EHR IMPACT
         Socio-economic impact
of interoperable electronic health record
  and ePrescription systems in Europe
...
2

                            Overview




    1. The EHR IMPACT (EHRI) case studies
    2. Summary results from EHRI
   ...
EHRI cases (I)

    1. Emergency Care Summary Scotland, UK
       §   medication and allergies record for the whole popula...
EHRI cases (II)
    7. Shared and Distributed Patient Record platform in the Rhône-
       Alpes Region, France
       §  ...
Economic value of impact to society
           400.000.000


           350.000.000


           300.000.000


           ...
Value of socio-economic impact
           1.600.000.000


           1.400.000.000


           1.200.000.000


          ...
Distribution according to stakeholder groups

             Costs                                                          ...
Value of cumulative net benefits
            350.000.000

            300.000.000

            250.000.000

            20...
Types of costs and benefits

           Costs                                                                      Benefit...
Estimated financial impact

       350.000.000


       300.000.000


       250.000.000


       200.000.000
 EUR




   ...
Different returns




     § Value of socio-economic return: 148%

     § Financial return: -20%




11               i201...
Value of socio-economic return
                                           6,00


                                         ...
Insights from the statistics


     § Usability and utilisation are key
        – Average correlation of utilisation to be...
Observations on impacts

     § Types of benefits
       – At the point of care: mainly quality and efficiency
         fr...
Timescales

 § Complex systems need patience
     – Average time to annual net benefit: 7 years (4 to 9)
     – Average ti...
Architectural set-up and meaning of EHR



 § Interoperability: key, but addressed in different ways
     – One system: Kr...
Insights on success


 § Organisational issues need to be sorted out
   first
     – The IT follows, and can create new op...
The EHR IMPACT conclusion


                  There is no silver bullet
     § Transferability of the ERHI sites is limite...
EHR IMPACT: Relevance to i2010 objectives



 § EHRI findings consistent with most i2010 goals
     – Access, inclusion, q...
Thank you!
Alexander Dobrev                                               Tom Jones

empirica Communications & Technology ...
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I2010 Ehri Study Summary Draft

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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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I2010 Ehri Study Summary Draft

  1. 1. EHR IMPACT Socio-economic impact of interoperable electronic health record and ePrescription systems in Europe STUDY RESULTS Alexander Dobrev, empirica Tom Jones, TanJent Yvonne Vatter, empirica Kai Peng, empirica Karl & Veli Stroetmann, empirica i2010 Sub Group on eHealth Brussels, 09 July 2009
  2. 2. 2 Overview 1. The EHR IMPACT (EHRI) case studies 2. Summary results from EHRI 3. Analysis and conclusions 4. Relevance to i2010 objectives 2 i2010 Sub Group on eHealth, Brussels, 09 July 2009
  3. 3. 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 3 i2010 Sub Group on eHealth, Brussels, 09 July 2009
  4. 4. 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 4 i2010 Sub Group on eHealth, Brussels, 09 July 2009
  5. 5. Economic value of impact to society 400.000.000 350.000.000 300.000.000 250.000.000 Euro 200.000.000 150.000.000 100.000.000 50.000.000 0 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Preliminary results; based on a virtual economy of 8 proven sites Present value of total annual costs Present value of annual benefits 5 i2010 Sub Group on eHealth, Brussels, 09 July 2009
  6. 6. Value of socio-economic impact 1.600.000.000 1.400.000.000 1.200.000.000 1.000.000.000 Euro 800.000.000 600.000.000 400.000.000 200.000.000 0 Preliminary results; based 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 on a virtual economy of 8 proven sites Present value of cumulative costs Present value of cumulative benefits 6 i2010 Sub Group on eHealth, Brussels, 09 July 2009
  7. 7. Distribution according to stakeholder groups Costs Benefits 3% 5% 1% 10% 23% 57% 17% 84% Preliminary results; based on a virtual economy of 8 proven sites Citizens Doctors, nurses, other staff Health provider organisation Third parties 7 i2010 Sub Group on eHealth, Brussels, 09 July 2009
  8. 8. Value of cumulative net benefits 350.000.000 300.000.000 250.000.000 200.000.000 150.000.000 Euro 100.000.000 50.000.000 0 -50.000.000 -100.000.000 -150.000.000 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Preliminary results; based on a virtual Citizens Doctors, nurses, other staff economy of 8 proven Health provider organisation 3rd parties sites 8 i2010 Sub Group on eHealth, Brussels, 09 July 2009
  9. 9. Types of costs and benefits Costs Benefits Financial extra Non-financial Non-financial 17% 9% 38% Financial redeployed Financial Financial 37% extra redeployed 54% 45% Preliminary results; based on a virtual economy of 8 proven sites 9 i2010 Sub Group on eHealth, Brussels, 09 July 2009
  10. 10. Estimated financial impact 350.000.000 300.000.000 250.000.000 200.000.000 EUR 150.000.000 100.000.000 50.000.000 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Preliminary results; based on a virtual economy of 8 proven sites Cumulative financial benefits Cumulative financial costs 10 i2010 Sub Group on eHealth, Brussels, 09 July 2009
  11. 11. Different returns § Value of socio-economic return: 148% § Financial return: -20% 11 i2010 Sub Group on eHealth, Brussels, 09 July 2009
  12. 12. Value of socio-economic return 6,00 5,00 Annual net benefits over cost ratio 4,00 3,00 2,00 1,00 0,00 -1,00 -2,00 07 09 98 99 00 01 02 03 04 05 06 08 10 20 20 19 19 20 20 20 20 20 20 20 20 20 Preliminary results; based on a virtual economy of 8 proven sites 12 i2010 Sub Group on eHealth, Brussels, 09 July 2009
  13. 13. 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 13 i2010 Sub Group on eHealth, Brussels, 09 July 2009
  14. 14. 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) 14 i2010 Sub Group on eHealth, Brussels, 09 July 2009
  15. 15. 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 15 i2010 Sub Group on eHealth, Brussels, 09 July 2009
  16. 16. 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 16 i2010 Sub Group on eHealth, Brussels, 09 July 2009
  17. 17. 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 17 i2010 Sub Group on eHealth, Brussels, 09 July 2009
  18. 18. 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 transferability between 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 18 i2010 Sub Group on eHealth, Brussels, 09 July 2009
  19. 19. 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 19 i2010 Sub Group on eHealth, Brussels, 09 July 2009
  20. 20. Thank you! Alexander Dobrev Tom Jones empirica Communications & Technology Research TanJent Oxfordstr. 2 Consultancy 53111 Bonn, Germany United Kingdom Tel: +49 (0)2 28 - 98 530 -0 Fax: +49 (0)2 28 - 9 85 30 -12 +44 7802 336 229 www.empirica.com www.ehr-impact.eu 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.

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