Sources of value from healthcare IT

Articles

Analysis of the HIMSS Value Suite database suggests that investments in healthcare IT can produce value, especially in terms of improved treatment and clinical care. However, gaps remain that the industry must fill before value from healthcare IT can be fully understood and maximized.

Health systems around the globe continue to invest in healthcare IT, but the extent of the value being captured from the investments has not always been clear. To better understand the types of value providers are deriving from those investments, we analyzed 1,370 case studies of healthcare IT use collected by the Healthcare Information and Management System Society (HIMSS) in its Value Suite database. As far as we know, it is the world’s largest database containing such information, and we are the first outside organization to have the opportunity to analyze it in full.1

The information in the database contains an important input health systems can use to sharpen the focus of IT optimization programs and new investments in healthcare IT: which sources of value are being reported most often. This data, when combined with other critical inputs (e.g., the technology capital and operating costs and implementation timelines2), may provide a foundation for calculating return on investment more accurately and help strategically direct investments for improved clinical efficiency and patient outcomes.

Admittedly, there are limitations in the available data, as we discuss below, and the industry has a long way to go before it can fully understand the long-term value being generated by healthcare IT in quantitative manner. Nevertheless, analysis of the database provides useful insights into how to extract value from healthcare IT.

The Value Suite database

The cases in the Value Suite database cover a range of technologies (Exhibit 1). Data sources include press and academic articles, award submissions, websites, and other publicly available information. Examples of what can be found in the cases appear on p. 8 of the attached PDF.

To classify the types of value cited in each case, HIMSS uses its STEPS™ framework. The categories in this framework are Satisfaction, Treatment/clinical, Electronic secure data, Patient engagement/population health, and Savings. HIMSS then identifies thespecific types of value reported (e.g., improved clinical documentation, improved quality of care). Many of the cases included in the database cite more than one type of technology and one source of value. However, the reports the cases are based on may not have mentioned every source of value gained from healthcare IT.

In many ways the Value Suite database is similar to a survey (in that it is based on self-reporting), but it has several unique benefits that make it an important resource for understanding healthcare IT value capture:

  • Size. The 1,370 cases in the database reflect the experience of about 1,200 different providers and report over 12,000 specific instances of value.
  • Breadth. The database includes information from a variety of providers around the world, including hospitals, large health systems, and other care delivery organizations.
  • Validation. Sixty-four percent of the cases have been validated in whole or in part by a third party (e.g., HIMSS, other industry associations, or a government organization) or were reported in the press. The remaining 500 cases were derived directly from vendor websites or provider press releases. (We analyzed the database both with and without the unvalidated data to check for potential bias.)

However, it is also important to be aware of the database’s current limitations:

  • Non-comprehensive. The database contains information from only a subset of all provider organizations, and most cases discuss only a limited range of topics.
  • Positive-oriented. For the most part, the database contains only “positive” experiences (i.e., instances of value gained) and does not include instances where value was not captured or may even have been destroyed.
  • Largely qualitative. Although all cases include detailed information about the type of value derived, many of them provide only limited quantitative information about the amount of value. Most of the cases also say little about the cost, time, etc., to achieve that value.

Categories of value 

The category of value mentioned in the highest proportion of cases was treatment/clinical (Exhibit 2). These cases describe how healthcare IT improved the quality, safety, and/or efficiency of care. This finding reflects that electronic health/medical records (EHRs/EMRs) were the predominant technology discussed in 90% of the cases.

The category of value cited second-most often was improvements in electronic secure data. In these cases, the technology strengthened data reporting or sharing, communications, or the practice of evidence-based medicine, all of which help enable better clinical and managerial decision making.

Savings were mentioned almost as often as improvements in electronic secure data. The savings were derived from labor efficiencies, operational improvements (e.g., better use of space), or financial benefits (e.g., malpractice premium reductions).

The other two categories of value, satisfaction and patient engagement/population health, were cited far less often. One-third of the cases mentioned an increase in satisfaction either by patients, care providers, or other staff members. This score is consistent with calls from many directions that healthcare IT still has a long way to go before it becomes a leader in user experience.

Slightly more than one-quarter of the cases cited improvements in patient engagement/population health. Most of these cases discussed how IT was used by patients to increase their level of engagement with their health and care plan. However, a few of the cases described evidence that a technology helped change patient behavior (e.g., by increasing screening and immunization rates).

