Health Information Technologies - Market Trends

HEALTH INFORMATION TECHNOLOGIES
Market Overview and Trends
Pawel Suwinski
2nd Annual Asia EHR Conference
2010, Singapore

EMR/EHR Emotional Journey
INFATUATION
For technologies to be used meaningfully and be accepted they need to become invisible to the intended end-user and work-flow processes.
FRUSTRATION
PHYSICAL JOY
What matters most is the care process and the other person that needs medical attention; anything else is just facilitation.

HIT ADOPTION AND GROWTH DRIVERS

HIT Adoption and Growth Drivers
HIT will experience healthy growth in the next 3 years. This high growth path will be possible thanks to 3 main factors
Innovations
Government Spending
Healthcare Demand
Innovations play a crucial role in blending technologies into healthcare processes. They also are drivers of healthcare services transformation.
Most regional governments recognised the importance of HIT and are rolling out national programs promoting the adoption of HIT, in most cases as EHR.
Healthcare Demand will be constantly on the rise as a result of Epidemiological, Demographic, and Life-Style changes.

Innovations – The Agent For Change
Knowledge Management
Flexible Architecture
Cloud Computing
Clinical & Business Intelligence & AI
Social Media
SMARTER HESLTHCARE
Health2.0
Mobility
Wireless Solutions
AI
Mobile Devices &
Robotics
Virtual Reality
Preventive, Proactive, Personalised, Participatory
5

Global Trends on Governments HIT/HER Initiatives
6
South Korea
USD 46 million– National Healthcare Information Infrastructure Plan to include development of EHR and interoperability standards (2007 to 2010)
China
USD 1.8 billion of total HIT investment pledged. Government published EHR policy in 2009.
EHR projects are now expanded to each province
Europe
United Kingdom : USD 12 billion – The National Programme for IT (NPfIT) from 2002 for 8 to 10 years
Denmark – National EHR since 2006
France –EHR mandatory by 2008
The Netherlands – 88 percent of GPs has an EHR
Sweden – Developing National EHR
Germany – E-Health card since January 2007
Canada
USD 1.2 billion – to set up National EHR
Japan
In 2001, “Grand
Design for the Development of Information Systems in the Health care and Medical Fields”, targeting for EHR to at least 60 % of Japan's hospitals with 400 or more beds by
2006. (Actual 10% in 2010)
Hong Kong
USD 184 million – E-Health Programme. The first phase of the project is budgeted at USD 98m from 2010 to 2014. E-Health Record Office to be established with total recurrent spending of about USD 45m for the years 2010 to 2012.
US
USD 19 billion– Meaningful Use of EHR.
Thailand
No legislation governing the use of EMR/EHR in the country. Less than 50% EHR utilization, mostly in public health institutions.
USD 140 million – To revolutionize public hospital information system
Malaysia
USD 27 million – Telehealth Programme: started 1997 . Halted in 2003 and reactivated in 2007. National roll-out by 2020.
Singapore
USD 140 million - National Electronic Health Record (NEHR) project / 10 yrs
Australia
USD 470 million – Under NEHTA guidance to develop Personally Controlled Electronic Health Record.

Despite HIT Shortcomings Sustained and Long Term Demand for Healthcare Services will support HIT Growth
7
Demand Drivers
Increased Supply of
HIT
Increased Demand for Healthcare Services
Increased Supply of
Healthcare Services

CHALLENGES TO HIT ADOPTION
8

Acceptance of End User is the Key to HIT Implementation and Adoption Success
The main challenge in HIT adoption is the resistance of end users due to lack of technological fit into operational processes.
TAM2
Subjective Norm
Image
Perceived Usefulness
Job Relevance
Actual Use
Behavioral Intention to Use
Output Quality
Perceived Ease of Use
Results Demonstrability
This, on the other hand, is caused by the complexity of business processes.
And lastly, the beneficiaries of healthcare services still exert weak demand for the use of computerised technologies by the healthcare providers.
Holden J. Richard, Karsh BenTzion. The Technology Acceptance Model: Its past and its future in health care,. Journal of Biomedical Informatics 2010; 43:59-172.

Technology Must Be Invisible to the End User
Despite Healthcare Delivery Industry having much to gain from Information and Communication Technologies, it is the slowest from all industries in the adoption. There are many reasons for IT failures in healthcare environment, but the single most important cause is the HIT capability mismatch to address work processes within healthcare service organisation.
Until today, for more than 20 years ICT and healthcare service organisations have been locked in a Love-&-Hate affair with neither being able the break the stalemate. It could be down to that we spent too much time on design and implementation and not on how end user react to already implemented HIT solutions.
HIT investment will only be successful if the fit between IT and clinical processes will be close to matching, which will be reflected by the acceptance or rejection of end users.
In the short history of HIT the emergence of new, disruptive technologies play a crucial role in closing the capability gap and gaining more acceptance from the main users.
The latest innovations are changing not only how the medical care is organised, practiced and delivered but are also redefining host of other qualities including changing patient-physician model and facilitating the emergence of new industry players within the value chain.

Evolution of Healthcare Information Technologies
80’
00’
2010
90’
2015
PMI
EMR
eHealth
Smart
eHealth
Health
Informatics
Stand Alone Applications
Stand Alone Applications
Hospital Information
System – Single EMR
E-Health – Lifetime
Health record
Personalised E-Health
Personalised Health Record
Limited Functionality
Extended Functionality
Full Functionality
Full Functionality, POC
Full Functionality, Home
Monitoring
No interoperability
Limited interoperability
First Healthcare Standards
Full interoperability within
The same location
Country and regional
interoperability
Full Interoperability
Focused on Back-office
Flow: Financial,
Inventory & Patient
Master Index
Focused on Administrative
Flow :ADT, Scheduling
Pharmacy
Focused on advanced
Clinical Flow and
Business Intelligence
Systems
Focused on Knowledge
Management/ Complex
BI and AI Systems
Focused on integration of
Administrative and Clinical
Flows
11

Complex Environment of HIT
Healthcare Information Technologies can be defined as any computer based products and services that are specifically designed and developed for Healthcare Industry. This broad classification includes infrastructure, software, devices, and services that are used by all the participants within the healthcare value chain. As we later will see, the major consumer of HIT are the healthcare services organisation – the care givers, and their will be our main focus when discussing the HIT.
HEALTH INFORMATION SYSTEMS
Life Sciences
Resource Management
Patient related
Financial
Clinical
GL
AR
AP
Billing
PO
Third Party Payer
Insurance
Bio-Informatics
Gene-Sequencing
Gene-Analytics
Library IS
College IS
Research IS
ADT
PMI
EMR
HER
PHR
Health Portal
CIS
Hospital Departmental Systems
LIS
RIS
PACS
Pharmacy
Decision Support System
Inventory
HR
Scheduling
Facility Management
Reporting
Business Intelligence

Collaboration and Sharing is the Key Function of Entire Healthcare Value Chain
Financial and Billing Systems
Resource Management Systems
Clinical Systems
Patient Management Systems
Life Sciences Systems

Industry Practice
Characteristics
Unmet Needs
Met Needs
Capability Gap
Full capture. POC Capture/ Retrieval
Non-disruptive to work processes/ Relevant Retrieval
Large quantity of
data/information
Partial Capture/Store/Retrieval
Sensitive Data/ Information
Partial Security/ Confidentiality/ Privacy (PKI, Biometrics, SSL)
Full Security/ Confidentiality/ Privacy
Non-disruptive to work processes and lifestyle. Remote sensors and automated capture/ retrieval/ alerts
Mobility
Mobile Devices/ Wireless Connectivity
Limited integration – not all processes automated. Long implementation times and high failure ratio. Limited customisability.
Follow work processes : improve on but do not disrupt. Easy to implement and customize by the user.
Complexity
One lifelong health record collating all wellness and illness parameters.
Limited Interoperability mostly at local level – EHR/PHR
Collaboration
Partial analytics (mostly non-clinical)
Analytics that deliver accurate and relevant information at the POC. Non-disruptive to work processes.
Mission Critical
Capability Gap

HIT Development/Adoption Cycle
Source: Frost & Sullivan.
Customer Satisfied
The ICT has entered into Healthcare Delivery Industry with “big bang” of excitement .
HIT Cycle
Requirements fully Implemented
Excitement
Requirements not Implemented
Disappointment Threshold
With new innovations on the horizon, the credibility credit has been rebuilt. We might be looking upwards and finally climbing the slope.
Decade later, the moods were running low as the technologies failed to meet the expectations. The ride has been continuously downwards.
Customer Dissatisfied
2010
1980
1990
2000
2020
15

MARKET OVERVIEW
16

Lifesciences & Healthcare IT, US$ Bn, 2009-2012
Asia Pacific Life sciences and Health IT Market*
Interoperability challenges hinder adoption
Market Drivers
Strong and sustained demand for healthcare services
Demand for higher quality of healthcare and access to information
CAGR
7%
62.5
58.4
54.6
50.6
Market Restraints
CAGR
11.3%
Interoperability of discrete medical equipment
Bandwidth
Lack of skilled resources for implementation
14.5%
15.7%
APAC Share
*Healthcare IT includes: Software, Hardware, IT services and Lifesciences IT
Note: All figures are rounded; the base year is 2009. Source: Frost and Sullivan

Global Total HIT Market Size by HIT Sector

Global Trends on Expenditure on HIT
19
The delivery of care depends on information made available to both: the caregivers and executives. The more accurate and timely data the better decision-making processes, and therefore better operational strategies and clinical outcomes can be attained.
The adoption of Information and Communication Technologies (ICT) is essential for modern healthcare delivery systems to gain greater efficiency, reduce overall healthcare costs and improve patient safety.
In recent years, the acquisition of computer technologies by healthcare organizations has increased substantially with the spending showing upward tendency placing the industry as one of the major consumer of ICT products and services.
In 2009, the Global expenditure on Healthcare Licensed Applications by healthcare providers stood at USD 3Billion for North America, USD 1.9 Billion for Western Europe, and USD 0.8 Billion for Asia Pacific. All three regions will experience high growth rate (on average CAGR ~10%) due to increased demand for healthcare services.
License Software Spent by Healthcare
Providers in 2010 in USD Billion
3.0
USD 3 Billion
1.9
USD 1.9 Billion
0.8
0.8
APAC:
China
India
Japan
South Korea
Singapore
Malaysia
Thailand
Australia
Europe:
UK
France
Germany
Italy
Spain
North America:
USA
Canada

APAC License Software Market (TMP) By CountryUS $ (MM) and 4 Year CAGR (%)
4 Year CAGR (%)
Licensed Software Spend in US $ (MM)
Japan, Australia and China are the biggest markets while China, Malaysia and Thailand presents the most significant market growth in APJ 2010 – 13.

APACJapan, Australia, China, Korea, India, Malaysia, Thailand & Singapore
Key Countries Diving IT Spending
Among the APAC countries, Japan, Australia, Korea and Singapore lead the region in technological advancement in HIS systems followed by Malaysia and Thailand and lastly by India and China
Japan has the biggest market in the region (348.7 million in 2009) but is almost stagnant in terms of growth with only 2.87% CAGR
Australia is the regions second biggest market (120.88 million in 2009) with 10.32% growth rate
China, India, Thailand and Malaysia show double digit growth. In terms of market size, China leads the group followed by Malaysia, Thailand and India.
Between Korea and Singapore, Korea has a bigger market size with 6.84% growth where as Singapore with a smaller market size with 9.31% growth.
Key Drivers by Region
Demographic Pressures - Rise in Chronic Diseases, Aging Population
Medical Tourism
Growth in Private Health Insurance
Increase in Revenue for Private Hospitals leading to Focus on Organizational Performance and a Competitive Environment among Private Hospitals
Interest and/or Lack thereof, of Government Initiatives
Greater Per Capita Healthcare Spending
Increase in Number of Internet Users
Promotion of Telemedicine
Encouraging Adoption of EMR and Move towards Centralized EHR’s

22
1
5
2
3
4
1
5
2
3
4
1
5
2
3
4
1
5
2
3
4
1
5
2
3
4
1
5
2
3
4
China will focus on improving the standard of its healthcare sector and government focus is key to realising the growth
Low
High
Low
High
Low
High
Low
High
Low
High
Low
High
Denotes the expected market growth >>>>>>>>
Denotes high CAGR (>15%)
Denotes medium CAGR (10-15%)
Denotes low CAGR (<10%)

23
All countries – particularly China and India – will make significant progress in relation to HIT adoption over the next 10 years >> investments will be made
Present and Future HIT Adoption Level
Clinical Decision Support Systems
Resource
management
Image management
PHR
EMR
Financial management
Patient management
Patient Administration
CIS
EHR
Integrated healthcare delivery
Administrative IT solutions
Clinical IT solutions
Japan represents the most mature and saturated market for HIT; however, it lacks interoperability between the sites (EHR). Presently, the government is focusing on facilitating the integrative efforts to provide seamless exchange layer for the EHR.
7 – 12 years
0 years
Singapore has already implemented EMR infrastructure in public and private sectors, and currently is focusing on providing collaborative platforms to link both into nationwide EHR. The small size of the market allows for faster progress toward EHR.
5 – 10 years
0 years
Most of India’s hospitals operate some kind of HIT; however, the full blown EMR/site is still 15 years away. Assuming that India’s economy remains strong and that the medical tourism trend remains, India may progress more quickly.
0 years
15 years
20 years
South Korea is finalizing its deployment of EMR and will move very fast into interoperability phase to achieve nationwide EHR. The HIT market is mature but isolated due to cultural and language barriers.
0 years
8 – 16 years
China is in hot pursuit of the other APAC countries in terms of adoption of HIT. The large financial commitment from central government might be a factor to speed up the process.
0 years
10 years
20 years
30 years
Source: F&S Research 2010

