The Impact of Expert Systems on Health Care: Economic Considerations, Slides of Public Health

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THE IMPACTS OF EXPERT SYSTEMS ON HEALTH

CARE:

ECONOMIC CONSIDERATIONS

“It is necessary to use electronic extensions o

f the

human memory and analytic capacity at the time ofaction, just as we need X-rays to extend human eye”

(Larry Weed)

Telemedicine

• Aids to decision-making(remote expert systems)• Remote sensing(eg. transmittal of patient info from remote siteto a collaborator in a distant site,teleconferences)• Collaborative arrangements(real-time management of patients)

Premise to the ongoing exponential rise in low-cost

computing power

• Development of telecommunications^ 

not only data can be exchanged rapidly, but

complex systems can be run remotely• Development of large knowledge bases

Answer?

A.^

• Physicians recalled only 50% of patient info 5 min after theappointment; -^

60% of physicians surveyed did not know the names of their patients’drugs;

-^

20% did not recall the purpose of the patients’ medication

(M.J. Ball, J.

Lillis, 2000) B. 180,000 patients die each year as a result of medical error

(M.J. Ball, J. Lillis,

C. 1.3 mln. Injuries may occur in the U.S. annually during hospitalization;

of them 20-70% may be preventable

(D.W. Bates et al., 1998)

Aids to decision-making

****************************************** Softwares designed to assist physicians withmedical knowledge pertinent to patient care ******************************************• Expert Systems • Clinical Decision Support Systems (CDSS) • Computer-based Patient Record (CPR) • Computerized Physician Order Entrysystems (POE)

Effects of expert systems

• Impact on quality of health care• Economic impact• Impact on medical education• Other impacts

Impact on quality of health care

• CDSS can enhance clinical performance for drugprescribing, drug dosing, preventive care

(D.L. Hunt, 1998)

• Using CDSS helped medication errors to decrease by 55%,from 10.7 events per 1,000 patient-days to 4.86 events per1,000 p-d. Dose errors decreased 23%, known allergies fell56%, drug-drug interaction errors fell 40%

(D.W. Bates, 1998)

Economic impact (cont’d)

How much does it cost to put CDSS into operation?

• Scale of initiative• Size of institution***********************************Eg.^

$700,000/yr. to implement+maintain

CDSS.ROI?

Cost savings from the intervention~$250,000 in the 1

st^ yr.

Overall savings -$5-10 mln./yr

Impact on medical education: help or hinder?CDSS cannot be considered an educational tool !!!

---

• Critiquing systems are more effective than reminding• High physicians compliance during CDSS trials (82.8% - 94.9%). But:Removal of CDSS



physicians revert to previous practicing behavior

Actual effects of expert system on health care1.Utilization of medical services2.Need in labor force3.Patient welfare4.Price for services and hospital expenditures5.Insurance premiums6.Impact on welfare loss

1. Decrease in utilization of med. Services (Q )

• Decrease in average length of stayTierney et al (1993) found that implementation of a POE systemon a medical service resulted in a reduction in the average length-of-stay days by 0.89 days and a 12.7% reduction in charges.• Avoidance of use of superfluous diagnostic tools due to utilizationof targeted diagnostic techniques and more rational differentialdiagnosis

3. Patients’ welfare
   • Increased patients’ satisfaction

• Increased utilization of medical services

• Better general health status of population

• Increased physician utilitydocsity.com

4. Prices for services + hospital expenditures

Decrease in utilization of medical services, and

Decrease in need in labor force Decrease in price for health services – P