A practical framework to assess the
     impacts of EMR systems


             Greta Nasi
  SDA Bocconi School of Manageme...
AGENDA

• EMR systems: an impact assessment model

• The model’s methods for data collection

• Findings of an empirical t...
Relevance of impacts of EMR
systems
• Healthcare efficiency and effectiveness is becoming
  increasingly dependent on info...
Main dimensions of the
assessment model
•   Efficiency includes impacts on the level of efficiency of internal processes
 ...
The EMR assessment framework
                  Time savings



    Efficiency    Cost efficiency


                  Infor...
The model’s methods for data
collection
A mix of quali-quantitive methods have been defined and used
for data collection. ...
A test of the assessment model
in Italy and Spain
The test was aimed at comparing impacts of EMR systems
on the overall pe...
Impact assessment timeframes
                   EMR system         After 1 year of EMR   After 6 years of EMR   ……. LONG R...
Assumption for timeframe of
impact materialization
                     EMR system        After 1 year of EMR   After 6 ye...
Preliminary findings: an overlook

  ITALIAN HEALTH PROVIDERS   CATALONIAN HEALTH PROVIDERS
Preliminary Findings: efficiency
                    The Italian health providers show
                    the greatest ef...
Preliminary Findings: effectiveness

                    Italian health providers argue that EMR
                    adopt...
Preliminary Findings: other impacts

                    •   In Italy , the adoption of EMR
                        system...
Discussion and recommendations
 •   Based on the test, we can state that the model can actually
     capture impacts of EM...
Acknowledgments
• Thanks to Azienda Ospedaliera Ospedale Civile di Legnano,
  Azienda USL della Valle d’Aosta, Hospital Cl...
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EMR and Healthcare Improvement Measuring / Assessing Organisational Impacts

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EMR and Healthcare Improvement Measuring / Assessing Organisational Impacts. Nasi G. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

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EMR and Healthcare Improvement Measuring / Assessing Organisational Impacts

