Is There Evidence of Cost Benefits of Electronic Medical Records, Standards, or Interoperability in Hospital Information Systems? Overview of Systematic Reviews

Reis, Zilma Silveira Nogueira; Maia, Thais Abreu; Marcolino, Milena Soriano; Becerra-Posada, Francisco; Novillo-Ortiz, David; Ribeiro, Antônio Luiz Pinho

doi:10.2196/medinform.7400

Cited by 50 publications

(44 citation statements)

References 28 publications

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“…Most of them conclude that the quality of the included studies was poor to moderate, reported outcomes were often heterogeneous, and the generalizability of the results therefore very limited [e.g. 1,4,21,62,74,76,110,111,146]. So, while many of these systematic reviews reach further back in time than this study, it can be concluded, in the light of the present assessment of literature, that this basic problem has not changed in recent years.…”

Section: Discussionmentioning

confidence: 71%

“…These ndings are broadly con rmed by an overview of systematic reviews on EMR/EHR by Reis et al [21] rare -so they conclude that proof of clinical improvements and economic effectiveness is lacking [40,41].…”

Section: Electronic Health Records/electronic Medical Records (Ehr/emr)mentioning

confidence: 79%

“…Thus, the main applications are electronic patient handover tools and the exchange of health information between different institutions or physicians. While we differentiate between both terms, some publications use both terms synonymously [21].…”

Section: Electronic Health Records/electronic Medical Records (Ehr/emr)mentioning

confidence: 99%

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Effectiveness of digital technologies to support nursing care: results of a scoping review

Hüter

Krick

Domhoff

et al. 2020

Preprint

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Background The field of digital technologies being developed or applied to support nursing care is very extensive. The aim of this scoping review is to provide an overview on technologies for which results on positive or negative effects on persons in need of care, caregivers or care institutions are available – and to appraise the reliability of these results. An additional focus is put on the question which care settings and target groups have been addressed by the research so far. Methods A scoping review design has been used to identify studies focussing on the effectiveness of digital technologies in nursing care for persons in need of care, caregivers or care institutions. The screening process included 19.510 scientific publications from 9 databases. Results A total of 123 single studies and 31 reviews were subjected to the analysis. The range of technologies that is researched to support nursing care is wide. The included technologies comprise nursing and health information technologies, such as assistive devices, information and communication technologies (including decision support systems, electronic health records, hospital and nursing home information systems), sensors and robotic technologies. The results show that there are many studies that demonstrate positive effects of the technologies, but the level of evidence is mostly low and study sizes are often small. Hardly any technology has been researched intensively enough to produce conclusive results. Studies on a high level of evidence (RCTs) lack for nearly all technological areas. Heterogeneous results in some areas indicate that effects may depend strongly on the mode and and specific context into which the technologies are introduced. Most studies are situated in inpatient care settings. Conclusion Due to the limited evidence on effectiveness of digital technologies in nursing care, it is not surprising that care institutions are reluctant to put innovative technologies into practice. The scoping review indicates technology areas that should be subject to future research with higher quality studies. Research on outpatient care settings, informal care arrangements and cross-sectoral care should be intensified to further exploit the potential of digital technologies to improve independence of care-recipients and unburden formal an informal carers.

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Section: Discussionmentioning

confidence: 71%

Section: Electronic Health Records/electronic Medical Records (Ehr/emr)mentioning

confidence: 79%

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Effectiveness of digital technologies to support nursing care: results of a scoping review

Hüter

Krick

Domhoff

et al. 2020

Preprint

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“…Another important result of this work was the measurement of data quality metrics to gauge the impact of the eHealth-Interop platform in informational continuity of care, since impact of HIE are yet inadequately studied [44,45].…”

Section: Principal Resultsmentioning

confidence: 99%

An eHealth Platform for the Support of a Brazilian Regional Network of Mental Health Care (eHealth-Interop): Development of an Interoperability Platform for Mental Care Integration (Preprint)