As noted earlier, 500 cases were drawn from vendor websites or provider press releases. To investigate whether the results described above were influenced by this fact, we eliminated those cases and re-ran our analysis. Our findings changed only slightly—the percentage of cases that cited savings and/or satisfaction dropped a few points, and the percentage describing improvements in patient engagement/population health rose a few points. Scores for the other two categories were unchanged.

Specific types of value

The STEPS™ framework includes 75 different specific types of value. Each case was assigned one or more types of value based on the benefit(s) mentioned in the underlying report. As a result, even the most common types of value cited were listed in less than one-third of the cases (Exhibit 3). This does not necessarily mean that these types of value were absent in the other two-thirds, merely that they were not specifically mentioned in the underlying reports.

The type of value reported most often was improved clinical documentation. This makes sense given that most of the cases discussed EHR/EMR systems, which often require more complete documentation than the paper processes they replaced. Improved quality of care—the anticipated benefit of better documentation—was mentioned in 30% of the cases. Improved workflow efficiency was cited in 25% of the cases, evidence against fears that more extensive documentation impairs workflow efficiency. Altogether, 46% of the cases reported improvements in quality, efficiency, or both.

Real-time, remote access to health records3 was also mentioned in 25% of the cases. This capability, which many EHR/EMR systems provide, may have contributed to the quality and efficiency gains. Improved continuity of care/care coordination was cited in 23% of the cases. Until recently, EHR/EMR systems were not commonly used for this purpose, but many health systems now make it a point of emphasis.

Again, our findings did not change much when we removed the cases sourced from vendor websites or press releases. The percentage of cases reporting improved clinical documentation or real-time, remote access to health records decreased slightly, and the percentage citing improved continuity of care/care coordination rose a few points.

Comparing the value cited by different provider types

The cases in the Value Suite database cover a variety of care organizations, including inpatient providers, ambulatory care providers, and multidisciplinary groups (e.g., integrated delivery networks). When we compared the 417 cases focused on inpatient providers with the 624 cases based on ambulatory care providers, some interesting similarities and differences emerged.

Although the two sets of cases ranked the categories of value in roughly the same sequence, the percentage of cases citing a given category was consistently higher in the ambulatory care set (Exhibit 4). Scores were fairly similar for treatment/clinical and electronic secure data. However, there were marked differences in the other three categories. In comparison with the inpatient cases, the ambulatory care cases were:

  • 16% more likely to mention savings
  • 36% more likely to mention satisfaction
  • 79% more likely to mention patient engagement/population health

Differences between the inpatient and ambulatory care cases became more pronounced when we analyzed specific types of value (Exhibit 5). Improved clinical documentation was cited most often in both sets, and three value types (improved quality of care, improved access to health records, and improved care continuity/coordination) were mentioned in roughly equal proportions in both sets. However, reductions in medication-related errors were reported almost twice as often in the inpatient cases as in the ambulatory care cases. Conversely, the ambulatory care cases reported improvements in workflow efficiency and real-time/remote access to health records much more often than the inpatient cases did.

Evaluating a specific technological feature: Patient portals

Patient portals are becoming an increasingly common feature of EHR/EMR systems. The 421 cases in the HIMSS database that included a discussion of patient portals were more likely than those without them to mention several types of value (Exhibit 6). Specifically, they were:

  • 122% more likely to cite improved patient engagement
  • 93% more likely to cite improved communication with patients
  • 72% more likely to cite increased efficiency in prescribing
  • 58% more likely to cite increased patient satisfaction and/or better patient survey scores

These findings are consistent with the functionality patient portals provide—the portals open an additional channel of communication with patients and place more information at their fingertips.

To view the full report, including exhibits, please download the PDF.

  1. HIMSS provided access to the Value Suite database. All the analyses and findings detailed in this article are McKinsey’s and McKinsey retained full editorial control of this article.
  2. Information about costs and implementation timelines are rarely included in the Value Suite database and thus were not included in our analysis.
  3. The term “access to health records” was used when the source document mentioned that records were easily available, could be viewed by multiple physicians, or were not lost. The term “real-time, remote access to health records” was used when the document also described the ability to access office records from home, or hospital records from an outpatient office.