What IT Systems are really being Implemented and used in Hospitals across Europe, and How Prevalent are Hospital Electronic Patient Records (EPR)?. Maurincomme E. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

1. COCIR session
eHealth Market?
Present and Prospects, A View from Industrial Players
What is really being implemented and used in
hospitals across Europe? What are the steps to
follow moving from basic infrastructure towards
advanced clinical applications?
Eric Maurincomme
COCIR Healthcare IT Committee Chair

2. Five ways eHealth enables
long-term healthcare 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

3. But where are we now in hospitals across
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 available, effective use of CIS
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. Maturity levels of HIT in EU hospitals
Installed base in % (2009)
D F UK IT SP
Admin. IS 99% 90% 100% 90% 99%
Radiology 70% 30% 95% 60% 60%
IS
Laboratory 80% 100% 100% 90% 80%
IS
Operating 70% 35% 85% 20% 40%
theater IS
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. Imaging IT – UK example
• England – NPfIT PACS/RIS
program launched in 2005 with first
NHS in
* Devolved
installation from 2006 onwards, now
Scotland*
responsibility completed
• Wales – National RIS programme
completed with hospitals free to
DHSS* deploy their preferred PACS
completed – on going
• Scotland – “Delivering for Health”
NHS
NHS in England
RIS/PACS program awarded
• Northern Ireland – National
in
Wales*
PACS/RIS awarded
• Private sectors – Contracts signed

6. Maturity levels of HIT in EU hospitals
Installed base in % (2009) • UK example of radiology
D F UK IT SP transformation: from films to IT
Admin. IS 99% 90% 100% 90% 99%
Screen & hardcopy film market (in GBP)
60,000,000
Radiology 70% 30% 95% 60% 60% 50,000,000
40,000,000
IS 30,000,000
20,000,000
Laboratory 80% 100% 100% 90% 80% 10,000,000
IS 0
2001 2002 2003 2004 2005 2006 2007 2008E
Operating 70% 35% 85% 20% 40%
theater IS COCIR Radiology IT Orders (in M€)
160
140
CPOE 10% 5% 45% 10% 10% 120
100
80
60
EPR 80% 35% 5% 70% 60% 40
20
0
2001 2002 2003 2004 2005 2006 2007 2008
Decision <1% <1% <1% <1% <1%
Support IS
Source: COCIR (2008, 2009) based on dii (2008)

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. What next ? Clinical Information Systems
the 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 high complexity
Imaging IT 550 4%
* Clinical Information Systems exclude « service »
departments such as Radiology and Laboratory
Current level of availability combined with limited investment in CIS:
NOT enough to enable “clinical” transformation
Source: COCIR (2008, 2009)

9. Expanding to eHealth and TeleHealth
• Generation 5: High impact of
The Gartner Generational model chronic diseases necessitates
better population and disease
National & preventive
100 eHealth infrastructure management
Generation 5:
The Mentor
• Generation 4: Workflows and
inter-professional collaboration
Reduction of Preventable Errors
80 Regional Health
driving evolution towards Regional
Generation 4:
The Colleague
electronic patient records
60 Enterprise RIS/PACS/IDC • Generation 3: New imperatives –
Enterprise HIS/CIS
Generation 3: costs, quality & safety – driving
40
The Helper demand for enterprise-wide
PACS & RIS & Image Distribution solutions
Generation 2:
The Documentor • Generation 2: Integrated imaging
20
PACS, RIS and data reporting expanding to
Generation 1:
48 other clinicals
The Collector
• Generation 1: Image collection at
1995 2005 2010 2015 …
departmental level
year
eHealth mainstream adoption will not happen
overnight but policy makers to shorten the
implementation of
“eHealth” vision and common goals.
Time to act NOW!
Source: Freely adapted from Gartner