How to measure ROI and the benefits of health technology
Improved clinician and patient experience is the cherry on top
At the recent Digital Health Summer School we hosted a workshop on how to measure the return on investment (ROI) of health technology. The session was well attended with a good cross section of people, particularly with the increased presence of nursing and midwifery.
As well as myself and Andy Wilcox, our Sr. Solutions Marketing Manager, we were joined by Shauna McMahon, Group Chief Information Officer, SIRO, and Martin Sykes, Chief Nursing & AHP Information Officer, both from North Lincolnshire & Goole NHS Foundation Trust.
Everyone wants ROI but where do you start?
The first point to make is that while the classic way to report on ROI is to look at the numbers – money saved, or costs avoided – there are no national guidelines as to what constitutes ROI and how to measure it.
Here are some observations and reflections inspired by the session.
Why track ROI?
Over and above money saved or costs avoided, the ultimate goal of any health IT project is to provide value to the patient care process. This can be for the benefit of the patient or the clinician, but ideally both. Attempting to measure ROI will help to identify what the clinical value is and where in the patient’s journey it is being delivered. A key step is to define what success looks like for each IT project, and another critical step is to ensure that expectations, from the frontline to the board, are managed accordingly. Everyone needs to know what a successful project will deliver.
What is ROI and who is it for?
As already mentioned traditional ROI is viewed in financial terms. However, there comes a time when you simply can’t save any more money or avoid costs without the risk or incurring larger costs at a later date sometimes referred to as the “costs of doing nothing”. (For example, cutting back on the maintenance of equipment may save costs now, but could result in much higher repair or even replacement costs at a later date).
As well as helping to define the success of a project, ROI can also provide the metrics to inform and drive change management. By benchmarking and identifying value to the clinical process ROI can guide the project team in terms of priorities and timescales. In this way ROI can help to maximise investment by optimising solutions ensuring that the absolute best value is achieved.
An alternative or complementary angle is to establish additional metrics that measure time available to ‘return to care’, where clinicians involved in a project need to take time out from caring. Any actions requested of staff should also have a ‘return to value’, this could be, for example, a change to a clinical workflow.
This might be seen in automating the population of a patient’s vitals data into an Electronic Medical Record who are being continuously monitored with telemetry instead of staff manually transcribing, validating, and accounting each set of vitals. Another example could be the deployment of Virtual Desktop Infrastructure (VDI) to all frontline clinicians in an acute care organisation presenting staff on login with data from their prior location and patient.
Both of these examples appear to deliver high value, but in reality, the digitisation of these workflows can also detract from their intended value by creating unnecessary work and increased risk. In the example of auto population of patient vitals, the unintended effect could be the introduction of erroneous data into a patient’s health record at one end of the spectrum and then at the other, result in missed abnormalities and early detection of a deteriorating patient’s condition.
In the case of VDI the clinical ROI may be eroded with the risk and workload of clinicians repeatedly being presented with screens from a clinician’s prior login and location that is not useful to all staff and roles. A holistic approach to ROI that considers the benefit and risk to the patient and their journey of care, with the impact on clinicians is warranted in addition to traditional financial concepts of ROI. This not only informs procurement but informs success of implementation and optimisation of investment in Health IT
Should ROI in healthcare be broader?
All this begs a further question that maybe ROI as a measure of the success of a project should be broadened to cover softer, less easier to quantify benefits. These could include
- Lessening the cognitive load on clinicians (the constant requirement to be logging in and out, and reauthenticating for every clinical application for each patient), giving full attention back to the patient
- Easier access to patient data making it easier for the clinician to absorb more data on which to base clinical decisions, potentially leading to better patient outcomes
- Increasing cyber security, so lessening the chance of a cyber attack that could compromise sensitive patient information and cause serious disruption to clinical services
- Increased compliance with data privacy regulations. Data breaches can result in untold distress on patients, as well as loss of confidence in the healthcare organisation.
Benefits of approaching ROI from multiple viewpoints
Imprivata takes a multidisciplinary team approach to any projects for our customers. The unique capability of having a clinical team with a product marketing analyst means that clinical insights are combined with product and backend metrics. This means that ROI information can be presented to different audiences in a way that provides them with the value they need. For example, senior leadership/board level need the cold hard financials, whereas clinical leadership are perhaps more interested in how clinical workflows are affected, time saved for clinicians and patient outcomes.
By understanding the problems to be solved, and defining in advance what success looks like, the team is far more likely to achieve that success, and be able to communicate that success to key stakeholders.
In a world where the clinical safety of health IT systems is still being established, innovation is needed to identify and understand risks from different angles, articulate the benefits and benchmark best practice so that new technologies can be evaluated and their value to patient care assessed. By widening the definition of ROI to include less tangible but arguably more important improvements to the clinician workload and patient experience, we could help to achieve better outcomes for everyone, its currently the cherry on top but needs to become the norm.