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eHealth Impact (eHI)

 Realising Net Benefits - Weak Practice Likely to Inhibit Success

Using the eHI methodology has revealed several themes that are likely to inhibit success in realising the net benefits ofeHealth.  These should be avoided or limited in eHI, and equivalentprojects, in healthcare organisations that are pursuing similar initiatives.

Pre-requisites of all eHealth projects is that the software solutions must work, be fit for purposeand be relevant to the benefits envisaged.  If the following features are prevalent, they will inhibit the realisation of net benefits from effective investment in the software:  

• Emphasis on achieving benefits, not net benefits, and so the relationship of total benefits and total costs over time
• Focus of effort on the implementation phase, and insufficient on the medium term operational phase
• Over-reliance on pilots that perpetuate double running costs, are not evaluated, and are not converted into routine operation when they are effective
• In effective clinical leadership, including committees of doctors that are consulted on changes, but dilute leadership, especially where the chair with a short, fixed term appointment is assigned the leadership role, so relying on position power
• Not engaging clinicians effectively, or at all, from the outset of the planning and developing stage
• A limited, or no, corporate vision of the new healthcare setting with eHealth, that combines free text, structured reports and images into easily accessible records, and replacing documents
• Inability of executives to transfer the vision to clinical, management and operational staff
• Insufficient time for planning and development to design the required eHealth solution and prepare for implementation
• An extended implementation period, that retains working practices, but retains them for extended timescales, does not support clinical practices and does not achieves maximum eHealth utilisation within a maximum of two years
• Inadequate, sustainable investment in design and development of the eHealth solution and new clinical and working practices, project management, training, procurement; about one-third, and possibly up to 45%, of total annual expenditure
• Decisions and actions through weak, isolated one-dimensional teams of ICT staff and general managers that exclude clinicians who cannot participate in planning the changes to clinical and working practices that can be achieved with the eHealth project
• Reliance on too many uni-disciplinary people
• eHealth projects based on weak and narrow specifications and that also provide tools for clinicians that can only be specified by them in the future
• Confusion on who will benefit, what benefits will be gained, when they will be gained and how they will be gained
• Infrequent, or no, comprehensive review of the fit of the eHealth project to the overall healthcare strategy of the organisation; preferably every two years.
• In effective project management that takes inappropriate action when the eHealth project diverts from the plan
• Investing resources in change management and benefits realisation effort, but not deploying them to good effect.

eHealth Impact (eHI)

 Realising Net Benefits - Good Practice Likely to be Critical for Success

The ten eHI case studies revealed themes that were essential to success in realising the net benefitsfrom eHealth.  These should be present in eHI, and in equivalent projects,in healthcare organisations pursuing similar initiatives.

Pre-requisites of all eHealth projects are that the software solutions must work, be fit for purposeand be relevant to the benefits envisaged.  On their own, these are not enough.  There are other themes essential to realising benefits,including:  

• Effective clinical leadership, preferably from a core clinical group that relies on personal power, not position power, to ensure voluntary commitment by clinicians to the planned changes
• Effectively engaging clinicians in achieving change from the outset of planning and development stage and sustaining the engagement into the operation stage
• Corporate vision of the new healthcare setting with eHealth, that combines free text, structured reports and images into easily accessible records, and replacing documents
• Ability to transfer the vision to clinical, management and operational staff
• Sufficient time for planning and development to design the required eHealth solution and prepare for implementation
• A short, very well-prepared implementation period, that works first time, transforms working practices, supports clinical practices and achieves maximum eHealth utilisation, preferably within a maximum of two years
• Adequate, sustainable investment in design and development of the eHealth solution and new clinical and working practices, project management, training, procurement; about one-third, and possibly up to 45%, of total annual expenditure
• Decisions and actions through high-powered, complex, multi-disciplinary teams that engage with clinicians so they can participate jointly in planning the changes to clinical and working practices that can be achieved with the eHealth project
• Reliance on multi-disciplinary people, especially with clinical knowledge, project management and ICT skills
• Clarity on who will benefit, what benefits will be gained, when they will be gained and how they will be gained 
•  Frequent, comprehensive review of the fit of the eHealth project to the overall healthcare strategy of the organisation; preferably every two years
• Effective project management that takes appropriate action when the eHealth project diverts from the plan.