investing in health systems of the future budapest, hungary 10 – 12 may 2011

Investing in Health Systems of Investing in Health Systems of the Futurethe Future

Budapest, Hungary10 – 12 May 2011

European EHR Market AnalysisThe EuroRec InstituteJos Devlies, M.D.

Topics

• The EHR-QTN project▫ Purpose of the project▫ Partners▫ Main results

• The European EHR Market Analysis▫ Methodology▫ The EHR system suppliers overview▫ The EHR stakeholders overview▫ Cross – domain suppliers▫ Cross – border suppliers

May 12, 2011

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European EHR Market Analysis - WoHIT2011 - Budapest

The EHR-QTN Project

May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest

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EHR-QTN

• Thematic Network project : 238912• “The main objective of the Thematic Network is

to better prepare the health community across Europe for systematic and comparable quality assurance and certification of e-Health products, more specifically of Electronic Healthcare Record systems.”

• Three years (February 2009 – January 2012)• Budget: 789.000€• 28 partners in 25 countries

May 12, 2011

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Partners


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European Institute for Health Records

ProRec Austria ProRec Belgium

RAMIT ProRec BulgariaHrvatsko drustvo za medicinsku informatiku

Cypriotic Society for Medical Informatics

České národní fórum pro eHealth, o.s

MEDIQ A/S

Eesti E-tervise SihtasutusCentro Poliklinika Vilnius – Lithuania

ProRec Germany

Foundation for Research and Technology – Hellas

National Institute for Strategic Health Research - ESKI

ProRec Ireland - Irish Centre for Health Telematics Ltd

ProRec Italy CRP Henri Tudor - SANTEC Stichting ProRec Nederland

KITH ASMarshal's Office of the Lodz Region

Administraçao Central do Sistema de Saúde, I. P.

ProRec Romania - Romanian Association for Electronic Registration of Medical Data

ProRec Serbia - Srpsko udruženje za elektronski zdravstveni karton

ProRec Slovakia

Ustanova - ProRec SloveniaHospital Universitario de Fuenlabrada

Instituto de Salud Carlos III

ProRec United Kingdom

Main Results of the EHR-QTN

• Awareness (72 National Workshops)

• Validation of the EuroRec Descriptive Functional Statements (+1.700) and the Certification Procedures

• Translation of the Statements in 19 languages

• EuroRec Seal Level 1 and Level 2 definition

• Quality labelling of EHR Market Products

• EHR Market Overview

• Roadmap towards Sustainable Pan-European Certification of EHR Systems

May 12, 2011

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The European EHR Market Analysis


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May 12, 2011

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Methodology

•Data collection per country▫Template▫Web Questionnaire▫Completed by the EHR-QTN partner

•Where feasible: strict inclusion criteria: ▫Suppliers based on market share. Goal: >

90% of the market▫Other stakeholders: “decisional impact”

Authorities User groups (mostly on demanding side but also

possible obstructers)May 12, 2011European EHR Market Analysis - WoHIT2011 -

Budapest

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Origin of the information

•Not so easy to collect•Either not available as such or considered

as “classified”•Possibilities:

▫Official list of labelled applications (a few countries for a limited number of domains of application)

▫Expertise of the partners▫Web searches (e.g. professional organisations)

▫Health Ministries▫Health IT suppliers organisations


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Result

•24 National Market Overviews•Two Deliverables

▫Del. D3.1 Part I: Suppliers and Supplier Organisations: 1.019 supplier / product ID

▫Del. D3.2 Part II: Authorities and important stakeholders: 663 addresses


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Suppliers and their products


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EHR Market Overview: Suppliers

•849 “Commercial” EHR systems• 25 “in house” large HIS with EHR•101 health IT service providers

(health telematics, privay enhancing etc…)

• 44 eHealth / Health IT representativeorganisations•Total: 1.019 addresses, contact

persons etc…


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Extract of the list (ambulatory care) per country

Extract of Hospital Systems (Alphabetically)


