Investing in Health Systems of the Future Budapest, Hungary 10 – 12 May 2011

European EHR Market Analysis The EuroRec Institute Jos Devlies, M.D.

Topics The EHR-Q TN 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, European EHR Market Analysis - WoHIT Budapest

The EHR-Q TN Project May 12, 2011European EHR Market Analysis - WoHIT Budapest 4

EHR-Q TN Thematic Network project : “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: € 28 partners in 25 countries May 12, European EHR Market Analysis - WoHIT Budapest

Partners May 12, 2011European EHR Market Analysis - WoHIT Budapest 6 European Institute for Health Records ProRec AustriaProRec Belgium RAMITProRec Bulgaria Hrvatsko drustvo za medicinsku informatiku Cypriotic Society for Medical Informatics České národní fórum pro eHealth, o.s MEDIQ A/S Eesti E-tervise Sihtasutus Centro 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 ItalyCRP Henri Tudor - SANTECStichting ProRec Nederland KITH AS Marshal'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 Slovenia Hospital Universitario de Fuenlabrada Instituto de Salud Carlos III ProRec United Kingdom

Main Results of the EHR-Q TN 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, European EHR Market Analysis - WoHIT Budapest

The European EHR Market Analysis May 12, 2011European EHR Market Analysis - WoHIT Budapest 8

May 12,

Methodology Data collection per country ▫ Template ▫ Web Questionnaire ▫ Completed by the EHR-Q TN 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 - WoHIT Budapest 10

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 May 12, 2011European EHR Market Analysis - WoHIT Budapest 11

Result 24 National Market Overviews Two Deliverables ▫ Del. D3.1 Part I: Suppliers and Supplier Organisations: supplier / product ID ▫ Del. D3.2 Part II: Authorities and important stakeholders: 663 addresses May 12, 2011European EHR Market Analysis - WoHIT Budapest 12

Suppliers and their products May 12, 2011European EHR Market Analysis - WoHIT Budapest 13

EHR Market Overview: Suppliers 849“Commercial” EHR systems 25“in house” large HIS with EHR 101health IT service providers (health telematics, privay enhancing etc…) 44eHealth / Health IT representative organisations Total: addresses, contact persons etc… May 12, 2011European EHR Market Analysis - WoHIT Budapest 14

May 12, 2011European EHR Market Analysis - WoHIT Budapest 15 Extract of the list (ambulatory care) per country

Extract of Hospital Systems (Alphabetically) May 12, 2011European EHR Market Analysis - WoHIT Budapest 16

EHR Overview : Suppliers May 12, 2011European EHR Market Analysis - WoHIT Budapest 17 GPHospitalHome / Nursing Para- medical Dental Suppliers Applications Applications/Supplier1,20831,22141,04601,19181,0167 International Applications Intern./National Applicat.8,97%31,88%8,79%12,64%14,75% Countries Reported Average Applic. / Country13,1813,335,356,214,07 Average Supplier/Country10,9110,925,125,214,00 Average Internat. Applic.1,184,250,470,790,60

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. May 12, 2011European EHR Market Analysis - WoHIT Budapest 18

Suppliers per domain of application May 12, 2011European EHR Market Analysis - WoHIT Budapest 19 Suppliers GPHospitalHome / Nursing Para- medical DentalTotal Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Germany Greece Hungary Ireland Italy Luxembourg Netherlands Norway Poland Portugal Romania Serbia Slovakia Slovenia Spain United Kingdom Total

Applications per domain May 12, 2011European EHR Market Analysis - WoHIT Budapest 20 Applications GPHosp.Home / Nursing ParamedDentalTotal Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Germany Greece Hungary Ireland Italy Luxembourg Netherlands Norway Poland Portugal Romania Serbia Slovakia Slovenia Spain United Kingdom Total

International / Cross- border applications May 12, 2011European EHR Market Analysis - WoHIT Budapest 21 Cross Border / International Applications GPHospitalHome / Nursing Para- medical DentalTotal Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Germany Greece Hungary Ireland Italy Luxembourg Netherlands Norway Poland Portugal Romania Serbia Slovakia Slovenia Spain United Kingdom Total

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 systems31,88% ▫ Dental systems14,75% ▫ Paramedical systems12,64% ▫ GP – Ambulatory systems 8,97% May 12, 2011European EHR Market Analysis - WoHIT Budapest 22

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) May 12, 2011European EHR Market Analysis - WoHIT Budapest 23

Authorities, users and other stakeholders May 12, 2011European EHR Market Analysis - WoHIT Budapest 24

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 May 12, 2011European EHR Market Analysis - WoHIT Budapest 25

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? May 12, 2011European EHR Market Analysis - WoHIT Budapest 26

Authorities May 12, 2011European EHR Market Analysis - WoHIT Budapest 27 CountryNumber of Authorit. National Ministry Contact Person Departm. Identified Other Public National Organisat. Specific Responsible Entity Regional Organis. National MinistryNational Public Entity Austria 7YYY6Y- Belgium 5YYY1Y3 Bulgaria 2YYY1Y- Croatia 1Y----- Cyprus 1YY---- Czech Republic 2YYY1Y- Denmark 6YY-3Y2 Estonia 4Y3Y- Germany 18Y(2)YY-Y16 Greece 14Y--6-7 Hungary 2Y--1-- Ireland 3YYY2Y- Italy 26Y(2)YY1Y22 Lithuania 1YY---- Luxembourg 1YY---- Netherlands 3YYY2Y- Norway 2YYY1Y- Poland 7YY-1-5 Portugal 2YY-1Y- Romania 2YY-1Y- Serbia 1YYY-Y- Slovakia 3YY-2-- Slovenia 1YY---- Spain 19YYY1Y17 England (UK) 2Y----Sev [1] [1] Not all the regional health authorities and regional organisations are listed; [2] [2] Specific for England

May 12, 2011European EHR Market Analysis - WoHIT Budapest 28 AuthorityH. InsurancePublic HealthResearchH. InstituteHC Prof.Total /Country Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Germany Greece Hungary Ireland Italy Lithuania 1 1 Luxembourg Netherlands Norway Poland Portugal Romania Serbia Slovakia Slovenia Spain England (UK) EHR Overview Stakeholders

(e)Health authorities May 12, 2011European EHR Market Analysis - WoHIT Budapest 29

Role of Stakeholders (also regarding EHR and EHR Certification) May 12, 2011European EHR Market Analysis - WoHIT Budapest 30

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 - WoHIT Budapest 31

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) May 12, 2011European EHR Market Analysis - WoHIT Budapest 32

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 May 12, 2011European EHR Market Analysis - WoHIT Budapest 33

Thank you May 12, 2011European EHR Market Analysis - WoHIT Budapest 34