The review of the literature confirmed that the implementation of health IT systems (and especially electronic health records -EHRs) is considered among the highest priorities of modern healthcare systems, actually confirmed by USA governments’ investment over $19bn to Health IT in 2009. However, the adoption of Health IT proceeds very slowly.
Rachelle Kaye et Al. (2010) motivated a research considering a lack of a clear picture of healthcare information technology value in terms of reducing costs and improving quality of cares provided. The quest was also focused on the understanding of barriers and factors in the diffusion oh such technologies in US as well as in Europe.
Health IT impact in US
Kaye et Al. (2010) went to the screening of 855 studies in US to draw some results. Researches shown that:
• ‘EHRs improved the quality of care in ambulatory care settings was demonstrated’ (safer, more effective, and more efficient)
• Cost-effectiveness of these systems wasn’t obvious from the data.
Health IT impact in Europe
Ten e-health sites in Europe were evaluated (in Germany, Sweden, Romania, France, Czech Republic, Belgium, Denmark and the UK…..) and permitted to draw conclusions as follows:
• Health IT systems enhance the quality of work and improve productivity.
• ‘Electronically enhanced healthcare [when properly implemented]promises to reduce costs, improve quality and efficiency and treat more patients with the same resources . . . The eHealth Impact project conclusively demonstrated that there is over a 2:1 ratio between economic benefits and costs.’ (Stroetmann et Al, 2006)
Differences among countries
Some countries are already well advanced in the implementation of electronic medical records and national network infrastructures: Scandinavian countries of Denmark, Finland, Norway and Sweden…
Some countries are committed to delivering results by the end of the current decade: France, Canada, Australia, England, New Zealand and the USA…
Some countries are implementing e-health policies: Hong Kong, Singapore, South Korea, Thailand and Taiwan…
Barriers and success factors of e-health implementation
So what can possibly be these barriers and success factors?
Kaye et Al. (2010), through the review of literature (Shortliffe, 2005; Hersh, 2004; Shortliffe, 2005) identified several common points as hindrance to health IT systems implementation:
• Financial and business barriers when solid evidence of the economic impact of health It is lacking (cost-benefit ratio to each of the stakeholders – payers, physicians, patients)
• Structural barriers are varying from one country to another.
In US, most of systems (apart from for Kaiser or Geisinger) are complex in operating with direct or indirect reimbursement and multiple stakeholders.
In France and Belgium, doctors are independent practitioners (paid by patients) which doesn’t facilitate the implementation in contrary to the Scandinavian countries, where physicians are paid by the government which makes things more straightforward.
Another major structural barrier is the lack of standardization and certification for EHR and health IT systems.
• Cultural barriers: both time-consuming and a threat to patient privacy and they own practices, practitioners are not always at ease with this perspective.
• Technical and professional barriers: Purchasers (doctors) don’t always know what to purchase, consultants to system developers are not always qualified; professional workforce in medical informatics is not always capable of leading the implementation…
• Innovative and committed leadership is clearly required, ‘be it political leadership as in the Scandinavian countries, or organizational leadership as in integrated healthcare systems in the USA such as Kaiser’.
This success factor is comprised of several sub-factors:
• The decision to invest in health IT
• Integrated responsibility: ‘The designation of an active integrating organization responsible for developing and managing the system is a key success factor’.
• Clear identification of concrete needs and the goals to be achieved
• Clear strategy and organizational process
• Partnership and collaboration with clinicians and other stakeholders are also necessary for the successful implementation of health IT. Clinicians have to be fully engaged into the process. Miller and Sim (2004) identified seven major doctor-related barriers: high initial financial costs and uncertain financial benefits, high initial physician time costs, difficulties with technology, difficult complementary changes and inadequate support, lack of adequate electronic data exchange between EHR and other clinical data systems, lack of incentives and physician attitudes.
There is certainly no magic solution that would show the path to a right implementation. However, one can get inspiration from Maccabi Health Fund in Israël comprising more than 18 years of data and almost 2 million members. Back in the 90s, with far fewer sophisticated tools, it took five years to the system to be functional.
Hersh, W. (2004) ‘Health care information technology: Progress and barriers’, Journal of the American Medical Association, Vol. 292, No. 18, pp. 2273–2274.
Kaye, R., Kokia, E., Shalev, V., Idar, D., et Chinitz, D. Barriers and success factors in health technology: A practitioner's perspective. Journal of Management & Marketing in Healthcare 3, 163-175.
Middleton, B., Hammond, W. E., Brennan, P. F. and Cooper, G. F. (2005) ‘Accelerating US EHR adoption: how to get there from here. Recommendations based on the 2004 ACMI Retreat’, Journal of the American Medical Association, Vol. 12, No. 1, pp. 13–19.
Miller, R. H. and Sim, I. (2004) ‘Physicians’ use of electronic medical records: Barriers and solutions’, Health Affairs, Vol. 23, No. 2, pp. 116–126.
Shortliffe, E. (2005) ‘Strategic action in health information technology: Why the obvious hastaken so long’, Health Affairs, Vol. 24, No. 5, pp. 1222–1233.
Stroetmann, K. A., Jones, T., Dobrev, A. and Stroetmann, V. N. (2006) ‘eHealth is Worth it? The Economic Benefits of Implemented eHealth Solutions at Ten European Sites’, EHealth IMPACT project study supported by the European Commission Information Society and Media Directorate- General. Luxembourg Office for Official Publications of the European Community.