2012 Canadian Health Policy Assembly

Session 2: Role of eHealth, mHealth, Informatics and Social Media in Managing Chronic Disease

Francis Lau PhD Nov 9, 2012

Agenda
Role of eHealth in managing chronic disease Review on Systematic Reviews of HIS Studies Impact of EMR on Physician Office Systematic Review Measuring Value for Money Scoping Review of HIS What does it all mean?
[1] [3]

[2]

[1] Lau F, Kuziemsky C, Price M, Gardner J. A review on systematic reviews of health information system studies. Journal of American Medical Informatics Association 2010; 17:637-45. [2] Lau F, Price M, et al. Impact of electronic medical record on physician practice in office settings: a systematic review. BMC Medical Informatics Decision Making 2012;12:42. [3] Bassi J, Lau F. Measuring value for money: A scoping review on economic evaluation of health information systems. Under review 2012.

Review on Systematic Reviews of Health Information System Studies, 2010

Questions: Cumulative effect? Metrics? Recommendations? Methods: Medline+Cochrane 1966-2008, HIS, providers, English Results:

[1]

50 reviews, 2122 studies, 1276 unique studies, 287 controlled studies Medication management, preventive care, health conditions, data quality Care quality, provider productivity, user satisfaction, information quality 180/287 or 63% studies positive, 34% neutral and 3% negative preventive care 72%, data quality 67%, medication management 64% immunization 85%, content accuracy 76%, screening 67%, med errors 64%

Conclusions
Some evidence of improved care, varied by topic, feature, setting, metric Recommendations: (1) make system workable; (2) address contextual issues; (3) measure clinical impact
3

Impact of EMR on Physician Practice in Office Settings: a Systematic Review, 2012

Questions: Impact? Factors? Lessons? Methods: Medline+CINAHL 2000-2008, physician office, EMR Results:
27 controlled + 16 descriptive studies Prescribing, disease management (DM), documentation, work practice, preventive care, patient-physician interaction 22/43 or 51.2% studies positive, 30.2% neutral and 18.6% negative preventive 66.7%, work practice 64.3%, DM 57.1%, productivity 63.6% Least documentation 16.7%, satisfaction 18.2%

[2]

Conclusions:
Modest positive EMR impact in physician office Lessons: (1) Robust EMR features; (2)EMR-practice fit; (3) demonstrating value; (4) realistic expectations; (5) engaging patients
4

Measuring Value for Money: A Scoping Review on Economic Evaluation of HIS, 2012
Questions: Components? Current evidence? Guidance? Methods: Medline+BSP 2000-12, HIS, providers, English Results:
Included 42 papers, 33 were high quality papers Types: 12 economic analyses, 5 input costs, 16 cost outcomes HIS: 7 EMRs, 6 CPOEs, 5 medications, 5 immunizations, 4 HIS, 3 disease management, 2 clinical documentation, 1 health info exchange 23/33 or 70% positive, 24% inclusive, 6% negative Positive: 5/7 EMRs, 3/5 CPOEs, 5/5 medications, 3/5 immunizations, 3/4 HIS, 3/3 disease management

[3]

Conclusions:
Wide range of studies, different assumptions, methods and metrics Some evidence of value for money in selected organizations and HIS types
5

What Does It All Mean?

Some evidence of positive impact with certain settings, HIS types and clinical domains Does not just happen, need to work at it ... making system workable, addressing contextual issues and measuring clinical impact Need to aim for benchmark practices in ways that are measurable, scalable and sustainable