The main lesson is that ICT is only part of the solution
At the recent European eHealth Conference in Slovenia, an EU commissioned study on the “Socio-economic impact of interoperable electronic health records and ePrescription in Europe - EHR Impact” was presented. One of the case studies is the computerised patient record (CPR) system at the University Hospitals of Geneva (HUG), which since 1998 has connected their seven hospitals at four campuses. Based on a service oriented architecture and utilising web technologies, it comprises unique patients’ and providers’ identification, access management, unified clinical documentation, order entry for all orders such as laboratory and radiology tests, and management information. HealthTech Wire talked to Prof. Dr. Christian Lovis, Head of the Clinical Informatics Unit at HUG, and Alexander Dobrev, consultant at the research and consulting firm empirica, about the impact of the CPR system on the hospitals.
- (HealthTech Wire) - Based on your initial research results, what are the major benefits of the CPR system for the hospitals?
The major benefits come from the redeployment of resources, including doctors’ and nurses’ time, leading to better quality care; a reduction of risk exposure; and avoidance of over-prescribing laboratory and radiology examinations. The hospital management also uses the system to provide important information for strategic decision-making. Health insurances benefit from fewer hospital admissions, because, e.g., patients in Accident & Emergency departments can often be helped immediately and need not become inpatients until their records are found. HUG also redeploys liberated resources to meet increasing demand.
More difficult to measure, but extremely important, are the benefits to the people involved. All clinical staff have to adapt to changing work flows and processes, and the gains must be of higher value than the extra effort required. We know from our interviews that these personal benefits include being able to focus on clinical tasks instead of searching for records, not having to chase colleagues to decipher illegible handwriting, and the feeling of being less vulnerable and exposed to risks, because the CPR system allows for better-informed decision making. There are gains to patient safety and quality of care – the CPR system provides doctors and nurses with the critical information and decision support they need to reduce the risk of adverse events, and it does so fast, so carers can pay more attention to individual patients.
Has the study shown a return on investment?
The EHR IMPACT study focuses on comprehensive benefit cost analysis, not on return on investment to a single stakeholder. These are different measures, but should be regarded together by decision makers. According to our research, based on accounting data and well-founded estimates, the value of economic benefits at HUG exceeded the value of economic costs on an annual basis for the first time in 2005. The cumulative turning point is achieved about now – 2007/2008, some ten years after the idea for the system in its current form was born. The analysis of the purely financial position is not yet complete but the preliminary results look promising.
What were the main challenges? What are the lessons to be learnt and to what extent do they apply to hospitals throughout Europe?
A major challenge was to integrate eHealth into the overall strategic context of all hospitals and the longer-term health policy of the canton of Geneva. Without this step, which has been successfully accomplished at HUG, investments in eHealth are exposed to enormous risks. Other challenges included dealing with the complexities of the healthcare sector. For example, the large number of stakeholders that need to be involved, the specific social mandate of healthcare organisations, and the sensitivity of health data.
There is a lot to learn from HUG’s experience – like the advanced architectural design of the overall system, the incremental approach taken, the involvement of stakeholders, but the main lesson is that ICT alone is only part of the solution. The real challenge is adapting ICT solutions to the priorities and needs of healthcare, and specifically the needs of users, then realizing the benefits at a level that exceeds the costs.