Effects of eHealth on hospital practice: synthesis of the current literature

Abstract

The transition to digital hospitals is fast-moving. Although US hospitals are further ahead than some others in implementing eHealth technologies, their early experiences are not necessarily generalisable to contemporary healthcare because both the systems and technologies have been rapidly evolving. It is important to provide up-to-date assessments of the evidence available. The aim of this paper is to provide an assessment of the current literature on the effects to be expected from hospital implementations of eHealth technologies. A narrative review was conducted of systematic reviews investigating the effects of eHealth technologies (clinical decision support systems (CDSS), computerised provider order entry (CPOE), ePrescribing, electronic medical records (EMRs)) published between November 2015 and August 2017 and compared the findings with those of a previous narrative review that examined studies published between January 2010 and October 2015. The same search strategy and selection criteria were used in both studies. Of the seven relevant articles, three (42.9%) examined the effects of more than one eHealth system: only two (28.6%) studies were high quality, three (42.9%) were of intermediate quality and two (28.6%) were of low quality. We identified that EMRs are largely associated with conflicting findings. Previous reviews suggested that CPOE are associated with significant positive results of cost savings, organisational efficiency gains, less resource utilisation and improved individual performance. However, these effects were not investigated in the more recent reviews, and only mixed findings for communication between clinicians were reported. Similarly, for ePrescribing, later reviews reported limited evidence of benefits, although when coupled with CDSS, more consistent positive findings were reported. This overview can help inform other hospitals in Australia and elsewhere of the likely effects resulting from eHealth technologies. The findings suggest that the effects of these systems are largely mixed, but there are positive findings, which encourage ongoing digital transformation of hospital practice. Governments are increasingly devoting substantial resources towards implementing eHealth technologies in hospital practice with the goals of improving clinical and financial outcomes. Yet, these outcomes are yet to be fully realised in practice and conflicting findings are often reported in the literature. This paper extends a previous narrative review of systematic reviews and categorises the effects of eHealth technologies into a typology of outcomes to enable overall findings to be reported and comparisons to be made. In doings so, we synthesise 7 years of eHealth effects. Mixed results are largely reported for EMRs, with many benefits being compromised by practices stemming from resistance to EMRs. Limited evidence of effectiveness exists for CPOE and ePrescribing. CDSS are associated with the most consistent positive findings for clinician- and hospital-level effects. We observed renewed int...

Mobile-Health Technologies for a Child Neuropsychiatry Service: Development and Usability of the Assioma Digital Platform

“…Importantly for the purposes of our study, nearly the 50% of both caregivers and clinicians indicated satisfaction levels in the middle range for the item concerning the improvement of patient-clinician communication. This is in line with literature reporting mixed findings on the improvement of communication between patients and clinicians induced by the introduction of technologies into clinical practice [19]. The heterogeneity of findings could be explained, at least in part, by the variety of the aspects related to patient-clinician communication that can be influenced by the use of m-Health, such as the exchange of information, the adequate response to emotion, the management of uncertainty, the decision-making process, and the enhancement of self-management [49].…”

Antecedents of use of e-health services in Central Eastern Europe: a qualitative comparative analysis

“…Referring to managerial and policy implications, the paper shows that the use of e-health services depends on enabling technology-supporting relations between patients and well-skilled clinicians. This study fosters observation regarding the need "for hospitals and decision makers to clearly identify and act on the drivers of successful implementations [of e-health solutions]" [74]. Moreover, it reduces uncertainty about the factors having an influence, as many barriers are observed [34].…”

Does digital health technology improve physicians’ job satisfaction and work–life balance? A cross-sectional national survey and regression analysis using an instrumental variable

“… 8 Findings on the effects of using digital health technology in hospital settings also are not conclusive. 9 In ambulatory and primary care, a recent survey showed an association between the use of electronic medical records and physicians’ burnout and stress, but that other working conditions mattered more. 10 Previous research in Australia found that general practitioners who agreed that IT was useful were more likely to experience higher work–life balance.…”