Research Article: The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview

Date Published: January 18, 2011

Publisher: Public Library of Science

Author(s): Ashly D. Black, Josip Car, Claudia Pagliari, Chantelle Anandan, Kathrin Cresswell, Tomislav Bokun, Brian McKinstry, Rob Procter, Azeem Majeed, Aziz Sheikh, Benjamin Djulbegovic

Abstract: Aziz Sheikh and colleagues report the findings of their systematic overview that assessed the impact of eHealth solutions on the quality and safety of health care.

Partial Text: Implementations of potentially transformative eHealth technologies are currently underway internationally, often with significant impact on national expenditure. England has, for example, invested at least £12.8 billion in a National Programme for Information Technology (NPfIT) for the National Health Service, and the Obama administration in the United States (US) has similarly committed to a US$38 billion eHealth investment in health care [1]. Such large-scale expenditure has been justified on the grounds that electronic health records (EHRs), picture archiving and communication systems (PACS), electronic prescribing (ePrescribing) and associated computerised provider (or physician) order entry systems (CPOE), and computerised decision support systems (CDSSs) will help address the problems of variable quality and safety in modern health care. However, the scientific basis of such claims—which are repeatedly made and seemingly uncritically accepted—remains to be established [2]–[7].

Our searches retrieved a total of 46,349 references from which we selected a total of 108 reviews for inclusion (Figure 1). Our final selection of 53 reviews provided the main empirical evidence base in relation to assessing the impact of the selected eHealth technologies (see Table 1 for our critical appraisal of these studies) [15]–[67], full details of which can be found in Table S2. An additional 55 supplementary reviews provided context to the findings [68]–[122], aiding in their interpretation [123]. In the case of systematic review updates, only the most recent review in a series of updates was selected. In the case of full and summary publications, we drew on the more substantive reports. Three related reviews – an update, a fuller report, and its more concise counterpart – were an exception due to the complementary nature of the reports rather than these being duplicative [22],[55],[56].

Our systematic review of systematic reviews on the impact of eHealth has demonstrated that many of the clinical claims made about the most commonly deployed eHealth technologies cannot be substantiated by the empirical evidence. Overall, the evidence base in support of these technologies is weak and inconsistent, which highlights the need for more considered claims, particularly in relation to the patient-level benefits, associated with these technologies. Also of note is that we found virtually no evidence in support of the cost-effectiveness claims (Tables 2–11) that are frequently being made by policy makers when constructing business cases to raise funding for the large-scale eHealth deployments that are now taking place in many parts of the world [1].



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