Nguyen Kim-Huong, Wright Chad, Simpson Digby, Woods Leanna, Comans Tracy, Sullivan Clair
Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.
NPJ Digit Med. 2022 Mar 8;5(1):29. doi: 10.1038/s41746-022-00565-1.
Digital transformation is expensive and rarely smooth, often leading to higher costs than anticipated. It is challenging to demonstrate the contribution of digital health investment in achieving the healthcare aims of population health and workforce sustainability. We conducted a scoping review to understand how electronic medical record (EMR) implementations in the hospital setting have been evaluated using cost-benefit analysis (CBA) approaches. The review search resulted in 1184 unique articles, a final list of 28 was collated of which 20 were US-based studies. All studies were published in 2010-2019, with fewer studies published in more recent years. The data used to estimate benefits and costs were dated from 1996 to 2016, with most data from 2000 to 2010. Only three studies were qualified as using cost-benefit analysis approaches. While studies indicated that there is a positive impact from the EMR implementation, the impacts measured varied greatly. We concluded that the current literature demonstrates a lack of appropriate and comprehensive economic frameworks to understand the value of digital hospital implementations. Additionally, most studies failed to align fully to the quadruple aims of healthcare: they focused either on cost savings and/or improved patient outcomes and population health, none investigated healthcare-workforce sustainability.
数字化转型成本高昂且鲜有顺利的情况，往往导致成本高于预期。要证明数字健康投资对实现人群健康和劳动力可持续性等医疗保健目标的贡献具有挑战性。我们进行了一项范围审查，以了解在医院环境中电子病历（EMR）实施情况是如何使用成本效益分析（CBA）方法进行评估的。审查搜索得到1184篇独特文章，最终整理出28篇文章的清单，其中20篇是美国的研究。所有研究均发表于2010年至2019年，近年来发表的研究较少。用于估计效益和成本的数据可追溯到1996年至2016年，大部分数据来自2000年至2010年。只有三项研究符合使用成本效益分析方法的标准。虽然研究表明电子病历实施有积极影响，但所衡量的影响差异很大。我们得出结论，当前文献表明缺乏适当和全面的经济框架来理解数字医院实施的价值。此外，大多数研究未能完全符合医疗保健的四重目标：它们要么侧重于成本节约和/或改善患者结局及人群健康，没有一项研究调查医疗保健劳动力的可持续性。
