Beyond Direct Savings: Administrative Productivity, Dual Workflows and Risk-Adjusted Assessment of Healthcare Digitalization in Kazakhstan
This study of a Kazakhstani university hospital reveals that while healthcare digitalization significantly boosted administrative productivity, it failed to generate immediate direct budgetary savings due to a dual-workflow effect where digital and paper-based processes coexisted, resulting in a conditional ROI that turns negative under risk-adjusted scenarios.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In the modern world, hospitals are increasingly trying to replace paper files with digital screens, hoping that this shift will save money and make doctors and nurses work faster. This idea rests on a simple logic: if a computer can find a patient's history in seconds, staff members spend less time searching for folders, and the hospital saves the cost of paper, ink, and storage space. For years, this promise has driven governments and health systems to invest billions in new software and electronic records. However, the reality of changing how a large organization works is rarely a straight line. When a hospital switches to digital tools, it often does not simply delete the old paper system; instead, it frequently ends up running both systems at the same time. This creates a complex situation where the hospital pays for new technology while still paying for the old paper processes, making it difficult to tell if the investment is actually saving money or just adding new costs on top of the old ones.
A team of researchers in Kazakhstan set out to untangle this confusion by looking closely at a single university hospital over a seven-year period. They examined the University Hospital of Semey Medical University, a large facility that treats thousands of patients, runs a medical school, and handles complex surgeries. The researchers wanted to see what really happened to the hospital's budget and its staff's daily work after they expanded their use of digital systems. They did not just ask if the computers were faster; they looked at the actual bank statements, the number of patients treated, and the specific costs of running the digital systems versus the paper ones. Their goal was to separate the visible changes in how much work the staff could do from the invisible changes in how much money the hospital actually saved.
The study found that the digital expansion did make the hospital more productive in a very tangible way. By 2025, the hospital was treating significantly more patients than it did in 2019, with the number of people receiving care rising from about 16,500 to over 20,000. At the same time, the number of administrative staff members—the people who handle paperwork, registrations, and records—actually decreased. As a result, each administrative employee was managing a much larger workload, handling roughly 670 treated cases by the end of the period, up from about 460 at the start. This suggests that the digital tools helped the staff process more information and handle more patients without needing to hire more people. The hospital was clearly doing more work with the same, or even fewer, human resources.
However, when the researchers looked at the hospital's bank accounts, they found a surprising twist that contradicts the usual story of digital savings. Despite the increase in efficiency and the rise in the number of patients, the hospital did not see its costs for administration, filing, or paper go down. In fact, these costs went up. The hospital spent more money on archives, more on registry work, and more on paper-based document flows than it did before the digital systems were expanded. The total cost of owning and running the digital systems, which included software, equipment, technical support, and training, added up to 182.6 million Kazakhstani tenge over the seven years. The data showed that the hospital was not replacing the paper system with the digital one; it was running both side by side. This "dual workflow" meant that staff were entering data into computers while still printing, signing, and storing physical copies, effectively paying for two systems instead of one.
Because the hospital was paying for both systems, the researchers could not claim that the digital investment had directly saved money in the traditional sense. Instead, they calculated what the value of the staff's saved time would have been if that time had been converted into cash. Based on their models, the time saved by using digital tools was worth an estimated 240.1 million tenge. If this were real cash in the bank, it would have meant a clear profit. But the researchers were careful to explain that this was a simulation, a way of measuring potential value rather than a record of actual savings. When they adjusted their calculations to account for the risks of the dual workflow—where the paper system was never fully turned off—the picture changed. In these more realistic scenarios, the potential profit disappeared, and the investment could even be seen as a financial loss.
The study concludes that the success of digital health projects cannot be measured simply by counting how many computers are installed or how many patients are treated. In this specific hospital, the digital tools helped the staff work faster and handle more cases, but they did not immediately reduce the bill for paper and filing because the old ways of working were never fully abandoned. The researchers suggest that for digital investments to truly pay off, hospitals must do more than just buy new software; they must actively redesign their processes to ensure the new digital systems replace the old paper ones completely. Until that happens, hospitals may find themselves in a transitional phase where they are more productive but also more expensive, paying for the benefits of the future while still carrying the costs of the past.
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