Big spending is not the road to eHealth

TheGlobeandMil.com – news/opinions/editorial
Published on Tuesday, Jan. 25, 2011.

The travails of electronic-health-record projects suffered in the past few years by the federal government and the governments of Ontario and British Columbia are quite consistent with an international pattern of exaggerated expectations and huge budgets. Long-term progress on eHealth is more likely to be achieved by moderate measures that build on proven success. A study published last week in the journal PLoS Medicine, which studied dozens of other studies around the world, concluded that, as yet, the evidence of real benefits from digitalization of health care is slim, though the theoretical potential remains great.

The 10 British researchers found very little proof of better results for patients’ health or cost-effectiveness for health-care institutions. Such disappointing data appeared in all of the three areas considered: patient records, electronic prescribing and facilitating health care from a distance.

They set these findings in the context of the Obama administration’s commitment of $38-billion to eHealth and of actual British spending of at least £13-billion. These numbers may offer some consolation to Health Canada and the McGuinty government of Ontario; if they were foolishly extravagant, at least they were by no means alone.

There are, however, a few bright spots. The PLoS article says that eHealth benefits are most likely in a few academic clinical centres of excellence, with in-house systems. One study cited names, for example, Brigham and Women’s Hospital in Boston, which is affiliated to Harvard, and the Regenstrief Institute in Indianapolis. “Off-the-shelf” systems are apt not to work well; at best, careful customization of them is needed.

Governments are often tempted to be extravagant in capital spending, in the hope that continuing annual expenditures can be reduced, especially with health care, where the upward cost pressures are strong, and sometimes seem inexorable.

Eventually, eHealth will work well in most hospitals and most countries, but throwing too much money at it invites trouble. Patience is a virtue.

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