Academic journal article Australian Health Review

Going Digital: A Narrative Overview of the Clinical and Organisational Impacts of eHealth Technologies in Hospital Practice

Academic journal article Australian Health Review

Going Digital: A Narrative Overview of the Clinical and Organisational Impacts of eHealth Technologies in Hospital Practice

Article excerpt

Introduction

Considerable financial investment is currently being devoted in many countries to implementing potentially transformative eHealth technologies. For example, England has invested at least £12.8 billion in a National Program for Information Technology (NPfIT) for the National Health Service1 and the Obama administration in the US has similarly committed to a US$34 billion eHealth investment in health care.2,3 The eHealth market worldwide is predicted to reach US$308 billion by 2022.4 Much of this expenditure has been directed towards digitising hospital practice. Queensland Health has embarked on an A$1.3 billion statewide campaign to digitise all its major public hospitals by 2020.5 Such large-scale expenditure has been justified on the grounds that electronic medical records (EMRs), electronic prescribing (ePrescribing) and associated computerised provider (or physician) order entry systems (CPOE) and computerised decision support systems (CDSS) will help address the problems of variable quality and safety in modern health care, improve efficiency and contain rising healthcare costs.5-9 However, the evidence base underpinning such claims remains uncertain.

The aim of the present study was to generate a narrative overview of systematic reviews and reviews of reviews of contemporary eHealth technologies that have assessed their effects on the quality, safety and resource utilisation of hospital-based health care delivery compared with traditional paperbased systems of care.

Methods

Scope of the overview

Given the wide spectrum of eHealth technologies, the foci of this review were those having two functions (with some inevitable overlap): (1) primary technology to enable the storage, retrieval and transmission of clinical data (EMRs); and (2) auxiliary technologies to support clinical decision making (CPOE, ePrescribing and CDSS). Technologies supporting remote care (Telehealth, Telemonitoring and similar) were excluded from the analysis, as were patient-focused interventions (patientcontrolled EMRs, electronic messaging or education). Given the rapid evolution ofeHealth technologies, we restricted the present review to reports published in the past 5 years to ensure relevance to current deliberations.

Search strategy, data sources and study selection

Established Cochrane-based systematic review principles were used to search for relevant systematic reviews and reviews of such reviews. We used the pre-specified PubMed Clinical Queries search string for 'electronic health record' (see Item S1, available as Supplementary Material to this paper) and 'article type = review' and 'publication date = last 5 years' filters to search PubMed, MEDLINE and Cochrane Library contents for reviews published in English-language journals, either in print or online, from 1 January 2010 to 31 October 2015. Additional searches were performed using PubMed Clinical Queries function (with 'systematic reviews' search filter) and relevant search terms for CPOE, ePrescribing and CDSS. The bibliographies of retrieved reviews were scrutinised to find additional reviews. Articles were screened for inclusion on the basis of: (1) reference to the study as being a systematic review or a review of systematic reviews by the authors within the title, abstract or text; and/or (2) evidence from the description of the methods that systematic review principles had been used in searching and appraising the evidence. Reviews that contained randomised trials and/or observational studies were included in the analysis. Studies were excluded if, for any of the four eHealth technologies: (1) they focused only on single disciplines (e.g. oncology, mental health), single class of investigations or medications or single vendor systems; (2) dealt primarily with implementation issues; or (3) were conducted exclusively or predominantly in non-hospital settings or in developing countries. A complete list of inclusion and exclusion criteria is provided in Item S2. …

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