Efficiency is essential to improving health systems, making them sustainable, and equipping them to face future emergencies. It is also crucial to progress towards universal health coverage in LAC.1
Efficiency measures whether the way health resources are being used achieves the best quality/price ratio,29 which is the relationship between costs (labor, capital, or equipment), intermediate products (number of patients treated, wait times, etc.), and final health outcomes (lives saved,for quality-adjusted life years [QALY], etc.).3
What would you do with four more years of life?
A study compared the efficiency of 22 LAC countries with that of other middle-income and OECD countries in key public health aspects like life expectancy, mortality rate for children under age 5, access to services, and immunization rates, among others. It found much room for improvement: all LAC countries fall into the lower half of the ranking, and 12 are in the lowest 25%.4
Even more startling are the projections that people in LAC could live an average of 4 years longer if the region’s countries caught up to their more efficient peers.5 In Bolivia, Guyana, Suriname and Trinidad and Tobago, this average is as much as 7 years longer. Such is the power of increasing the efficiency of health systems. In addition to the cost in life years, poor quality costs low- and middle-income countries $1.4 to $1.6 trillion per year in lost productivity 6
*This video is only available in spanish
How did Chile transform waiting list in the public system?
In the current context of a devastating health crisis and what has been called the greatest economic contraction in the history of LAC,7 what could be a higher priority for countries than investing in tools that help use scarce resources more efficiently?
The value of DT
To do more for public health with the same budget, especially in a health crisis, the people who decide where to invest public funds, directors of health institutions, and those in charge of the enormously complex task of providing medical care all have to make effective and well-informed decisions.
*This video is only available in spanish
In Uruguay, "My Electronic Health Record" gives citizens timely access and effective management of their health information.
On any given day at work, a physician has to juggle caring for patients, administrative tasks, exchanging information with colleagues, and staying up to date on new developments in their field to provide evidence-based care. The last task alone entails each doctor reading 5,000 articles per day, since a new article is published in a specialized journal approximately every 26 seconds.8 Even if doctors could stay up-to-date on their reading, by the time something is published, it is often is outdated given the time to publish. There is so much information that an estimated 17 years to translate healthcare data to research findings that would then inform clinical decisions9 Given this almost surreal state of affairs, physicians must use technology in order to make full use of their time and protect their own physical and mental wellbeing. Similarly, DT processes can considerably enhance the immediate and long-term performance of each stakeholder and area of the health ecosystem.
Tangible digital benefits
The network of DT solutions is vast and will only be effective with a strategy tailored to each country’s needs and resources.
Also, there is mixed evidence on ineffective implementations and uses of IT tools in specific contexts.
The examples and information below are specific cases where introducing technology has led to greater efficiency.
- Data management systems reduce the amount of time health providers spend on administrative tasks, finding test results, and searching for information so they can make decisions.
- EHR systems allow different stakeholders from diverse contexts to access patient information so less time and money are wasted on redundant diagnoses.10
In health care:
- Tools like telemedicine and EHR systems make it possible to move information instead of people, giving patients access to health care. This saves them significant amounts of productive time and cuts down the high costs associated with moving patients..
- CDSS can notify users of more affordable drug alternatives or of conditions that insurance companies will cover..
For the patient:
- DT gives members of a care network the ability to store and use the same information generated in many places. This prevents entering the same data multiple times, so professionals spend less time on data entry and have fewer chances of making mistakes in doing so.17
- Digital tools facilitate task shifting and improve quality by providing decisionmaking support at the point of care and adapting procedures designed for medical workers with limited training ,like community health workers.18
- When integrated with computerized provider order entry (CPOE) systems, clinical decision support systems (CDSS) can suggest more affordable drug alternatives and reduce redundant testing.
- Electronic referral systems can improve communication between primary care and specialists.. However, they have a positive but limited impact on reducing wait times. Economic evaluations are needed to analyze these referral systems clinical and economic value for health care.
