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1 Socio-economic benefits of interoperable electronic health record systems in Europe the evidence - Karl A. Stroetmann FRSM PhD MBA with Alexander Dobrev, Tom Jones, Yvonne Vatter empirica Communication & Technology Research

2 BONN - BRUSSELS 2

3 Contents 1. The EHR Impact methodology 2. The Computerised Patient Record (CPR) system at the University Hospitals of Geneva 3. The Scottish Emergency Care Summary (ECS) Programme 4. Conclusions and lessons learned 3

4 The EHR Impact methodology 4

5 Study context 5 EC-commissioned study on the Socio-economic impact of interoperable electronic health record and eprescription systems in Europe Identification, analysis and evidence on 10 good practice cases Policy recommendations to foster their diffusion in Europe Follow-up to ehealth IMPACT study (www.ehealthimpact.org) 5

6 Focus of the EHRI methodology Net socio-economic gains and ehealth utilisation (= the usage of services enabled by EHR and eprescribing systems) Underlying economic concept: benefit cost analysis (BCA) Value added from ehealth = value of health services with ehealth less value of health services without ehealth Total value added/net benefit = sum of positive and negative value added for each stakeholder group Overall socio-economic impact of interoperable EHR and eprescribing systems = net benefits over time for the system 6

7 Stakeholder analysis Patients, carers, and other citizens Healthcare staff professionals, teams Health service provider organisations Third parties Insurance companies Other payers Governments Public authorities Not: secondary/tertiary impacts 7

8 Assigning monetary values to benefits and costs 8

9 Data summary sheet EHRI generic data summary total Estimated COSTS Citizens HPOs Doctors, nurses, other staff Organisation rd parties Present value of total annual costs Present value of cumulative costs Estimated BENEFITS Citizens HPOs Doctors, nurses, other staff Organisation rd parties Present value of annual benefits Present value of cumulative benefits Net benefits Present value of annual net benefits Present value of cumulative net benefits Net benefits over cost ratio - annual -1,00-1,00-0,98-0,79-0,74 0,00 0,96 1,78 2,60-0,16 Net benefits over cost ratio - cumulative -1,00-1,00-0,98-0,91-0,86-0,73-0,54-0,34-0,16 Number of records Number of times records are accessed Distribution of benefits Citizens 40,47% 14,26% 18,51% 32,36% 38,60% 40,30% 41,06% 36,59% HPOs Doctors, nurses, other staff 16,10% 63,85% 57,82% 32,05% 20,30% 17,83% 17,13% 24,81% Health provider organisation 35,78% 13,48% 18,25% 33,30% 41,10% 43,96% 46,01% 38,60% 3rd parties 0,00% 0,00% 0,00% 0,00% 0,00% 0,00% 0,00% 0,00% Base year: 2008; Discount rate: 3,5% 9

10 The Computerised Patient Record (CPR) at the University Hospitals of Geneva (HUG) With support from Prof. Dr. Christian Lovis Head, Unit of Clinical Informatics, University Hospitals of Geneva 10

11 11 About the University Hospitals of Geneva (HUG) Consortium of public and teaching state hospitals 9 major facilities at four campuses > 30 ambulatory facilities Community, primary, secondary and tertiary care > inpatients and > outpatients yearly > beds > care professionals, Annual budget of nearly 1.4bn CHF 11

12 12 About the Computerised Patient Record (CPR) 12

13 Benefits from the CPR system at HUG 13 Citizens Patient safety Time saving and avoided admissions Better care because of better informed carers Doctors & nurses Do not have to waste time looking for records Lower exposure to risk carers feel safer, less vulnerable Nurses do not have to chase doctors Doctors do not have to guess while waiting for data Life made easier through integrated presentation of different reports 13

14 Benefits from the CPR system at HUG 14 Benefits to HUG Time savings redeployment of resources: Looking for records Looking for colleagues Ward rounds Discharge letters Reduction in exposure to risk due to better clinical governance Critical information is always available where needed Lower risk of errors when transferring patients across HUG sites Avoided admissions also for insurances Reductions in number of tests Extra income from better billing processes 14

15 HUG cumulative economic performance CHF Present value of cumulative costs Present value of cumulative benefits Preliminary data 15

