NHS Connecting for Health Evaluation Programme

Investigating the impact of eHealth on the quality and safety of health care:

Systematic literature overview & evidence synthesis

Aziz Sheikh MD, FRCGP, FRCP

eHealth Research Group, Centre for Population Healt h Sciences, The University of Edinburgh

Birmingham, 10 th November 2011

NHS Connecting for Health Evaluation Programme

• Chantelle Anandan

• Kathrin Cresswell

• Akiko Hemmi

• Joe Liu

• Brian McKinstry

• Susannah McLean

• Mome Mukherjee

• Ulugbek Nurmatov

• Claudia Pagliari

• Aziz Sheikh

• Anna Wierzoch

• Ashly Black

• Tomislav Bokun

• Josip Car

• Azeem Majeed

• Yannis Pappas

• Rob Procter

Research team

NHS Connecting for Health Evaluation Programme

Independent Project Steering Committee

•Professor Denis Protti, University of Victoria, Can ada (chair)

•Professor David Bates, Harvard University, USA

•Professor Jeremy Wyatt, University of Warwick, UK

•Dr Maureen Baker, NHS CFH

•Alison Turner, NHS Evidence

•Mr Antony Chutter, RCGP Expert Patient Panel Member

Supporting cast…

NHS Connecting for Health Evaluation Programme

•Professor Richard Lilford (chair)

•Lee Priest

•Jo Foster

•Nathalie Maillard

NHS Connecting for Health Evaluation Programme

• Rationale for eHealth-based transformations of healthcare

• Aims of our evaluation • Methods

• Phase I• Phase II

• Five key contributions• Conclusions• Looking ahead…

Overview

NHS Connecting for Health Evaluation Programme

Spiralling healthcare costs…

NHS Connecting for Health Evaluation Programme

• To produce a systematic overview of the literature examining the effectiveness of eHealth applications to improve the quality and safety of healthcare (Phase I)

• To undertake eHealth focused systematic reviews in strategically important areas (Phase II)

• To deliver a series of eHealth Masterclasses bringing together academics, clinicians, industry representatives and policy makers (Phase II)

Aims

NHS Connecting for Health Evaluation Programme

• Formative work to map and integrate relevant terrains• Systematic overview of the literature focusing on identifying

and reviewing relevant:o Systematic reviews of the literatureo Technical reportso Grey literature

• Systematic reviews undertaken in association with the Cochrane Collaboration and national/international academic collaborators

• Masterclasses on:o Implementation/adoption of electronic health recordso Structuring and coding of electronic health record datao Computerised decision support systemso Telehealthcare-based models of care

Methods

NHS Connecting for Health Evaluation Programme

1. Conceptually mapping the eHealth literature and integrating this with frameworks of quality and safety

5 Main Contributions

MacLean S, et al BMJ 2011

Quality map

EfficiencyStreaming processes

Increasing access (to data)Reducing costs

EquityEnhanced access

Reduced variation

AcceptabilityEnhanced patient satisfaction

communication, empowerment

AccessTo services, knowledge,

data, people, support

EffectivenessClinical appropriateness

(evidence-base + tailoring)Clinical impact

(Derived from multiple sources, e.g. Campbell, Donabedian, Shekelle, Schuster)

NHS Connecting for Health Evaluation Programme

5 Main Contributions

NHS Connecting for Health Evaluation Programme

• The available evidence is of variable quality• Overall, a substantial mismatch between the anticipated/claimed

clinical benefits and those that are currently being demonstrated• The benefits that are being seen relate in the main to shifts in process

measures, with relatively little/disappointing evidence of improvements in clinical endpoints/clinical effectiveness

• These benefits tend to be seen in relation to “home grown” systems, with few evaluations of commercial “off-the-shelf” systems

• Moving forward, there is a need to:o Move from “push” to “pull” based approaches to technology

development/deploymento Recognise the importance of sociotechnical dimensions to aid

adoptiono Understand the importance of time horizonso Think about investments/returns “in the round”, including from

secondary uses of digitial data

Key Findings

“We’ve found is because we’ve got our own system we can develop the system to capture what we need very quickly, it’s quite responsive and that’s kind of put us streets ahead of the other Trusts in that respect. So I think what we’ve decided is we won’t ditch the system it’s actually quite valuable to us, if we bought a ready made system it would be costing us a fortune to have all these amendments made to it.” (Interview 19, Research Nurse, Secondary Care)

Can we speed up and improve returns on investment?

eHealth Research Group, The University of Edinburgh

Can we better align investments and returns?

eHealth Research Group, The University of Edinburgh

NHS Connecting for Health Evaluation Programme

5 Main Contributions

Asthma-specific quality of life

MacLean S, et al Cochrane 2011

Hospitalisations over 12 months

MacLean S, et al Cochrane 2011

t+asthma Abingdon,Oxford

Mobile phone telehealthcare system

Password protected website

NHS Connecting for Health Evaluation Programme

5 Main Contributions

NHS Connecting for Health Evaluation Programme

5 Main Contributions

NHS Connecting for Health Evaluation Programme

• eHealth applications offer considerable potential to develop innovative new approaches to develop care – a key area to focus on is “consumer informatics” as this is potentially low-hanging fruit

• Their benefits should not simply be assumed – rather, these interventions need to be evaluated throughout all stages of the lifecycle

• The importance of secondary uses of coded data to the NHS/academia/UK should not be under-estimated – these benefits tend to accrue as datasets mature over years, if not decades

• We need to create the infrastructure and opportunities to ensure that UK academics remain at the forefront of this rapidly advancing field of enquiry…

Conclusions