The eHealth Landscape
Veronique Lessens / Dirk De Langhe
Agfa HealthCare, Market Intelligence
Healthcare trends
3
World population is growing expanding the number of “health” consumers
Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat,
World Population Prospects: The 2004 Revision and World Urbanization Prospects: The 2003 Revision
9,075,9032050
8,907,4172045
8,701,3192040
8,463,2652035
8,199,1042030
7,905,2392025
7,577,8892020
7,219,4312015
6,842,9232010
Population
(in thousands)Year
Population(in billions)
World
Asia
Africa
Latin Am.& Car.
Europe
Northern Am.
4
World population is ageing, especially in developed countries
World
population
is ageing
Global
Explosion of
over 60
years -olds
Ageing is
especially
pronounced
in Europe
x
Source: Long-Range World Population Projections: Based on the 1998 Revision. The Population Division,
Department of Economic and Social Affairs, United Nations Secretariat; US Census Bureau
1 0 %
1 5 %
2 0 %
2 5 %
3 0 %
0 %
5 %
E u ro p e N o rth A m e r ic a A s ia La tin A m e r icaP e rce n t 6 0 y e a rs a n d o ld e r , 2 0 3 0 p ro je c t io n
1 0 %
1 5 %
2 0 %
2 5 %
3 0 %
0 %
5 %
E u ro p e N o rth A m e r ic a A s ia La tin A m e r icaP e rce n t 6 0 y e a rs a n d o ld e r , 2 0 3 0 p ro je c t io n
6.98.1
10
22.1
28.1
0.0
5.0
10.0
15.0
20.0
25.0
30.0
1900 1950 2000 2050 2100
Pe
rce
nta
ge
60
ye
ars
or
old
er
5
Changing patterns of diseases: 60% of all deaths are due to chronic diseases
• 35.000.000 people died from chronic diseases in 2005 in the world.
• The highest chronic diseases prevalence are for:
• Cardiovascular disease, mainly heart disease, stroke
• Cancer
• Chronic respiratory diseases
• Diabetes
• Without actions to address the causes, deaths from chronic diseases will increase by 17% over the next 10 years.
• In the USA, 85% of all hospital costs and 69% of all physician costs go to treat chronic diseases
Source: WHO (2006)
6
Number of procedures increases with age putting pressures on HC expenditures
Number of
procedures
increases
with age
putting
pressures
on HC
expenditures
Ageing
Population is
consuming
more
healthcare
and
diagnostic
services
!Medical advancements result in people living longer
!The elderly consume even greater amounts of healthcare delivery
services.
!When people are above 65 years old, they receive four times the number
of diagnostic procedures as others receive
!Annual rate of growth in the number of images radiologists must interpret
– estimated at 6% to 12%
Increasing
age profiles
put pressure
on public
health
expenditures
x
Av
era
ge
ex
pe
nd
itu
re p
er
he
ad
ex
pre
ss
ed
as
a s
ha
re o
f G
DP
pe
r c
ap
ita
A g e g r o u p s
Av
era
ge
ex
pe
nd
itu
re p
er
he
ad
ex
pre
ss
ed
as
a s
ha
re o
f G
DP
pe
r c
ap
ita
A g e g r o u p s
Av
era
ge
ex
pe
nd
itu
re p
er
he
ad
ex
pre
ss
ed
as
a s
ha
re o
f G
DP
pe
r c
ap
ita
A g e g r o u p s
Source: Economic Policy Committee (2001) “Budgetary challenges posed by ageing populations”
7
1 10 100 1 000 10 000 100 000 1 000 000 10 0000 000
10
100
1 000
10 000
100 000
Dangerous
(>1/1 000)
Regulated Ultra-Safe
(>1/100 000)
Number of encounters for each fatality
Tota
l lives
lost
per
year
HealthcareDriving
ScheduledAirlines
MountainClimbing
ChemicalManufacturing
EuropeanRailroad
BungeeJumping
CharteredFlight
NuclearPower
Healthcare delivery… a very risky activity
More deaths per encounter than for any other activities ! Adverse events carry a high financial cost, £2 billion a
year in additional hospital stays alone in the NHS !
