Value of Investment as a Key Driver for Prioritization and Implementation of Healthcare Software

摘要

Health systems across the nation are recovering from massive financial and resource investments in electronic health record applications. In the midst of these recovery efforts, implementations of new care models, including accountable care organizations and population health initiatives, are underway. The shift from fee-for-service to fee-for-outcomes and fee-for-value payment models calls for care providers to work in new ways. It also changes how physicians are compensated and reimbursed. These changes necessitate that healthcare systems further invest in information technology solutions. Selecting which information technology (IT) projects are of most value is vital, especially in light of recent expenditures. Return-on-investment analysis is a powerful tool used in various industries to select the most appropriate IT investments. It has proven vital in selecting, justifying, and implementing software projects. Other financial metrics, such as net present value, economic value added, and total economic impact, also quantify the success of expenditures on information systems. This paper extends the concept of quantifying project value to include clinical outcomes and nonfinancial value as investment returns, applying a systematic approach to healthcare software projects. We term this inclusive approach Value of Investment. It offers a necessary extension for application in clinical settings where a strictly financial view may fall short in providing a complete picture of important benefits. This paper outlines the Value of Investment process and its attributes, and uses illustrative examples to explore the efficacy of this methodology within a midsized health system. Key words: value of investment, benefits estimator, healthcare software, project prioritization, ROI, SDLCIntroductionHealth systems across the nation are recovering from massive financial and resource investments in electronic health record (EHR) applications. In 2009, the American Recovery and Reinvestment Act (ARRA) mandated that physicians, clinics, and hospitals implement EHR technology. This provision of the act invigorated the languishing EHR business and forced healthcare entities to spend billions of dollars nationwide on adopting this technology. With an overall budget of almost $800,000,000, the staggering investment in accelerating the adoption of health IT put forth by the ARRA was unprecedented. The ARRA also provides grants and loans to help establish utilization of a certified EHR for each person in the United States.~(~(1)) To push the health information systems agenda even further, as of 2015 physicians and hospitals that do not use certified information systems in a meaningful way began to be penalized. ARRA has taken far-reaching initiatives to increase the use of information systems.These mandates have changed the healthcare industry. In no previous time in healthcare has patient care been inextricably bound to data entered into information systems such as EHRs. The power of hundreds of EHRs and thousands of clinicians producing meaningful EHR data cannot be overstated. When the current situation is compared to previous years when patient information was in paper form, the significance of the EHR mandate is evident. The cost of implementing information systems, accessibility of the clinical data, change of reimbursement to new models, and more changes on the horizon underline the need for improved information systems and an improved process by which associated projects are selected and implemented.Despite the substantial investments in information systems by physicians, hospitals, and government, the expected effects of reducing overall costs and improving outcomes through this technology remain elusive.~(~(2), ~(3), ~(4)) Instead of continuing in the same manner, hospital systems should focus on tightly associating these projects with needed outcomes and require demonstration of their value. Rather than continuing to implement applications in hopes of helping patient care, healthcare systems need to explore new ideas to justify spending, improve financial outcomes, reduce healthcare costs, and improve clinical efficiency and care quality.Return on investment (ROI) is a powerful concept used to justify spending and select the most appropriate investment projects. When ROI is coupled with other tools, projects in various industries have recognized significant success in justifying, prioritizing, and measuring success.~(~(5)) ROI models have proven to be vital in improving the process of selecting, justifying, and designing application projects. Although ROI can have multiple interpretations, within this research ROI is an indicator used to measure the financial value and organizational impact of a project in relation to its cost. This definition works well with the operational approach to research that real-world applications offer. Real-world examples lend insight into more than numbers. They are instrumental in ascerta