Evaluation of IT modernisation in the NHS - NETSCC

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Report to SDO for NCRS ProjectReview of Economic Implications3.4. ResultsThe initial search identified 1725 studies from the Medline database and 529studies from the Cochrane Library. The combined list of references from Medlineand the Cochrane library was checked for duplicates and 118 were removed.Figure 3 summarises the selection process. A total of 149 papers were identifiedfor full text review. An additional 20 papers were identified from the bibliographiesof the included papers. Overall, 18 studies were identified for data extraction.Agreement between the two reviewers with respect to identification of papers forfull text review was ‘good’ 55 (weighted Kappa=0.68, CI (0.641, 0.737)), with simpleagreement on 98% of papers.Figure 3 : Search resultsTitles and Abstracts identified for review1725Rejected - 1576Full Text Articles Requested for furtherscreening - 149Reference lists of 149 werescreened - additional 20 articleswere requested for further screeningRejected - 172 unable to obtainRejected - 116Articles Selected for Data Extraction1Articles Selected for Data Extraction – 1828
Report to SDO for NCRS ProjectReview of Economic ImplicationsThe full text review identified a total of eighteen studies for inclusion. Of thosenine evaluated PACS, five evaluated EMR and four evaluated CPOE (i.e. studiesof CPOE in the United States). It is important to note that two of the studies werebased on the same empirical data. 56,57 Furthermore, it was discovered that, apartfrom variations in titles and abstracts, three studies were virtually identical 58-60 ;therefore, only one of these was included.3.4.1. Study descriptionTable 6 summarises the studies included in the review. The majority wereconducted in the US 36,50-52,58,61-66 (11 of 16), three 49,53,67 in Scandinavia (two inFinland and one in Sweden) and two in the UK. 56,57 All but one study of theeffects of PACS were conducted in a hospital or medical centre setting. Twoof the four studies that looked at the effects of CPOE were conducted at adepartmental level across a number of hospitals 36,63 and the remaining twowithin a single hospital. 51,52 All studies evaluating the effects of EMR wereconducted across a number of primary care practices.The evaluation design varied considerably across the included studies. Fourstudies 49-52 used either an accounting or financial approach, such as activitybasedanalysis, return on investment (ROI) or value on investment. Twostudies were cost comparison, before and after implementation. 53,64 Onestudy only evaluated the effectiveness of IT implementation 65 and one studywas a pilot RCT. 62 The remaining 8 studies used some form of ‘before andafter’ comparison of costs or benefits. 36,56-58,61,62,66,673.4.2. Methodological qualityTable 7 shows the results of the quality assessment of the identified studies.Ten studies clearly identified competing alternatives. 36,49,50,56-58,61,63,65,67 Apartfrom Bryan et al., 56 the studies reported either partial incremental analysis (i.e.just costs or benefits) or no analysis at all; 7 studies reported incrementalanalysis of the effects, and one of costs. 67 The results of sensitivity analysiswere reported in six studies. 49,53,56,57,63,6629
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