Miyoshi¹,

Marques²,

Alves³

et al. 2018

Preprint

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BACKGROUND The electronic exchange of health-related data can support different professionals and services to act in a more coordinated and transparent manner and make the management of health service networks more efficient. Although mental health care is one of the areas that can benefit from a secure health information exchange (HIE), as it usually involves long-term and multiprofessional care, there are few published studies on this topic, particularly in low- and middle-income countries. OBJECTIVE The aim of this study was to design, implement, and evaluate an electronic health (eHealth) platform that allows the technical and informational support of a Brazilian regional network of mental health care. This solution was to enable HIE, improve data quality, and identify and monitor patients over time and in different services. METHODS The proposed platform is based on client-server architecture to be deployed on the Web following a Web services communication model. The interoperability information model was based on international and Brazilian health standards. To test platform usage, we have utilized the case of the mental health care network of the XIII Regional Health Department of the São Paulo state, Brazil. Data were extracted from 5 different sources, involving 26 municipalities, and included national demographic data, data from primary health care, data from requests for psychiatric hospitalizations performed by community services, and data obtained from 2 psychiatric hospitals about hospitalizations. Data quality metrics such as accuracy and completeness were evaluated to test the proposed solution. RESULTS The eHealth-Interop integration platform was designed, developed, and tested. It contains a built-in terminology server and a record linkage module to support patients’ identification and deduplication. The proposed interoperability environment was able to integrate information in the mental health care network case with the support of 5 international and national terminologies. In total, 27,353 records containing demographic and clinical data were integrated into eHealth-Interop. Of these records, 34.91% (9548/27,353) were identified as patients who were present in more than 1 data source with different levels of accuracy and completeness. The data quality analysis was performed on 26 demographic attributes for each integrable patient record, totaling 248,248 comparisons. In general, it was possible to achieve an improvement of 18.40% (45,678/248,248) in completeness and 1.10% (2731/248,248) in syntactic accuracy over the test dataset after integration and deduplication. CONCLUSIONS The proposed platform established an eHealth solution to fill the gap in the availability and quality of information within a network of health services to improve the continuity of care and the health services management. It has been successfully applied in the context of mental health care and is flexible to be tested in other areas of care.

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“…Numerous basic clinical informatics research questions remain to be satisfactorily addressed,27 including in the fields of: Cost effectiveness28 , 29Efficiency/productivity30 – 32Impact on service utilisation33Patient empowerment/outcomes34Decision support35Usability and human factors36 , 37Unintended consequences38 – 41Application of safety-critical software engineering methods 42…”

Section: Expanding Clinical Informatics Research and Education Capacimentioning

confidence: 99%

Learning health systems need to bridge the ‘two cultures’ of clinical informatics and data science

Scott

Dunscombe

Evans

et al. 2018

BMJ Health Care Inform

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BackgroundUK health research policy and plans for population health management are predicated upon transformative knowledge discovery from operational ‘Big Data’. Learning health systems require not only data, but feedback loops of knowledge into changed practice. This depends on knowledge management and application, which in turn depends upon effective system design and implementation. Biomedical informatics is the interdisciplinary field at the intersection of health science, social science and information science and technology that spans this entire scope.IssuesIn the UK, the separate worlds of health data science (bioinformatics, ‘Big Data’) and effective healthcare system design and implementation (clinical informatics, ‘Digital Health’) have operated as ‘two cultures’. Much National Health Service and social care data is of very poor quality. Substantial research funding is wasted on ‘data cleansing’ or by producing very weak evidence. There is not yet a sufficiently powerful professional community or evidence base of best practice to influence the practitioner community or the digital health industry.RecommendationThe UK needs increased clinical informatics research and education capacity and capability at much greater scale and ambition to be able to meet policy expectations, address the fundamental gaps in the discipline’s evidence base and mitigate the absence of regulation. Independent evaluation of digital health interventions should be the norm, not the exception.ConclusionsPolicy makers and research funders need to acknowledge the existing gap between the ‘two cultures’ and recognise that the full social and economic benefits of digital health and data science can only be realised by accepting the interdisciplinary nature of biomedical informatics and supporting a significant expansion of clinical informatics capacity and capability.

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Is There Evidence of Cost Benefits of Electronic Medical Records, Standards, or Interoperability in Hospital Information Systems? Overview of Systematic Reviews

Cited by 50 publications

References 28 publications

Effectiveness of digital technologies to support nursing care: results of a scoping review

Effectiveness of digital technologies to support nursing care: results of a scoping review

An eHealth Platform for the Support of a Brazilian Regional Network of Mental Health Care (eHealth-Interop): Development of an Interoperability Platform for Mental Care Integration (Preprint)

Learning health systems need to bridge the ‘two cultures’ of clinical informatics and data science

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