Sharing information between health professionals and their organisations is an important and large potential benefit of eHealth. The probability of realising it’s less clear. A team from the Department of Medical Informatics and Clinical Epidemiology at Oregon Health and Science University, the University of Washington in Seattle and the Veteran's Affairs Maine Healthcare System reviewed the performance of Health Information Exchange (HIE) identified in 34 outcome studies, mostly in the USA. Eight were from Europe, Canada, Israel, and South Korea. The studies also part of a report from the USA’s Agency for Healthcare Research and Quality (AHRQ) on HIE, and reported by eHNA.
It found that the full impact of HIE on clinical outcomes and potential harms aren’t evaluated adequately. This is in a context where evidence supports other HIE benefits of HIE in reducing the use of specific resources and improving the healthcare quality. The finding’s important for Africa’s health systems with HIE plans.
Writing in the Journal of Medical Internet Research (JMIR), the team says it identified 34 HIE outcome studies. None included clinical outcomes. Examples of the missing components are mortality and morbidity or identified harms. It did find low-quality evidence such as fewer duplicative laboratory and radiology tests, emergency department costs, hospital admissions, moderate benefits in fewer readmissions, better public health reporting, population outcomes, ambulatory healthcare quality, and disability claims processing. Most clinicians in the studies attributed to HIE positive changes in healthcare coordination, communication and knowledge about patients.
The team makes an important point about the challenges of evaluating HIE, which applies to most of eHealth: cause and effect is difficult to specify precisely. It says HIEs are intermediate to improving healthcare delivery. Its role’s to enable clinicians and other health workers better access to patient data to inform decisions, and facilitate appropriate testing and treatment. HIE isn’t specific to any health issue or diagnosis.
HIE’s financing isn’t always on a sustainable footing. It seems that some programmes have initial non-recurring start-up funding but not longer-term finance.
Issues from the study include:
- Most evidence for health ICT impact’s from a relatively small number of centres, usually referred to as health ITC leaders that are typically large academic medical centres with internally developed health ICT systems, implemented incrementally, and refined over long periods, so unique
- It’s difficult to separate the effects of the health ICT from the confounding influences of the health system itself and clouds the scope to generalise benefits to the very different context of health system and hospital implementations of commercially developed systems over shorter periods with less internal development and implementation infrastructure.
- The overall model of health ICT purchase and installation of organisations no seen as health ICT leaders are usually different from the incremental internal development, implementation, and refinement by health ICT leader systems
- It seems that some health ICT, especially Clinical Decision Support (CDS), where systems evaluated by their developers tend to realise more positive outcomes from their evaluation than external evaluators find, so needs reflecting in HIE evaluations
- Most importantly, transferability of evaluation findings is limied, so predicting whether specific HIE projects in specific health care contexts will have favourable impacts on specific desired outcomes isn’t possible yet.
Africa’s health systems can use this study to leaven their HIE plans with extra caution about the impact they might have and setting their long-term financial foundations. It also helps to set their focus on the benefits they can attribute to HIE and the wider eHealth initiatives needed to realise them.