Measuring value for money: a scoping review on economic evaluation of health information systems

Bassi, Jesdeep; Lau, Francis

doi:10.1136/amiajnl-2012-001422

Cited by 67 publications

(53 citation statements)

References 54 publications

(254 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our review findings are consistent with previous reviews in the area of health information technology [9,[12][13][14]. There are issues surrounding the reliability and quality of the methods used in published economic evaluations.…”

Section: Discussionsupporting

confidence: 89%

“…Moreover, variations in study designs and systems used in the literature make it difficult to extrapolate data to other settings. Previous reviews in this area have explored the economic effects of a wide range of technological interventions in various healthcare settings [12][13][14]. In contrast, our review specifically focuses on EP and the medicationrelated aspects of CPOE in the hospital setting.…”

Section: Discussionmentioning

confidence: 99%

“…We followed the PRISMA guidelines for reporting systematic reviews and meta-analyses References in relevant previous reviews were screened [12][13][14]. …”

Section: Search Strategymentioning

confidence: 99%

See 2 more Smart Citations

Economic impact of electronic prescribing in the hospital setting: A systematic review

Ahmed

Barber

Jani

et al. 2016

International Journal of Medical Informatics

View full text Add to dashboard Cite

Objective: To examine evidence on the economic impact of electronic prescribing (EP) systems in the hospital setting. Method: We conducted a systematic search of MEDLINE, EMBASE, PsycINFO, International Pharmaceutical Abstracts, the NHS Economic Evaluation Database, the European Network of Health Economic Evaluation Database and Web of Science from inception to October 2013. Full and partial economic evaluations of EP or computerised provider order entry were included. We excluded studies assessing prescribing packages for specific drugs, and monetary outcomes that were not related to medicines. A checklist was used to evaluate risk of bias and evidence quality. Results: The search yielded 1,160 articles of which three met the inclusion criteria. Two were full economic evaluations and one a partial economic evaluation. A meta-analysis wasn't appropriate as studies were heterogeneous in design, economic evaluation method, interventions and outcome measures. Two studies investigated the financial impact of reducing preventable adverse drug events. The third measured savings related to various aspects of the system including those related to medication. Two studies reported positive financial effects. However the overall quality of the economic evidence was low and key details often not reported. Discussion There seems to be some evidence of financial benefits of EP in the hospital setting. However, it is not clear if evidence is transferable to other settings. Research is scarce and limited in quality, and reported methods are not always transparent. Further robust, high quality research is required to establish if hospital EP is cost effective and thus inform policy makers' decisions. We are pleased to submit our manuscript entitled: "Economic impact of electronic prescribing in the hospital setting: a systematic review". This systematic review examines the evidence to establish if electronic prescribing systems use in the hospital setting is cost effective. We conducted a systematic search of seven databases from inception to October 2013 and included full and partial economic evaluations of electronic prescribing systems or computerised provider order entry. COVER LETTERWe found some evidence of financial benefits of EP use. However, it is not clear if evidence is transferable to other settings. Our review also shows that studies exploring the economic impact of electronic prescribing systems in this context are scarce and limited in quality. Therefore we endorse further robust research to establish if electronic prescribing systems use in hospitals is good value for money. This manuscript has not been previously published and is not under consideration in the same or substantially similar form in any other peer-reviewed media. All authors listed have contributed sufficiently to the project to be included as authors, and all those who are qualified to be authors are listed in the author byline. To the best of our knowledge, no conflict of interest, financial or other, exists. We have included acknowle...

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Economic impact of electronic prescribing in the hospital setting: A systematic review

Ahmed

Barber

Jani

et al. 2016

International Journal of Medical Informatics

View full text Add to dashboard Cite

show abstract

“…investment (ROI). Such financial return is expected from improved health professionals' work-flow management, suppression of order transcription costs, reduced length of stays, reduced duplicated actions, improved communication between stakeholders, and better financial recovery from third party payers [2,[5][6][7][8][9][10]. From an academic point of view, a CIS should foster clinical research (e.g., through better patient inclusion in public and privately sponsored clinical trials) and accelerate publication of novel outcomes in peer-reviewed journals.…”

Section: Introductionmentioning

confidence: 99%

The Virtuous Circles of Clinical Information Systems: a Modern Utopia

Degoulet

2016

Yearb Med Inform

View full text Add to dashboard Cite

SummaryContext: Clinical information systems (CIS) are developed with the aim of improving both the efficiency and the quality of care. Objective: This position paper is based on the hypothesis that such vision is partly a utopian view of the emerging eSociety. Methods: Examples are drawn from 15 years of experience with the fully integrated Georges Pompidou University Hospital (HEGP) CIS and temporal data series extracted from the data warehouses of Assistance Publique -Hôpitaux de Paris (AP-HP) acute care hospitals which share the same administrative organization as HEGP. Three main virtuous circles are considered: user satisfaction vs. system use, system use vs. cost efficiency, and system use vs quality of care. Results: In structural equation models (SEM), the positive bidirectional relationship between user satisfaction and use was only observed in the early HEGP CIS deployment phase (first four years) but disappeared in late post-adoption (≥8 years). From 2009 to 2013, financial efficiency of 20 AP-HP hospitals evaluated with stochastic frontier analysis (SFA) models diminished by 0.5% per year. The lower decrease of efficiency observed between the three hospitals equipped with a more mature CIS and the 17 other hospitals was of the same order of magnitude than the difference observed between pediatric and non-pediatric hospitals. Outcome quality benefits that would bring evidence to the system use vs. quality loop are unlikely to be obtained in a near future since they require integration with population-based outcome measures including mortality, morbidity, and quality of life that may not be easily available. Conclusion: Barriers to making the transformation of the utopian part of the CIS virtuous circles happen should be overcome to actually benefit the emerging eSociety. KeywordsEvaluation of clinical information systems; return on investment; outcome research; acceptance models; information system success criteria Yearb Med Inform 2016:256-63 http://dx

show abstract

“…Moreover, the suggested restriction of ordering of high cost tests and drugs to senior clinicians [6] may reduce some costs, but can be done only when these are not time-critical interventions. Health information systems could improve knowledge on value for money [7]. Nevertheless, a computerized provider order entry system displaying fees for inpatient medical prescriptions showed only a small decrease in the rate of ordered tests (0.32 per patient-day) [8].…”

mentioning

confidence: 99%

Should cost considerations be included in medical decisions? Not so sure…

Capuzzo

Rhodes

2015

Intensive Care Med

View full text Add to dashboard Cite

Most western healthcare systems are experiencing significant increases in costs that can be attributed to a growing and ageing population that has ever more frequent chronic diseases, and advances in costly healthcare technologies and interventions. These driving factors for increasing costs resonate strongly for intensive care unit (ICU) physicians who see the need for their service grow steadily each year to cope with the rising demands placed upon them. The UK National Health Service (NHS) has required spending increases in real terms of 3.8 % per year throughout its history [1]. This growth is much higher than underlying increases in gross domestic product for the country, with the implication that the status quo is not sustainable in the longer term. This scenario is not unique to the UK and the trend can be seen in many similar western countries.In the current austere economic climate, the direct consequence of increasing healthcare expenditure to ICU managers and clinicians is stark and obvious. Flat-lining (or reducing) budgets with a simultaneous increase in demand means choices need to be made and choosing based upon cost is difficult. Difficult because clinicians often have neither the training nor the knowledge to base such decisions upon, but also because it forces controversial ethical discussions to be had, sometimes with perverse consequences. However, to contain the costs of care, physicians need to know the costs and indications of each of the investigations/drugs that they order.Unfortunately, physicians' awareness of the cost of drug prescriptions (or investigations) is generally very poor [2]. A systematic review of 24 articles, the latest being published in 2005, showed an accuracy in cost estimation of 29 % for the articles with the highest quality and of 38 % for those with lowest [2]. A recent multicentre French study published in Intensive Care Medicine by Hernu et al. [3] compared the costs of drugs, blood products, imaging modalities and laboratory tests estimated by a wide sample of ICU physicians with the true costs. Correct estimation was defined as an estimate within 50 % of the true cost. Drug costs were underestimated and, among drugs, the costs of those exceeding 10 € were all underestimated [3]. We suspect that the same physicians who do not know the costs of the most expensive drugs, the ones that they underestimate the most, will carefully consider a difference of 50 % in prices when they buy a new car! Hernu et al. [3] report results similar to those found in other European countries [4,5]. They also present two clinical situations (septic and haemorrhagic shock) showing how relevant the differences can be between estimated and true costs at ICU, regional, and national level.The lack of any improvement in physicians' awareness of the costs of drugs over time [2,3] agrees with the slow and continuous decrease in the percentage of articles in

show abstract

Measuring value for money: a scoping review on economic evaluation of health information systems

Cited by 67 publications

References 54 publications

Economic impact of electronic prescribing in the hospital setting: A systematic review

Economic impact of electronic prescribing in the hospital setting: A systematic review

The Virtuous Circles of Clinical Information Systems: a Modern Utopia

Should cost considerations be included in medical decisions? Not so sure…

Contact Info

Product

Resources

About