EHR Impact Study Findings: Interoperability, long-term strategic focus, good management essential to realize eventual benefit from investment

Findings from the recently released EHR Impact study: The Socio-Economic Impact of Interoperable Electronic Health Record (EHR) and Eprescribing Systems in Europe and Beyond, show that EHRs and ePrescribing are not quick wins, but they are sustainable wins. An important finding was that interoperability is a prime driver of benefits from EHR and ePrescribing systems, as benefits rely on access to information regardless of place and time. Local, closed ICT systems lacking interoperability would not release these substantial gains. Extremely important to success of such investments, also, is the skill and expertise of executives and managers in managing organisational change and resource redeployment. The study comprised nine quantitative and two qualitative independent evaluations of selected case studies (listed below). Two perspectives were applied: the socio-economic, and a narrower, financial one within the socio-economic to enable estimation of the long-term impacts of interoperable EHR and eprescribing systems. Calculations involved some 1300 time series variables and about 600 estimates and assumptions that do not change over time.

Cost levels depend on the scope of the EHR and ePrescribing solution, the range of healthcare levels affected, the type of health system, and the economic environment of the investment. Per estimates, it can take at least four and, more typically, up to nine years before initiatives produce their first positive annual socio-economic returns, and six to eleven years to realise a cumulative net benefit. A key finding of the study was that benefits from EHR and ePrescribing investments come under very broad, diverse categories, but are very individual and specific to the respective context of an investment.

In the sub-analysis of financial impacts, study findings show extensive reliance on executives’ and managers’ skill and expertise in organisational change and resource redeployment to realise financial returns. However, engagement must be continuous, not just consultative: both management and professionals need to constructively address issues that arise regarding positions, propositions, concerns and requirements on an ongoing basis. Achievement of specific goals requires a consistent, continuous investment in people as well as technology over a long time period.

Perhaps not surprising, the report finds there is no single, theoretically right strategy for implementing interoperable EHRs and ePrescribing systems. It is advisable that decisions to invest in EHR and ePrescribing systems devise and adopt strategies that fit their local or regional setting and are designed to succeed by meeting clearly identified, measurable needs.

By taking the socio-economic perspective, it was estimated that initiatives can achieve returns of close to 200% on their total investment, and an average of about 80% over some nine years. Financial gains can be up to 60% of the total socio-economic benefits, with an average of some 13%.  Financial outlay can be between 20% and 85% of the total socio-economic cost of investment, and an average of about 50%. The match of extra cash for the initiative and extra cash generated is usually a negative bottom line, with exceptions proving the rule. When opportunities to redeploy resources liberated by efficiency gains are included, the financial gains increase to an average 60% of total benefits, exceeding the extra cash invested.

The case studies upon which this evaluation is based are:

• The Emergency Care Summary of NHS Scotland, UK
• The Computerised Patient Record System at the University Hospitals of the Canton of Geneva, Switzerland
• The Hospital Information System at the National Heart Hospital Sofia, Bulgaria
• The regional EHR and ePrescribing system Diraya in Andalucía, Spain
• The regional ePrescribing system Receta XXI in Andalucía, Spain
• The regional integrated EHR and ePrescribing across Kronoberg County, Sweden
• The Kolín-Čáslav health data and exchange network, Czech Republic
• Dossier Patient Partagé Réparti (DPPR) – Shared and Distributed Patient Record platform in the Rhône-Alpes Region, France
• The regional Healthcare Information System in Lombardy, Italy
• A nation-wide health information network in Israel - qualitative report
• Evanston Hospital, Northwestern Healthcare, USA - qualitative report

The study was commissioned by the European Union DG Information Society and Media.