Benefits and Costs of Public Sector Health Information Systems Projects
"Why proceed with my e-health project?"
In rational terms, your public sector e-health project should go ahead if its expected benefits are greater than its costs. If, on the other hand, the expected costs are greater than the benefits, you should not proceed or should only proceed if your project is redesigned.
Two problems, though, with this simple analysis. First, it is hard to identify all project costs and even harder to quantify project benefits. Therefore, it is almost impossible to say which is bigger: costs or benefits. Second, e-health project "go/no go" decisions are determined largely by political factors which may or may not be linked to objective benefits and costs.
Despite these problems, it normally makes sense to at least roughly sketch out likely costs and benefits of your e-health project. The details below give you a checklist for this.
Below are listed the potential benefits of your e-health project. The word 'potential' is important: in practice, few e-health projects have managed to deliver these benefits; most e-health projects have so far failed to deliver these benefits (follow this link for case evidence). Some of the example links below thus give potential, expected or hoped-for rather than actual benefits. However, you can still use all the items as a checklist to identify potential benefits on your project.
There are many ways in which benefits for e-health projects can be classified. An alternative to the one shown below, is to divide into:
Task-level benefits, e.g. improvements to the cost or speed of data-handling tasks.
Health process-level benefits, e.g. improvements to the speed or quality of health management or health policy decision-making, or of health care delivery.
ICTs can cut the costs of health tasks and processes. For example, telemedicine can reduce the need for travel and the need for referral to a secondary or tertiary health institution; this cuts costs for both patients and the health system. eHealth systems used in immunisation can save wastage of vaccines.
ICTs can reduce the time required to perform health tasks and processes. For example, new technology can reduce the time that health workers spend on data-handling tasks. This can have the additional benefit of then releasing health worker time for more valuable health interventions. Quicker data-handling can also lead to faster health decisions and action, potentially saving lives. By making health data accessible on the desktop, ICTs can also enable faster health decisions and actions.
ICTs can enable health processes to handle more cases without raising staff numbers or associated costs. For example, computerised systems can help patient registration and medical records staff to cope with increases in patient numbers.
ICTs can improve the quality of health tasks and processes. For example, they can improve the quality of data held in health systems. This, in turn, can make for better-quality health decisions and actions at the operational level and at the managerial and policy levels.
ICTs can also make things better in deeper, less tangible ways. They can improve the skills of health workers. They can improve the knowledge of health workers; for example their understanding of the importance and role of information in their working lives. Thus, more generally, they can empower health workers in different ways.
v. First Time
ICTs can help new health tasks and processes to be undertaken for the first time: things that were simply not possible before. No explicit examples were provided in the case studies given here, but a number of health management and health policy decisions can only be made once ICT-enabled health information systems deliver reliable data for the first time.
Self-interest and politics play an important role in e-health projects; as in all projects. Therefore, you should recognise the informal, personal benefits that an e-health project can bring. In some cases, these will support the formal benefits; but in other cases there may be a conflict:
- Imagery: an ICT project can give an appearance that something concrete is being done to improve health even if, behind the scenes, nothing is changing.
- Spotlight and shadow: senior officials sometimes use e-health projects to highlight one aspect of a health system, hoping that spotlight will cast under-performing areas of the health system even deeper into the shadows.
- Kudos: there is personal prestige to be gained from being associated with a successful, modernising project.
- Competencies: there are career benefits both inside and, especially, outside the public sector of picking up ICT-related skills and knowledge.
- Control: e-health projects can give managers greater access to workflow and performance data; some may use this to exert greater control over their staff.
- Resources: projects bring money, staff, travel opportunities, etc that are beneficial to those who can access them.
Benefits of an e-health project are often potential rather than real. Costs, though, are very real and typically fall into the following categories that can be used as a cost checklist for your e-health project:
- ICTs: the hardware, system and applications software, and network/telecommunications infrastructure that make up the e-health system.
- Information systems staff costs: for analysis, design, development, operation, maintenance, support and upgrade of the e-health system.
- Other staff costs: all the time invested by managers, administrators, medical professionals, health workers, clerical staff, etc in the planning, implementation and use of the e-health system. Opportunity costs of taking medical/health staff away from their health care delivery roles can be considerable.
- Training: direct costs plus opportunity cost of staff time lost.
- Other implementation costs: including site equipment, preparation and installation.
- Other operational costs: ongoing recurrent costs for running the e-health system, and for maintaining and upgrading it.
Costs estimates provided in the e-health cases reported on this Web site vary enormously: from systems costing just a few thousands of US dollars, to a hospital system costing more than US$200,000 in direct costs alone. None of these estimates covers anything other than the ICTs category listed above.
Downsides of eHealth
In addition to financial costs, there are also "dis-benefits": downsides that can emerge when you use ICTs to support public health systems:
- Failure: most projects fail either totally or partially and that includes most e-health projects. In addition to the wasted costs, and inability to achieve benefits, failure brings additional costs. Follow this link for more details on failure of information systems in the public sector.
- Security/privacy: unless there is some very serious planning and investment, e-health systems can reduce the security and privacy of individuals' medical data.