Electronic Medical Records Are Spreading in Italy

Electronic Medical Records (EMRs) have been adopted by 15% of Italian healthcare organizations. It's a system that promises shorter times in the handling of patients, cost reductions, and improvements in organizational processes. In short, better performance and quality in the services supplied by Italian healthcare firms. To measure the incidence on performance of EMRs, an analytical model is needed which considers not only costs and benefits and financial indicators, but also the results of their implementation on various fronts. Such analysis was conducted by Maria Cucciniello and Greta Nasi of the Public Management and Policy Division of SDA Bocconi School of Management. The two researchers have designed a new model in order to assess the impact of EMRs. They have tested it on two Italian healthcare firms. It emerges from their analysis that EMRs tend to have the biggest impact on efficiency, along three dimensions: time savings, cost reductions, and better information quality.

The two firms considered differed in size and positioning: one was the Valle d'Aosta health agency, and the other the Legnano Civil Hospital. They also implemented information systems for the management of EMRs at different times. In Aosta, where the introduction was more recent, the advantage of EMRs in terms of efficiency is clearly signalled by the data. On a scale of 1 to 10, time savings attain a value of 7.8, while better quality of information and cost reduction were ranked 8.4 and 8.6, respectively. Timewise, according to the medical and nursing personnel interviewed, the advantages derive from the speed and ease with which medical data are now shared. Thanks to an EMR, it takes 70 minutes less to retrieve the medical history of a patient, while between 51 and 70 minutes are saved in diagnoses. Quality of information also increases thanks to EMRs, as users note with respect to its completeness and accuracy. On the front of cost reduction (the empirical result deemed to be the most significant), EMRs are effective thanks to the dematerialization of the old paper files and better information sharing, making the diagnostic process leaner and more effective. Other parameters considered in the research study were organizational efficacy, service quality and clinical governance, but presently they don't seem to benefit as much from the introduction of electronic records. As a whole, the index of organizational effectiveness stays at 4.9, while service quality and clinical governance are graded 3.2 and 3.5, respectively. "The latter results can be explained by the fact that this firm is still in the implementation phase," Maria Cucciniello explains. "The impact on these dimensions is not yet perceived by healthcare personnel, as it shows up in the longer term. But doctors and nurses also feel optimistic about improvements in this area." This is what the case of the Legnano Hospital seems to point out, since the new system of EMRs was introduced there earlier. Also in this case, the most striking impact is on efficiency (overall index of 5.9). However the results in terms of effectiveness (4.8), service quality (5.4), and clinical governance are higher than in the Aosta case. With respect to effectiveness, the advantages listed include the reduction of risks for the patient, the simplification of processes, and increased organizational effectiveness. Improvements in diagnosis, therapy and care were instead considered to be less evident. With respect to service quality, the variable of systemic performance reaches the high value of 8.3, since EMRs are perceived to enable a better continuity in service provision. Conversely, the value assigned to the possibility of EMRs positively affecting coordination between healthcare firms is low (1.1). Summing up, field testing of the SDA Bocconi model highlights the importance of time lags to assess the impact of EMRs. As Greta Nasi says: "When health care firms consider the effects of the introduction of EMRs, they expect an immediate return in terms of effectiveness. This however is misguided, since the new system needs to be interiorized by medical personnel first. The impact on organizational effectiveness and clinical governance can only be evaluated in the medium-long run. Healthcare organizations should continue to invest in such systems and avoid limiting their commitment to the initial phase."