Thursday, June 13, 2013

When You Look Real Benefits From Major Health IT Programs Are Hard To Find. There Are Some Hard Lessons Here.

The following appeared a few days ago. A Review of the National Program For Health IT in the UK has recently been published.

98 per cent NPfIT benefits unrealised

7 June 2013   Lyn Whitfield
Ninety-eight per cent of the estimated benefits of several high-profile National Programme for IT programmes are yet to be realised, according to the National Audit Office.
However, the Department of Health believes that benefits will slightly exceed costs over the whole life of the systems implemented.
In a note for the Commons’ Public Accounts Committee, the NAO says that 98% of estimated benefits of the London Programme for IT, the South Programme for IT and the Electronic Prescription Service and Summary Care Record programme, were still to be realised at March 2012.
The note, which reports on a much-delayed review of the benefits of the programme demanded by the PAC when it investigated NPfIT in August 2011, says that in March 2012, the DH put the total cost of the programme at £7.3 billion.
It put the total benefits at that point at £3.7 billion. It estimated that by the end of the programme, the total costs would be £9.8 billion and the benefits £10.7 billion.
These figures do not include the costs and benefits of the programme in the North, Midlands and East of England, where CSC was contracted to deliver the Lorenzo electronic patient record, because of repeated contract negotiations in the region.
The NAO comments that because of these changes, which make the end point of the programme uncertain, and questions about whether systems can be effectively deployed on time, there is “very considerable uncertainty about whether the forecast benefits will be realised.”
In a statement, it explained: “Around two thirds (£6.5 billion) of the total estimated benefits are forecast to arise after March 2012. For three programmes, 98% of the total estimated benefits are still to be realised.
“There is a range of risks to the realisation of future benefits. In particular, for some programmes, future benefits rely on the successful deployment of a set number of systems at a set time.
“Experience over the past ten years suggests this will be challenging to achieve, particularly in the case of the local care records programme.”
Lots more here:
Here is the summary from the Audit Office:

Review of the final benefits statement for programmes previously managed under the National Programme for IT in the NHS

Benefits are expected to exceed costs slightly over the life of the systems, but there is uncertainty around whether the benefits will be realised
Downloads
The National Audit Office has reported the results of its review of a statement by the Department of Health of costs and benefits of the programmes previously managed under the National Programme for IT in the NHS.
The NAO report, published as a memorandum for the Committee of Public Accounts, finds the Department took a structured, logical approach to measuring and reporting costs and benefits. The Department forecasts that benefits will slightly exceed costs over the whole life of the systems, £10.7 billion compared with £9.8 billion.
There is, however, very considerable uncertainty around whether the forecast benefits will be realised. Around two-thirds (£6.6 billion) of the total estimated benefits are forecast to arise after March 2012. For three programmes, 98 per cent of the total estimated benefits were still to be realised. Some £2.5 billion (26 per cent) of the total costs are also forecast to arise after March 2012.
There is a range of risks to the realisation of future benefits. In particular, for some programmes, future benefits rely on the successful deployment of a set number of systems at a set time. Experience over the last ten years suggests this will be challenging to achieve, particularly in the case of the local care records systems.
This is found here:
Close reading shows just how rubbery all this is.
What I found most interesting was that it was essentially the infrastructure (NHS e-mail, the National Health IT Spine, PACS and one application (Choose and Book) that had delivered as promised but that the Hospital and GP systems appeared to be much less successful - as was the Shared Health Record. (The semi - equivalent of the PCEHR).
Note they are assuming for the breakeven case that the systems will remain in place until 2024. A bit of a stretch I suspect.
It will be interesting to see how much better DoHA and NEHTA can do and whether they will be prepared to contemplate an audit of how they have done.
David.

1 comment:

Bernard Robertson-Dunn said...

David,

IMHO, benefits are characteristics of a solution. If someone wants those benefits then they have a value to that person. That's why they talk in terms of realizing benefits - i.e translating benefits into value.

What I have never seen is an analysis of value to the Australian community of eHealth.

Saying that you can access your PCeHR anywhere in the country is a benefit of the solution. However, if only 1% of people would ever need that benefit, then the value is rather low.

My understanding of government business cases is that they require a cost/benefit analysis, not a value analysis. Such an analysis would identify the groups who can demonstrate how they would actively utilize a PCeHR and what they would actually use it for. You can put a value on that.

Those who promote eHealth need to understand that realizing benefits can only be done by those who use eHalth not by those who are trying to sell it.

This government can advertise, promote, sell and persuade Australians to have a PCeHR, but if nobody values it, it won't get used. Whatever the potential benefits.