eHealth for the EconomyHow can the eHealth industry support the

transformation of healthcare systems

and enable their sustainability?

Eric Maurincomme

COCIR Board Member and Healthcare IT Committee Chair

Hospital Information Systems

Clinical Information Systems

Telemedicine

Electronic Health Records

Public Health Surveillance

Chronic Disease

Productivity for

Providers & Payers

Access for

Patients

Quality for

Citizens (and Consumers)

Basic Intermediate Advanced

Wellness & Welfare

eHealth deployment roadmap

Shared Infrastructure

Administrative IS

Clinical IS

•Significant progress in Europe

•BUT very fragmented

•Very often locally driven/procured, hence

not shared

•100% of hospitals have an administrative

information system in place

•Slow on-going replacement cycle to

modernize & extract intelligence

•60+% of hospitals have Clinical

Information Systems (CIS) in place

•BUT 60+% still rely on paper as their

main media to manage patient records

•Even when CIS is available, effective use

is lagging behind

Where are we now in Europe?

Source: COCIR (2008, 2009)

Maturity levels of HIT in EU hospitals

D F UK IT SP

Admin. IS 99% 90% 100% 90% 99%

Radiology

IS

70% 30% 95% 60% 60%

Laboratory

IS

80% 100% 100% 90% 80%

Operating

theater IS

70% 35% 85% 20% 40%

CPOE 10% 5% 45% 10% 10%

EPR 80% 35% 5% 70% 60%

Decision

Support IS

<1% <1% <1% <1% <1%

Installed base in % (2009)

Source: COCIR (2008, 2009) based on dii (2008)

NHS in

Scotland*

DHSS*

NHSin

Wales*

* Devolvedresponsibility

NHS in England

NHS in

Scotland*

DHSS*

NHSin

Wales*

* Devolvedresponsibility

NHS in England

Enhanced turnaround handling all traumas/ER patient in max 25’ and conducting all studies 52’ (Meg Richman from UCSD Thornton Hospital / USA)

Faster reporting time for preliminary report of 3.43 days for conventional workflow and less than 0.5 day digital and for

the final report from 5.49 days in conventional to 1.45 days in digital (Agfa HealthCare)

Improving care outcomes: in 43% of the cases, the lack of old images surely (38%) or possibly (6%) has an effect on

diagnostic or treatment outcome (Gur, D, Straub, W.H., Lieberman, R.H. & Gennari, R.C.)

Saving lives by reducing the time between image creation and clinical patient action by 30% in intensive care (Gur, D, Straub,

W.H., Lieberman, R.H. & Gennari, R.C.)

Un–Hang Films

& Attach Report

Patient

Registered Exam PerformedPatient Data

Re–Entered

at Acq Device

Previous

Exams

hung in

Reading

Room

GEYMS

CT

Return Films

to File RoomRe–assemble

Film Jacket

Send Films &

Report to Referring

Physician

Retrieve Films &

Report to Referring

Physician

Radiologist Read

Dictate & Approve

Develop

FilmQuality

Assurance

Hang

Films

Example: Imaging IT for sustainability Decreased films, Increased efficiency, Improved quality and safety

Exam PerformedPatient

Registered

GEYMS

CT

Radiologist Read

Dictate & Approve

Referring Physician

Accesses Report

and Films

Without PACS With PACS

Many steps…room for error Reduced time to intervention saving life

Successful HealthCare Transformation - Radiology

• Radiology film market decline

• Radiology IT orders reflect contracts awarding wave

• Sustained investment, delivering: • patient safety,

• improved efficiency,

• image access.

0

10,000,000

20,000,000

30,000,000

40,000,000

50,000,000

60,000,000

2008E2007200620052004200320022001

Screen & hardcopy film market (in GBP)

0

20

40

60

80

100

120

140

160

2001 2002 2003 2004 2005 2006 2007 2008

COCIR Radiology IT Orders (in M€)*

0

20

40

60

80

100

120

2005 2006 2007 2008

COCIR Radiology IT Sales (in M€)*

Sources: COCIR (* COCIR vendors represents 70% of UK/Ireland market

Film market from UK Photo Imaging Council (PIC - MIC), no reproduction unless by prior agreement by Agfa HealthCare