  1. 1. A practical framework to assess the impacts of EMR systems Greta Nasi SDA Bocconi School of Management Bocconi University, Milan Italy
  2. 2. AGENDA • EMR systems: an impact assessment model • The model’s methods for data collection • Findings of an empirical test of the assessment model in Italy and Spain • Discussion and recommendations
  3. 3. Relevance of impacts of EMR systems • Healthcare efficiency and effectiveness is becoming increasingly dependent on information and communication technologies • EMR systems promise to improve health care quality to advance inter-organizational integration and data sharing across different health care providers, and to empower patients through greater access to personal data • However the variety and heterogeneity of potential impacts described in literature has not been framed into a comprehensive assessment model able to capture all relevant dimensions of EMR impacts on health care performance
  4. 4. Main dimensions of the assessment model • Efficiency includes impacts on the level of efficiency of internal processes which the application of the electronic medical record system has produced or will produce in the future in terms of time and cost savings and quality of information; • Effectiveness includes impacts in terms of improvement of the organisation as a whole measured as process integration, organizational effectiveness, risk management and better care processes; • Quality of service includes impacts on the overall care process, taking into account its performance, the continuity of care and the degree of empowerment of the patient; • Clinical Governance comprises the group of effects produced in terms of organisational culture, capacity for change as well as overall clinical performance.
  5. 5. The EMR assessment framework Time savings Efficiency Cost efficiency Information Quality Improvement of diagnostic and therapeutic activities Service Effictivennes Risk Management Value Effectiveness of processes Organizational effectiveness Patient Empowerment Patient Empowerment Efficiency of Quality of service care Quality of service Continuity of care Quality Improvement Quality systems Accountability Information management Clinical Governance Strategic management Clinical Audit
  6. 6. The model’s methods for data collection A mix of quali-quantitive methods have been defined and used for data collection. Here is a summary of the methodology adopted: • “Self-completion questionnaires”, concerning information about the EMR system implementation which include: • An assessment of the organization’s context; • The status of EMR system implementation and its functionalities; • Organizational impacts based on the four dimensions perceived by main stakeholders including physicians, nurses, CIOs and controllers, Boards, patients • Semi-structured interview schemes to be used to interview key actors of the EMR system’ implementation project; • Document scrutiny and analysis of other relevant information, as organizational and strategic documents, study reports
  7. 7. A test of the assessment model in Italy and Spain The test was aimed at comparing impacts of EMR systems on the overall performance of different types of health care providers for: • Contexts (Italy and Catalonia) and types of health care provider, • Time elapsed since EMR system implementation; • Functionalities of the EMR systems • Main objectives of EMR system implementation (continuity of care vs. standardization and rationalization of processes and resource usage) The sample: • Italian healthcare providers: a Local Healthcare Authority, which provides both acute and primary care services and an Acute care hospital; • Catalonian healthcare providers: five acute and primary care providers and one acute care provider All data was collected between March and July 2009
  8. 8. Impact assessment timeframes EMR system After 1 year of EMR After 6 years of EMR ……. LONG RUN Pre-EMR system sys implementation sys implementation Go Live Local health care authority Acute care hospital 6 Spanish providers
  9. 9. Assumption for timeframe of impact materialization EMR system After 1 year of EMR After 6 years of EMR ……. LONG RUN Pre-EMR system sys implementation sys implementation Go Live Efficiency Effectiveness Quality of service Clinical governance
  10. 10. Preliminary findings: an overlook ITALIAN HEALTH PROVIDERS CATALONIAN HEALTH PROVIDERS
  11. 11. Preliminary Findings: efficiency The Italian health providers show the greatest effects in terms of efficiency and time saving in particular, which in turn might have an overall effect on the economics of some wards The Catalonian health providers recognize as most important impact the quality of information in terms of accuracy, completeness, easy of understanding and reliability of data
  12. 12. Preliminary Findings: effectiveness Italian health providers argue that EMR adoption has increased organizational effectiveness, in terms of improvement of the interaction between clinicians and patients and also shows its impacts on the effectiveness of processes, enhancing decision making process with time and cost savings results. Catalonian health providers show an improvement of diagnostic, therapeutic and service activities in terms of better ability to plan admissions, precision in diagnosis and treatment and reduction in the number of errors in ordering diagnostic tests and in the compiling reports.
  13. 13. Preliminary Findings: other impacts • In Italy , the adoption of EMR systems has lead to a higher awareness of patient empowerment, with particular reference to the possibility of further involvement of patient to the process due to the increased availability of information • In Catalonia, EMR adoption has strengthened the information exchange between acute care, primary care and GPs (due to the fact that most of the hospitals are both primary and acute care), improving the continuity of care
  14. 14. Discussion and recommendations • Based on the test, we can state that the model can actually capture impacts of EMR systems at organizational level, regardless of the status of EMR implementation, the functionalities adopted, the type and functions of the health provider and the context • Short term impacts tend to be forgotten and taken for granted • These findings are mainly in line with the assumptions made while drafting the model • There is no significant difference in long run effects between acute care and primary care providers • Adopting these framework systematically may help: • Health providers in understanding whether EMR adoption might help them in reaching their goals; • Policy makers to set guidelines for successful EMR implementations; • Academics and practitioners to compare different EMR system uses.
  15. 15. Acknowledgments • Thanks to Azienda Ospedaliera Ospedale Civile di Legnano, Azienda USL della Valle d’Aosta, Hospital Clinic, Hospital de Sant Pau, Hospital del Mar, Hospital General de l'Hospitalet, Institute Català de la Salut, Hospital de Bellvitge • Research team: Claudio Caccia, Maria Cucciniello, Greta Nasi, Xavier Pastor • Research assistants: Paola Cantarelli, Manish Gawande • This research project has been co-financed by InterSystems Italia srl, NoemaLife SpA, Claudio Dematté Research Division and the Public Policy and Management Area of SDA Bocconi School of Management

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