In most countries, there is a push to adopt electronic health record systems, spurred by government financing and the promise of improved decision-making, integration of care, improved efficiency in health care services management and ability to involve patients in their care. However, there still are barriers to adoption of systems that include the cost of purchasing a system, defining needs and customizing a system to meet those needs, uncertainty about the return on investment, and concern about meeting future needs (scalability, compatibility with other systems, ability to add functionality). What evidence is there to evaluate what system to invest in, best practices in implementation, and how to measure return on investment across an organization? In the past week, Evaluating the Value and Impact of an Electronic Health Record in a Complex Health System (Mayes & Mador, 2010) was published in ElectronicHealthcare. NetCARE, as mentioned in the article, is Canada’s first region-wide electronic health record, implemented in 2004 in Alberta Health Services, Edmonton. It is a clinical, web-based, view-only record of an individual’s key health information drawn from multiple sources, it is accessible in hospital and community settings, and is accessed by a variety of clinical users. The study’s purpose was to evaluate the value and impact of netCARE using a systematic approach for quantifying tangible and intangible outcomes from both, a clinical-user and organizational perspective. It used an approach that included a survey of users across occupation and clinical area to assess dimensions such as acceptability, accessibility, effectiveness, efficiency, quality of patient care, and workflow, and it measured impact through analyzing EHR system usage logs, changes in physician monthly log-ons to the existing legacy health information system, and utilization changes in requests for lab reports. Survey results demonstrated that the perceived value of netCARE varied according to profession, information provided and clinical setting. All users found it valuable to varying degrees, but often for different reasons. The system-level data showed increases in netCARE utilization together with a decrease in the use of older health information systems during the same period. Success of netCARE is attributed to having clinicians heavily involved during its design, implementation and ongoing maintenance, as well as commitment to the use of evaluation for quality- and performance improvement purposes.
In their Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care (Chaudhry et al, 2010) found some evidence that health information technology investments improved quality and efficacy. However, this evidence came from only 4 benchmark institutions: of the 257 studies that met the inclusion criteria, approximately 25% were from 4 academic institutions that implemented internally developed systems, and only 9 studies evaluated multifunctional, commercially developed systems.
Benefits to quality were found to be increased adherence to guideline-based care, enhanced surveillance and monitoring, and decreased medication errors; to efficiency --decreased utilization of care. Findings regarding time utilization were mixed, and empirical cost data were limited. As systems were heterogeneous and incompletely described, and only limited quantitative research and financial and contextual data were available, it was not possible to draw general conclusions as to best practices relating to such issues as return on investment in health technology, alignment of incentives for its use, management of organizational change, workflow redesign and maximization of the value of the health technology investment.