Background: Implementations of national electronic health record (EHR) were currently underway worldwide as a core objective of eHealth strategies. It was widely believed that implementation of EHR might lead to considerable financial savings. This paper aimed to conduct a systematic review to assess return-on-investment (ROI) of HER implementation and to identify areas with greatest potential to positive ROI for ongoing deliberation on continuous development of EHR.
Methodology: An inclusive string was developed to search English paper published between January 2003 and June 2013. This paper only included studies meet the following criteria 1) Primary study; 2) Involve a computerized system with electronic health record; and 3) include some form of economic evaluation. Critical appraisal was undertaken and articles with higher quality were selected. Hard ROI and soft ROI defined for EHR implementation were adopted as outcome metrics to examine both tangible and intangible return of EHR implementation.
Results: A total of 18 articles were examined for data extraction and synthesis. Most of the available evidences came from pre-post evaluation or cross-sectional analysis without uniform standards for reporting. Findings of 56% of the articles indicated that there is cost saving after EHR implementation while 17% of the articles indicated loss in totalrevenue. The remaining articles concluded that there is no association between cost reduction and EHR implementation. Among the defined hard ROI, most studies mentioned the positive effect in resource reduction. Some authors argued that the resource was reallocated to other initiatives and resulted in negligible cost saving. According to the selected literatures, evidences showed that EHR was able to achieve defined soft ROI, especially for improving caring process, but the overall outcome was subject to individual practice. Authors of 12 out of 18 articles have identified the factor leading to positive return and provided recommendation toward successful EHR implementation. Other than implying helpful EHR functions and promoting practice change, additional incentive on quality improvement and performance benchmarking should be considered. The organizations and EHR systems studied in the articles examined were vastly different; it would be desirable if a controlled study adopting EHR with uniform standards can be performed to evaluate the ROI of different clinical settings.
Conclusions: The benefits of EHR are not guaranteed, it requires change of practice and substantial efforts. Healthcare industries have to equip themselves for implementing the new technology and to exploit the usage for better clinical outcome. / published_or_final_version / Public Health / Master / Master of Public Health
| Identifer | oai:union.ndltd.org:HKU/oai:hub.hku.hk:10722/193818 |
| Date | January 2013 |
| Creators | Tse, Pui-yin, Fiona, 謝佩妍 |
| Publisher | The University of Hong Kong (Pokfulam, Hong Kong) |
| Source Sets | Hong Kong University Theses |
| Language | English |
| Detected Language | English |
| Type | PG_Thesis |
| Rights | Creative Commons: Attribution 3.0 Hong Kong License, The author retains all proprietary rights, (such as patent rights) and the right to use in future works. |
| Relation | HKU Theses Online (HKUTO) |
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