technology
Alison Verhoeven, chief executive of the Australian Healthcare
and Hospitals Association, says without the right vision, attitudes
and research base, e-health initiatives in hospitals can end up being
extraordinarily expensive mistakes.
“I think it’s fair to say that, in Australia, we have had variable
success in our attempts to digitise and integrate health records,
provider ordering, prescribing and decision support systems.
“In many ways we should not be surprised.”
She says there are three main areas of difficulty for policymakers.
POTENTIAL IMPACTS
Avoiding costly
e-health mistakes
Research shows the effects of digitisation
in healthcare are mixed, so what can
be done to guarantee success?
By Dallas Bastian
N
ew e-health initiatives won’t benefit staff or patients if
policymakers and hospital administrators focus solely
on meeting organisational goals and metrics, Australian
researchers warn.
Instead, experts from the Deeble Institute for Health Policy
Research say implementations should be seen as an opportunity
to fundamentally rethink what it means to be a high value hospital
and redefine the metrics used to assess their performance.
“This approach will motivate all stakeholders to leverage new
opportunities as they emerge and allow governments to reap
the transformational benefits that these technologies have the
potential to confer on patient care,” the authors of an evidence
brief on the subject say.
Titled The Impacts of eHealth upon Hospital Practice: Synthesis
of the Current Literature, it notes that governments worldwide are
increasingly adopting e-health technologies in a bid to increase
the value from healthcare expenditures.
It works through technologies such as electronic medical
records, computer provider order entry, e-prescribing, and
computerised decision support systems.
Co-author Dr Rebekah Eden, a postdoctoral researcher at the
University of Queensland, says multiple Australian hospitals are in
the process of going live with electronic medical record systems,
and the Deeble Institute team wanted to see whether or not the
impacts align with what’s purported.
Eden says the sector often hears about improved clinical and
financial outcomes and efficiency gains, but when looking at the
literature, the effects of digitisation are mixed.
“There are definitely success stories, but there are also some
negative stories,” Eden says.
“What we wanted to do is highlight that policymakers should
try to devote research into understanding what mechanisms need
to be put into place to help ensure that those positive outcomes
can be obtained.”
32 | nursingreview.com.au
Just as e-health technologies can affect a great number and variety
of stakeholders, across a wide range of locations and outcome
types, the vision for any project must also be wide and of expanded
possibilities, Verhoeven says.
“If the vision is just about fixing up records in your own hospital or
even your own state, the project’s success will be very limited.”
EMERGING IMPACTS
These are the surprising and unpredictable effects of e-health
efforts. Verhoeven says this is often due to the entire field constantly
changing as a result of various internal and external factors, such as
clinical judgments, staff movements and funding decisions.
“E-health policies and practices, and the people administering
them, need to be open, flexible and adaptable, so that the project is
not constrained by current practice or pre-existing expectations.”
UNCERTAIN IMPACTS
An e-health initiative may work amazingly well in one area, but
not so much in another, Verhoeven says.
“The trouble is that through a lack of research in Australia
particularly, we don’t know why — we don’t know the current or
potential drivers of e-health success in the Australian context,
and we need to.”
Eden hopes policymakers and hospital administrators think about
these impacts beyond standard metrics, such as improving patient
or efficiency of care. She says while those are good outcomes,
a range of impacts need to be considered, as well as ways to
measure those impacts.
“For instance ... how do we measure completeness of
information? That information being generated is also highly visible.
So, there might be some practices that were being performed
previously that weren’t detrimental to patient care but probably
weren’t the optimum. And now we have visibility of that. So, how
exactly can we use this visibility of information in a positive light?”
Ultimately, more research is needed, Eden says.
“We need to have policymakers actually looking at what are the
drivers to the successful outcomes and making sure that research
is being dedicated to trying to figure out how we can attain these
successful outcomes.
“So, is it through using these systems more effectively? And,
if so, what does that effective use mean? Or, is it, for instance,
putting different governance strategies in place to be able to
handle this new visibility of information that we have?
“We need there to be more research into the drivers of positive
outcomes of electronic medical record systems.”
Despite the challenges digitisation poses to policymakers and
hospital administrators, Verhoeven says digital healthcare is the
way of the future.
“We need to harness the benefits for both patients and the
health system as a whole.” ■