They did it their way: empirical evidence on the socio-economic added
value of eHealth solutions
eHealth Conference 2010 – Telematik bringt mehrWERT
Hannover, 14-15.09.2010
Alexander Dobrev
Communication & Technology Research
Bonn / Germany
eHealth Conference 2010 – Telematik bringt mehrWERT, Hannover, 14-15.09.2010 2
Contents
1. The European EHR IMPACT study
2. Evidence on economic impact
� European good practice case studies
� Measurement methodology
� Economic potential
3. Subtleties of success, or how to make it happen
eHealth Conference 2010 – Telematik bringt mehrWERT, Hannover, 14-15.09.2010 3
Socio-economic impact
of interoperable electronic health
record and ePrescription systems
in Europe
www.ehr-impact.eu
Alexander Dobrev, empirica
Tom Jones, TanJent
Karl and Veli Stroetmann, empirica
Yvonne Vatter, empirica
Kai Peng, empirica
Site teams from 10 countries
eHealth Conference 2010 – Telematik bringt mehrWERT, Hannover, 14-15.09.2010 4
Empirical evidence
Case studies
5
EHRI cases (I)
1. Emergency Care Summary Scotland, UK� medication and allergies record for the whole population
2. University Hospitals of Geneva, Switzerland� EPR-based information system, including full CPOE within the hospitals
3. National Heart Hospital Sofia, Bulgaria� EPR-based information system
4. Kolin-Caslav health data & exchange network, Czech Republic� regional network of hospitals and GPs/specialists
5. Diraya, Andalusia, Spain� regional EHR system with focus on primary care
6. Receta XXI - ePrescribing in Andalusia� in connection with Diraya
6
EHRI cases (II)
7. Shared and Distributed Patient Record platform in the Rhône-Alpes Region, France� covering 30 hospitals and 200,000 patients; 2 m medical documents
8. Regional integrated EHR and ePrescribing across the Kronoberg County, Sweden� spanning the entire health service system
9. Health information platform SISS in Lombardy, Italy� covering the whole population, primary & secondary care, pharmacies
10. Nation-wide health information network, Israel (qualitative report)� based on local EPRs, incl. primary and secondary care
11. EHR system at NorthShore University HealthSystem, USA(qualitaitive report)� comprehensive EPR-based information system, including secondary use
data warehouse
7
EHRI cases
These are all proven eHealth investments, so the good results are expected.
They are not typical of all eHealth investment, where many fail to deliver socio-economic returns and
add net socio-economic costs.
eHealth Conference 2010 – Telematik bringt mehrWERT, Hannover, 14-15.09.2010 8
Measuring socio-economic impact
Methodology
9
Empirical data of EHR IMPACT
� Empirical data from more than 20 site visits
– Approximately 100 face-to-face interviews
– Some 500 people across all sites
� Data items
– 1,300 time series variables
– 600 estimates and assumptions that do not change over time
� Socio-economic impact indicators
– 304 cost functions
– 423 benefit functions
10
Estimating costs
� ICT costs– e.g. for hardware, middleware, software, licences, and obsolescence
� Organisational change– e.g. for stakeholder engagement, procurement, project management, programme management, training, change management, and information governance
� Negative impacts– e.g. extra time needed for data input, forgone income because of reduction on tests and admissions, increased risk due to over-reliance on the eHealth system
11
Estimating benefits
� Quality– Informed citizens and carers: e.g. better self-care, less anxiety
– Information designed around the citizen: e.g. better informed decisions
– Timeliness of care: not too early, not too late
– Safety: e.g. reduction in risk of adverse events
– Effectiveness: e.g. complete instead of partial cure
� Access– Equity: e.g. enabling quality care for the poor
– Stakeholder coverage: e.g. enabling care to citizens from remote areas
– Information flow: access to information
� Efficiency– Improved productivity: e.g. meeting increasing demand
– Avoided waste: e.g. duplications
– Optimisation of resource utilisation
eHealth Conference 2010 – Telematik bringt mehrWERT, Hannover, 14-15.09.2010 12
Economic potential of eHealth
Empirical insights
13
Annual socio-economic value of impact to society
0
20
40
60
80
100
120
140
1 2 3 4 5 6 7 8 9 10 11
Years
Investm
en
t / R
etu
rn
Value of socio-economic costs Value of socio-economic benefits
14
Value of cumulative socio-economic impact
-100
0
100
200
300
400
500
600
1 2 3 4 5 6 7 8 9 10 11
Years
Inv
es
tme
nt
/ R
etu
rn
Socio-economic cost curve Socio-economic benefit curve
15
Stakeholders‘ value of cumulative net benefits
-300.000.000
-200.000.000
-100.000.000
0
100.000.000
200.000.000
300.000.000
400.000.000
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Euro
Citizens Doctors, nurses, other staff
Health provider organisation 3rd parties*Based on 9 EHRI sites
16
Estimated economic and financial impact
*Based on 9 EHRI sites
-600.000.000
-500.000.000
-400.000.000
-300.000.000
-200.000.000
-100.000.000
0
100.000.000
200.000.000
300.000.000
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
EU
R
Cumulative financial net-benefits Cumulative financial + resource net-benefits
eHealth Conference 2010 – Telematik bringt mehrWERT, Hannover, 14-15.09.2010 17
Realising the potential
How to make it happen
18
The right strategic goals
� Aim at strategic gains for healthcare, not at an ICT project:– High socio-economic potential: 80% return*
– Very good economic potential: 16% return*
– Poor cash return: -70%*
� Precise value of strategic gains depends on:– The performance of the healthcare system before eHealth
– The scope and functionality of the new interoperable information systems.
Better healthcare, not cash
*Over 9 sites and between 9 and 13 years
19
Architectural set-up
� Interoperability: key benefit driver, but addressed in different ways
– One system: Kronoberg, Andalusia
– Network of systems and integration platforms: Scotland, Rhône Alpes, Lombardy, Kolin, Geneva, Israel, Sofia
� A trend towards virtual EHRs– Not a stand alone record, but a health information system that can present a personal profile for a specific patient and purpose
– ePrescribing forms an essential part of successful examples
20
Importance of organisational changes
� A never-ending story– Consistent, continuous investment in people and technology over a long time
– Refrain from setting a firm end point to their investments and development
– The risk paradox: Longer timescale as a risk mitigation tool
� Engagement, consultation, and implementation management– Early engagement ensures usefulness– Consultation is insufficient
– Users need to adapt at their own pace, with the IT following suit
21
The success recipe
They did it their way,
you have to do it yours
No right or wrong approaches,
just good ways to do it:
� Clear objectives derived from needs of health service delivery
� Fitting the political environment – opportunities and threats
� Fitting cultural specificities, especially when planning implementation
eHealth Conference 2010 – Telematik bringt mehrWERT, Hannover, 14-15.09.2010 22
Disclaimer
We thank the European Commission for their financial and non-financial support!
This presentation is based on of various research supported by the European Commission,
Directorate General Information Society and Media, Brussels. It reflects solely the views of its presenter. The European Community is not liable for any use that may be made of the information
contained therein.
eHealth Conference 2010 – Telematik bringt mehrWERT, Hannover, 14-15.09.2010 23
Thank you for your attention
Further information:
Alexander Dobrev
empirica Communication & Technology Research
Oxfordstr. 2, 53111 Bonn, Germany
Tel: +49 (0)2 28 - 98 530 - 0
Fax: +49 (0)2 28 - 9 85 30 - 12
www.empirica.com
