Faculty of Medicine, The University of Queensland, Brisbane, Australia.
Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.
BMC Health Serv Res. 2024 May 31;24(1):694. doi: 10.1186/s12913-024-11132-7.
For many countries, especially those outside the USA without incentive payments, implementing and maintaining electronic medical records (EMR) is expensive and can be controversial given the large amounts of investment. Evaluating the value of EMR implementation is necessary to understand whether or not, such investment, especially when it comes from the public source, is an efficient allocation of healthcare resources. Nonetheless, most countries have struggled to measure the return on EMR investment due to the lack of appropriate evaluation frameworks.
This paper outlines the development of an evidence-based digital health cost-benefit analysis (eHealth-CBA) framework to calculate the total economic value of the EMR implementation over time. A net positive benefit indicates such investment represents improved efficiency, and a net negative is considered a wasteful use of public resources.
We developed a three-stage process that takes into account the complexity of the healthcare system and its stakeholders, the investment appraisal and evaluation practice, and the existing knowledge of EMR implementation. The three stages include (1) literature review, (2) stakeholder consultation, and (3) CBA framework development. The framework maps the impacts of the EMR to the quadruple aim of healthcare and clearly creates a method for value assessment.
The proposed framework is the first step toward developing a comprehensive evaluation framework for EMRs to inform health decision-makers about the economic value of digital investments rather than just the financial value.
对于许多国家来说，特别是对于那些没有激励性支付的美国以外的国家，实施和维护电子病历（EMR）成本高昂，而且考虑到大量投资，可能会引发争议。评估 EMR 实施的价值对于了解此类投资是否是医疗资源的有效分配是必要的，特别是当投资来自公共资金时。尽管如此，由于缺乏适当的评估框架，大多数国家都难以衡量 EMR 投资的回报。
本文概述了开发基于证据的数字健康成本效益分析（eHealth-CBA）框架的过程，以计算 EMR 实施随时间推移的总经济价值。净正效益表明此类投资代表了效率的提高，而净负效益则被认为是对公共资源的浪费。
我们开发了一个三阶段的流程，该流程考虑了医疗保健系统及其利益相关者的复杂性、投资评估和评估实践以及 EMR 实施的现有知识。三个阶段包括：（1）文献综述，（2）利益相关者咨询，（3）CBA 框架的开发。该框架将 EMR 的影响映射到医疗保健的四重目标上，并明确创建了一种价值评估方法。
拟议的框架是朝着开发全面的 EMR 评估框架迈出的第一步，旨在为卫生决策者提供有关数字投资的经济价值的信息，而不仅仅是财务价值。