INNOVATIONS
TRANSFORMING HEALTHCARE DELIVERY THROUGH DISRUPTIVE TECHNOLOGIES
24

Extending Care Beyond Hospitals - Connected Healthcare
Connected Healthcare is a care delivery model that uses technology enabled solutions to expand the care capabilities beyond healthcare institutions to natural human habitats.
The main aim of Connected Healthcare is to maximize healthcare resources, increase preventive and predictive component of care with the expectation of keeping individuals as healthy as possible and less dependent on curative care.
It works through deploying sensor – monitoring devices, data storage and analytics, and communication channels to healthcare providers for decision making process, care planning and delivery. It empowers the individuals to self manage medical needs, and provide cannels for more interactive communications with healthcare professionals.
At present, It is directed at chronic diseases, aged population, and dependency. The scope, however, is rapidly expanding to include entire population to mange health rather than to monitor illness. Smart homes, the mush up of real estate and healthcare is a natural expansion of Connected Healthcare.

Connected Healthcare – Uses and Benefits
Maturity/Adoption Level
Products/Services
Growth Potential
Telehealth
Wired/wireless sensors
Nursing Alarms/Alerts
Enterprise Mobility Solutions
GSM/Wimax healthcare applications
Voice Communication
Pagers
3
2
3
2
1
4
1
4
2.0
4.0
5
5
0
0
Growth Potential
Practical Applications
Outreach Programmes for underserved locations: Telehealth and Telemedicine
In-building Communication – providing common infrastructure for all voice and data communication
Preventive and predictive measures against Hospital Acquired Infections
Patient monitoring within hospital and outside (home monitoring)
Remote consultation and supervision.
Emergency medicine – alerts/alarms

Empowering Patients/Individuals - Interactive Healthcare
With the adoption of Web 2.0, collaborative technologies were introduced allowing unprecedented level of social interactivity. The use of Web 2.0 applications and resources for health related purposes is called Health 2.0
Health 2.0 has become very popular and important platform for patients and consumers to find health information, interact with each other in virtual communities, and communicate with care givers. It empowers individual to manage own health according to personal preferences.
Health 2.0 provides communication platform to healthcare organisations to reach out to their existing and potential clients. Hospital Portals and presence in the Social Networking Medias (e. g. Facebook, Twitter) has redefined marketing and sales strategies.
According to the Pew Internet & American Life Project, 83 percent of Internet users have looked online for health information. New data released by Pew this week show many people are now using cell phones to search for health information - 29 percent of cell phone owners age 18 to 29, and 17 percent of cell owners overall. It's the first time Pew has surveyed health searches on cell phones.

Interactive Healthcare – Uses and Benefits
Products/Services
Growth Potential
Email
Instant Messenger
Blog
PHR
Analytics Applications (Health 3.0)
Web – Mobile Devices interfaces
Wikis
3
3
2
2
1
1
4
4
1.5
3.5
5
5
0
0
Growth Potential
Practical Applications
Provider – Consumer Relationship: influence on Consumer by providing relevant information
Provider: Promotion and Marketing Activities
Medical Tourism : enabling decision making about the desired destination
Consumer: source of information on healthcare related topics
Consumer: Support groups
Provider/Researcher: analytical tools

Making Care More Efficient - Cloud Healthcare
Cloud Computing is an IT architecture model that virtualises computing resources to deliver them on demand and in required quantities. These resources are highly scalable (almost infinite) and highly available (24/7).
The main characteristics of cloud computing are:
User does not own hardware, network, and application resources
Computing resources are provided through remote data centres on a subscription basis (on demand).
The infrastructure and services are delivered, accessed by user, via web browser (cloud).
In cloud computing architecture, user is running services not on the local terminal but remotely. It means that instead of transferring data from remote host to be processed on the local terminal all transactions take place outside the local terminal.
Healthcare industry is just exploring the capabilities and benefits of cloud computing. The main concern is over security of medical information as all is residing off-site in remote datacenter. However, the economic advantages to healthcare providers are making some to venture into the virtual realm of cloud computing.

