“The main lesson is that ICT is only part of the solution”
At the recent European eHealth Conference in Slovenia, an EU commissioned study on the “Socio-economic impact of interoperable electronic health records and ePrescription in Europe - EHR Impact” was presented. One of the case studies is the computerised patient record (CPR) system at the University Hospitals of Geneva (HUG), which since 1998 has connected their seven hospitals at four campuses. Based on a service oriented architecture and utilising web technologies, it comprises unique patients’ and providers’ identification, access management, unified clinical documentation, order entry for all orders such as laboratory and radiology tests, and management information. HealthTech Wire talked to Prof. Dr. Christian Lovis, Head of the Clinical Informatics Unit at HUG, and Alexander Dobrev, consultant at the research and consulting firm empirica, about the impact of the CPR system on the hospitals.
- (HealthTech Wire) - Based on your initial research results, what are the major benefits of the CPR system for the hospitals?
The major benefits come from the redeployment of resources, including doctors’ and nurses’ time, leading to better quality care; a reduction of risk exposure; and avoidance of over-prescribing laboratory and radiology examinations. The hospital management also uses the system to provide important information for strategic decision-making. Health insurances benefit from fewer hospital admissions, because, e.g., patients in Accident & Emergency departments can often be helped immediately and need not become inpatients until their records are found. HUG also redeploys liberated resources to meet increasing demand.
More difficult to measure, but extremely important, are the benefits to the people involved. All clinical staff have to adapt to changing work flows and processes, and the gains must be of higher value than the extra effort required. We know from our interviews that these personal benefits include being able to focus on clinical tasks instead of searching for records, not having to chase colleagues to decipher illegible handwriting, and the feeling of being less vulnerable and exposed to risks, because the CPR system allows for better-informed decision making. There are gains to patient safety and quality of care – the CPR system provides doctors and nurses with the critical information and decision support they need to reduce the risk of adverse events, and it does so fast, so carers can pay more attention to individual patients.
Has the study shown a return on investment?
The EHR IMPACT study focuses on comprehensive benefit cost analysis, not on return on investment to a single stakeholder. These are different measures, but should be regarded together by decision makers. According to our research, based on accounting data and well-founded estimates, the value of economic benefits at HUG exceeded the value of economic costs on an annual basis for the first time in 2005. The cumulative turning point is achieved about now – 2007/2008, some ten years after the idea for the system in its current form was born. The analysis of the purely financial position is not yet complete but the preliminary results look promising.
More here
http://www.healthtechwire.com/Pressrelease.146+M5b4ee4b5902.0.html
The ongoing project has a web site which can be found here:
As part of these studies two evaluations have already started. These are the computerised patient record system at the University Hospitals in Geneva, Switzerland, and the Scottish Emergency Care Summary Programme in the UK.
Presentations on the Geneva project are already available here:
http://www.ehr-impact.eu/downloads/documents/2008-05-07%20eHealth%20Portoroz%20Lovis.pdf
and here
http://www.ehr-impact.eu/downloads/documents/eHealth_2008_Portoroz_dobrev.pdf
These were presented at the conference referred to earlier in the blog.
These presentations and the various papers provided at http://www.financing-ehealth.eu/ deserve careful review by all those interested in justification of e-Health investment.
David.
3 comments:
Hospitals, hospitals, hospitals...so often the discussion is about hospitals, and not about the system of care outside hospitals. This is understandable since in the current operation of the health system, public hospitals devour is it 60%? of the health budget, and therefore any efficiency gains and savings represent big dollars, but I do hope that equal attention will come to be focussed on what can be achieved outside hospitals to increase quality of care and efficiency.
“The main lesson is that ICT is only part of the solution”, this is my endless frustration when working with clinicians who are only able to focus on the technology. ICT is the tool for manipulating information, and that information must be usable to impact on health services.
All three domains: technology, information management and health care need to be addressed by eHealth, yet in nearly every instance eHealth is about "web", "SOA", "databases", "CIS/PAS", etc. Get the health part first, figure out the information needed, then what technology will support it. Put it all together over a time frame and then we will finally have an eHealth Strategy.
M
http://www.zdnet.com.au/news/software/soa/NEHTA-asks-for-patience-on-patient-records/0,130061733,339289144,00.htm
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