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EHR Overview : Suppliers


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GP Hospital Home / Nursing

Para-medical

Dental

Suppliers 240 262 87 73 60

Applications 290 320 91 87 61

Applications/Supplier 1,2083 1,2214 1,0460 1,1918 1,0167

International Applications 26 102 8 11 9

Intern./National Applicat. 8,97% 31,88% 8,79% 12,64% 14,75%

Countries Reported 22 24 17 14 15

Average Applic. / Country 13,18 13,33 5,35 6,21 4,07

Average Supplier/Country 10,91 10,92 5,12 5,21 4,00

Average Internat. Applic. 1,18 4,25 0,47 0,79 0,60

Some conclusions

• International applications/suppliers:▫rather limited▫most in Hospital Care and in Dental Care

•Number of applications: most “medical” applications … easiest to get the information

•Most suppliers support ONE application only (and in the same domain) . Average 1,21 for ambulatory systems, 1,22 for hospital systems.


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Suppliers

GP Hospital Home / Nursing

Para-medical

Dental Total

Austria 40 20 0 1 7 68Belgium 17 8 25 19 4 73Bulgaria 6 3 0 0 0 9Croatia 7 1 0 0 6 14Cyprus 0 3 1 0 1 5Czech Republic 4 8 3 1 1 17Denmark 17 8 4 16 12 57Estonia 3 5 1 1 0 10Germany 43 10 0 0 0 53Greece 17 25 4 1 7 54Hungary 3 6 3 0 3 15Ireland 5 8 1 3 0 17Italy 10 38 5 0 1 54Luxembourg 6 5 2 2 0 15Netherlands 6 21 12 5 0 44Norway 3 7 3 5 1 19Poland 0 7 0 0 0 7Portugal 12 11 0 0 0 23Romania 9 6 1 0 3 19Serbia 3 3 0 0 0 6Slovakia 11 14 2 2 4 33Slovenia 5 5 1 1 1 12Spain 8 24 10 6 4 52United Kingdom 5 16 9 10 5 45

Total 240 262 87 73 60 722


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Applications

GP Hosp. Home / Nursing

Paramed Dental Total


Total 290 320 91 87 61 849


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Cross Border / International ApplicationsGP Hospital Home /

NursingPara-medical

Dental Total


Total 26 102 8 11 9 156

International suppliers / applications• International =

▫Product used in more than one country▫Product owned by an entity in another

country•Countries with most international systems:

United Kingdom, Spain, Italy, Denmark and Austria.

•Domains with most international systems:▫Hospital systems 31,88%▫Dental systems 14,75%▫Paramedical systems 12,64%▫GP – Ambulatory systems 8,97%May 12, 2011European EHR Market Analysis - WoHIT2011 -

Budapest

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Cross-Border & Cross-Domain

• International suppliers:▫6 in Primary / Ambulatory Care▫19 in Hospital Care (… hardware oriented?)

•Cross-Border applications▫None or nearly no applications in primary care /

ambulatory care▫Same “product names” in several countries:

same application ???(Alert, Clinicom, HP-HCIS, Impax, Lorenzo, Maxims Clinical, Orbis, PCS, Sorian, StaproAkord, Cerner)

•Cross-Domain suppliers: 89 (at least in one country

more than one target market)


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Authorities, users and other stakeholders


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Importance of stakeholders

• Involvement of all important stakeholders is vital to the success of implementation and use of EHR systems. (EHR-Implement project)

•Listed stakeholders are▫Health authorities▫Healthcare insurance organisations▫Public health organisations▫Research organisations – Academic institutes▫Healthcare institutes (associations)▫Healthcare professionals organisations


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Selection criteria• Do they actually have an active role in quality

assurance of EHR systems, if any in the country?• Did they manifest a particular knowledge of the

domain (certification / quality labelling) in the past?

• Is their approval or at least their cooperation essential in order to introduce successfully certification and quality labelling of EHR systems?