France 6%

Spain 1%

Italy 2%

Netherlands 5%

8%Germany

0%Denmark

3%Norway

1%Sweden

WesternEU-8

5%

Microfiche

12%

24%

17%

31%

25%

37%

37%

44%

19%

Computeras main mediafor patient record

12%

15%

9%

21%

14%

25%

18%

28%

13%

Scanned/Digitized

70%

60%

72%

43%

53%

38%

42%

28%

63%

Paper-based as main mediafor patient record

Clinical Adoption - critical for success

Clinical Information Systems:

next challenge for Europe

• Hospital IT market of 2.4B€ -offering a 4% growth prospect

• CIS market* of 735M€ in 2008 -contained 5% growth prospect

• Investment in Clinical Information Systems (CIS) extremely low - in comparison to Hospital Administrative Information Systems – with higher complexity

* Clinical Information Systems exclude « service » departments such as Radiology and Laboratory

Market

size'08

CAGR

(08-12)

Hospital IT 2400 4%

Admin. IS 900 2%

Clinical IS 735 5%

Laboratory IS 220 3%

Imaging IT 550 4%

NOT enough to enable “clinical” transformation

Market size (revenues-based) in million€

Source: COCIR (2008, 2009)

And then? expanding to Telehealth

• Telehealth market is currently a tiny part (<1%) of the overall EU eHealth market - worth 21 B€

• Barriers continues to hinder its introduction or prevent from achieving optimal benefits. • No vision, no sustainable funding

• Fragmented governance, missing incentives & lack of new business models for “continuum of care”

• Many “isolated” pilots projects, not scalable enough

• Lack of IT standards and issues on interoperability

• Lack of trust & confidence in maturity and positive results

• Lack of legal certainty with unclear legal responsibilities, different regulations within EU states

Telehealth mainstream adoption will not happen overnight but policy makers can shorten the implementation of

“eHealth” vision and common goals.

Time to act is NOW!

Source: Gartner (2009); IPTS (2009); COCIR (2009, 2010)

Gartner hype-cycle for Telehealth

1. Define a vision2. Overcome governance fragmentation3.Develop innovative economic model4. Build trust5. Support citizen/patient empowerment6.Foster standards and interoperability7. Achieve legal certainty8.Enable market development9. Strengthen international position10.Stimulate innovation

10 Interlinked Actions for eHealth

Appendix

The Gartner Generational model

Source: Freely adapted from Gartner

48

20

40

60

Red

uctio

n o

f P

reve

nta

ble

Err

ors 80

100

1995 2005 2010 2015 …

Generation 1:

The Collector

Generation 2:

The Documentor

Generation 3:

The Helper

Generation 4:

The Colleague

Generation 5:

The Mentor

year

• Generation 5: High impact of

chronic diseases necessitates

better population and disease

management

• Generation 4: Workflows and

inter-professional collaboration

driving evolution towards Regional

electronic patient records

• Generation 3: New imperatives –

costs, quality & safety – driving

demand for enterprise-wide

solutions

• Generation 2: Integrated imaging

and data reporting expanding to

other clinicals

• Generation 1: Image collection at

departmental level

PACS, RIS

PACS & RIS & Image Distribution

Enterprise RIS/PACS/IDC

Enterprise HIS/CIS

Regional Health

National & preventive

eHealth infrastructure

Five steps for eHealth sustainability

Acceptance

Clinical

Outcomes

Healthcare

Cost

Compliance improvements

Morbidity and mortality reduction

Better Health-related Quality of Life

Direct cost reductions: Hospitalisation,

emergency incidents, GP visits, medication, etc.

Patient usage of service and satisfaction

Physician acceptance of new service

A large number of studies and trials have proven the various

positive outcomes of Telehealth enabled Healthcare.

How to build confidence in and acceptance of

TeleHealth services?

1. European Commission and Member States to establish an appropriate legal framework with effective transposition at country level

2. Strengthen cooperation between healthcare stakeholders around “best practice health strategies” supporting telehealth adoption in routine clinical practice

3. Finance more and sustainable large scale projects with health economic evaluation to assess the impact of telehealth solutions

4. Integrate telehealth into existing care delivery structures and ensure interoperability of telehealth solutions

5. Establish sustainable economic model for telehealth by starting dialogue between healthcare stakeholders

COCIR’s Call for Action to promote

the further deployment of Telehealth