The document presents the findings of the EHR Impact (EHRI) study, which evaluates the socio-economic benefits of interoperable electronic health record and e-prescription systems across various case studies in Europe and the USA. The results indicate substantial economic value generated, with cumulative benefits significantly exceeding costs, though the investment yields differing returns across stakeholder groups. Key insights emphasize the importance of usability, the role of organizational readiness, and the necessity for interoperability in achieving effective health information systems.

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
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. 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. 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. 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. 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. 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. 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. 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. 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. Different returns
§ Value of socio-economic return: 148%
§ Financial return: -20%
11 i2010 Sub Group on eHealth, Brussels, 09 July 2009

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. 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. 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. 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. 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. 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. 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. 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. 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.