Are Electronic Health Systems Cost Effective? Not So Much

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Ben Edwards

If you’ve visited the doctor or a hospital recently, you can’t help but notice how much of your care depends on some form of electronic information exchange. From the prescription your doctor writes to the chart she consults, medicine is very definitely going digital.

But how effective is all this electronic data capture? Is it making the health care system more efficient? And what about patient care — are e-health technologies improving health outcomes for people who are sick? (More on The Top 10 Medical Breakthroughs of 2010)

Unfortunately, the answer is no, according to research published in PLoS Medicine. And this is despite the billions that governments like the U.S. have poured into such technologies — the Obama administration approved $38 billion to digitize the American health care system.

After analyzing 53 reviews of electronic technologies in health care, researchers led by Dr. Aziz Sheikh at the University of Edinburgh report that there is little or weak evidence to support the massive investment that policy makers have made in electronic systems such as electronic health records and computerizing physician orders and other decision-making. The strongest evidence in support of digitizing medical information came in electronic prescriptions, which showed a small benefit in reducing errors and streamlining ordering.

“The results didn’t come as a complete surprise,” says Sheikh. “Early on in the analysis, it became quite clear there was a gulf between the investment being made and the claims made about what was actually being realized in terms of patient outcomes.”

The reason, he says, has a lot to do with the politics of health policy making. “In many countries now, technology-driven programs are quite politically motivated,” he says. (More on 5 Ways to Get the Most Out of Health Reform)

That doesn’t mean that technology can’t benefit patients and improve health care. Sheikh says that the most impressive changes due to e-health interventions emerged in hospitals and health centers where the technology was embraced and customized to optimize performance of health care personnel and maximize the delivery of quality care to patients. “The technology was home-grown, and had the opportunity to mature and be refined in numerous cycles of iteration,” he says.

Unfortunately, that doesn’t happen everywhere. In the majority of cases, “the technologies are parachuted in, there is little in the way of customization and adaptation, and quite often the system does not fit with the way people work so it fails to realize its potential.”

In part, he says, the weak effect he found in his analysis may reflect the fact that measuring patient outcomes often takes decades, rather than the years represented in the databases he pooled. These reviews also failed to find significant cost effectiveness savings with the introduction of e-health technologies, despite claims frequently made by their proponents that electronic systems streamline administrative costs and tighten budgets. (More on Healthland’s Guide to Life 2011)

The lesson, he says, for patients and policy makers alike is that when it comes to technology in the health care setting, it may be premature to count our savings. It might make intuitive sense that electronic data systems are more efficient and effectiveness in delivering quality health care, but we don’t have the scientific data to prove it — yet.

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