7 The benefits
In common with the Better Health Better Care Action Plan, the benefits of eHealth can be described using the Institute of Medicine's six dimensions of quality framework, as depicted below:
Examples can be shown for each area of benefit:
a. Safe and effective
eHealth is recognised internationally as having a very significant contribution to make to the safety and effectiveness agenda, in terms of directly supporting evidence based health care ( EBHC). Bates and colleagues 6 summarised the contribution that information technology can make to patient safety as:
- make safer, faster diagnoses, based on a better understanding of patient history and current health status
- reduce redundant or unnecessary repeat investigations
- reduce complications due to drug interactions
- create data for audit, improvement, population based studies etc
- support protocols, pathways of care and application of best evidence.
"Investment in, and adoption of, new forms of information technology must be understood to be as vital to good patient care as the adoption of new technological tools for diagnosis and treatment". Institute of Medicine
Further examples can be offered:
Effective patient identification will prevent miss-match of elements of records.
Access, with the patient's consent, to essential medical information can be potentially life-saving.
| Allan attends A&E having fallen in the street one evening, and cannot remember all the drugs he takes. He gives Staff Nurse George permission to access his Electronic Care Summary. This helps the clinical team to fully assess the patient and consider whether his medication contributed to the fall. |
Data quality will be improved and maintained through automatic validation, where possible, and appropriate feedback to clinicians.
| GP Paul records Edith's medication during the consultation. His computer system automatically flags up contra-indications, helping reduce errors. |
Access to accredited knowledge and standards will be improved, to support the clinical decision making process. Guidelines/protocols can be built into care-related processes to encourage appropriate evidence-based care pathways. Under the auspices of NHS National Education for Scotland, a new Clinical Decisions Portal has been launched 7.
High quality information will be provided to support clinical governance, in particular clinical audit, patient safety, clinical effectiveness and health outcomes.
| During an incident investigation, consultant Gillian demonstrated that her team had followed the correct protocol by analysis of the audit trail which recorded times and date of actions. |
Advances in telehealth and telecare will be exploited to support the delivery of care closer to home, to improve chronic disease management and anticipatory care, and to support clinical education.
b. Timely and efficient
eHealth supports improved communication and sharing of information between clinicians, patients and carers within the health sectors and across partner agencies.
| Shirley, the speech and language therapist attached to the language development unit in a nursery school, receives a referral in the department's shared mail box from the school. She is able to access relevant past history, linked using the CHI number. This allows Shirley to prioritise her caseload to enable her to plan a visit to the school to see the child, assess her therapeutic needs and agree a joint intervention plan with parents and teachers and educational support workers. |
Duplication of effort through repeated data collection and recording will be avoided where possible, to reduce the administration burden and improve information flows. Record once and use often to create more time for patient care.
| Janet, a case manager, reviews the care of Simon whose bipolar disorder has recently become worse. By accessing the Integrated Care Pathway she is able to check compliance with the care plan and access assessment tools to review clinical risks and the requirement for a clinical review. As a member of the mental health community team, she is able to access the team's NHS mail shared diaries and make an appointment with Deirdre, Simon's CPN. She puts a note into the patient's Electronic Health Record and texts Simon with the date and time of the appointment. |
Case management will be improved to support the multi-disciplinary and multi-agency teams to reduce delays and waiting times.
More efficient and effective collection, analysis and usability of national statistics through "by product" services from clinical and operational systems will be introduced, facilitated by the development of a secondary uses/ health information service.
| Lorna, clinical director of vascular surgery, decides to audit patients with aortic aneurysm who were operated on as an emergency. She accesses anonymised data online to identify all patients who were operated on as an emergency within the last three years, the surgical team who cared for them, the patients' outcome following surgery and their current state of health. She reviews the care of these patients by the surgical teams, taking account of information obtained on the severity of the patients' conditions on admission and other co-existing conditions or complications. |
Real-time information will be provided to support operational management.
| At 3 a.m. on a busy winter morning, Helen, a bed manager in an acute hospital, checks the computer system to review the availability of unoccupied beds within the hospital. She is able to see that ward 23 is unavailable because of a flu outbreak but there are medical beds free on wards 25 and 26. |
Information on patient journeys will be provided with a patient centric rather than disease based approach, to facilitate the care of patients with multiple long-term conditions and/or complex care needs.
| Planner, Mary, wants to ensure that the recently established Diabetic Retinopathy Screening Programme is effective. Routine information allows the Board to check how many patients with diabetic retinopathy were detected by the screening programme, whether they were identified at an early stage of their disease, what treatment was provided, the outcome of treatment and what their current vision is. Linked data allows Mary to monitor the impact of the screening programme on hospital (ophthalmology) outpatient and inpatient activity. |
C. Equitable and patient-centred
There will be less need for patients to repeat information, thereby improving confidence in service efficiency and demonstrating seamless service.
More clinical time will be created for patients with less time spent searching for information.
| A&E junior doctor, John, is assessing Laura's symptoms. He is able to access the clinical summary information from her recent outpatient and inpatient episodes and the recent investigations that have been requested by her GP. This helps him to make a diagnosis quickly and effectively. |
Patients will be supported in exercising their rights to access their health records and be involved in verifying and amending if appropriate.
Patients and carers will have improved access to information about their condition or about a procedure they may have to undergo, encouraging greater involvement in maintaining and improving their own health.
| Susan has been recently diagnosed with breast cancer. Naturally worried, she wants to know as much as she can about treatment, procedures, aftercare, prognosis etc. in the privacy of her own home. Rather than making random searches on the internet, she accesses assured websites that her GP has recommended. |
eHealth will help promote equality and diversity standards.
| Mrs Singh has been referred to a cardiology clinic. The referral has automatically highlighted that Mrs Singh requires a Punjabi interpreter and the system has prompted that a longer appointment will therefore be required. |