- Telehealth can bring costs down by eliminating trips funded by the health system and by reducing the need for costly procedures or specialized monitoring by providing competent care in a more efficient manner.
For organizations:
- Interoperability processes and data management systems can optimize how the many service providers and funders throughout the country enter the data comprising the health system. This can help governments make better decisions about health.
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A health system that is integrated, at least on an informational level, can:
- Reduce health care costs associated with redundant diagnostic testing, unnecessary hospitalizations, and preventable readmissions, among other aspects.
- Make better use of resources and management to know how, when, and where those resources are used.
- Effectively monitor notifiable diseases, seasonal diseases, communities’ disease burden, and other aspects.
- Keep an accurate record of the population’s diseases.
- Aid public health research.
- Strengthen disaster response.
- Improvements related to information in EHR can help make studies requiring large sample sizes more efficient, since their data can be compiled more quickly and inexpensively.70 However, it is critical to ensure ethical use of the data, privacy, and information security.
For governments:
Digital and sustainable health
Can digital tools like EHR systems and telehealth have a positive environmental impact?
A study by Kaiser Permanente found that although EHR systems generated25 250 tons of electronic waste, they saved 1000 tons of paper and 68 tons of x-rays, resulting in a net positive effect.
Likewise, a report26 indicated that using ICT could cut emissions by 0.205 Gt of CO2 globally as a result of reducing trips and decreasing use of physical medical facilities. It also indicates that telehealth has the potential to save 1.7 billion liters of fuel used for transfers and more than US$66 billion by freeing up space, with 271.4 million square meters made available for other uses by 2030.
References:
1 Camilo Cid et. al., “La eficiencia en la agenda de la estrategia de acceso y cobertura universales en salud en las Américas,” Salud Pública de México 58, no. 5 (Sept./Oct. 2016): 496–503, https://saludpublica.mx/index.php/spm/article/view/8182.
2 A Williams, “Priority setting in public and private health care. A guide through the ideological jungle,” Journal of Health Economics 7 (June 1988): 173–83, https://www.sciencedirect.com/science/article/abs/pii/016762968890015X?via%3Dihub.
3 Gavin Mooney et al., Choices for health care: a practical Introduction to the economics of health care provision , (London: Macmillian, 1986).
4 Diana Pinto et al., Better Spending for Better Lives: How Latin America and teh Caribbean Can Do More With Less , (Washington D. C.: IDB, 2018). https://publications.iadb.org/publications/english/document/Better-Spending-for-Better-Lives-How-Latin-America-and-the-Caribbean-Can-Do-More-with-Less.pdf
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5 Ibid.
6 WHO, “Servicios sanitarios de calidad,” WHO news room/fact sheets, August 11, 2020. https://www.who.int/es/news-room/fact-sheets/detail/quality-health-services.
7 ECLAC, Measuring the impact of COVID-19 with a view to reactivation, (Santiago: ECLAC, 2020), 1. https://www.cepal.org/en/publications/45477-measuring-impact-covid-19-view-reactivation .
8 M Linzer et. al., “Role of a medical journal club in residency training”, J Med Educ 61, no. 6 (June 1986): 471-3. https://journals.lww.com/academicmedicine/abstract/1986/06000/role_of_a_medical_journal_club_in_residency.7.aspx.
9 Amy Harris Nordo et al., “Use of EHRs data for clinical research: Historical progress and current applications”, Learning health systems 3, no.1 (January 2016). https://onlinelibrary.wiley.com/doi/10.1002/lrh2.10076.
10 Nir Menachemi et. al., “Benefits and drawbacks of electronic health record systems,” Risk Manag Healthc Policy 4, 47-55 (May 2011), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3270933/.
11Amy Cheung et al., “The Organizational and Clinical Impact of Integrating Bedside Equipment to an Information System: A Systematic Literature Review of Patient Data Management Systems (PDMS)”, International Journal of Medical Informatics 84, no.3 (marzo de 2015). https://www.sciencedirect.com/science/article/abs/pii/S1386505614002470?via%3Dihub.
