Measuring value for money: a scoping review on economic evaluation of health information systems

Abstract

Objective: To explore how key components of economic evaluations have been included in evaluations of health information systems (HIS), to determine the state of knowledge on value for money for HIS, and provide guidance for future evaluations.

Materials and methods: We searched databases, previously collected papers, and references for relevant papers published from January 2000 to June 2012. For selection, papers had to: be a primary study; involve a computerized system for health information processing, decision support, or management reporting; and include an economic evaluation. Data on study design and economic evaluation methods were extracted and analyzed.

Results: Forty-two papers were selected and 33 were deemed high quality (scores ≥ 8/10) for further analysis. These included 12 economic analyses, five input cost analyses, and 16 cost-related outcome analyses. For HIS types, there were seven primary care electronic medical records, six computerized provider order entry systems, five medication management systems, five immunization information systems, four institutional information systems, three disease management systems, two clinical documentation systems, and one health information exchange network. In terms of value for money, 23 papers reported positive findings, eight were inconclusive, and two were negative.

Conclusions: We found a wide range of economic evaluation papers that were based on different assumptions, methods, and metrics. There is some evidence of value for money in selected healthcare organizations and HIS types. However, caution is needed when generalizing these findings. Better reporting of economic evaluation studies is needed to compare findings and build on the existing evidence base we identified.

Keywords: Economic Evaluation; Health Information Technology; Value For Money.

Figure 1

Economic evaluation classification. All economic analyses are conducted over a time frame, optional for input cost analysis and cost-related outcome analysis. ‘Option’ indicates that comparison options may not be present in the analysis. Source: eHealth Observatory (http://ehealth.uvic.ca/methodology/models/EEFramework.php). CBA, cost-benefit analysis; CCA, cost-consequence analysis; CEA, cost-effectiveness analysis; CMA, cost-minimization analysis; CUA, cost-utility analysis.

Figure 2

Paper selection flow.