eHealth and the Benefits of Standards Deployment Avoiding Market Fragmentation

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eHealth and the Benefits of Standards Deployment Avoiding Market Fragmentation. Maurincomme E. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

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eHealth and the Benefits of Standards Deployment Avoiding Market Fragmentation

  1. 1. eHealth for the Economy How can the eHealth industry support the transformation of healthcare systems and enable their sustainability? Eric Maurincomme COCIR Board Member and Healthcare IT Committee Chair
  2. 2. eHealth deployment roadmap Basic Intermediate Advanced Productivity for Access for Quality for Providers & Payers Patients Citizens (and Consumers) Wellness & Welfare Chronic Disease Public Health Surveillance Electronic Health Records Telemedicine Clinical Information Systems Hospital Information Systems
  3. 3. Where are we now in Europe? •60+% of hospitals have Clinical Information Systems (CIS) in place •BUT 60+% still rely on paper as their Clinical IS main media to manage patient records •Even when CIS is available, effective use is lagging behind •100% of hospitals have an administrative information system in place Administrative IS •Slow on-going replacement cycle to modernize & extract intelligence •Significant progress in Europe •BUT very fragmented Shared Infrastructure •Very often locally driven/procured, hence not shared Source: COCIR (2008, 2009)
  4. 4. Maturity levels of HIT in EU hospitals Installed base in % (2009) D F UK IT SP NHS in Admin. IS 99% 90% 100% 90% 99% Scotland* * Devolved responsibility Radiology 70% 30% 95% 60% 60% IS DHSS* Laboratory 80% 100% 100% 90% 80% IS Operating 70% 35% 85% 20% 40% NHS theater IS in NHS in England Wales* CPOE 10% 5% 45% 10% 10% EPR 80% 35% 5% 70% 60% Decision <1% <1% <1% <1% <1% Support IS Source: COCIR (2008, 2009) based on dii (2008)
  5. 5. Example: Imaging IT for sustainability Decreased films, Increased efficiency, Improved quality and safety Without PACS With PACS GEYM S CT GEYM S CT Patient Patient Previous Patient Data Registered Exam Performed Registered Exams Re–Entered Exam Performed hung in at Acq Device Reading Room Develop Quality Hang Radiologist Read Un–Hang Films Film Assurance Films Dictate & Approve & Attach Report Radiologist Read Dictate & Approve Send Films & Retrieve Films & Re–assemble Return Films Report to Referring Report to Referring Referring Physician Film Jacket to File Room Physician Physician Accesses Report and Films Many steps…room for error Reduced time to intervention saving life  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.)
  6. 6. Successful HealthCare Transformation - Radiology Screen & hardcopy film market (in GBP) 60,000,000 • Radiology film market decline 50,000,000 • Radiology IT orders reflect contracts 40,000,000 awarding wave • Sustained investment, delivering: 30,000,000 20,000,000 10,000,000 • patient safety, 0 2001 2002 2003 2004 2005 2006 2007 2008E • improved efficiency, • image access. COCIR Radiology IT Orders (in M€)* 160 COCIR Radiology IT Sales (in M€)* 140 120 120 100 100 80 80 60 60 40 40 20 20 0 0 2005 2006 2007 2008 2001 2002 2003 2004 2005 2006 2007 2008 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
  7. 7. Clinical Adoption - critical for success Paper-based Computer as main media as main media for patient record Microfiche Scanned/Digitized for patient record Western 63%  5%  13%  19% EU-8 France 70%  6%  12%  12% Spain 60%  1%  15%  24% Italy 72%  2%  9%  17% Netherlands 43%  5%  21%  31% Germany 53%  8%  14%  25% Denmark 38%  0%  25%  37% Norway 42%  3%  18%  37% Sweden 28%  1%  28%  44%
  8. 8. Clinical Information Systems: next challenge for Europe Market size (revenues-based) in million€ • Hospital IT market of 2.4B€ - Market CAGR offering a 4% growth prospect size'08 (08-12) Hospital IT 2400 4% • CIS market* of 735M€ in 2008 - contained 5% growth prospect Admin. IS 900 2% • Investment in Clinical Information Clinical IS 735 5% Systems (CIS) extremely low - in comparison to Hospital Administrative Information Laboratory IS 220 3% Systems – with higher complexity Imaging IT 550 4% * Clinical Information Systems exclude « service » departments such as Radiology and Laboratory NOT enough to enable “clinical” transformation Source: COCIR (2008, 2009)
  9. 9. And then? expanding to Telehealth • Telehealth market is currently a tiny part (<1%) Gartner hype-cycle for Telehealth 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)
  10. 10. 10 Interlinked Actions for eHealth 1. Define a vision 2. Overcome governance fragmentation 3. Develop innovative economic model 4. Build trust 5. Support citizen/patient empowerment 6. Foster standards and interoperability 7. Achieve legal certainty 8. Enable market development 9. Strengthen international position 10.Stimulate innovation
  11. 11. Appendix
  12. 12. Five steps for eHealth sustainability • Generation 5: High impact of The Gartner Generational model chronic diseases necessitates better population and disease National & preventive 100 eHealth infrastructure management Generation 5: • Generation 4: Workflows and The Mentor inter-professional collaboration 80 Regional Health driving evolution towards Regional Reduction of Preventable Errors Generation 4: electronic patient records The Colleague • Generation 3: New imperatives – 60 Enterprise RIS/PACS/IDC Enterprise HIS/CIS costs, quality & safety – driving Generation 3: demand for enterprise-wide The Helper solutions 40 PACS & RIS & Image Distribution • Generation 2: Integrated imaging Generation 2: The Documentor and data reporting expanding to 20 PACS, RIS other clinicals Generation 1: 48 • Generation 1: Image collection at The Collector departmental level 1995 2005 2010 2015 … year Source: Freely adapted from Gartner
  13. 13. How to build confidence in and acceptance of TeleHealth services?  Compliance improvements Clinical  Morbidity and mortality reduction Outcomes  Better Health-related Quality of Life Healthcare  Direct cost reductions: Hospitalisation, Cost emergency incidents, GP visits, medication, etc. Acceptance  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.
  14. 14. COCIR’s Call for Action to promote the further deployment of Telehealth 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

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