Benefits+Realization

=Realizing Benefits=

The eHealth literature, and in particular business cases that support eHealth interventions, suggest a wide range of opportunities and benefits that would result from the application of eHealth. Benefits include:


 * **Class** || **Benefit** || **eHealth Interventions** || **Performance Measures** ||
 * **Productivity** || Improved Efficiency || Regional Picture Archiving and Communications systems (PACS), provincial and national registries, electronic Master Patient Index (eMPI), Clinical Management Systems (CMS), Pharmacy Information Networks (PIN) || Cost reduction, cost containment, cost avoidance, increased productivity, reduced duplication of tests/procedures ||
 * || Support to program reform or health system change management || Integrated Health Information Systems (HIS), Regional PACS, regional and provincial data repositories and registries || Impact on success of reform or change initiative ||
 * **Access** || Improved service || Telemedicine, Wait-times Information Systems || Easier access to health services in remote areas, reduction in wait-times for medical and surgical procedures ||
 * || Improved quality and access to data for research || EHR, provincial and national registries and repositories, systems for anonymization and pseudonimization || Increased availability of data, improved quality of data ||
 * **Quality** || Improved patient health outcomes || Electronic Health Records (EHR), Computerized Practitioner Order Entry (CPOE), Wait-times Information Systems (WTIS), CMS, PIN || Reduced mortality (specific causes), reduced morbidity (clinical events, physiologic and metabolic measures), level of disability, functional status, symptom status, quality of life ||
 * || Improved population health outcomes || Public health surveillance systems, crisis communications systems, public health portals || Reduced mortality (specific causes), reduced morbidity (clinical events, physiologic and metabolic measures) ||
 * || Improved safety || EHR, CPOE, WTIS, PIN || Reduction in preventable adverse events ||
 * || Patient empowerment || Patient-oriented web portals, email, patient access to personal electronic health record, telehomecare. || Patient satisfaction surveys, rate of access to electronic services (e.g. hits on website) ||
 * || Patient satisfaction || All eHealth interventions || Patient satisfaction surveys, level of patient inquiries and complaints ||
 * || Enhanced accountability || Strong authentication, logging of system interventions (access, add, modify, delete), non-repudiation || Positive audit or operational review observations ||
 * || Improved privacy and security || Strong authentication, role-based access control, intrusion detection systems, logging of systems events || Reduction in privacy and security incidents, effective response to privacy and security incidents ||

=eHealth Opportunities=

An opportunity arises when circumstances align such that there is a good possibility of realizing a benefit. In recent years, advances in ICTs, increasing demand for health services in an environment of severe financial constraint, and the need for business transformation in health care have aligned such that eHealth presents an opportunity to realize benefits to patients, health care providers and health care organizations. = = = = =Managing to Achieve Benefits Realization=

Harvesting the benefits of eHealth requires an aggressive management program. John Thorp, in his seminal book [|The Information Paradox: Realizing the Business Benefits of Information Technology], reminds us of a few realities of benefits realization:


 * **Benefits do not just happen**. They don’t just automatically appear when a new technology is delivered. A benefits stream flows and evolves over time as people learn to use it.
 * **Benefits rarely happen according to plan**. A forecast of benefits to support the business case for an investment is just an early estimate. It is unlikely to turn out as expected, much like corporate earnings forecasts. You have to keep checking, just as you would with a financial investment that fluctuates in value on the securities market.
 * **Benefits realization is a continuous process** of envisioning results, implementing, checking intermediate results and dynamically adjusting the path leading from investments to business results. Benefits realization is a process that can and must be managed, just like any other business process.”

Thorp's book recommends a methodology very similar to classical risk management processes. Realization of benefits and managing the risk of adverse events in eHealth are two sides of the same coin and are managed using similar techniques.

=Evidence for Achievement of eHealth Benefits=

Due to the lack of experience with ICTs in health care, many of the forecast benefits are speculative. For example, business cases and articles describing electronic health records and other eHealth interventions often quote the statistic that between 9,250 and 23,750 Canadians die each year as a result of preventable adverse events. These business cases or articles then imply or suggest that the eHealth intervention will reduce the instance of preventable adverse events thus saving lives; even though there is no hard evidence that this indeed will occur.

While there is some evidence that eHealth will improve the efficiency of the health system, there is little to no evidence at this moment that it has a meaningful impact on patient health outcomes. A 2005 study titled [|Effects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes] concluded, “Many CDSSs [Clinical Decision Support Systems] improve practitioner performance. To date, the effects on patient outcomes remain understudied and, when studied, inconsistent.”

Strong evidence is still limited or lacking for eHealth opportunities including improved patient health outcomes, safety and patient empowerment.

This is not to say that lives will not be saved, outcomes improved or patients empowered through the implementation eHealth interventions. Based on experience in health care and other industries it is a reasonable hypothesis to suggest that these benefits are achievable. However, the hypotheses need to be tested and the testing of the hypotheses should be one of the primary objectives of any eHealth initiative: an objective that is backed up by a rigorous evaluation of the outcomes.

In some cases it might not be possible or practical to isolate the impact of ICTs and information management techniques on outcomes because of the large number of variables involved in an eHealth program. For example, a computerized physician order entry (CPOE) system may alert physicians to clinical protocols for a specific treatment that results in an improved outcome or avoids an adverse event. The extent to which the eHealth system or the clinical protocol was responsible for the improved outcome is moot. In such cases an evaluation of the integrated program that includes the system and clinical protocols should be conducted noting where possible the contribution of the eHealth system and perhaps commenting on whether or not the outcome would have been achieved in the absence of the system