Friday, July 15, 2011

The UK Still Seems to Still Have Doubts About the Benefits of A Shared Summary Clinical Record.

The following appeared last week.

BMA still worried about benefits of SCR

1 July 2011 - Fiona Barr

Doctors have expressed concern about the benefits of the Summary Care Record programme but stepped back from calling for the roll-out to be halted.

The BMA’s Annual Representative Meeting said it was concerned about evidence questioning the benefits of the English summary record.

However, it did not give its wholehearted backing to calls for the roll-out of the SCR to be stopped. It agreed instead that such a move should be given further consideration by the BMA.

Dr Peter Holden, a negotiator for the BMA’s GP committee, told the ARM that he believed many patients were still ignorant of their right to opt-out.

He also claimed that the benefits of the SCR had been “hugely overstated”, citing last year’s report on the independent evaluation of the SCR by University College London.

Dr Holden added: “There is no direct evidence of improved patient safety apart from some anecdotal evidence which is frankly pretty weak.”

He argued that the NHS was still waiting to see the benefits for patients of emergency summary records and claimed the SCR could become “just another expensive IT white elephant.”

However, the SCR was defended by Dr Paul Flynn, who was one of the BMA adviser’s to the UCL report. He claimed suspension of the roll-out would prevent further monitoring of its potential benefits.

He added: “The SCR is a step along the way to full electronic health records and I think it’s just too early to see benefits in terms of hard outcomes.

"To expect specific measurable clinical benefits is premature. Throughout the history of IT in health no IT has been right from the start.”

The full article with other comments is here:

http://www.ehi.co.uk/news/primary-care/6990/bma-still-worried-about-benefits-of-scr

The guts of this issue, and it applies directly to the present plans for the PCEHR, is that there is virtually no published evidence that having access to a shared record of the basics of a patient’s clinical information actually makes a real difference to patient care and patient outcomes.

That said, if a trusted source of clinically validated basic information could be made easily available when needed it does seem intuitively obvious there might be the occasions where such an information source could be very useful.

The following article suggests to be some caution before rushing in is warranted.

The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview

Ashly D. Black,1 Josip Car,1 Claudia Pagliari,2 Chantelle Anandan,2 Kathrin Cresswell,2 Tomislav Bokun,1 Brian McKinstry,2 Rob Procter,3 Azeem Majeed,4 and Aziz Sheikh2

Background

There is considerable international interest in exploiting the potential of digital solutions to enhance the quality and safety of health care. Implementations of transformative eHealth technologies are underway globally, often at very considerable cost. In order to assess the impact of eHealth solutions on the quality and safety of health care, and to inform policy decisions on eHealth deployments, we undertook a systematic review of systematic reviews assessing the effectiveness and consequences of various eHealth technologies on the quality and safety of care.

Methods and Findings

We developed novel search strategies, conceptual maps of health care quality, safety, and eHealth interventions, and then systematically identified, scrutinised, and synthesised the systematic review literature. Major biomedical databases were searched to identify systematic reviews published between 1997 and 2010. Related theoretical, methodological, and technical material was also reviewed. We identified 53 systematic reviews that focused on assessing the impact of eHealth interventions on the quality and/or safety of health care and 55 supplementary systematic reviews providing relevant supportive information. This systematic review literature was found to be generally of substandard quality with regards to methodology, reporting, and utility. We thematically categorised eHealth technologies into three main areas: (1) storing, managing, and transmission of data; (2) clinical decision support; and (3) facilitating care from a distance. We found that despite support from policymakers, there was relatively little empirical evidence to substantiate many of the claims made in relation to these technologies. Whether the success of those relatively few solutions identified to improve quality and safety would continue if these were deployed beyond the contexts in which they were originally developed, has yet to be established. Importantly, best practice guidelines in effective development and deployment strategies are lacking.

Conclusions

There is a large gap between the postulated and empirically demonstrated benefits of eHealth technologies. In addition, there is a lack of robust research on the risks of implementing these technologies and their cost-effectiveness has yet to be demonstrated, despite being frequently promoted by policymakers and “techno-enthusiasts” as if this was a given. In the light of the paucity of evidence in relation to improvements in patient outcomes, as well as the lack of evidence on their cost-effectiveness, it is vital that future eHealth technologies are evaluated against a comprehensive set of measures, ideally throughout all stages of the technology's life cycle. Such evaluation should be characterised by careful attention to socio-technical factors to maximise the likelihood of successful implementation and adoption.

Full text is here:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3022523/?tool=pmcentrez

While there are all sorts of possible criticisms of this review - and while it is also true there are good studies showing strong evidence for the benefits of some aspects of e-Health - large scale projects do seem to have particular problems. We also have a genuine need not to throw out the baby with the bathwater here.

However, given the evidence from the UK and elsewhere is qualified at best it seems to me that before investing almost half a billion dollars in a new system we should be conducting a proper large scale test of a completed PCEHR - not a collection of partial pilots - (the Wave 1 and 2 sites) to demonstrate some actual utility, benefit and adoption before rushing in. Just hoping the evidence will emerge as we roll along is a very bad way to play this in my view.

Evidence based design of systems which will really work, be adopted and make a difference is what is needed - not to fly off on a wing and hopeful prayer. Of course you also need to know just why the system is being designed for and why!

David.

No comments: