Health Information Exchange and e-Health—Creating Sustainable Healthcare SystemsEMEA Region 2010

A Frost & Sullivan White Paperin Partnership with HP Enterprise Services

2 Frost & Sullivan

TABLE OF CONTENTS

Executive Summary......................................................................................... 3

Sustainability ................................................................................................... 4

We Are All Stakeholders ................................................................................... 4

Health Information Exchange ......................................................................... 5

Underlying Challenge ...................................................................................... 5

Transforming Health Data into Knowledge-Driven Solutions ......................... 6

Key Issues and Healthcare System Sustainability in EMEA Countries............ 6

Maintaining a Sustainable Health System ....................................................... 7

Juggling Healthcare Initiatives......................................................................... 7

Health Information Exchange and e-Health .................................................... 7

Viewing e-Health as an Enterprise System ...................................................... 7

Issues ............................................................................................................... 8

Convergence of e-Health and Health IT Priorities .......................................... 8

Leveraging Health Data................................................................................... 8

Access to Health Data..................................................................................... 8

Health Data Exchange .................................................................................... 9

Near-Term Opportunities ................................................................................ 10

Enabling Public Health Initiatives ................................................................... 10

Consumer Empowerment................................................................................ 10

Stakeholder Roles ............................................................................................ 10

Barriers to Consumer Empowerment ............................................................... 10

Associated Benefits.......................................................................................... 11

Health Information Exchange in EMEA Countries .......................................... 11

Overview ......................................................................................................... 11

Transforming Health Data into Knowledge-Driven Solutions ......................... 12

Future Directions ............................................................................................ 13

Paradigm Shift ................................................................................................. 13

Sustainability................................................................................................... 14

New Business Models ...................................................................................... 14

Principal Drivers .............................................................................................. 15

Access and Security ......................................................................................... 15

Consumer Empowerment ................................................................................. 16

Acknowledgement of Collaborating Organizations......................................... 16

A sustainable health system relies on our ability to transform health data into knowledgeand knowledge into action to achieve cost-effective health outcomes on individual andpopulation levels. A sustainable healthcare system is one that meets current consumerdemands without reducing its capacity to provide for future generations.

Advances in information and communication technologies have progressed enough toenable the electronic exchange of health data between service providers, consumers, and community stakeholders. The exchange of health information facilitates prevention,wellness, and chronic disease management. Health information exchange (HIE) is madepossible through e-health, the electronic exchange of patient data via health information networks.

EXECUTIVE SUMMARY

A country’s economic growth is interminably intertwined with the health of its population. A critical point is reached, however, when healthcare spending becomes aneconomic burden to individuals, communities, governments, and society at large. At thatjuncture, the sustainability of a country’s healthcare system is threatened and its economicgrowth endangered.

The underlying challenge is to offer the right healthcare product/service to the right person at the right place and time at the right price to achieve optimal health outcomes. HIE and e-health can meet this challenge as advancements in information, communication, andmedical technologies have dovetailed to create the tools. The missing element is a definitiveprocess—one that HP describes as a 360-Degree Healthcare Continuum.

In 2010, Frost & Sullivan and HP sponsored a global exercise to lay the foundation for anopen dialogue on e-health, HIE, and sustainability. In focus groups and surveys, C-levelexecutives—representing a cross-section of stakeholders—shared their insights on keyissues, priorities, and processes, leveraging health data and consumer empowerment in theirindividual countries.

In the Europe, Middle East, and Africa (EMEA) region, findings reflected the uniquestakeholder environment in which these executives contend in 14 countries. Thesedecision-makers cited healthcare financing, policy and planning, and human power aspredominant issues. Access to care and providing quality healthcare trumped costmanagement in importance to achieving sustainability.

The decision-makers viewed e-health as an enterprise-wide capability system, withtechnology integration and public information and health awareness considered critical toestablishing the intrinsic role of HIE in achieving better health outcomes. Stakeholdercollaboration in planning and policy-making was vital in measuring return on investment interms of societal costs and benefits versus total healthcare costs.

HIE is an intermediate endpoint leading to sustainable health systems.

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SUSTAINABILITY

There is a strong relationship between population health and economic growth anddevelopment. A healthy population may be considered a prerequisite for economicproductivity, prosperity, and sustainability.

Health spurs community economic development directly and indirectly. Direct economicdevelopment results from healthcare services delivered by medical and non-medicalproviders. Those services would be paid for by consumers and private and governmentthird-party payers, with the latter bringing new dollars into the community. Indirecteconomic growth results from productivity levels driven by a healthy population.

We Are All Stakeholders

We reach a critical point when spending on health and health-related conditions becomesa significant economic burden for individuals, families, businesses, and society at large. Theoperative words are “significant economic burden.” Spending is driven by a complex mazeof consumer demographics, expectations, and care-seeking behaviors on one hand; providersettings, practice protocols, and use of technologies for screening, diagnosis, treatment, andhealth maintenance are on the other hand. Economic burden relates to value—ability to pay,willingness to pay, and expected outcomes. Expected outcomes are measured in terms ofsafer care and healthier, productive lives.

As stakeholders, we all share in the responsibility to maintain a sustainable health systemand a productive economy. Contributions to maintaining a sustainable health system takedifferent forms. For example, individuals are responsible for living healthy lifestyles andadopting healthy behaviors to maintain and/or improve health. Employers are responsiblefor providing a safe and healthy work environment; they may offer benefits such as healthand/or disability plans, prevention and wellness programs, and paid leaves.

Government policymakers and agencies are responsible for regulating and monitoringpublic health safety, funding entitlement programs, approving new medical/drugtechnologies, and so on. Government and private third-party health insurers, as payers,focus on risk, actuaries, reimbursement, costs, and cost efficiencies. In varying degrees, eachstakeholder is concerned with health and healthcare spending related to prevention andwellness, access to care, quality of care, and the inherent value in maintaining a betterquality of life.

Stakeholder collaboration now has the potential to positively ease the complex maze ofhealthcare spending. Advances in information and communication technologies have mergedwith medical device innovations to capture real-time health data across physical boundaries.These technologies, with the essential infrastructure (broadband and/or private networks),provide the mechanisms to achieve sustainable health systems. Stakeholder utilization andcollaboration will provide the means via health information exchange.

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Health Information Exchange

HP describes the health information exchange process as a critical part of its 360-DegreeHealthcare Continuum—“moving pieces” centered on the following core priorities:knowledge distribution, consumer empowerment, performance improvement, streamlinedbusiness practices, and leveraged infrastructure and applications (see Figure 1).

The Continuum accommodates diversity in healthcare financing (government versusprivate), access to care (multiple entry points), electronic practices (automated processesto manage workflows, communications, and recordkeeping), and provision of care (in-person and real-time virtualization). It is solution-based to build and reinforce stakeholdertrust; provide measurable, cost-effective results; and demonstrate value.

The Continuum, however, does not infer linear functions. It involves a dynamic flow of health data that need to be transformed into knowledge to devise solutions—solutions to achieve cost-effective health outcomes on individual and population levels tofoster sustainability.

Figure 1: The 360-Degree Healthcare Continuum

Source: HP

Underlying Challenge

The challenge is not technology-oriented or technology-driven. The underlying challenge isin restructuring stakeholder relationships to support health information exchange thatgenerates health solutions. The underlying challenge is to provide health solutions that offerthe right product/service to the right person at the right place and time at the right price.

PopulationHealth

Analysis Communityand Family

SupportSystems

CustomerContact

Systems andServices

PaymentSystems and

Incentives

HealthInformation

and ElectronicHealth

Records

PharmacyManagement

CareManagement

BenefitDesign andConsulting

Services

Quality andBenchmarking

Public HealthSystems

Eligibilityand

EnrollmentServices

360-DegreeHealthcareContinuum

ConsumerEmpowerment

Streamlined

BusinessProcesses

Knowledge

Distribution

Performance

Improvem

ent

Leve

rage

dApplic

atio

ns

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To this end, HP and Frost & Sullivan partnered to explore and lay the foundation for aninternational dialogue on health system sustainability, e-health, and health informationexchange in North America, EMEA, and the Asia Pacific countries.

TRANSFORMING HEALTH DATA INTO KNOWLEDGE-DRIVEN SOLUTIONS

In 2010, C-level executive stakeholders—representing government and privateorganizations, healthcare providers (hospitals and physicians), third-party payers, andassociations (physician and consumer)—were invited to share their perspectives, insights,and plans by participating in an online survey. Questions focused on the five elements inHP’s 360-Degree Healthcare Continuum.

One-hundred twelve organizations completed the survey. Findings were analyzedindependently and then compared to similar questions posed to chief information officers (CIOs) during a series of focus groups and interviews conducted by Frost & Sullivanindustry analysts in our North America, EMEA, and Asia Pacific offices in late 2009 and early 2010.

This paper focuses on the insights and perceptions shared by 30 C-level executives fromeight EMEA. This number comprises 15 executives who participated in the online survey and15 chief information executives from the region who participated in focus groups andinterviews. Survey respondents equally included hospital/physician providers, governmentauthorities and agencies, government payers, and physician or consumer associations. Themajority described themselves either as C-level decision-makers (74 percent), C-levelinformation technology executives (12 percent), or C-level medical officials.

Of note, insights and responses appeared to be influenced by the extent of universalhealthcare coverage in each country and the extent of governmental regulations, oversight,and financing of healthcare initiatives.

KEY ISSUES AND HEALTHCARE SYSTEM SUSTAINABILITY IN EMEA COUNTRIES

C-level executives were asked their opinions on issues affecting sustainability of thehealthcare system in their individual countries and what issues their organizations werespecifically addressing. Responses focused on healthcare finance, consumer behavior anddemands, access to care, human manpower, medical model focus, policy/planning, andimproved health outcomes. Of interest, health information technology was not cited as akey issue or as a factor in sustainability.

Healthcare finance was the dominant issue related to sustainability by participants in all ofthe countries (87 percent), followed by policy and planning (33 percent), and humanmanpower. Healthcare finance, however, was not an action item currently being addressedby respondent organizations. Current initiatives focused on policy and planning, access tocare, information technology, and improving health outcomes.

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COMPETINGPRIORITIES

“… funding issuesand increased demand…”

United Kingdom

“… address healthinequalities; use IT tobring care closer topatients’ homes …”

United Kingdom

“… measure theoutcome and improvethe quality inconnection withprevention andpromotion …”

Cyprus

“… promotion ofcomprehensiveprogram on chronicdiseases that involveall stakeholders …”

Belgium

Maintaining a Sustainable Health System

Recent Frost & Sullivan interviews of key healthcare thought leaders support publishedfindings that access to care, prevention and wellness activities, quality of healthcare, andcost management are the four principal ingredients to maintaining a sustainable healthsystem, whether or not universal health coverage has been implemented. Surveyparticipants were asked to rank these factors on a four-point scale of importance, with “4”being most important. Access to healthcare and quality care received the highest averagerankings, 3.7 and 3.6 respectively. Prevention and wellness activities had the lowest averagerating (3.1).

Although participants believed healthcare finance was the key issue in sustainability, only 28percent of respondents ranked cost management as most important in maintaining asustainable health system (average ranking 3.4). Frost & Sullivan believes these findingsreflect the perception that access and quality healthcare lead to better health outcomesthat, in turn, lead to less utilization of scarce health resources.

Juggling Healthcare Initiatives

C-level executives were asked what advice they would give to those struggling to balancehealthcare initiatives to improve access to care and patient outcomes (quality healthcare)with cost-management directives. Four themes emerged: measure return on investment (34percent), plan/change policy (27 percent), adopt best practices (20 percent), and takeincremental steps (13 percent).

The majority of participants gave lengthy responses that centered on measuring return oninvestment in terms of societal costs and benefits versus total healthcare costs. It wassuggested that the higher value is achieved through planning and policy processes.

HEALTH INFORMATION EXCHANGE AND E-HEALTH

Viewing e-Health as an Enterprise System

Sixty-seven percent of EMEA survey respondents believed that e-health was best describedas an enterprise system that did not follow a linear adoption and utilization pathway. Ofnote, 85 percent of participants believed electronic medical records and electronic healthrecords were basic minimum requirements for a sustainable health system. The majority (77percent) also reported that online medical information was an essential component,reflecting a commitment to consumer empowerment and engagement in healthcaredecisions. Only 8 percent of executives believed administrative functions such as eligibility,claims, and processing were essential (see Figure 2).

Frost & Sullivan finds the latter finding curious, as it suggests that almost 50 percent ofthese C-level executives view electronic operational capabilities related to billing forservices as an adjunct function with a neutral impact on sustainability.

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“… define theboundaries betweenthe responsibilities ofthe individual, theemployer, and thestate … create theenvironment for theseto embed …”

England

“… try to combinethe pragmatic view ofthe economist in costmanagement withthat of a healthcarepolicymaker in awelfare state in orderto pick the benefits ofboth. (Quiteimpossible, I agree.)

Romania

“… put accent onearly diagnosis andprevention; choosewhat the prioritiesare in the healthcaresystem, i.e.,differentiate what isessential for qualityand accessibility toall (that should befunded by public)from what is notessential (that can bepaid for by theindividual) …”

Italy

Figure 2: Minimum e-health components for health system sustainability

Issues

C-level executives broadly described issues related to e-health and health informationtechnology in their survey responses and focus group discussions. Two unrelated issueswere cited most often (43 percent)—technology applications and public information andhealth awareness, followed by adoption and utilization and data integrity and confidentiality,respectively. Financing considerations were related to levels of government funding andpolicy changes.

Convergence of e-Health and Health IT Priorities

Survey participants did not distinguish between e-health and health information prioritiesover the next 12 to 18 months. The pervading themes were the expansion of ITinfrastructure and telemedicine services.

Figure 3: e-Health priorities

LEVERAGING HEALTH DATA

Access to Health Data

The debate over who should have access to health data continues. Concerns center onmaintaining data integrity, data security and confidentiality, and the place of “raw” healthdata in a personal health record. Survey respondents were asked to select from nine groupsthose who should have open access to health data.

Clear lines were drawn. The vast majority of participants (92 percent) believed primary caredoctors should have unlimited access to health data; 77 percent felt that medical specialists,

IT

ITIT e-Health

e-Health

e-Health

IT

IT APPs Expansion

EMR/EHR Implementation

Policy and Planning

Government Support

Adoption and Utilization

Adoption and Utilization

Infrastructure Expansion

Electronic Medical RecordsElectronic Health Records85%

Personal Health Records69%

Clinical Decision Support62%

54%Comparison ofPatient Outcomes

Online Medical Information

Prevention & Wellness Activities

Clinical Workflow

Public Health Monitoring

Eligibility Claims & Processing45%

77%

69%

54%

54%

8%

EMRs/EHRs and Online MedicalInformation were

considered theminimum e-Healthcomponents for asustainable health

systemPhysician Education & Training

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hospitals, and patients should have similar rights. Although universal healthcare coveragewas provided, C-level executives had mixed opinions on whether or not public health andgovernment agencies should have open access to health data, 62 percent versus 38 percent.(See Figure 4.)

Figure 4: Access to health data results

Health Data Exchange

In a similar vein, there are countless debates on who should be responsible for sharing,storing, and maintaining health data and then “control” after health information is shared.Should there be industry standards for health data exchange? Should data be shared in realtime? How does one accommodate integration demands?

Using a seven-point scale to gauge level of responsibility, survey respondents believed apatient’s healthcare provider should have a more responsible role in sharing, storing, andmaintaining health data than national or local/regional government agencies, healthinformation networks, or private companies. (See Figure 5.)

Figure 5: Who should be responsible for health data?

1 2

Internet Provider

3 4 5 6 7

2.5

Private Company 3.0

Local/Regional Govt. Agency 3.9

Health Info. Network of Hospitals 4.1

Each Patient 4.2

National Govt. Agency 4.5

Each Patient’s Healthcare Provider 5.6

30% cited least responsible

31% cited least responsible

0% 10%

Non-medical Healthcare Providers

20% 30% 40% 50% 60% 70% 80% 90% 100%

16%

Private Insurance Companies 16%

Healthy Consumers 23%

Government Agencies 38%

Caregivers 48%

Public Health Agencies 62%

Hospitals 77%

Medical Specialists 77%

Patients 77%

Primary Care Doctors 82%

Thumbs Up

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Near-Term Opportunities

Focus group discussions conducted by Frost & Sullivan support published research findingsshowing multiple ways health data can be leveraged to improve and facilitate access to care,quality of care, and cost-management activities in the near term. These include chronicdisease management, clinical decision-support, consumer empowerment, consumer healthpromotion, healthcare policy development, patient safety, public health programs, andoperational efficiencies. Survey respondents suggested health data utilization could have thegreatest impact on chronic disease management, clinical decision support, and patientsafety. They believed the ability to leverage health data was more dependent on politicalwill, planning, and stakeholder collaboration than improving systems or funding.

Enabling Public Health Initiatives

In terms of public health initiatives, respondents felt health data could be leveraged tosupport evidence-based medicine, identify and develop health policy priorities, and supporthealth promotion more than to support design and development of behavioral health andwellness programs.

CONSUMER EMPOWERMENT

On one level, healthcare economists have suggested that the absence of consumerinvolvement has contributed to rising healthcare costs and led individuals to ignore theirhealth. On another level, “consumer connectivity” has been aligned with higher treatmentplan compliance and less risky health behaviors.

Stakeholder Roles

Organizations have engaged in four main activities to encourage individuals to take controlof their health: developing employee health education programs, developing consumerhealth literacy programs, sponsoring wellness activities (for example, weight control andnutrition programs), and sponsoring online blogs and health portals.

Survey respondents believed sponsoring wellness programs would be given the highestpriority in their organization, while establishing an online blog or health portal would havethe lowest priority. This choice supports previous findings that stakeholders place a highervalue on impact than simple costs.

Individuals who participate in a company-sponsored exercise or weight reduction programhave better health outcomes than those accessing company health portals or blogsproviding diet and exercise information. The former is an ongoing activity (higher employercost) versus a transaction activity (lower employer cost), but the benefits—such as usingfewer sick days—are higher.

Barriers to Consumer Empowerment

Healthcare providers have suggested that there are a number of barriers to consumerempowerment, including: computer literacy, Internet access, health literacy, mobile phoneaccess, and the movement of consumers between health organizations.

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When asked to rank these four barriers, survey participants were most concerned withhealth literacy and the movement of consumers between health organizations thanlimitations associated with accessing information. This finding supports other researchhighlighting the significance of the consumer’s understanding of “data” versus having anabundance of data.

Associated Benefits

Survey respondents from each country provided detailed statements on the potentialbenefits associated with consumer empowerment. The core benefit would be improvedhealth management from better self-management of chronic diseases, enhancedcommunication with providers, and more responsible use of services. Improved healthmanagement would then result in higher levels of patient satisfaction.

HEALTH INFORMATION EXCHANGE IN EMEA COUNTRIES

Our principal research objective was to explore and lay the foundation for an internationaldialogue on health system sustainability, e-health, and health information exchange,recognizing two important factors. First, the convergence of advances in information,communication, and medical device technologies enabling the electronic exchange of healthdata between service providers, consumers, and community stakeholders is a relatively newphenomenon. Second, the intrinsic value of the research findings would be found in how theinformation was used by stakeholders to support HIE and the transformation of health datainto solutions to create and maintain sustainable healthcare systems.

In the EMEA countries, ministers of health recognize the process of transforming healthdata into knowledge to achieve tangible cost-effective health outcomes as works inprogress. Developed countries (for example, the European Union) are moving toward moreadvanced stages of development and implementation than developing countries (such asEastern Europe, Middle East, and Africa). In the developing countries, there are competingdemands for limited government financial resources to support healthcare initiatives.

Overview

Envision “Lego Lands” (ecosystems) of health and healthcare activities and practicessupported by electronic processes and communication in four distinct regions—WesternEurope, Eastern Europe, the Middle East, and Africa. Within each region, country-specificLego modules are suspended, anchored by diverse healthcare IT silos linked to varioushealthcare settings.

The ecosystems in each country are characterized by unique populations, cultures, politics,socio-economic dynamics, and regional healthcare delivery systems. Within this framework,national governments have funded infrastructure development to provide and supportaccess to healthcare for rural populations in their individual countries.

Today, multiple “member state commissions” (EMEA stakeholder partnerships) have beenformed to further e-health and HIE initiatives. These initiatives include standard

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nomenclature, semantic interoperability of IT, and electronic identification domains (patientand provider) to access data. Development and implementation efforts continue to befunded by national governments with additional funding from transindustry stakeholders.

TRANSFORMING HEALTH DATA INTO KNOWLEDGE-DRIVEN SOLUTIONS

Frost & Sullivan has found that HIT planning and decision-making in the EMEA countries aretempered by ROI expectations based on societal cost/benefit ratios. Adoption and use ofelectronic processes vary by the scope of universal healthcare services and payment forservices by provider (hospital versus physician specialty), and by practice setting.

The EMEA countries face challenges similar to those faced by individual states in the UnitedStates. There, some are more advanced than others, state government funding is limited, andcollaborative partnerships are being pursued to help create sustainable health systems.

In the European Union, policy-makers legalized the free movement of doctors and patientsthroughout the 27 European countries. They also support integration of transnational publicpayment systems and privacy needs. Current regulations stipulate that EU citizens areentitled to reimbursement from their national governments for emergency care received inanother EU country. The emphasis is in building and fostering collaborative partnerships andlinks, such as:

• Vielife, a London-based Cigna company, provides culturally-sensitive health and wellnessprograms online in 15 different languages.

• Smart Open Services for European Patients (epSOS) was established by 12 EU membersto provide interoperable cross-border services to exchange basic patient summary dataand electronic prescriptions.

• “Paperless Practice,” a 7.6 million Euro project, was initiated to computerize all primarycare practices in Croatia in 2010.

• Dossier Medical Personnel, the French electronic health record, will enable patients toorganize their health records for consultations with their general practitioners. It is setto launch in December 2010.

• An agreement between Acibadem Mobile Health and Avea (a mobile phone operator)will offer a “HelloDoctor” service to smartphone customers in 81 cities in Turkey.

• A partnership between Telefonica and the government in Spain will open a global e-health unit to offer “patient-centered” products and services in a cost-effectivehealthcare model.

In the Middle East, two events are noteworthy. In the United Arab Emirates, ImtacTechnologies partnered with Oracle and HP to launch iCT HEALTH in Dubai HealthcareCity. It is the region's first integrated health information exchange. In Egypt, QualComm, awireless chipmaker, launched a five-year plan to roll out 3G networks and smartphone take-up for health monitoring of chronic diseases and diagnostic services in Egypt.

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Incremental steps continue to be taken in Africa, such as:

• The World Bank approved $63.6 million to create a regional network of 25 publichealth laboratories to make optimal use of Internet and mobile communications.

• The Nkhoma Synod Health Department set up a digital health information system inMalawi, similar to the one in Tanzania, with the support of IICD Tanzania partners.

• Geneva University Hospitals expands telemedicine services to 14 countries in north, west, and central Africa through RAFT (Telemedicine Network for FrancophoneAfrican Countries).

FUTURE DIRECTIONS

Paradigm Shift

The health system of the future demands a paradigm shift as stakeholders move fromfragmented health information systems to an integrated and automated exchange of healthinformation in real time and as silos of health IT resources dissolve.

Frost & Sullivan envisions connectivity across EMEA countries as government-fundedprimary care services are supplemented by more private insurance offerings for specialtyprocedures and attract medical tourism. Connectivity will be fostered by stakeholderpartnerships forged to deliver health, wellness, and healthcare services across Europe, theMiddle East, and Africa. Telehealth and telemedicine programs will become a mainstay of health systems, and medical tourism will be funded as a new industry andeconomic growth opportunity.

Connectivity also will be fueled by real-time exchange of health information, withconsumers taking a proactive, responsible role in improving or maintaining their health.Personalized medicine will weave its root in chronic disease management as monitoringmoves into the community and home. Electronic personal health records (e-PHRs) willshare equal prominence with electronic medical records (EMRs).

Figure 6: Health system of the future

Invasive

Provider Centric

Centralized—Hospital

One Size Fits All

Therapeutics/Diagnostics/Devices

Treating Sickness

Fragmented

Diagnosis & Treatment

Focus

Monitor

Approach

Objective

Health Information

Less Invasive, Preventative,Image Based

Patient Centric

De-Centralized-Shift to Community

Personalized Medicine

“Theranostics’Tools

Preventing Sickness—”Wellness”

Integrated & Automated

From... To...

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Sustainability

A sustainable health system is dependent upon its capacity to absorb current and futuredemands for its capabilities. Sustainable health systems will be achieved as “results-management” policies replace “cost-savings” directives. Return on investment (ROI) will bemeasured in terms of total costs versus total value.

A sustainable health system is one that provides the right service (prevention, screening,diagnosis, or treatment) to the right person at the right time in the right venue at the rightcost. This will be based on health data exchanged between integrated national, regional, andlocal health information networks.

In turn, integrated health information networks achieve sustainability through collaborationand stakeholder partnerships in which the benefits derived justify the investment. Althoughthere are relatively few network providers, there are hundreds of hardware and softwarevendors that offer a variety of legacy-compatible systems and application modules thatcontribute to an integrated network of EMRs, EHRs, and PHRs. Most of these offerings are“customized” to meet individual provider needs and preferences.

As healthcare providers across segments move to establish or expand their health ITapplications and data integration activities, decision-makers will be looking for solutionsthat are quantitative and predictive in informing their business decisions—not transactionalpurchases. Frost & Sullivan believes providers will turn to vendors that offer planningservices and solutions derived from cross-industry strategic partnerships that will spurimplementation, adoption, and utilization and help dissolve health IT silos.

For example, the HP Digital Hospital is a holistic approach to integrate and manageinformation, medical, communication, and building technologies to improve processes,enhance safety, and improve quality of care.

New Business Models

Frost & Sullivan EMEA industry analysts reported an increase in cross-industry mergers andacquisitions as vendors move from offering fragmented products to integrated solutions.Traditional communication and telecommunication providers believe the health industryoffers new opportunities. Traditional health providers are looking to share investment riskand increase market share.

One example is HP’s acquisition of EDS. This created an entity that serves organizationsacross the health and life sciences value chain to improve business and health outcomesthrough the capture, management, and integration of information. By providing an extensive,integrated portfolio of products, solutions, services, and partnerships, HP has enabledhealth and life sciences organizations to lower costs, speed innovation, function moreefficiently, and improve the quality of care. As a result, HP is positioned as a valuedtechnology leader, providing the healthcare marketplace with innovative solutions thatimprove operational efficiencies while delivering a higher quality of care.

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On another level, the HP Digital Hospital solution uses a holistic approach to integrate andmanage information, medical, communication, and building technologies to improveprocesses, enhance safety, improve quality of care, and enable customized healthcare. HP’sDigital Hospital was born out of a ground-breaking project delivered by HP, Cisco andIMATIS at St. Olavs Hospital (Trondheim, Norway).

Principal Drivers

Frost & Sullivan analysts have ranked, in order of impact, four principal drivers for e-healthand HIE in the EMEA region: government directives for greater operational efficiencies inhospitals; desire to improve quality of care and public safety; government and transindustrycollaboration to expand infrastructure and spur EMR/EHR adoption; and private/publiccollaboration to expand telemedicine and medical tourism.

The degree of impact will reflect each country’s evaluation of the ROI and estimatedinvestment risk associated with different solutions.

Access and Security

Health systems of the future will require health information networks that have real-time,intuitive, automated processes to distinguish access permit levels among users, identifysecurity breaches, and implement immediate corrective actions. In Europe, authorizingaccess to shared patient data involves role-based and legitimate relationship-basedauthentication, in varying degrees.

The health systems assume patients want to share their health data with providers unlessthey have “opted out” or “opted in with restrictions.” Typically, direct access to health datarequires a user to have a smart card or UZI to sign on to the system. The smart card orUZI identifies the user as a citizen or professional who is correlated to a patient ID numberor professional ID number.

