MEASURING THE BENEFITS OF HEALTH IT SYSTEMS

Transcription

1 MEASURING THE BENEFITS OF HEALTH IT SYSTEMS NOT SO EASY, BUT Juan Luis Cruz CIO Hospital Puerta de Hierro Madrid - Spain

2 INDEX 1. What we have done 2. ROI: not so easy 3. But possible! 4. Final thoughts 2

3 1. What we have done Hospital Puerta de Hierro in brief General public hospital since 1964: 50 anniversary Pioneer integrating patient care, education and investigation in Spain High complexity hospital. New location, building and ICT in 2008 EMRAM Stage 6. Working hard to achieve stage 7 3

4 1. What we have done Hospital Puerta de Hierro in brief some ciphers Population: habitants About health personnel m hospitalization beds, 22 Operating Rooms Activity (per year): external consultations emergencies inpatient admissions surgeries 4

5 1. What we have done Hospital Puerta de Hierro in brief some IT ciphers About IT users About service desk contacts / year PCs software applications + 90 servers LAN switches in 36 distribution rooms +170 WiFi n Access Points Android Tablets, +50 Ruggerized PDAs +150 Other mobile devices (BYOD) +500 actual mobile users 5

6 1. What we have done many ehealth projects Well, but what about ROI?

7 2. ROI: not so easy a simple definition Return = net profit: end value (outcomes, gain) investment >0 ROI: return on investment (%): (Return / Investment) 100 >0 Investment = 100 Outcomes (gain) = 200 7

8 2. ROI: not so easy a simple definition ROI 8

9 2. ROI: not so easy some aspects to consider (gain) 1. Hard vs. Soft ROI. IT caused directly a quantifiable gain? Hard ROI Or is it just correlated with some kind of gain? Soft ROI Often we have a soft ROI: IT isn t a lonely factor, but goes in hand with aspects like better awareness, motivation, staff training or process redesign. So What part of the gain is due to our IT project? 9

10 2. ROI: not so easy some aspects to consider (gain) 2. Economic vs. Clinical & Organizational The conversion to electronic health records has failed to produce the hoped-for savings in health care costs Arthur L. Kellermann, Spencer S. Jones. What It Will Take To Achieve The As-Yet-Unfulfilled Promises Of Health Information Technology. Health Affairs, 2013; 32 (1): DOI: /hlthaff Howley MJ, Chou EY, Hansen N, Dalrymple PW. The long-term financial impact of electronic health record implementation. J Am Med Inform Assoc Aug 27. pii: amiajnl doi: /amiajnl [Epub ahead of print] 10

11 2. ROI: not so easy some aspects to consider (gain) 2. Economic vs. Clinical & Organizational the traditional definition of ROI as used in other industries isn t necessarily a good fit for the healthcare industry; successfully demonstrating ROI in healthcare involves more than simply looking at how much money is saved or earned. HIMSS recommends that health providers use the following areas to evaluate ROI: Efficiency Savings Improved outcomes of care compared to pre-health IT implementation Additional revenue generated as the result of an IT implementation Non-financial gains such as, but not limited to, increased patient satisfaction with care encounters, decreased provider time at work, and higher levels of employee satisfaction Increased knowledge of providers about the patient population they serve. 11

12 2. ROI: not so easy some aspects to consider (cost) 1. What part of the investment should we consider in a corporate development (serving many centres)? 2. Should you account all the preexistent infrastructure and common services as investment in every ROI analysis of future IT projects based on them? 3. What s the investment time period to consider for calculating costs and gains? 12

13 2. ROI: not so easy Oh my Just another year without budget 13

14 2. ROI: not so easy Don t give up. A broader view on ROI We shouldn t avoid talking about ROI even though we don t have always hard economic case studies. ehealth ROI is often a soft/non-economic ROI (and that s ok). Soft/non-economic ROI also demonstrates the utility of HIT projects and could be key for investment decisions. So don t give up and document those (success) stories! 14

15 3. But possible! Some examples Next: some examples of real valuable experiences in our Hospital Description, IT subject, investments & outcomes For each example degree (subjective) of: Hard vs. soft ROI Economical vs. non-economical outcomes Investment, outcomes return & ROI wherever possible 15

16 3. But possible! - Week Hospital Description Grouping inpatients that have diagnostics with average stay < 5 in the same hospitalization ward, so it can be closed on the weekend. IT subjects: BI - Analytics Investments 160 man-hours for implementing the project (6.400 ) BI platform (preexisting) Outcomes Cost savings in nurses & assistants contracts not working in weekends. Better clinical outcomes: nurses specialization in short stay cares (expected, not yet measured). Non Discharge before weekend Investments: Return: eur / year ROI (1st year): 3766 % Hard Soft 16