• Is there a risk of obstruction not including them in the process of certification and quality labelling?

• Are they representative or an important party in the particular EHR market, addressing a specified group of users?


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Country Number of Authorit.

NationalMinistry

Contact Person

Departm. Identified

Other Public NationalOrganisat.

SpecificResponsibleEntity

RegionalOrganis.

National Ministry National Public EntityAustria 7 Y Y Y 6 Y -Belgium 5 Y Y Y 1 Y 3Bulgaria 2 Y Y Y 1 Y -Croatia 1 Y - - - - -Cyprus 1 Y Y - - - -Czech Republic

2 Y Y Y 1 Y -

Denmark 6 Y Y - 3 Y 2Estonia 4 Y 3 Y -Germany 18 Y(2) Y Y - Y 16Greece 14 Y - - 6 - 7Hungary 2 Y - - 1 - -Ireland 3 Y Y Y 2 Y -Italy 26 Y(2) Y Y 1 Y 22Lithuania 1 Y Y - - - -Luxembourg

1 Y Y - - - -

Netherlands

3 Y Y Y 2 Y -

Norway 2 Y Y Y 1 Y -Poland 7 Y Y - 1 - 5Portugal 2 Y Y - 1 Y -Romania 2 Y Y - 1 Y -Serbia 1 Y Y Y - Y -Slovakia 3 Y Y - 2 - -Slovenia 1 Y Y - - - -Spain 19 Y Y Y 1 Y 17England (UK)

2 Y - - - - Sev

[1] Not all the regional health authorities and regional organisations are listed;[2] Specific for England


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Authority H. Insurance Public Health Research H. Institute HC Prof. Total /CountryAustria 7 2 1 21 12 7 50Belgium 5 3 2 5 6 20 41Bulgaria 2 16 1 2 2 6 29Croatia 1 4 1 6 4 7 23Cyprus 1 2 2 3 - 3 11Czech Republic 2 8 1 3 2 6 22Denmark 6 2 1 1 - 3 13Estonia 4 2 1 2 1 8 18Germany 18 5 8 6 5 9 51Greece 14 1 1 12 16 8 52Hungary 2 1 2 - 19 5 29Ireland 3 3 - 9 2 6 23Italy 26 1 4 2 2 5 40Lithuania 1 1Luxembourg 1 3 1 2 2 6 15Netherlands 3 1 - 2 2 12 20Norway 2 1 1 2 4 7 17Poland 7 2 4 6 12 6 37Portugal 2 3 2 4 2 6 19Romania 2 6 1 4 4 7 24Serbia 1 1 1 2 5 4 14Slovakia 3 6 1 4 1 8 23Slovenia 1 4 1 2 3 8 19Spain 19 8 - 12 6 9 54England (UK) 2 2 2 2 2 8 18

135 87 39 114 114 174 663

(e)Health authorities


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Role of Stakeholders (also regarding EHR and EHR Certification)


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Market Fragmentation…•Not only a problem of the market• Internationally operating trusts

▫Not per definition leading to product consolidation… even differentiating the same product in different countries.

▫More interested (actually) in Market presence Making use of the outcome of EHR systems:

clinical content•More consolidation within one area

(country / region) between the domains than cross-border consolidation within the same domain. May 12, 2011European EHR Market Analysis - WoHIT2011 -

Budapest

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And now?

•Maintenance is an important issue•Maintenance requires resources• Involve the market to maintain the

database•Use the database to promote quality

labelling and certification•Make the data available to the market

(restricted)


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Exploitation of the Overview

•Mail to National Health Authorities▫EuroRec Letter▫National Partner Letter

•End of April: mail to the Suppliers about▫Importance of quality▫Importance of quality assessment▫The EuroRec Seal


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Thank you


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investing in health systems of the future budapest, hungary 10 – 12 may 2011

Documents

market share

european institute

budapestthe ehrqtn projectmay

ehrqtn partnerwhere

health systems

health products

health community

marketother stakeholders