12 Researchers have published numerous articles on how physicians are burnt out by how much time EHR-S documentation requires, but this problem seems to be specific to the requirements of the US system. https://www.researchgate.net/publication/325020995_Physician_Burnout_in_the_Electronic_Health_Record_Era_Are_We_Ignoring_the_Real_Cause.
13 Campanella et. al., “The impact of”, 60-64.
14 See Lise Poissant et. al., (May 2005): “The impact of electronic health records on time efficiency of physicians and nurses: a systematic review,” and Esther C Moore, et. al., (May 2020) “A systematic review of the impact of health information technology on nurses’ time.”
15 2 Kolsum Deldar et. al., “Teleconsultation and Clinical Decision Making: A Systematic Review,” Acta Inform Med 24, no.4 (July 2016).https://www.bibliomed.org/mnsfulltext/6/6-1468676794.pdf?1643692347 .
16 Daniel Avidor et al., “Cost-effectiveness of diabetic retinopathy screening programs using telemedicine: a systematic review.” Cost Eff Resour Alloc. 18 no.16 (April 2020), https://resource-allocation.biomedcentral.com/articles/10.1186/s12962-020-00211-1.
17 John Glaser, “Interoperability: The Key to Breaking Down Information Silos in Health Care”, Healthc Financ Manage 65, no. 11, (November 2011): 44-6, 48, 50. https://pubmed.ncbi.nlm.nih.gov/22128594/.
18Alan Labrique et al., “mHealth innovations as health system strengthening tools: 12 common applications and a visual framework” Global health, science and practice 1, no.2 (August 2013): 160-71. https://www.ghspjournal.org/content/1/2/160.
19 Centaine L Snoswell et al., “Determining if Telehealth Can Reduce Health System Costs: Scoping Review”, Journal of medical Internet research, 22, no. 10, (August 2020) https://www.jmir.org/2020/10/e17298/.
20 Daniel Lewkowicz et al., “Economic impact of clinical decision support interventions based on electronic health records”, BMC Health Serv Res 20, no. 871 (September 2020). https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05688-3.
21 8 Eftekhari, Saeede et al., “Do Health Information Exchanges Deter Repetition of Medical Services?”, ACM Transactions on Management Information Systems 8, no. 1 (April 2017). https://dl.acm.org/doi/abs/10.1145/3057272?download=true.
22 CCentaine L Snoswell et al., “Determining if Tele - health Can Reduce Health System Costs: Scoping Review”, Journal of medical Internet research, 22, no. 10, (October 2020). https://www.jmir.org/2020/10/e17298/.
23Nir Menachemi y Taleah H Collum. “Benefits and drawbacks of electronic health record systems”. Risk Manag Healthc Policy 4. 47-55 (May 2011). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3270933/.
24 Farahnaz Sadoughi, et al., “The impact of heal - th information exchange on healthcare quality and cost-effectiveness: A systematic literature review”, Computer Methods and Programs in Bio - medicine 161 (July 2018), 209-232.https://www.sciencedirect.com/science/article/abs/pii/S0169260718300907?via%3Dihub.
25 Gartner, “Connected Health Information in Canada: A Benefits Evaluation Study,” (April 2018): https://www.infoway-inforoute.ca/en/component/edocman/3510-connected-health-information-in-canada-a-benefits-evaluation-study-document/view-document?Itemid=0 .
26 Marianne C Turley et al., “Use Of Electronic Health Records Can Improve the Health Care Industry’s Environmental Footprint”, Health affairs 30, no. 5 (May 2011) https://www.healthaffairs.org/doi/10.1377/hlthaff.2010.1215 .
27 GeSI, SMARTer2030 ICT Solutions for 21st Century Challenges, (Belgium: Gesi, 2015), 32.