Friday, October 27, 2017

Researchers Suggest The Value In Hospital System Implementations Is Hard To Pin Down And Failures Are Common!

This appeared last week:

The impacts of eHealth upon hospital practice: synthesis of the current literature

17 Oct 2017
CREATORS
The aim of this brief is to provide policy-makers with an analysis of current literature relating to the effects to be expected from hospital implementation of eHealth technologies.

Description

To increase value from health-care expenditures, governments worldwide are increasingly adopting (or planning to adopt) eHealth technologies (e.g. Electronic Medical Records (EMR), Computer Provider Order Entry (CPOE), ePrescribing, and Computerised Decision Support Systems (CDSS)). The US government devoted $34 billion to this effort, and as a result, over 75% of US hospitals have now implemented EMRs. Alternatively, the UK National Health Service suspended their digitization efforts in 2011 after spending approximately £12 billion, but in 2016 dedicated a further £4.2 billion to digitise healthcare. The Queensland Government has budgeted $1.26 billion in an ambitious attempt to digitally transform the state’s public hospitals and similar initiatives have also been undertaken by other Australian states. Investing in eHealth is largely viewed as a means for the healthcare industry to improve financial and clinical outcomes. However, some of these outcomes are yet to be fully realised7 and effects of digitisation reported in the literature are often conflicting.
While many US hospitals have implemented eHealth technologies, their early experiences are not necessarily generalizable to today’s environments because digital systems are rapidly evolving. Because of this, and the heterogeneity of effects reported in past literature, it is important to provide up-to-date assessments of the currently available evidence. The aim of this brief is to provide, for policy-makers, an analysis of current literature relating to the effects to be expected from hospital implementation of eHealth technologies.

PUBLICATION DETAILS

Resource Type: Briefing paper
APO URI: http://apo.org.au/node/115061
Publication Place: Canberra
Series Title: Deeble Institute Evidence Brief
Series Volume/No.: 16
Copyright: Deeble Institute, Australian Healthcare & Hospitals Association 2017
More here:
The study conclusions are as follows:

What Does This Mean For Policy Makers?

On aggregate, the evidence implies three issues for policy makers:
1.  Implications from evidence of wide-ranging impacts:
The studies show significant impacts from eHealth technologies on different stakeholders (patients, clinicians, hospitals, and health services) and of different outcomes (efficiency, effectiveness, short-term, long-term). This implies the need for policy makers to adopt a comprehensive perspective when assessing success of eHealth implementations and consider both quantitative and qualitative data. Policy- makers also need to take a very inclusive approach when detailing expectations regarding the future success of proposed implementations.
2.  Implications from evidence of emerging impacts:
The studies reveal new evidence about specific impacts that have emerged over time (e.g. clinical judgement, changing practices, staff movements). Given that transformation of hospital practice is ongoing and inherently unpredictable, policy- makers need to keep policies open and flexible enough to allow for innovation and which encourage stakeholders to act on opportunities as they emerge rather than being constrained by pre-existing expectations.
3.    Implications from evidence of uncertain impacts:
The studies show that success from eHealth is not guaranteed, as implementations vary widely in terms of positive and/or negative outcomes. This suggests that rather than simply supporting eHealth projects per se, policy makers need to identify and support the drivers of successful outcomes. It is not currently clear which particular drivers are most critical, and resolving this uncertainty constitutes a pressing research need.
Synthesis
The wide-ranging, emergent, and uncertain nature of eHealth impacts implies that policy-makers and hospital administrators are unlikely to succeed with eHealth initiatives if they assume that the sole aim is to achieve pre-conceived organisational goals and metrics. Rather, they should consider eHealth implementations to be an opportunity to fundamentally rethink what it means to be a high value hospital and redefine the metrics used to assess their performance. This approach will motivate all stakeholders to leverage new opportunities as they emerge and allow governments to reap the transformational benefits that these technologies have the potential to confer on patient care.
----- End Extract.
What is really good about this study is that the authors recognize that data that is more than a few years old is probably not all that useful.
Also good it that the recognize to capture real benefits you have to do more than just automate the ‘status-quo’.
What is missing is a sufficiently large number of high quality comparable studies to derive firm evidence of benefits and what really works!
We have to wait a little longer I guess.
Comments welcome.
David.

2 comments:

Bernard Robertson-Dunn said...

"... policy-makers ... should consider eHealth implementations to be an opportunity to fundamentally rethink what it means to be a high value hospital and redefine the metrics used to assess their performance."

Yes, and not only hospitals. That's yet another reason why the fundamental architecture of the MyHR is fatally flawed - it's just automation of a rudimentary manual process - the keeping of medical records.

eHealth needs a fundamental rethink of medical practice. The consequences of this are two fold:

1. You don't know what the rethink is going to result in and so you don't implement huge, expensive IT solutions that mirror the past and embarrassingly show no heath outcomes.

2. You need an approach that is evolutionary, experimental, innovative, fosters organic growth and focuses on health outcomes.

Sadly nothing I have seen from NEHTA, ADHA, Health resembles anything you might, even in your wildest dreams, call a rethink.

john scott said...

Bernard,

I agree entirely with your comments.

The challenge and strategic opportunity is to see how social innovation is as important as new science and new technology in providing the way forward. Indeed social innovation is often more important.

We will only succeed by changing the rules, not by playing within the existing system.