Email updates

Keep up to date with the latest news and content from BMC Health Services Research and BioMed Central.

Open Access Study protocol

Protocol for evaluation of the cost-effectiveness of ePrescribing systems and candidate prototype for other related health information technologies

Richard J Lilford1*, Alan J Girling2, Aziz Sheikh34, Jamie J Coleman2, Peter J Chilton2, Samantha L Burn2, David J Jenkinson1, Laurence Blake2 and Karla Hemming2

Author Affiliations

1 Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK

2 College of Medical and Dental Sciences, University of Birmingham, Edgbaston, West Midlands B15 2TT, UK

3 eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh EH8 9AD, UK

4 Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital/Harvard Medical School, Boston, MA 02115, USA

For all author emails, please log on.

BMC Health Services Research 2014, 14:314  doi:10.1186/1472-6963-14-314

Published: 19 July 2014



This protocol concerns the assessment of cost-effectiveness of hospital health information technology (HIT) in four hospitals. Two of these hospitals are acquiring ePrescribing systems incorporating extensive decision support, while the other two will implement systems incorporating more basic clinical algorithms. Implementation of an ePrescribing system will have diffuse effects over myriad clinical processes, so the protocol has to deal with a large amount of information collected at various ‘levels’ across the system.


The method we propose is use of Bayesian ideas as a philosophical guide.

Assessment of cost-effectiveness requires a number of parameters in order to measure incremental cost utility or benefit – the effectiveness of the intervention in reducing frequency of preventable adverse events; utilities for these adverse events; costs of HIT systems; and cost consequences of adverse events averted. There is no single end-point that adequately and unproblematically captures the effectiveness of the intervention; we therefore plan to observe changes in error rates and adverse events in four error categories (death, permanent disability, moderate disability, minimal effect). For each category we will elicit and pool subjective probability densities from experts for reductions in adverse events, resulting from deployment of the intervention in a hospital with extensive decision support. The experts will have been briefed with quantitative and qualitative data from the study and external data sources prior to elicitation. Following this, there will be a process of deliberative dialogues so that experts can “re-calibrate” their subjective probability estimates. The consolidated densities assembled from the repeat elicitation exercise will then be used to populate a health economic model, along with salient utilities. The credible limits from these densities can define thresholds for sensitivity analyses.


The protocol we present here was designed for evaluation of ePrescribing systems. However, the methodology we propose could be used whenever research cannot provide a direct and unbiased measure of comparative effectiveness.

ePrescribing; Health information technology; Cost-effectiveness; Adverse events; Bayesian elicitation; Probability densities