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What’s needed to avoid ‘extraordinarily expensive mistakes’ in eHealth

New eHealth initiatives won’t benefit staff or patients if policymakers and hospital administrators focus solely on meeting organisational goals and metrics, Australian researchers warn.

Instead, experts from the Deeble Institute for Health Policy Research say, implementations should be seen as an opportunity to fundamentally rethink what it means to be a high value hospital and redefine the metrics used to assess their performance.

“This approach will motivate all stakeholders to leverage new opportunities as they emerge and allow governments to reap the transformational benefits that these technologies have the potential to confer on patient care,” the authors of an evidence brief on the subject say.

Titled The impacts of eHealth upon hospital practice: synthesis of the current literature, the evidence brief notes that governments worldwide are increasingly adopting eHealth technologies in a bid to increase the value from healthcare expenditures.

It works through technologies such as electronic medical records, computer provider order entry, ePrescribing and computerised decision support systems.

Co-author Dr Rebekah Eden, a postdoctoral researcher at The University of Queensland, says multiple Australian hospitals are in a process of going live with electronic medical record systems and the Deeble Institute team wanted to see whether or not the impacts align with what’s purported.

Eden says the sector often hears about improved clinical and financial outcomes and efficiency gains but when looking at the literature, the effects of digitisation are mixed.

“There are definitely success stories, but there are also some negative stories,” Eden says. “What we wanted to do is highlight that policymakers should try to devote research into understanding what mechanisms need to be put into place to help ensure that those positive outcomes can be obtained.”

Alison Verhoeven, chief executive of the Australian Healthcare and Hospitals Association, says without the right vision, attitudes and research base, eHealth initiatives in hospitals can end up being extraordinarily expensive mistakes.

“I think it’s fair to say that, in Australia, we have had variable success in our attempts to digitise and integrate health records, provider ordering, prescribing and decision support systems.

“In many ways we should not be surprised.”

Verhoeven says there are three main areas of difficulty for policymakers.

Potential impacts

Verhoeven says just as eHealth technologies can affect a great number and variety of stakeholders, across a wide range of locations and a wide range of outcome types, the vision for any project must also be wide and of expanded possibilities.

“If the vision is just about fixing up records in your own hospital or even your own state, the project’s success will be very limited,” she says.

Emerging impacts

These are the surprising and unpredictable effects of eHealth efforts. Verhoeven says this is often due to the entire field constantly changing caused by a range of internal and external factors, such as clinical judgments, staff movements and funding decisions.

“eHealth policies and practices, and the people administering them, need to be open, flexible and adaptable, so that the project is not constrained by current practice or pre-existing expectations," she says.

Uncertain impacts

An eHealth initiative may work amazingly well in one area, but not so much in another, Verhoeven says. “The trouble is that through a lack of research in Australia particularly, we don’t know why — we don’t know the current or potential drivers of eHealth success in the Australian context, and we need to.”

Eden hopes policymakers and hospital administrators think about these impacts beyond standard metrics, such as improving patient or efficiency of care. She says while those are good outcomes, there are a range of impacts that need to be considered, as well as ways to measure those impacts. “For instance ... how do we measure completeness of information? That information being generated is also highly visible. So, there might be some practices that were being performed previously that weren't detrimental to patient care, but probably weren't the optimum. And now we have visibility of that. So, how exactly can we use this visibility of information in a positive light?”

Ultimately, more research is needed, Eden says.

“We need to have policymakers actually looking at what are the drivers to the successful outcomes and making sure that research is being dedicated to trying to figure out how we can attain these successful outcomes. So, is it through using these systems more effectively? And, if so, what does that effective use mean? Or, is it, for instance, putting different governance strategies in place to be able to handle this new visibility of information that we have?

“We need there to be more research into the drivers of positive outcomes of electronic medical record systems.”

Despite the challenges digitisation poses for policymakers and hospital administrators, Verhoeven says digital healthcare is the way of the future. “We need to harness the benefits for both patients and the health system as a whole."

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