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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