In the wake of reports that the push to go digital in healthcare hasn't produced the promised results, a literature review of economic evaluations of health IT systems finds an array of methods, but generally positive conclusions.
Researchers from the University of Victoria in British Columbia looked at 33 papers that sought to pin down the value the systems provided, not just the cost. Their research is published in the Journal of the American Medical Informatics Association.
The papers included 12 economic analyses, five input cost analyses and 16 cost-related outcome analyses and covered primary care electronic medical records (seven papers); six computerized provider order entry systems (six); medication management systems (five); immunization information systems (five); institutional information systems (four); disease management systems (three); clinical documentation systems (two); and one health information exchange network.
In terms of value for money, 23 papers reported positive findings, eight were inconclusive and two were negative.
The majority of papers pre- and post-implementation looked at costs over a set time period. However, without including the initial costs of those systems, the researchers found it impossible to determine the return on investment.
They also found variations by system type: 86.7 percent of papers on primary care EMR, medication management, and disease management systems had positive findings. CPOE, immunization, and documentation had mixed findings in more than one paper.
"As the HIS become more complicated as in CPOE and clinical documentation and immunization systems where there are multiple objectives, target audiences, and performance variations, there may be diminishing returns in having to manage the increased complexities, needed coordination, and stakeholder expectations," the authors wrote. "In these instances there is still need for more research to determine how best to design and implement these systems in ways that can help, not hinder, the clinical work."
For stakeholders who still must make a business case for investing in some of these costly systems, the authors point to six key components to a quality economic evaluation: having a perspective, options for comparison, time frame, costs, outcomes and comparison of costs and outcomes for each option.
Professors from Harvard and Penn made a splash last fall in a Wall Street Journal op-ed in which they argued that EHRs don't actually reduce healthcare costs or improve patient care. Claims that they do rarely include the full cost of installation, training and maintenance, they said.
A more recent RAND Corp. analysis following up on 2005 projections said health IT so far has not lived up to its promise, largely because it's not interconnected or easy to use, and because providers have not made changes in the way they deliver healthcare services to reap its benefits.
A study looking at a hospital-wide EHR implementation in a tertiary facility in Malawi found a good ROI, citing the need to evaluate EHRs in such low-income settings because they face additional challenges, such as staff and supply shortages.
To learn more:
- read the research