The European eBusiness Watch is an observatory on IT and eBusiness use that was funded by the European Commission, Enterprise and Industry Directorate General in 2001. In 2006, eBusiness Watch included hospital activities as one of 10 economic industries. The other sectors were: food and beverages, footwear, pulp and paper, information and communications technology (ICT) manufacturing, consumer electronics, shipbuilding, construction, tourism and telecommunication services. In a European-wide survey, IT managers of acute care hospitals were interviewed. The figures presented in the following refer to 539 hospitals in 10 EU Member States: the Czech Republic, Finland, France, Germany, Hungary, Italy, the Netherlands, Poland, Spain and the UK.
The survey found that hospitals are, in general, quite advanced in ICT and eBusiness use compared with the other sectors. Hospitals are relatively strong in eProcurement: 59% purchase goods online, compared with 45% of firms in all 10 sectors. However, hospitals are relatively weak in allowing patients to book services online (10% versus 25% of firms in all sectors selling goods online). Furthermore, the survey found that almost all hospitals (83%) have a patient administration system, but only a minority has more advanced systems such as picture archiving and communication systems (PACS) (25%) and computerised physician order entry (CPOE) (19%).
The eBusiness Watch questionnaire also included questions about the perceived influence of IT use in hospitals. The interviewees could state whether there was a positive or negative influence, or no influence at all. The percentage of interviewees reporting negative impacts was very small for each item (see Figure 1).
The most important positive influence was identified for internal work organisation (73% of the interviewees stated a positive impact), business process efficiency (69%) and productivity (59%). These items can be grouped under the term “streamlining”. This result can be interpreted in the way that many hospitals have been successful in cost-containment by using IT. There was also a considerable percentage of interviewees stating positive impacts on quality of patient care (45%) and product or service quality (38%). However, these objectives appear to have been achieved to a smaller extent than streamlining. More than one-third (37%) of hospitals reported positive IT impacts on procurement costs. The least important influence appears to have been on revenue growth (28%). This may be related to the fact that the number of potential patients is limited and the revenues are largely subject to state regulation.
The interviewees were also asked about several possible future impacts of ICT. They expected high impacts, particularly on administration and accounting (48%), as well as management and controlling (47%) (see Figure 2). As regards accounting, a possible interpretation is that ICT can improve the availability and systematisation of cost data from different medical departments. Such data are today quite scattered and unsystematic. The increasing importance of disease-related groups makes the streamlining of the accounting system a necessity.
The high predicted impact on management may be related to the fact that hospitals are often complex organisations with many medical departments. Hospital information systems that enable and require the sharing of data across medical departments may lead to a shift of power from the departments to central management. It may also be that more comprehensive and detailed cost data, provided by IT, enable improved planning and tighter controlling.
A considerable share of the interviewees (31%) said that they expect high impacts of IT on patient care. This may indicate that hospitals are aware that current IT applications are not much oriented towards patients and citizens. The share of interviewees attributing a high influence on logistics was also 31%. IT impacts on other preformulated items in the future were assessed as less important but still as worthy: marketing (26% “high impact”), research and development (R&D) (25%) and production (19%).
Finally, findings from literature, interviews and case studies suggest that the role of hospitals is changing incrementally in the course of increased IT use. While hospitals’ information systems can rarely be accessed by other health service providers or patients, this may change in the future. The relationship with patients and the need for inpatient care in particular may be strongly affected. The boundaries of the hospital are becoming increasingly permeable due to IT; the role of the hospital is slowly shifting, from an inhouse care provider service to an outbound communicator one.
All in all, the findings show that IT has had and will continue to have considerable impact on hospitals. Health and eBusiness policymakers should develop a clear concept for the future of eBusiness in hospitals. They should continue or strengthen the monitoring and analysis of related activities and progress in order to drive the desired developments and to react proactively to unwanted developments if need be.
European Commission, Enterprise and Industry Directorate General: ICT and e-Business in Hospital Activities. Sector Impact Study No. 10/2006. Final Report. January 2007
e-Business Watch report W: www.ebusiness-watch.org