The Impact of eHealth on the Quality and Safety of Healthcare - An updated systematic overview & synthesis of the literature: Final report for the NHS Connecting for Health Evaluation Programme (NHS CFHEP 001)

• Increasing life expectancy, improved survival in people with acute and long-term conditions and a greater array of available treatment options are combining to place an increasing burden on healthcare systems internationally.
• This picture is particularly true of the economically developed world where high salaries for healthcare professionals and ever-increasing public expectations contribute to the challenges facing governments trying to contain spending on healthcare provision and planning. Similar pressures are also emerging in economic transition and developing countries.
• There is now a substantial body of research, both domestic and international, identifying considerable shortcomings in the current provision of healthcare.
• Key issues emerging from this literature are substantial variations in the quality of healthcare, the considerable risks of iatrogenic harm and inefficiencies in healthcare provision; this latter issue has become a particularly acute cause for concern in the light of the economic downturn and the resulting pressures on healthcare budgets.
• These failings contribute in a major way to the high rates of potentially avoidable morbidity, mortality and healthcare expenditure.
• There have been substantial developments in information technology (IT), hardware and software capabilities over recent decades and there is now considerable potential to apply these technological developments in relation to aspects of healthcare provision (the application of IT in this way will henceforth in this report be referred to by the term “eHealth”).
• Of particular international interest is the development and deployment of an array of eHealth applications, with a view to improving the quality, safety and efficiency of healthcare delivery.
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• Whilst these eHealth applications have considerable potential to aid professionals in delivering healthcare and patients in self-management, it is not widely appreciated that use of these new technologies may also introduce significant new risks to patients.
• Also of concern is that even when potentially useful interventions are developed and deployed, they frequently fail to live up to their potential when deployed in the “real world”; a major factor contributing to this paradox is the failure of these technological fixes to integrate effectively with existing work patterns or to be adequately conceptualised as a change management reform which can then be used to reshape delivery of care.
• Given that England’s National Health Service (NHS) is engaged in one of the largest eHealth-based modernisation programmes in the world, it is appropriate and timely to critically review the international eHealth literature with a view to identifying lessons that can usefully be learned with respect to the development, design, deployment, integration and evaluation of eHealth applications.