Science and health informatics, what is the evidence on cost efficiency?

Apologies for the delayed posting, as I have been away at a health informatics conference in the USA (alas I didn’t win the mega-millions lottery as some may have begun to suspect).

The conference presented a number of interesting papers. An interesting theme (apart from the use of Prezi as an alternative to PowerPoint by the hippest and coolest presenters; something I still don’t quite get, as apart from zooming in and out it doesn’t seem to actually offer anything new, call me an old tusker, but there you go), was the massive expenditure on a variety of health-information projects across the USA and elsewhere in the economically developed world.

Fundamentally these projects are working towards establishing electronic health records (EHR), electronic medical records (EMR), and health information transfer/exchange (HIT/E) and interoperability.  The goals of these projects are certainly worthy, and usually include establishing national electronic health record/information exchange and transfer, reducing administrative workload and improving patient safety and health outcomes. On patient safety, there are plenty of horror stories of nursing and medical errors due to poor communication killing people under medical care (e.g. the Josie King case), and any systems that can improve this aspect of health would seem a good area to invest research dollars.

My question is though, is this multi-billion dollar (literally) investment in health care really the best use of our very limited health care and research budgets? The evidence for cost-efficiency is remarkably spares. There is good evidence that investment in health informatics can improve outcomes (typically in the order of 4-8%) but virtually none on how efficient this is compared to expenditure on other healthcare interventions (such as tackling chronic diabetes, heart disease, stroke, mental health issues or even obesity). As a segment of health expenditure it seems to represent a huge and expanding area where the benefits are very specifically only to the country involved. There is rarely some international work.

So this raises the age-old question, why does scientific enquiry still tend to focus on areas that are politically attractive, or result in outcomes that are not widely generalizable to other contexts. That is not to say this isn’t important work, but the ratio of expenditure to results in this field to date does seem highly questionable, compared with to other areas of scientific endeavour. Particularly when you consider the cost of this compared to that spent on fighting malaria. Food for thought.