17 3. But possible! - Remote consultations from PC Description Sharing EMR between Primary Care (PC) and Hospital and doing TLC (remote consultations without the patient) so GP can ask for advice to the specialist instead of making regular appointments. IT subjects: HIE Investments 120 man-hours for starting the project (4.800 ) TLC development (4.000 ) EMR platform shared btw PC-Hospital (preexisting) Outcomes remote consultations PC-Hospital / year. Regular consultations & Time saved for the patient Non Hard Soft GP Regular appointment Remote TLC Investments: Outcomes (some examples): Sleep apnea: st visits, patient-days saved Hematology: 426 IM 1 st visits, patient-days saved Sciatica & v.disc prolapse: 224 TRA 1 st visits, patientdays saved ROI:? H 17

18 3. But possible! - SMS appointment reminder Description Activating a SMS appointment reminder system (in late 2011) for 40% of all possible appointments. IT subjects: mhealth Investments 80 man-hours for starting the project (3.200 ) SMS development (9.600 ) SMS sending ( /year) Corporate SMS platform (preexisting) Outcomes Less consultations missed (5.400 in 1st year) Doctors hours not lost (1.350 in 1st year) Non 7,2 7 6,8 6,6 6,4 6,2 6 5,8 5,6 5,4 5,2 % missed consultations - 1,08% Return (1st year): ROI (1st year): 50 % Return (5 years): ROI (5 years): 113 % Hard Soft 18

19 3. But possible! - Radiology and Pathology alerts Description Manual activating an alert in the EMR in case of unexpected malingnant outcomes in radiological or pathological tests, so as the referring physician can be informed and can bring forward the appointment if necessary. IT subjects: CDSS, HIE Investments 120 man-hours for managing the project (4.800 ) Alerts + integration corporate development ( ) EMR, Radiology & Pathology systems (preexisting) Outcomes About 10% of 1073 alerts generated so far caused an early appointment (26 days saved on average). Non Hard Soft Investments: Outcomes (1,5 years): 1073 alerts generated 105 early appointments patient-days with malignant disease saved ROI:? 19

20 3. But possible! - Alerts in eprescribing Description Firing alerts to physicians prescribing medication related to patient allergies, interactions, duplications or maximum dosage reached. IT subjects: CDSS Investments 160 man-hours for defining alerts (6.400 ) Alerts corporate development ( ) EMR with eprescribing, Pharmacy systems (preexisting) Outcomes More than alerts/year (>500K prescriptions). 384 presciption changes due to alerts. Non 16,00% 14,00% 12,00% 10,00% 8,00% 6,00% 4,00% 2,00% 0,00% eprescribing alerts performance (1st year) Maximum dosage Allergies Active ingredient duplicity Medication duplicity % Alerts modifying prescription No. Alerts fired Interactions Investments: Outcomes (1st year): 384 prescription changes due to alerts. 19 potential allergic reactions avoided Hard Soft ROI:? 20

21 3. But possible! - Secure blood products admin. Description New blood transfusion protocol, training for 800 nurses & a mobile system for triple verification (extraction, blood bank, administration). 1/10 errors causes a death. IT subjects: CLMA, CDSS, mhealth Investments 220 man-hours for starting up & training (8.800 ) Cost of consumables per year (includes equipment) for prescriptions/year ( ) WiFi infrastructure (preexisting) Outcomes 3 errors avoided in first 6 months. 6 potential administration errors avoided / year. Non Investments (5 years): Outcomes (5 years): 1 life saved 10 severe reactions avoided, 50 inpatient-days saved Hard Soft ROI:? 21

22 4. Final thoughts 22

23 4. Final thoughts ROI is a tool for investment decision support of C-suite (CEO, CFO, CIO, ). So let us adapt ROI for what they need to decide. Their decisions are not only based on economic parameters, but on patient safety, clinical outcomes, satisfaction of patients and professionals or just fame and prestige. Health IT systems often offer non-economic and soft outcomes (acting as a catalyst for the organization), but very valuable. Interesting ROI & outcomes can be achieved with small improvements upon existing IT infrastructure. 23

24 4. Final thoughts When IT aims to patient safety, demonstrating a ROI becomes less critical. ROI is important, but it s more important to be committed to demonstrate the usefulness of Health IT. Sometimes just knowing the outcomes is enough for demonstrating utility and taking a decision. Invest time to document it to help others. 24 It's not so easy... but possible!

25 Juan Luis Cruz CIO Hospital Puerta de 14 Noviembre 2014 Únete a la Comunidad! 25