Cloud Healthcare – Uses and Benefits
Products/Services
Growth Potential
Software as a service (SaaS)
Infrastructure as a service (IaaS)
Platform as a service (PaaS)
3
3
2
2
1
1
4
4
0.5
1.5
5
5
0
0
Growth Potential
Practical Applications/Benefits
Back office applications (Resource Management) , Office Automation and Productivity Tools can be easily accessed already without costly investments.
Providers do not need to maintain infrastructure
Clinical Applications and Patient Management can be delivered using Private Cloud where all data is protected. Such network can be created with data-centre within organisation.
Payment Model is based on subscription or pay-as-you-go.

Knowledge care - Business Intelligence in Healthcare
Business Intelligence (BI) is a broad concept describing the process of transforming data into actionable knowledge. In recent years the term has became a label for information technologies: software and infrastructure that facilitate the BI process. Such applications capture, collate, store, transfer, retrieve, and analyse data to generate best choices for strategic decisions in the form of “what-if” analysis, predictive analytics, and multi dimensional data mining that in a blink of an eye deliver, insightful advises for managerial and clinical use.
BI applications act as integration platform across the entire organisation. They connect together disparate systems to collect and exchange needed data. They glue the “silo” environment together to provide a seamless framework for information exchange and processing.
Can be used as Health 2.0 and 3.0 applications linking data sources with analytical capabilities.
By linking applications that otherwise were not communicating freely the BI is able to reduce the manual process effort used to facilitate exchange of information. The automation significantly can reduce access to data as well the occurrence of unintentional human errors while handling the data.
BI solutions provide dedicated informational path linking the source of request/query with timely and relevant information.

Intelligence in Healthcare - Impact and Uses
Products/Services
Growth Potential
Reporting
Analytics
Predictive information modelling
Integration
Visualisation - Dashboards
3
3
2
2
1
1
4
4
2.0
4.5
5
5
0
0
Growth Potential
Practical Uses/Benefits
Administrators: timely and accurately information on organizational economic performance and resource utilisation.
Care Givers: timely and relevant information delivered at the point of care
Patients: Improved quality of care
Organisation: creating platform for virtual organisation.
Public/scientists: utilisation of Health 2.0 analytical capability to conduct custom research

Moving Beyond Reality - Virtual Healthcare
Virtual Reality is the ability to create artificial environment with the ability to act as it was real. It used advanced technologies to generate space and physical fabric and applies artificial intelligence to add interactive component. It is experienced by two senses (presently): sight and sound.
Lighter version of Virtual Reality – Simulation has been well adopted by most industries including healthcare.
The major users of these technology are gaming and military industries. It has also been successfully adopted by healthcare for simulations, 3D Image modelling for laparoscopic procedures, treatments, rehabilitation, and assessment.
Virtual reality can be divided into:
The simulation of a real environment for workflow processes analysis and design, training, education, therapies.
The development of an imagined environment for health assessment, capability assessment, and therapies.

Virtual Healthcare – Uses and Benefits
Products/Services
Growth Potential
Simulators
Virtual Reality
Augmented Reality
3D Modelling
Games
3
3
2
2
1
1
4
4
1.5
3.0
5
5
0
0
Growth Potential
Practical Uses/Benefits
Training for healthcare professionals
Simulation for work processes and facility design
Disease Control: spread of contagious diseases
3D preoperative and perioperativemodelling
Treatment (phobias, rehabilitation, compliance to medication)

Technology Impact on Stakeholders and Care Quality
1
5
2
3
4
1
5
2
3
4
1
5
2
3
4
1
5
2
3
4
1
5
2
3
4
1
5
2
3
4
1
5
2
3
4
1
5
2
3
4
1
5
2
3
4
1
5
2
3
4
1
5
2
3
4
1
5
2
3
4
1
5
2
3
4
1
5
2
3
4
1
5
2
3
4
Provider
Consumer
Outcomes
Total
15 Points
Connected Healthcare
10.0
Low
High
Low
High
Low
High
Cloud Healthcare
8.0
Low
High
Low
High
Low
High
Interactive Healthcare
12.0
Low
High
Low
High
Low
High
Intelligent Healthcare
12.0
Low
High
Low
High
Low
High
Virtual Healthcare
8.0
Low
High
Low
High
Low
High
Low
High
Key :
Source: Frost & Sullivan.
35

Smart Healthcare: Communication Trends
Smart Model: Continuum of Care & Patient Focused.
HOME CARE
Smart Homes
Telehealth
Aged Care
Critical Alarms
Assisted Living
Home Monitoring
Current Model: Curative & Provider Focused
INSTITUTIONAL CARE
Nursing Homes
Communication/Data
Specialty Clinic
Communication/Voice
Hospitals
Tracking/Resource
Management
Connectivity
Source: Frost & Sullivan, Motorola

Health Information Technologies - Market Trends

by Frost & Sullivan on Dec 01, 2010

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