8
New trend: the patient has a voice and choice
Engaged patient Empowered patient
Financialresponsibility
Publicpolicy
Comparativequality
indicators Connectivity
Social / demographic
changes
• Patient empowerment is a increasingly undisputed fact
• Patients are more informed and thus more opinionated
• Informed patients will shop for healthcare providers that meet their specific
needs and expectations
• Informed patients want more customization and move convenience
9
Quality Access
Efficiency
ACCESS
" “Consumer led” delivery service
" Supporting increased demand for services (in volume and sophistication)
" Meeting 24hour/7days a week service expectation
" Facing ageing population and new pattern of diseases
" Facing individualism and diminishing
family care potential
" Avoiding waiting time
" Increasing private care
" Increasing patient’s co-payment
QUALITY OF CARE
" Patient oriented care/Clinical pathways
" Collaborative care/Continuum of care
" Disease management programmes
" “Voluntary” gatekeeper approach (Global Medical Record)
" Continuous medical education (Accreditation) & Peer Review initiatives
" Increasing attention to medical/medication errors
" Patient satisfaction
" More evidence-based medicine (outcomes based)
Efficiency
" Matching capacity to demand
" Deploying resources more effectively
" Avoid abuse (multiple exams/acts, etc.)
" Reducing costs of well-established procedures
" Controlling escalation of costs
" Transforming healthcare (process & workflows)
" Using new ICT technology to support transformation
Public authorities search for answers to increased demand and cost escalation: Better quality can cost less !
10
Public authorities need to do things differently: « Good health can save costs »
From «late disease» To «early health»
• Symptom based
• Data silos
• Managing illness
• Average therapies
• Prevention / prediction
• Detailed patient info
• Early diagnosis
• Targeted therapies
Critical information whenever and wherever it’s needed
INFORM & SHARE
Prevent Diagnose Treat Monitor
Identify at risk patients earlier
Earlier, more accurate diagnosis
Earlier, more targeted treatment
Track efficacy of treatment
11
New ways of working opening doors to collaborative platforms (eHealth)
Collaborati
on
More and
more
collaboration
is required
“Early
Health”
breaking the
hospital
boundaries
x
0 % 9 0 %8 0 %7 0 %6 0 %5 0 %4 0 %3 0 %2 0 %1 0 % 1 0 0 %
T o d a y 2 0 0 2
0 % 9 0 %8 0 %7 0 %6 0 %5 0 %4 0 %3 0 %2 0 %1 0 % 1 0 0 %
T o d a y 2 0 0 2
S o u r c e : T h e F u tu r e o f H e a lth C a r e 2 0 0 5 , D e lo it te D e v e lo p m e n t L L C .
L a b re s u l ts
In s u ra n c e in fo r m a t io n
D ia g n o s t ic im a g in g
S c h e d u lin g
P a t ie n t h is to r y
M e d ic a l r e c o rd s ( E M R )
S o u r c e : T h e F u tu r e o f H e a lth C a r e 2 0 0 5 , D e lo it te D e v e lo p m e n t L L C .
L a b re s u l ts
In s u ra n c e in fo r m a t io n
D ia g n o s t ic im a g in g
S c h e d u lin g
P a t ie n t h is to r y
M e d ic a l r e c o rd s ( E M R )
Source: The Future of Health Care 2005, Deloitte Development LLC.
R ad io lo gy
in fo rm atio n
system s and
m ed ical
techno lo g ies
@ H osp ita l
R ad io lo gy
in fo rm atio n
system s and
m ed ical
techno lo g ies
@ H osp ita l
@ G P
@ S p ec ia lis t
@ T e le ra io lo g y co m p an@ P riva te R ad io lo g y ce n tres
@ L o c a l fac ilities
P rov id er/P a tien t
@ G P
@ S p ec ia lis t
@ T e le ra io lo g y co m p an@ P riva te R ad io lo g y ce n tres
@ L o c a l fac ilities
P rov id er/P a tien t
12
Summary: The Healthcare paradigm is evolving …
TODAY TOMORROW
ParadigmTreatment of
patientsHealth of citizens
Focus Provider centric Patient centric
Time ScopeEpisodic approach,
curativeLifetime care, preventive
Space Scope Hospital basedDecentralized,
community based
Treatment &
imaging scope
Invasive,
uncomfortable
Less invasive visualization
& treatment
Workflow Fragmented Integrated & automated
Transforming healthcare…
14
The Problem…
15
And…
16
Data Access Limited, Difficult to Access Ready Real Time Access
Technology Disparate Information Systems Connected Information Systems
Care Delivery Individual Experience Adoption of Clinical Best Practices
Patient Record Multiple Sources, Incomplete Single Integrated / Complete Source
Ordering Process Manual, Multiple Hand-Offs Automated, Minimal Hand-Offs
Decision Support Personal Preference Rules / Evidence Based
OutcomeMeasurement
No Linkage to Care Delivered
Structured Data Repository Linking Outcomes to Care Delivered
Data Accuracy / Completeness
Manual Systematic Controls / Checks
Today Tomorrow
Defining a Vision of the Future: eHealth
The eHealth market
18
Global Healthcare IT (eHealth) market worth €55 Billion…but representing only 1.5% of HC spending
ICT market
= $2,490 billion
IT market
= $1,129 billion
GDP
= $46,305 billion
HC market
= $4,581 billion
HC IT market* (per year)
= $68 billion
9.9% GDP5.4 % GDP
45.3% ICT market
6.0% IT market 1.5% HC market
Source: European Information Technology Observatory in co-operation with IDC (2006): Cutler & McClellan;
Health Industry Insights, an IDC company (2006); Clinica (2003); Espicom; Agfa’own estimates.
