Austin and Boxerman chapter 10

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Austin and Boxerman chapter 10

• HSPM J713

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Information Management / Information Technology
Value

• How to evaluate IM/IT decisions
• Can we do better than anecdote, inference, and
  opinion?

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Executive Information Systems

• Private market competition among EIS systems
  could work
• But this chapter doesnt talk about that

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Clinical Information Systems

• This chapter focuses on Clinical Information
  Systems
• The following are my comments (not the
  textbooks)
• Imposed standards trump hospital choice
• Evaluation should be at the national level rather
  than by individual units
• External benefits (public good aspects) to health
  care IT
• Leaving IT funding to providers leads to
  underinvestment

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Countries that lead in HIT are those with
government standards and insurance system funding
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Clinical Information Systems

• In the US unfunded mandates
• Standards therefore lag
• Implementation slow
• In other advanced countries government
  standards with funding

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US hospital IT spending

• In 2006 (AHA survey)
• Median spending
• 5556 per bed for capital cost
• 12060 per bed for operating cost
• Works out to about 60 per bed-day at 80
  occupancy
• Half of hospitals said capital costs a barrier
• 1/3 said operating costs a barrier

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EHR

• Savings estimated at 77 billion
• 4 of NHE, which is less than one years growth
• Dont all accrue to those who are being asked to
  pay for it

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Systems challenges

• Adamss five
• Globalization international price competition
• Consumerism
• Old and fat
• Expensive-to-treat diseases
• New medical and surgical treatments
• Whats missing from Adamss five?

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Systems challenges

• Adams value decisions must extend beyond
  individual organizations to the perspective
  of society as a whole
• Enthoven and Tolley call for integrated delivery
  systems encouraged by government
• But then the books view reverts to the
  individual enterprise CIO and CEO.

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Cost and Outcome Decision Matrix
This matrix is one of the chapters learning
objectives Not totally senseless, because Before
you do a cost-benefit analysis, you have to have
costs and benefits
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Cost and Outcome Decision Matrix

• One of the chapters learning objectives
• Not totally senseless, because
• Before you do a cost-benefit analysis, you have
  to have costs and benefits

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Evaluation steps

• Identify study objectives
• Costs and benefits to whom?
• Specify alternatives
• Cost-effectiveness analysis compares alternatives
• Develop a framework
• Full account of the process without and without
  proposed changes

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Evaluation steps

• Measure costs
• Total cost of ownership means capital and
  operating?
• Include all opportunity costs as well as spending
• Cost shifts
• Measure benefits
• Include organizational, financial, and clinical

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Evaluation steps

• Lifecycle and discounting
• Costs and benefits occur over time
• One should select the project with the costs
  skewed toward the future rather than with the
  benefits skewed toward the present.?
• Among projects with same net costs and benefits
• Same?

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Evaluation steps

• Deal with uncertainty
• Sensitivity analysis different scenarios
• Equity
• Avoid gainers and losers by allocating costs to
  gainers
• Cost-benefit analysis adds up the costs and the
  benefits
• So costs to some balance out benefits to others
• Equity problem

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Challenges to evaluation

• Documentation
• Assessing costs and impacts is itself uncertain
  and costly
• Interdependence
• May not be possible to isolate the effect of an
  investment
• Benefits and costs spread across the enterprise
  and outside
• EHR example

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Value realization

• More guides to thinking and planning
• Four questions
• Three-part strategy
• Eight-part fact sheet, as first of 8 evaluation
  steps