A general framework for predictive economic evaluation of computerized hospital information systems and an application to a British Columbia hospital

Hospital decision-makers face several uncertainties during evaluation and selection of computerized hospital information systems. Cost-benefit analysis is one method of predictive economic evaluation and is particularly important from the perspective of the hospital. Unless hospitals can economically justify such systems, it makes little sense to pursue them unless there are over-riding political or qualitative reasons. This thesis discusses the principles of cost-benefit analysis and a general framework for such analysis from the perspective of the hospital, in order to answer the question of whether a proposed hospital information system is justifiable on cost-benefit grounds relative to the status quo method of handling information. Three dominant approaches to planning for such systems in British Columbia and Ministry of Health funding guidelines and policies are discussed in relation to the framework. An application of the framework is made to a community general hospital in British Columbia using actual data obtained during the complete planning process for a proposed system. The analysis demonstrates that over the expected duration of the project, the sample hospital will experience net costs, as opposed to net savings for the proposed system, even if all one-time capital costs are funded by others. It is unlikely that this finding is unique to this single hospital; thus, there are broader implications for other hospitals considering such systems, especially in the face of recently published expenditure limits and priorities in British Columbia.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat