The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview

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Impact of eHealth on the quality and safety of Health Care is a big topic internationally, particularly in the industrialized countries with massive amounts of money committed to its implementation (as an example, Obama administration has committed $38B in eHealth investment initiative and countries like UK are not far behind). While it is generally assumed that the impact of eHealth implementation is very positive, not much evidence is available to support this according to the authors as they set out to validate the tall claims by taking a systematic approach to classifying and assessing both effectiveness and consequences of eHealth technology implementation.


In 2005, the World Health Assembly passed an eHealth resolution calling the member countries to invest in developing and implementing eHealth technologies.The major components of this eHealth initiative that demand large investments are Electronic Health records (EHR), Picture Archiving and Communication Systems (PACS), Computerized Physician Order Entry CPOE) systems including ePrescribing and Computerized Clinical Decision Support Systems (CDSS). Despite widespread acceptance of this initiative and perceived benefits internationally, evidence on the advantages (improved quality and patient safety) of eHealth implementation has not been established with a scientific basis and that is exactly why the authors have taken up a systematic study to inform the international community of their scientific findings.


eHealth implementation is a vast initiative and in order to study this, categorizing and boxing sub systems is a necessary first step. Understanding this, the authors first created three logical categories and grouped key eHealth functionality under those as follows to make their study and interpretation of results easy.

Category-I (data storage, management and retrieval systems): candidates - EHR and PACS systems

Category-II (clinical decision making support systems): candidates - CPOE and ePrescribing systems

Category-III: (systems that facilitate remote care) candidates - Clinical and Demographic patient information systems

The authors then determined that their approach would be narrative and qualitative rather than objective and quantitative by choosing the following evaluation methods.

  • Systematic review methodology (developed by Cochrane collaboration)
  • Evidence synthesis ( developed by UK National Health Service).

The authors then categorized their study under two major themes and summarized their key findings under those:

  • Primary Evidence of benefits associated with identified systems:
  • Primary Evidence of risks associated with identified systems:


As the authors point out, evidence doesn’t support the common understanding that eHealth initiatives implementation will contribute greatly to quality and safety of health care but there is tremendous scope for improvement.

A few examples are presented below to give the reader a better understanding of the approach chosen and findings recorded by the authors.

Primary Evidence of benefits associated with EHR systems: Time efficiency and data quality for administrators

Primary Evidence of risks associated with EHR systems: Security concerns, Weak evidence base (lack of quantity, quality, consistency)

Primary evidence of benefits associated with CPOE systems: Time efficiency and organizational savings during order transmission (not necessarily when results were acted upon)

Primary evidence of risks associated with CPOE systems: Time taken by Physicians to complete the orders by entering them in the computer, workflow incompatibility across systems.

Primary evidence of benefits associated with CDSS systems:multifaceted approach to the identification of systematic reviews and the synthesis of this body of evidence.

Primary evidence of risks associated with CDSS systems: Outcome measures and analysis published research is of poor quality

Opinion Summary

Evaluating eHealth initiative implementation is first and foremost a very challenging initiative and the authors have taken the bold step to categorize the various initiatives under eHealth and to use approaches and review methods to qualify (not quantify) their assessment to either support and substantiate the commonly held view that the eHealth implementation would lead to great benefits in the quality and patient safety areas or Not. In my opinion, this is a substantial undertaking to expose certain myths but putting it in a positive tone for others to take a close look at and appreciate.[1]


  1. Black, A., Car, J., Pagliari, C., Anandan, C., Cresswell, K., Bokun, T., ... Sheikh, A. (2011, January 18). The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview. Retrieved February 22, 2015, from