16 The Scottish Emergency Care Summary (ECS) Programme With support from Jonathan Cameron Programme Manager for Emergency Care Summary, National Health Service Scotland 16

17 Emergency Care Summary (ECS) 17 NHS in Scotland Primary and Secondary Care 14 Local Health Boards 1030 GP Practices (Family Practitioners) 4 suppliers of GPs EHR 1 National Ambulance Board 5.3 million population 17

18 Background 18 A new GP contract meant changes to Out of Hours (OOH) care for Patients A useful summary was needed for Emergency and Out of Hours services A&E, Ambulance, NHS24 (National OOH Call Centre) Previously localised, paper based, patchy system of information between contributors to patient care 18

19 Policy and Strategy 19 Incremental and pragmatic approach to Electronic Patient Records Focus on business challenges, not technology Clinical leadership Aim to deliver benefits, not IT systems Integration across patient journeys 19

20 Agreed Dataset 20 Patient demographics (address, telephone, CHI number) Allergies and adverse reactions to medications Medication history -Repeat prescriptions in past 12 months -Acute prescriptions in past 30 days Consent flag Patient opt out status 20

21 Engagement with Stakeholders 21 From the start. GP and senior clinical leadership Patient groups Focus groups National Patient Leaflet Written by independent patient group Variety of media used in different areas Continued engagement throughout 21

22 Progress and Usage 22 Over 5.3 million records extracted from GPs EHRs 1400 citizens have opted out Represents 0.026% of all patients Over 1.6 million accesses to date and increasing trend in use more than 100,000 accesses p.m. Expected increase in use as new developments are available 22

23 Progress and Usage 23 ECS Accesses - Cumulative Total ECS Accesses ECS Accesses 0 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Month Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 23

24 Costs and financing of ECS 24 Investment redeployed resources GPs engaged in ECS development from start Extra expenditure NHS Scotland project budget Operations and maintenance Time spent on ECS by GP / GP Admin Technical and organisational ICT cost: 3.3m = 13% Total investment = 25.3m 24

25 Benefits from the ECS 25 Citizens Patient safety -reduced risk of ADE harm Some avoided admissions & referrals Time saving for patients fewer repeat questions at OOH, NHS24 and A&E More efficient consultation at NHS 24 time & satisfaction Doctors & nurses Comfort to GPs patients are taken care of efficiently out of hours No manual preparation of medication records at NHS24 and OOH Doctors and nurses life made easier 25

26 Benefits from the ECS 26 Benefits to NHS Scotland Reduction in exposure to risk due to better clinical governance Assurance that drugs are recorded correctly and fully Assurance that advice is based on better information Time savings redeployment of resources: Fewer repeat questioning about medications by doctors and nurses at OOH and A&E More bed-side time by A&E pharmacists as fewer calls to GPs Faster completion of current medication list at NHS24 No manual input of medication lists at NHS24 1 min per call Avoided admissions & visits Avoided referrals by NHS24 to OOH and A&E Faster treatment and some avoided admission at A&E no overnight waiting for clarification with GP 26

27 ECS annual economic performance Preliminary data Present value of total annual costs Present value of annual benefits 27

28 Conclusions and lessons learnt 28

29 Conclusions and lessons learnt I 29 Engagement with all stakeholders before design is complete and implementation begins The largest single estimated cost, over 50%, was the time of doctors needed for engagement, compared to the 13% for ICT (in Scotland) Patient safety, the original goal, was about one-third of estimated benefits The consent of patients and citizens can be achieved effectively and efficiently Step by step progress is effective in realising a net benefit and managing risk Interoperability can be achieved, enabling integrated care 29

30 Conclusions and lessons learnt II 30 Business cases for all stakeholders! You need deep pockets & lots of patience! up to ten years of sustained investment requires also sustained financing You need to know what you will get! quality, risk reduction, and efficiency; not cash You need to know what can go wrong! realistic risk management 30

31 Acknowledgements We thank the European Commission for their financial and non-financial support! This presentation is part of research supported by the European Commission, Directorate General Information Society and Media, Brussels. It reflects solely the views of its presenters. The European Community is not liable for any use that may be made of the information contained therein. Further information: European Commission empirica

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