Identity management measures validate providers’ credentials to access data; providedelegated administration to link the same clinician to multiple organizations; provide role-based access to give users different capabilities within a clinical setting; validatemembers’ access to clinical records; and serve as an extension of the existingprovider/citizen portal security.

Consumer Empowerment

At an accelerated rate, individuals will assume more ownership of their health data in orderto navigate through the dynamic maze of modern healthcare to choose the “right” product.Medical providers will continue to adopt more patient-centric approaches in diagnosis,treatment, and care management.

Government and private payers will focus on more consumer-oriented benefit plans andhealth promotion activities, including support of employer-sponsored wellness programs.Consumers will need simple ways to process and assimilate this information.

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The need for information and transparency is greatest when an individual or family member has been hospitalized. The HP Digital Hospital provides an innovative solution:Each patient bed is equipped with a patient portal, providing interactive entertainment andeducation, along with bedside computing and communication. Healthcare self-service kiosksare also available.

SUMMARY

A new age in health information exchange has emerged that enables stakeholders in EMEAcountries to collaborate and create sustainable health care systems. Information,communication and medical technologies have converged to provide the tools. Thechallenge is to devise the process. As an initial step, C-level stakeholders from eight EMEAcountries have shared their insights and perspectives to build a foundation that will bringthe right product/service to the right person at the right place and time at the right price toachieve optimal health outcomes.

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ACKNOWLEDGEMENT OF COLLABORATING ORGANIZATIONS

NORTH AMERICACANADA Alberta Health and Wellness

Alzheimer Society B.C.

Brain Injury Association of NS

Cancer Care Nova Scotia

Central East Local Health Integration Network

Eastern Health

Covenant Health (Edmonton)

Headwaters Health Care Centre

Interior Health Authority

Local Health Integration Network

London Health Sciences Centre

Manitoba Blue Cross

National Indian & Inuit CHR Organization

UNITED STATESAcute Care, Inc.

Arizona Association of Community Health Centers

Baptist Health System

Barnes-Kasson Hospital

Baylor UT Houston Center AIDS Research

Bowdle Health Care

Broadstone Memorial Hospital

Cass Regional Medical Center

DCH Health System

Florida Agency for Health Care Administration

Good Samaritan Hospital

Hawaii Primary Care Assn.

Healthcare Care Access San Antonio

North Simcoe Muskoka Local Health Integration Network

Regina-Qu’Appelle Health Region

SAHO

Saskatoon Health Region

South East Local Health Integration Network

Spina Bifida & Hydrocephalus Canada

Stanton Territorial Health Authority

Sunrise Health Region

Trillium Health Centre

Western Health

MEXICOMedicina a Distancia

UMAE HTO 21 IMISS

EMEAAIMAR (Italy)

EACCI (Europe)

European Fundraising Assn. (Belgium)

Herzog Hospital (Israel)

Institute of Social Medicine (Macedonia)

Ministry of Health (Cyprus)

Ministry of Health (Romania)

NHS 24 (UK)

NHS Yorkshire and the Humber (UK)

Nuffield Hospital (UK)

Obafemi Awolowo University (Nigeria)

Técnicas de Salud (Spain)

University of KwaZulu-Natal (South Africa)

Humana, Inc.

Indian Health Service

Iowa Medicaid Enterprise

Kaiser Permanente (2)

Maine Primary Care Assn.

Martin Memorial Mayo Clinic

McLaren Regional Medical Center

National Center for Health Care Informatics

Oklahoma Healthcare Authority

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Frost & Sullivan, the Growth Partnership Company, partners with clients to accelerate theirgrowth. The company's TEAM Research, Growth Consulting, and Growth TeamMembership™ empower clients to create a growth-focused culture that generates,evaluates, and implements effective growth strategies. Frost & Sullivan employs over 45years of experience in partnering with Global 1000 companies, emerging businesses, and theinvestment community from more than 35 offices on six continents. For more informationabout Frost & Sullivan’s Growth Partnership Services, visit http://www.frost.com.

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