Investigating the cost-effectiveness of health information technologies: a systematic review protocol

This study examines how selected British hospitals made the transition to electronic health records. The paper discusses how the hospitals planned and executed the transition. Pay special attention to the unexpected impacts of implementing new software.


Health systems globally face substantial challenges associated with, among other issues,rapidly changing demographic profiles (in particular, ageing populations and the reduced proportion of the population, ie, economically active), increasing numbers of people living with long-term conditions and associated spiralling healthcare costs, and the substantial, persistent variation in the quality and safety of care provision.

There is, in response to these challenges, considerable policy interest in the potential of health information technologies (HITs) to support fundamental and far-reaching transformations of health systems, but achieving change on the scale required is, as our recent work and that of others has clearly demonstrated, challenging, time-consuming and expensive. Policy makers are therefore increasingly facing major challenges. These include questions surrounding the justification of substantial investments in HIT, particularly in times of austerity and unprecedented cuts in public investment, and associated pressures to achieve returns on investment in the short to medium terms.

For example, as in many other parts of the world, the USA and the UK governments have already committed to making the transition from paper-based health systems to digital health economies. Substantial investments have thus been made through the Health Information Technology for Economic and Clinical Health (HITECH) Act in the USA and the National Programme for Information Technology (NPfIT) in the UK. These however represent first-wave investments in basic underpinning technologies and infrastructures associated with electronic health record (EHR) functionality. Very substantial subsequent investments will be needed in order to build on these infrastructures and utilise data held within them to redesign health systems.

Given these challenges, there is a pressing need to better understand issues relating to the cost-effectiveness of HITs and also to identify strategies of proven value in enhancing economic returns on investments in HITs. This systematic review builds on our recent systematic overviews of the evidence investigating the impact of HITs, and is the first step in a related phased programme of work investigating approaches to enhancing returns on investments in HITs.

Strengths and limitations of this study

  • We will systematically identify and critically appraise the available evidence and grey literature on this important policy question and identify research in progress.
  • The main limitations are those that are common to all systematic reviews, namely the possibility of failing to identify all relevant evidence and the need to ensure that the synthesis of evidence is appropriate and meaningful.