Electronic health record and e-prescribing systems deliver benefits such as safer and more convenient services, but only over long periods of time and with a net increase in spending, a major European study has concluded.
The final report of the European Commission EHR IMPACT study pulls together more than 700 indicators of cost and benefit derived from detailed case studies of 11 EHR and e-prescribing systems in use in Europe, the US and Israel.
It also assigns them monetary values, in order to estimate a ‘socio-economic return’ and a proxy for the financial ‘return on investment’ of the deployments.
Its key findings are that EHR and e-prescribing systems deliver benefits such as improved patient safety, more effective use of staff time and more timely care for patients.
The study says such socio-economic benefits eventually exceed their costs and become substantial. “That is why investment in such systems is worthwhile and justifies their net financial boost.”
However, it says the socio-economic benefits take a long time to be realised. “It takes at least four and more typically up to nine years before initiatives produce their first positive annual SER and six to eleven years to realise a cumulative net benefit,” it says.
The report goes on to explain that this is because there are large costs in involving clinical and managerial staff in new systems, in procuring and deploying them and in seeing them widely used.
As a result, it warns policy makers that they should not expect quick wins, neat outcomes or results that are easy to generalise.
“No single or small group of benefits comprise a sufficient reason for investment in EHRs and e-prescribing systems, even if such expected benefits provide an initial policy or strategic start point,” it says.
“A wide range of many benefits… depends on the functionalities and utilisation of the systems, and may occur in unexpected places… specific to the context of an investment.”
The study also concludes that because many of the socio-economic benefits come from making information more widely available, interoperability is vital.
“Benefits rely on access to information regardless of place and time. Local, closed ICT systems lacking interoperability would not realise these substantial gains.”
The report, the culmination of hundreds of interviews, modelling and analysis, says the underpinning case studies show that it is possible to generate some cash savings from EHR and e-prescribing systems, and that these may be as much as half the cost of investment over time.
However, it concludes that these financial returns come from freeing up resources to deploy elsewhere, so realising them will depend on executive and managerial expertise in organisational change and resource management.
Only one of the 11 studies generated a positive financial return – and this was a specialist hospital that had previously been overstocked. “In all other cases, an overall net inflow of new financial resources was required.”
The findings of the report appear to echo those of a study published in the American Journal of Medicine two weeks ago, which found that digitisation improved quality but did not cut costs in US hospitals.
They also appear to echo a smaller study published this week in the UK that found small implementations were more likely to deliver benefits than large ones.
However, the EHR IMPACT report scotches one myth about IT projects – that long running projects are more likely to fail. Because the benefits it identifies take so long to achieve, it says longer running projects are actually more likely to succeed.