy Team (MTDST), and the Regional Product Council (RPC). The medical technology management process seeks to evaluate medical technology in a timely manner, using principles of evidence-based medicine and focusing on efficacy, safety, and expected improvement in health outcomes. The evaluation process also provides analytical and tactical support to SCPMG physicians by assisting them with systematic, well-thought-out deployment of medical technology. The final component of the process considers benchmark standards to coordinate purchase of the technology while ensuring that KP leverages its collective purchasing power, and provides appropriate vendor support. The medical technology management process seeks to evaluate medical technology in a timely manner, using principles of evidence-based medicine and focusing on efficacy, safety, and expected improvement in health outcomes for KP members. Over the past two decades, the process of managing new technology in the KP Southern California Region has evolved continuously. Initially, in 1983, a Medical Technology Committee was formed to evaluate requests of local medical centers for regional approval to purchase capital medical equipment. At that time, much focus was directed on new types of imaging technology, such as computed tomography (CT) or magnetic resonance imaging (MRI). In 1995, the Technology Assessment and Guidelines (TAG) Unit was developed to support the committee by providing evidence-based evaluation of new technology. In 1998, the California legislature enacted the Friedman-Knowles Act, which set the stage for independent medical review of coverage decisions for individual health plan enrollees. The Medical Technology Inquiry Line was created in the KP Southern California Region as a one-stop location for giving clinicians prompt access to objective, evidence-based medical information on new technology. With the support of the Permanente Federation, this service was expanded to include support for KP regions outside California. In 2000, a process called the Medical Technology Management Process was implemented to connect the discipline of evidence-based evaluation of medical technology with a strategy for planned equipment purchase and deployment. Figure 1 shows the groups currently participating in this process, the components of which include assessing and deploying medical technology as well as responding to inquiries about it. Figure 1 Diagram illustrates the KP Southern California Region technology management process. Technology Assessment The Medical Technology Assessment Team (MTAT) performs critical analysis of published, peer-reviewed medical literature to evaluate the evidence supporting use (or avoidance) of specific types of technology for medical diagnosis or treatment. Assessment of new technology includes describing the specific health problem, the population of concern, the new technology, any alternative interventions, and the desired health outcomes. The medical problem of interest is described precisely and systematically with input from clinicians practicing in specialties relevant to the specified condition. One of the analytical staff uses PubMed (an online bibliographic resource) to search the medical literature. The published medical literature is searched also to identify any previous assessments that may have been conducted by other organizations that use evidence-based methodology (for example, the Emergency Care Research Institute, Blue Cross/Blue Shield, or Hayes, Inc, an independent assessor of health technology). Information is sought also from government agencies, such as the US Food and Drug Administration (FDA), National Institutes of Health (NIH), National Cancer Institute (NCI), Centers for Disease Control and Prevention (CDC), and from medical specialty societies. The MTAT carefully evaluates the quality of available evidence by thoughtfully considering such factors as number of studies and subjects, quality of investigation (Figure 2),1 consistency of study results, certainty and magnitude of possible benefits and harms, and number of potential candidates for a specified intervention. Stating the rationale for its conclusion, the MTAT develops and forwards to interested specialty groups a recommendation based on the sufficiency of the evidence. Figure 2 Diagram shows pyramidal hierarchy of evidence used by clinicians, researchers, and administrative decisionmakers to evaluate medical technology for possible use in the KP Southern California Region. Technology Deployment Technology whose use is supported by available evidence is also recommended by MTAT to the Medical Technology Deployment Strategy Team (MTDST), which considers the logistics of deployment, including forecasting the need and uses for the technology, developing a business case for its use, determining requirements for training and credentialing staff who will use the technology, and defining processes for monitoring the quality of the technology's outcomes. The Regional Product Council (RPC) is responsible for acquiring, standardizing, and budgeting for medical equipment. The RPC communicates with KP's geographic service areas in Southern California. This process of evaluating, recommending, planning, acquiring, and monitoring use of new medical technology is tied together and is administratively coordinated by the Joint Chairs Committee (a group which includes the Chair and Cochairs of the MTAT, MTDST, and RPC). The Joint Chairs Committee ultimately makes regionwide recommendations about new technology after carefully consulting with KP internal experts, chiefs groups, regional clinical committees, and clinical technology committees. At their meetings, the medical directors and medical group administrators receive regular updates on new technology, including capital requirements as well as implications for future space planning.