Show me the money: how do we justify spending health care dollars on digital health?

• DOI: 10.5694/mja2.51799
• Publication Date: 2022-12-11T14:01:16Z
• Authors: Leanna Woods; Rebekah Eden; Oliver J Canfell; Kim‐Huong Nguyen; Tracy Comans; Clair Sullivan
• Keywords: Digital Health; Telehealth; Population Health; Investment

Focusing solely on financial measures is unlikely to deliver a comprehensive view of the value digital health Digital health, which refers use technology provide and support care services, promises strengthen systems worldwide has been accelerated by coronavirus disease 2019 (COVID-19) pandemic.1 Amid rapid transformation care,2, 3 sizeable investments remains unclear.3, 4 The required for are often substantial may come at cost existing delivery models. Decision makers can be paralysed situation where investment in unavoidable but conventionally measured short term outcomes do not convincing fiscal return investment.2, These quality safety benefits, despite being significant meaningful clinicians consumers, difficult cost, rarely benefit funder, traditionally evaluations. To maximise potential more sophisticated approach than simple monetary needs developed adopted. quadruple aim — better population outcomes, improved experience patients, work life professionals, reduced costs6 straightforward increasingly adopted evaluating improvement interventions care. In this perspective article, we show transform how so it valued. Using as streamlined, scalable framework quantify real-world impact transformations allows new level granularity that enables continuous clinically improvement. We present case study applying understand hospital-based EMR, delivering 65% all public across 16 hospitals Queensland, Australia. Criteria performance have evolved since world report 2000 initially identified three fundamental criteria measure systems: good ability respond consumers' expectations, fairness contribution.7 2001, Institute Medicine published consensus-based evaluate functioning safe, effective, patient-centred, timely, efficient equitable.8 Then 2008, Healthcare Improvement9 proposed pursuit triple aim: improving patient experience, reducing This was later challenged an article 2014 argued positive engagement workforce paramount achieving aim.6 fourth dimension added. workforce,10, 11 innovation implementation,12 COVID-19 pandemic13 contexts drive balanced scorecard projects, forcing funders look beyond traditional return. discourse 2022 include equity form quintuple aim.14 Recent systematic reviews highlighted multiple strategies assess inform future investments15, reported challenges due heterogenous, emerging uncertain nature impacts.15, 17, 18 A range models currently (Box 1). Information technologies (eg, computers) implemented decades, advances data they produce mobile virtual care, precision medicine) transforming Recouping costs from information medium large upfront expense limited efficiencies delivered term. business approach, many evaluation adopt, fails consider downstream effects connected ecosystem, technological such artificial intelligence, machine learning medicine. suggest no longer technical capability efficiency, rather critical enabler aim. With burden system continue service with static resourcing, ageing growing inequities, provides unrivalled opportunity improve scale. balances economic (input side) clinician (throughput) consumer (outputs).6 area solitary focus deployment resulted negative experiences and, some cases, harm.22 Investing careful consideration, advancements cause unanticipated consequences, creating divide,23 depersonalisation clinician–patient relationship,24 poor integration other systems,1, 24 increased workload.1 Modernising frame reference assessing impacts aligned modern underpinned Digitally mature services exploiting capabilities EMRs platform, technology. Investments controversial, disrupt usual ways working, create slower workflows, shown contribute frustration burnout.24, 25 Evidence supports EMR clinical decision systems, electronic medication management pathways care.15, 26 driven secondary routinely collected delivery, become important improvement.27 Traditional cases only horizon 1 (the implementation workflows), neglecting aggregated data, analytics develop over time.28 immediate easily measurable reduction printing costs).28 increase enabled digitally transformed realised horizons 2 3, captured cases. therefore adequately measuring real long clinicians, our community. study, also sought implementation. Economic individual places (from both subjective objective elements) or based (perceived actual) derive it. It accurately constructs elements. previously undertook literature review extract metrics methods implementations,28 mapped these then framework, adapting approaches sectors implementing process engagements including consultations stakeholders academia, government industry. incorporates additional elements yet market price definite value, whether negative, 3). includes items satisfaction, disruption learned practices. captures hypothesised benefits require testing confirmation savings primary after admission hospital). Additional will emerge time through improvements, evolving KPI = key indicators; QALY quality-adjusted life-years. Health organisations true implementations thus, prioritised given competing demands. modern, streamlined providing shifts away efficiency tool platform innovation. staff, consumers goes simplistic profit loss evaluations acknowledged measured. alone slow necessary unsustainable system. Clinicians should aware there way implementations. ensures that, addition productivity, non-financial centre inevitable thank Queensland staff their contribution work. Leanna Woods Oliver Canfell supported CRC, funded Commonwealth Government Cooperative Research Centres Program. funding source salary only, had input collection, analysis, interpretation reporting. Open access publishing facilitated University part Wiley - agreement via Council Australian Librarians. No relevant disclosures. Not commissioned; externally peer reviewed.