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Étude internationale - L\'impact socioéconomique des dossiers médicaux informatisés La Commission européenne tente d\'évaluer l\'impact socio-économique des dossiers médicaux informatisés et des systèmes de prescription en ligne (ePrescription). Pour ce faire, elle a analysé 11 études de cas exposant les bonnes pratiques mises en place en Europe, ainsi qu\'aux États-Unis et en Israël. Les conclusions montrent que les gains socio-économiques de ces nouvelles technologies excèdent les investissements réalisés, à condition, toutefois, d\'être patient. ePractice.eu
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EHR IMPACTSocio-economic impact
of interoperable electronic health record and ePrescription systems in Europe
STUDY RESULTS
Alexander Dobrev, empiricaTom Jones, TanJent
Yvonne Vatter, empiricaKai Peng, empirica
Karl & Veli Stroetmann, empirica
i2010 Sub Group on eHealthBrussels, 09 July 2009
i2010 Sub Group on eHealth, Brussels, 09 July 20092
2
Overview
1. The EHR IMPACT (EHRI) case studies2. Summary results from EHRI3. Analysis and conclusions4. Relevance to i2010 objectives
i2010 Sub Group on eHealth, Brussels, 09 July 20093
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
i2010 Sub Group on eHealth, Brussels, 09 July 20094
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. ePrescribing and EHR network in Lombardy, Italy§ covering the whole population, primary & secondary care, pharmacies
10. Nation-wide health information network, Israel (qual. report)§ based on local EPRs, incl. primary and secondary care
11. Evanston Hospital, Northwestern Healthcare, USA (qual. report)§ comprehensive EPR-based information system, including secondary use
data warehouse
i2010 Sub Group on eHealth, Brussels, 09 July 20095
Economic value of impact to society
0
50.000.000
100.000.000
150.000.000
200.000.000
250.000.000
300.000.000
350.000.000
400.000.000
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Euro
Present value of total annual costs Present value of annual benefitsPreliminary results; basedon a virtual economy of 8 proven sites
i2010 Sub Group on eHealth, Brussels, 09 July 20096
Value of socio-economic impact
0
200.000.000
400.000.000
600.000.000
800.000.000
1.000.000.000
1.200.000.000
1.400.000.000
1.600.000.000
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Euro
Present value of cumulative costs Present value of cumulative benefits
Preliminary results; basedon a virtual economy of 8 proven sites
i2010 Sub Group on eHealth, Brussels, 09 July 20097
Distribution according to stakeholder groups
10%
84%
5% 1%
Citizens Doctors, nurses, other staff Health provider organisation Third parties
23%
17%57%
3%
Costs Benefits
Preliminary results; based on a virtual economy of 8 proven sites
i2010 Sub Group on eHealth, Brussels, 09 July 20098
Value of cumulative net benefits
-150.000.000
-100.000.000
-50.000.000
0
50.000.000
100.000.000
150.000.000
200.000.000
250.000.000
300.000.000
350.000.000
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Euro
Citizens Doctors, nurses, other staffHealth provider organisation 3rd parties
Preliminary results; based on a virtualeconomy of 8 provensites
i2010 Sub Group on eHealth, Brussels, 09 July 20099
Types of costs and benefits
Financial extra17%
Financial redeployed
45%
Non-financial38%
Financial redeployed
37%Financial
extra54%
Non-financial9%
Preliminary results; based on a virtual economy of 8 proven sites
Costs Benefits
i2010 Sub Group on eHealth, Brussels, 09 July 200910
Estimated financial impact
0
50.000.000
100.000.000
150.000.000
200.000.000
250.000.000
300.000.000
350.000.000
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
EUR
Cumulative financial benefits Cumulative financial costsPreliminary results; based on a virtual economy of 8 proven sites
i2010 Sub Group on eHealth, Brussels, 09 July 200911
Different returns
§ Value of socio-economic return: 148%
