Last week I had an opportunity to attend a presentation given by Prof. Denis Protti on the value of Information Technology in Healthcare. This provided a detailed worldwide review of where healthcare systems have demonstrated success and value in terms of their investment in technology. Significant advances have been made in Europe in terms of investment in IT to facilitate efficiency and systems change.
In a 2006 study published by Stroetman et al on the economic benefits of eHealth solutions, the group found: "Healthcare is one of the most information-intensive sectors of European economies and can greatly profit from recent advances in information and communications technology. Given that the health sector currently lags behind other sectors in the use of this technology - eHealth - there is great potential for rapid, sustained growth." Stroetmann et al eHealth is Worth it: The economic benefits of implemented eHealth solutions at ten European sites European Communities, 2006 www.ehealth-impact.org
In an OECD study by Anderson et al, published in Health Affairs, Vol 25, 2006, they found, "Over 20 countries have accepted the idea that Information and Communications Technology (ICT) will lower health spending and improve outcomes. They are at least 4-13 years ahead of the United States in initiating national ICT programs. The centerpiece of most of these programs is the Electronic Health Record (EHR), but ICT also encompasses a wide range of services including telehealth, electronic ordering systems, decision support tools, networks, and infrastructure.
In a study of 10 countries by Protti et al which included Australia, Denmark, England, New Zealand, Germany and the Netherlands, (all countries in which there has been significant adoption of EMR), they found that the ability to prescribe medications electronically (using varying degrees of clinical decision support and alerts) was used by the majority of physicians in those countries. These data were confirmed by a Commonwealth Fund study in 2006 that demonstrated similarly high numbers of physicians who reported routine use of electronic prescribing: Australia (81%), Germany (59%), Netherlands (85%), New Zealand (78%) and the UK (55%). Canada was at 11% and the US 20%.
This will come as no surprise to any physician who has used an EMR to prescribe medications. It is faster, more legible and with direct to pharmacy transmission of the prescription (either by fax or via electronic transmission) it is much more effeicient than the traditional printed prescription.
The Veteran's Administration in the US has become the model and gold standard in terms of system efficiency and has demonstrated consistently better outcomes and lower cost of service delivery than other segments of the US healthcare system.
Bottom Line: There is growing evidence as to the value of IT investment in healthcare where the evidence is less anecdotal than in the past. However there is still much work to do. If one looks carefully as the work done by Prof. Protti and his team and the Commonwealth Fund, the biggest benefit seems to come from the ability to prescribe electronically. This should be a key area of focus for all vendors and healthcare systems if there is to be adoption of IT by physicians and other healthcare providers.
Mark your calendars for the New Brunswick Medical Society – Provincial EMR Conference to be held in Fredericton, New Brunswick on January 10th and 11th, 2008. I will be giving the keynote address at the conference on "Issues, challenges and rewards (financial, clinical, office efficiency, etc.) of using an EMR for the charting and managing of patient care and the medical practice." The official program has not yet been released. Check the NBMS web site for more details
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