Canadian research questions impact of health-care IT investments

IT investments don’t necessarily lead to the reduced costs and improved patient care that some health-care organizations expect, according to a Canadian study of computer-based decision support software.

The study, which was done by a group of London, Ont. researchers and published in the

March 9, 2005 issue of the Journal of the American Medical Association, found that while computerized decision support systems are improving, they are no panacea for the ills that plague the system, which include medical errors, understaffing of doctors and nurses and long wait times.

Computerized decision support software (CDSS) is used for a variety of purposes in health care facilities, ranging from diagnosing chest pain to reminding doctors it’s time to immunize certain patients or to send them for a mammogram, for example.

According to the study, in which the researchers reviewed the last two decades of studies describing the testing of various CDSS systems, the IT aid improved practitioner performance only 64 per cent of the time. Most of that improvement was associated with systems that automatically prompted doctors (such as reminding them to send patients for tests). As well, the most successful systems (74 per cent) were those that the users were involved in developing.  

Dr. Amit Garg, a scientist at the Lawson Health Research Institute and an associate professor at the University of Western Ontario who led the study, said CDSSs are particularly useful in situations where a physician sees a lot of patients every day and may not always remember to remind them they need regular preventive tests.

“You can imagine in a busy clinic — despite my best intentions I don’t order a mammogram for every person who needs it, whereas the computer system may remind me this is something that should be done, so these computerized decision support systems overall seem to be beneficial in improving practitioner performance, increasing mammography rates or improving treatments used in diabetes,” said Garg. “But whether these systems improve patient care meaningfully  — in other words, they make patients live longer or prevent them from getting ill — is still uncertain.”

Most CDSSs are homegrown systems that have been developed in-house, rather than by vendors. 

Garg said CDSSs are at the “Phase 2 drug testing” level.

“They’re gaining popularity and there is promise, but further testing is needed to see how they’re going to translate into improved outcomes and whether those translations are cost-effective.”

The key to developing systems that work well, he says, is to make sure they fit easily into the workflow of doctors and nurses.

“If you have a system that requires the physician to do pages of order entry and go through drop-down menus, that time is potentially taken away from the patient,” he said. “If it is going to take longer than it would traditionally, that system is doomed to fail. What we’re saying is this is not an IT issue, this is a complex health delivery issue of which IT is one component, and IT people have to be very sensitive to the fact that there are many more issues than just developing the best IT system.”

The Branham Group Inc., an Ottawa-based research firm, has launched a national survey of Canadian hospitals’ IT spending it hopes to have completed by May that will attempt to bring more insight into the investments made in Canadian health care. 

While the Canadian Health Information Institute identifies the percentage of the total health care budget that’s spent on IT, there is nothing that drills down into specifics, said Michael Martineau, project leader at Branham.

Martineau said the study targets health care administrators, such as CFOs, CIOs and CEOs, as well as health care providers in a hospital setting. The survey does not include long-term care facilities or doctors’ offices, however.

Although IT vendors are interested in learning how better to sell to the health care market, the study also has two federal departments –- Industry Canada and the national Research Council — as sponsors, which are interested in seeing a flourishing local ICT sector so Canadian companies are the ones supplying to our own health-care system. But, he added, “They’d also like to see export opportunities come out of that.”

For the NRC, for example, it’s important to know what kinds of research and development it should be funding. 

Branham also hopes the information coming out of the survey will help hospitals get a better idea of how they compare with other facilities in terms of IT investments.

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