§ Financial return: -20%
i2010 Sub Group on eHealth, Brussels, 09 July 200912
Value of socio-economic return
-2,00
-1,00
0,00
1,00
2,00
3,00
4,00
5,00
6,00
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Ann
ual n
et b
enef
its o
ver c
ost r
atio
Preliminary results; based on a virtual economy of 8 proven sites
i2010 Sub Group on eHealth, Brussels, 09 July 200913
Insights from the statistics
§ Usability and utilisation are key– Average correlation of utilisation to benefit: 0.98– Average correlation of utilisation to net benefit: 0.91
§ Most of the investment is not the IT– ICT cost as share of total: 38%– ICT costs as share of health service provider
organisation costs: 45%
§ Most initiatives will remain financial investments in non-financial returns
i2010 Sub Group on eHealth, Brussels, 09 July 200914
Observations on impacts
§ Types of benefits– At the point of care: mainly quality and efficiency
from better informed decisions– Cash gains may be realised when leapfrogging from
paper-based admin processes
§ EHRs facilitate meeting information-intensive goals– Continuity of care (Rhône-Alpes, Lombardy, Kronoberg, Israel,
Andalusia)
– Epidemiology & other public health statistics (Andalusia, Sofia, Geneva, Israel)
– Waiting time management (Andalusia, Scotland, Sofia, Kolin)
– Out of hours and A&E healthcare provision (Scotland, Kronoberg, Andalusia)
i2010 Sub Group on eHealth, Brussels, 09 July 200915
Timescales
§ Complex systems need patience– Average time to annual net benefit: 7 years (4 to 9)– Average time to cumulative net benefit: 9 years (6 to 11)
§ The EHRI timescale is artificially cut at 2010– Some impacts will continue to grow (esp. Scotland, Rhône-
Alpes, Lombardy, Kronoberg)
§ Common time horizons of strategies are too short– Include mainly the costs, but do not reach out long enough
to include the realisation of benefits
§ The risk paradox– Longer timescale as a risk mitigation tool
i2010 Sub Group on eHealth, Brussels, 09 July 200916
Architectural set-up and meaning of EHR
§ Interoperability: key, but addressed in different ways– One system: Kronoberg, Andalusia – Network of systems & 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– ePrescribing forms an essential part of successful examples
i2010 Sub Group on eHealth, Brussels, 09 July 200917
Insights on success
§ Organisational issues need to be sorted out first– The IT follows, and can create new opportunities
§ 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
i2010 Sub Group on eHealth, Brussels, 09 July 200918
The EHR IMPACT conclusion
There is no silver bullet
§ Transferability of the ERHI sites is limited by the political, structural, and health system environment
§ The need for interoperability also limits transferabilitybetween sites
§ No right or wrong approach, just a good way 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
i2010 Sub Group on eHealth, Brussels, 09 July 200919
EHR IMPACT: Relevance to i2010 objectives
§ EHRI findings consistent with most i2010 goals– Access, inclusion, quality, effectiveness, efficiency
§ It is not consistent with goals for economies of scale because:– Costs, benefits and utilisation are broadly correlated– Investment is step by step– EHRI found only cases with < 10 million population
Thank you!Alexander Dobrev
empirica Communications & Technology ResearchOxfordstr. 253111 Bonn, GermanyTel: +49 (0)2 28 - 98 530 -0Fax: +49 (0)2 28 - 9 85 30 -12www.empirica.comwww.ehr-impact.eu
Tom Jones
TanJent ConsultancyUnited Kingdom
+44 7802 336 229
www.tanjent.co.uk
This presentation is part of a Study on the socio-economic impact of interoperable electronic health record and ePrescribing systems (www.ehr-impact.eu) commissioned by the European Commission, Directorate General Information Society and Media, Brussels. This presentation reflects solely the views of its authors. The European Community is not liable for any use that may be made of the information contained therein.
