Assessing the realistic value - ICMCC

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Assessing the realistic value - ICMCC

The Value of Information for Decision

Making in the Healthcare Environment

Itamar Shabtai, College of Management Academic Studies

Moshe Leshno, Tel Aviv University

Orna Blondheim, Clalit Healthcare Services – HMO

Jonathan Kornbluth, Hebrew University of Jerusalem

ICMCC 2007


Aim of the research

Assessing the contribution of information technology to

improving decision making in the healthcare environment

• Checking whether IT investments in the healthcare

environment are worthwhile

Assessing the value of information provided to the

decision makers (physicians)

ICMCC 2007


The productivity paradox

• Organizations invest huge sums in IT

• You don’t always get value for your money

• It isn’t easy to assess the contribution of IT to

improving performance

• One of the common ways of assessing the

contribution of IT is to assess the value of information

ICMCC 2007


Assessing the value of information

• Subjective value of information –

determined by the intuitive perception of the decision

maker (the physician)

• Realistic value of information –

the actual contribution of information. the differences in the

outcomes with and without the information

• Normative value of information –

based on normative models. The common paradigm is

utility theory

ICMCC 2007


Research field (1)

• A healthcare information integration system that

facilitates interoperability and information exchange at

the point of care

• Adopted by “Clalit” the largest HMO in Israel

• Based on an innovative technology for designing,

establishing, operating and managing medical

information based on the internet

• Enables the gathering of medical information on-line

from decentralized databases and their transfer to

authorized users

ICMCC 2007


Research field (2)

• The system is based on the relevant medical history of the

patient

• The system operates within a heterogeneous environment

• In such an environment there is a growing need for

complete, uniform, reliable and accessible medical

information

• The system has been in use in hospitals and community

clinics since 2003

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Methodology

Pilot research

Literature

Background

Assessing the subjective value

Examining the relations

among various dimensions

Assessing the realistic value

Assessing the

value of information

Assessing the normative value

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Sample

• All internal and surgical departments at the Meir

Hospital

• The data were gathered in the second half of 2004

• Data on physicians and patients were confidential

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Physician’s mission at the point of care

Providing

Medical Service

Efficient Service

Quality Care

and Safety

Diagnosis

Prior Prior Diagnosis

Prior Prior Diagnosis

Prior Prior Diagnosis

Sensitivity Sensitivity to to Medicine/Other

Medicine/Other

Sensitivity Sensitivity

Sensitivity Sensitivity to to Medicine/Other

Medicine/Other

Sensitivity Sensitivity

Sensitivity Sensitivity to to Medicine/Other

Medicine/Other

Sensitivity Sensitivity

Demographic Data Data

and and Habits Habits

Demographic Data Data

and and Habits Habits

Demographic Data Data

and and Habits Habits

Medicines

Medicines

Medicines

Surgeries/Procedures

Surgeries/Procedures

Surgeries/Procedures

Labs/Imaging

Labs/Imaging

Labs/Imaging

Patient's Preferences

Patient's Complaints

ICMCC 2007


Assessing the subjective value

Goals:

• Defining the most important information components, as

perceived by the physicians, at the point of care.

• Determining the degree of importance the physicians attribute to

each information component.

• Determining any differences in the perception of information value

among the various groups of physicians by:

– Area of specialization

– Seniority

ICMCC 2007


Assessing the subjective value

Results:

Relative Importance of Information Componenets

0.45

0.33

0.3

0.15

0

Labs/Imaging

Surgeries/Procedures

Internal Medicine Physicians

Surgeons

0.21 0.21 0.21 0.22

0.13

0.15

0.10 0.11 0.09

0.05 0.06 0.05 0.04

0.02

Prior Diagnosis

Medicines

Patients Complaints

Medicine/Other Sensitivities

Demographic and Habits

Patients preferences

0.01

P value < 0.05

For physicians specializing in internal medicine, labs/imaging is the most important

ICMCC information 2007 component in providing medical service, while for surgeons the most

important information component is prior diagnosis


Assessing the realistic value

Goals:

• Usability analysis –

to find whether the physicians really use the information

system and how they do so

Assessing the realistic value

does historical information actually lead to improvements in

outcomes

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Assessing the realistic value

Method:

• Usability analysis

– Tracking entries to data by log file analysis

– Analysis of entries to data

Assessing the realistic value

– Statistical methods

Data analysis includes:

descriptive statistics, chi square, t-tests, correlations and multiple

regression

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Assessing the realistic value

Results (1):

• Extensive use of historical information in

internal medicine departments VS. surgical departments

• In the internal medicine departments -

no significant differences were found regarding the use of

information on patients from the various HMOs

on the other hand,

• In the surgical departments -

significant differences were found regarding the use of

information on “Clalit” patients and on patients from other

HMOs

ICMCC 2007


Assessing the realistic value

Results(2):

• In the internal medicine departments - patients arrive randomly

and spontaneously while surgery is generally on an elective basis

• Therefore:

– The information system is more important in the internal

medicine departments because it is usually their only source of

historical information

– Surgical department activity is more arranged in advance and

the historical information is collected and organized

accordingly

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Assessing the realistic value

Results(3):

(from internal medicine departments)

Reduction in the amount of redundant singleday

admissions

• Stepwise linear regression results indicate that the patient’s HMO

significantly (p


Assessing the realistic value

Results(4):

(from internal medicine departments)

Reduction in the use and consumption

of medical services

From a stepwise linear regression we found (p


Assessing the normative value

Goals:

– Estimating the added utility per patient, in QALY

units, deriving from the use of historical information

– Conducting a cost-benefit analysis in order to find

the threshold value per unit of QALY

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QALY – Quality Adjusted Life Year

• A measure that takes into account both quantity and the

quality of life generated by healthcare interventions

• It is the arithmetic product of life expectancy and a

measure of the quality of the remaining years of life

• It serves as a general measure for evaluating the benefit

and effectiveness of introducing improvements into the

area of medicine and examining whether the investment is

worthwhile

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Assessing the normative value

the model developed:

Using Historical Infromation

Not Using Historical Information

0

High HI contribute

pHHIC

Low HI contribute

pLHIC

Cases HI no contribution

#

0

S1

S2

S3

S1

S2

S3

#

pS2

pS3

#

rr*pS2

rr*pS3

The added benefit to be expected from using historical

information was 0.0687 QALY per patient

Q1

Q2

Q3D

Q1

Q2

Q3D

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Assessing the normative value

Assumptions for the cost/effectiveness analysis:

• Information system lifecycle: 15 years

• Number of admissions per year in the internal medicine

department at the Meir Hospital: 11,000

• The added utility per patient derived from the use of

information (in QALY units): 0.0678

• The cost of the system in the first year is: $1,000,000

• The cost of the system for each consecutive year is: 15%

of the initial cost

ICMCC 2007


Assessing the normative value

Results of the cost/effectiveness analysis:

year

N

(admissions)

∆QALY

(per admission)

Total cost

Cost per

patient per

admission

(∆C)

∆C/∆QALY

1 11,000.00 0.0687 1,000,000.00 91.00 1,455.60

2 11,000.00 0.0687 145,631.07 13.24 193

In the first year after the system’s adoption,

the added cost per 1 QALY was $1,455.60 per patient

ICMCC 2007


Thanks !

Itamar.shabtai@colman.ac.il

ICMCC 2007


• Estimating the subjective (perceived) value of information

– It was found that the physicians attribute great importance to the historical information provided by the

system at the point of care. They claim that the historical information contributes substantially to improving

the process of providing the medical service

– Differences were found between the internal medicine specialists and the surgeons in their perception of the

value of the information and its components

• Estimating the realistic value of information

– Differences were found between the internal medicine specialists and the surgeons in the level of use and

pattern of use of the various information components

– The level of use in the internal medicine departments was higher than in the surgical departments. This may

be explained by differences in the nature of the activity in the two departments: surgical procedures are

scheduled in advance and information is collected accordingly, whereas arrival at the internal medicine

departments is mostly unscheduled

– In the internal medicine departments, historical information reduced the number of one-day hospitalizations

– The use of historical information does not lead to a reduction in the demand for the services (X-rays,

imaging)

• Estimating the normative value of information

– The incremental benefit to be expected from using historical information was found to be 0.0687 QALY per

patient

– A cost/effectiveness analysis showed that, under the assumptions of the model, in the first year following

adoption of the system the incremental cost per unit of QALY was $1,315 per patient

ICMCC 2007

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