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Innovation as a strategic differentiator

Dr Helmar Wauer MBA
Hospital Business Director,
Charité – Universitätsmedizin,
Berlin, Germany
1 What does innovation mean to you in the medical field?
Innovations help to improve the treatment of diseases. Not only does the implementation of new techniques not lead to cost expansion, but in many cases it results in minimising costs and greater efficiency. Besides better therapy results, the patients benefit as a result of relief from the disorder and shorter treatment time, as well as an improvement in the quality of life. 
2 Do you see medical innovations as a way to differentiate Charité from surrounding hospitals?
Patients seeking help are often looking for new and modern technologies and treatment facilities. As the Charité offers innovative treatment concepts as well as modern technologies, regional and international patients come here to benefit from the knowledge of our doctors. The implementation of the latest medical technologies and their scientific evaluation in an interdisciplinary setting offer the possibility of gathering fast and early experience with new techniques and concepts. 
3 What is Charité’s overall approach to innovative technologies? 
Charité University wants to combine treatment offering with teaching and science. The use of innovative technologies and overall progress in medicine ought to be translated into practice as quickly as possible. That’s why we want to be the number one partner for the industry. Developing partnership with the industry is essential for accessing the best and the most updated technologies. For example, our industry partners in radiation technologies have been very active in collecting feedback and enhancements from customers to develop always that which is clinically needed in the demanding market of whole body stereotactic treatments.
4 How does innovation influence working processes at Charité?
Introduction of new techniques can lead to improvement of the patient course. Therefore, hospital staff must receive continuous training on the job. The industry often offers complete and intense training, enabling new users, from radiation oncologists to RTTs, to perform high-quality and safe treatments without delay. Improved and simplified processes can influence length of hospital stay and reduce waiting lists.
5 What was the business rationale for adding two innovative technologies such as TomoTherapy and CyberKnife to your practice?
The TomoTherapy and CyberKnife systems offer additional treatment options in innovative radiation oncology and therefore in cancer treatment in general. As one of the largest university hospitals treating national and international patients, we specialise in the care of the most complicated medical cases. This means that we have to offer the complete range of treatment modalities even for rare conditions, because our reputation attracts patients who do not find any help in conventional treatment concepts.
With TomoTherapy and CyberKnife, we have the capability to cover complicated treatments far beyond that offered by conventional treatment institutions.
6 What specific advantage did you seek by adding TomoTherapy and CyberKnife?
TomoTherapy has specific advantages in the treatment of long volumes or larger targets with awkward shapes, but also in the better quality delivery of radiation in general. 
CyberKnife is a highly specialised technology for radiosurgical treatments. As local treatment concepts gain more importance because of either better systemic or supportive therapies, systems such as CyberKnife, which offers a dedicated local treatment with high precision and sparing of surrounding structures, will cover a wider range of indications in the near future. Introducing high-end machines, such as the CyberKnife System, into an existing radiation oncology department enables the broadening of the patient population in the treatment of patients who would not have been treated previously.
7 What was the clinical rationale for adding TomoTherapy and CyberKnife to your practice?
As treatment with TomoTherapy and CyberKnife become non invasive, treatment times and therefore inpatient stays can be shortened and patients can be treated in an outpatient setting. Radiosurgery with the CyberKnife allows, for example, the re-treatment of patients who have had previous conventional radiotherapy. Those patients could not have been treated until now because of the high radiation burden on adjacent normal tissue. The highly conformal radiosurgery opens up additional treatment options for those previously irradiated patients.
8 What are the other radiation delivery system(s)? How have you positioned two innovative technologies in an existing department?
In addition to TomoTherapy and CyberKnife, the department uses two conventional LINAC systems with integrated cone beam CT, RapidArc and IMRT options. Additionally, a Novalis system  (a hybrid LINAC) performs stereotactic treatments, but its use is mainly restricted to intracranial radiosurgery. Extracranial high-precision stereotactic treatments and single fraction intracranial radiosurgery are performed with the CyberKnife because of its precision.
9 Have the two innovative systems resulted in a change in the referral pattern?
The radiosurgical abilities of the CyberKnife, in combination with a highly specialised team, attract external as well as internal referrers. In general, the referrers are looking for expert treatment for their patients, regardless of technique or machine. Let me use prostate treatment as an example. Both the CyberKnife and the TomoTherapy Systems have now taken their position in the armamentarium of the radiation oncologist in a manner that is equivalent to, if not better than, other conventional radiation therapy techniques. We are seriously thinking of developing a prostate program aimed at partnering with urologists. Patients will benefit from an additional non-invasive treatment option.
10 Do you think that the current reimbursement and hospital financing situations in Germany encourage the deployment of innovative technologies?
No, unfortunately not. Hospital financing is a responsibility of the German Länder. Due to the difficult financial situation of the Länder – partly caused through the economic and financial crisis in Europe – necessary investment in medical technologies and infrastructure are either postponed or simply cancelled. Therefore, we need to look into other options to finance desperately needed improvements in patient care. New medical technologies and treatment alternatives are usually not included in the existing reimbursement patterns from the point of their market access, neither for the inpatient sector nor for the outpatient sector. But policy makers in Germany have created a possibility for carers, such as the Charité, to partner with payers via integrated care contracts. Unfortunately, payers are still reluctant to negotiate such contracts due to either budget restraints or the lack of knowledge about innovative technologies such as the CyberKnife. I see a chance to move forward, though, if we all make an effort to sit down together to explain and discuss in detail the benefits that new technologies offer for patients, payers, hospitals and the system.   
11 What do you believe needs to change?
Cost-intensive technologies cannot be tried and evaluated because investment in innovative techniques is insufficient. 
However, the health system allows hospitals to run those treatments in an inpatient setting, but without providing adequate reimbursement. The result is that only few hospitals go down this path. Many innovative techniques allow for shorter hospital stays or even outpatient treatments, but, as these treatments are not sufficiently reimbursed, the healthcare system keeps the number of more costly inpatient treatments high.
12 Who is generally the driver of purchasing innovative medical technologies?
In most cases, the treating doctors are the drivers of new technologies. It is seldom the administration and even less often the health (insurance) system, as their biggest concern is cost control and not better treatment modalities.