"This report presents a synthesis of the outcomes of the study: Chapter 2 summarises the approach and methodology of economic evaluation and assessment developed by eHealth IMPACT. Next, the results from the economic evaluations performed are summarised, demonstrating the potential of eHealth to impact health services – both in economic and in qualitative terms. The third part, chapters 4 to 6, provides an analytical treatment of the results, including lessons learned and policy recommendations. Chapter 7 presents short summaries of the ten case studies and the results of each evaluation.
eHealth IMPACT developed a generic methodology for the economic evaluation of eHealth applications. It is a context adaptive model, so it fits a wide diversity of applications, from clinical settings to supply chain solutions. The model relies on the concept of cost-benefit analysis. Costs include the initial and continuous eHealth investments, such as those in ICT and change management, as well as the running costs of healthcare. Special attention has been paid to identifying the benefits to, and impact on, citizens. At the same time, benefits to all potential stakeholders can be analysed. The concept of cost-avoidance is important in identifying benefits. This is the cost for achieving the ICT-based performance without ICT, which is often prohibitive. The results of the study show that given the right approach, context and implementation process, benefits from effective eHealth investment are indeed better quality and improved productivity, which in turn liberate capacity and enable greater access. Once development and implementation stages have been successfully realised, the value of these benefits, for what we have called a 'virtual health economy' consisting of the 10 evaluated cases, rises each year and exceeds the costs, usually very significantly.
Annual costs are broadly stable once implementation has been completed, whereas net benefits tend to grow each year with expanding usage, showing that eHealth can contribute increasingly to satisfying citizensâ€™ needs and wants for healthcare. The eHealth IMPACT study provides empirical evidence on the benefits of eHealth systems and services. It demonstrates the potential of eHealth as enabling tool for meeting the 'grand challenges' of European health delivery systems. Policy makers, industry, and healthcare providers alike must be aware that the realisation of this potential depends on six key factors:
1) Commitment and involvement of all stakeholders: All phases of eHealth development, implementation and deployment have to be supported by citizens/patients, health providers, industry, authorities, and third party payers.
2) Strong health policy and clinical leadership that guides a flexible and regularly reviewed eHealth strategy: While the strategy should be directed by a long term vision of a citizen-centred health delivery system, it must address concrete needs of actors in the system. The strategy should include achievable, shorter term goals that create an eHealth investment dynamic. A big-bang approach with ambitious goals to be achieved over a short period of time is not recommended.
3) Regular assessment of costs, incentives and benefits for all stakeholders: Considering purely financial return on investment at an institutional level, or potential benefits for only one of the stakeholders, may lead to suboptimal decisions. Particular attention should be paid to include all users, some of whom are often neglected in such assessments.
4) Organisational changes in clinical and working practices: This is indispensable in order
to optimise the use of ICT-enabled solutions and realise the benefits. Such changes should be facilitated by greater legal certainty in using eHealth solutions.
5) Strong clinical leadership, good organisational change management, multi-disciplinary teams with a well-grounded experience in ICT and clear incentives: The combination of skills of the people involved will make the difference between success and failure, not the specific eHealth solution. Skills development through continuous education and training is essential.
6) Long term perspective, endurance and patience: Beneficial eHealth investment is like a good wine. It takes a considerable amount of time (about 5 years) to mature and develop its potential fully."