* HC IT market includes Government, Payers and Providers
19
Healthcare currently one of the lower IT spending sector although urgent need for transformation
• Currently one of the lower IT spending sector with 1.5% average
(w.r.t. revenues) compared to retail (~4%) and financials (10+%)
• Set to increase at an annual growth rate of ~9%
Source: European Information Technology Observatory in co-operation with IDC (2006): Cutler & McClellan;
Health Industry Insights, an IDC company (2006); Clinica (2003); Espicom; Agfa’own estimates.
% of IT spending on total revenues
1.50%
3.90%
11.10%
0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
12.00%
Healthcare Retail Financial
20
Busin
ess
serv
ices
Annual spend per employee (UK only)£8,790
£5,538
£4,333£3,833
£3,393£3,017 £2,920
£979
Fin
ance
Dis
trib
ution
Oth
er
serv
ices
Utilities
Manufa
ctu
ring
Govern
ment
Health
Although one of the most complex and information-intensive, spend per employee are far behind other sector domains
Source: HINE (2004)
21
European end-users also lacking behind … with 70% of EU hospitals spending less than 2% of revenues
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
IT Budget as % of total budget
EU 70.4% 10.9% 6.8% 5.9% 6.1%
USA 24% 25% 18% 19% 9%
2% or less 2.1 - 2.5% 2.6 - 3% 3.1 - 4% >4%
• In Europe, 70% of the hospitals spend less than 2% of their total
revenues, while 70% of their US colleagues were spending more than
2% in 2004.
• But spending are on the increasing pattern.
Source: HINE 2005&2006; HIMSS Analystics 2005&6
22
eHealth creating tremendous opportunity for Europe at the crossroads of Health and Technology
Healthcare
Responding to healthcare challenges for the citizens
• Escalating demands
• Labour shortage
• Higher quality health services
• Patient safety imperative
• At a ‘contained’ cost level
Health is important to a country’s economy.
• Health employs currently 10% of Europe’s workforce
• Health represents 8.6% of the EU-15’s economy
• Health is expected to triple by 2020 and reach 16% of GDP.
Health infrastructure is key
• Health infrastructure which improves health and supports strategic objectives of prosperity, solidarity and security is needed.
Health is wealth.
• A society in good health leads to higher productivity, increased labour supply, better education and contributes to sustainable long-term growth.
Health is Wealth
Healthcare IT
Demand for automation solutions
• Eliminate manual, error-prone workflow
• Improve clinical productivity
• Re-allocate resources; emphasize revenue generating opportunities
Digital medical record initiatives
• Must be multimodal
• Workflow includes clinical patient data
• Maximize value of IT investments
Government initiatives
• National/Regional programs
• E-Health
• Disease management/Population Management
A tool for transformation
Innovation supporting paradigm shift from “sick care” to “health care”,
the so-called Continnum of Care
Source: Agfa’own estimates
23
But … Key issues to address
• eHealth currently treated as an add-on rather than part of an integrated
eco-system.
• Standards for interoperability of ICT, being adopted consistently, should
be further encouraged.
• Increased funding and alignment of Incentives between who pays and
who benefits from ICT in health should be undertaken.
• People, processes and change management should receive more
attention for implementation.
• The involvement of end users (health professionals and patients) is
essential for developing ICT solutions.
• An emerging challenge is coming to widely held concepts of privacy and
confidentiality.
• Innovation and research should be stimulated and better coordinated at
crossroads of social, health, ICT and life science aspects.
•
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