1. Health Information Network Europe Progress towards EPR in Europe’s hospitals Are they ready for eHealth? Véronique Lessens Tromso, 24 May 2005

2. © 2005 Deloitte HINE (24 May 2005) 2 How did HINE get started? HINE was established in 2001 to provide a comprehensive service for one stop access to key eHealth information and: Be the premier European source of market information for healthcare IT Help senior executives to anticipate and understand healthcare industry changes Enable meaningful comparison between European and other global eHealth markets ….. supported by EU and leading industry organisations to meet business needs of healthcare stakeholders

3. © 2005 Deloitte HINE (24 May 2005) 3 First comprehensive survey to address European market unknowns The HINE 2004 European eHospital Census by HBS Installed base Usage patterns Suppliers 900 hospitals interviewed in 15 countries Sponsored by: Agfa Deloitte HP iSOFT McKesson Microsoft Philips SAP Siemens

4. © 2005 Deloitte HINE (24 May 2005) 4 43214321 Levels of sophistication Are European hospitals ready for eHealth? Note: # = total number of installations across Europe Total population considered for forecasts is 5032 hospitals across 15 European countries (acute hospitals larger than 100 beds) 2,13% 18,70% 87,34% 98,87% 107 941 4395 4975 % # Decision support, ePrescribing Clinical orders, results, Advanced medical library Common MPI / integration around patient number PAS

5. © 2005 Deloitte HINE (24 May 2005) 5 Significant differences from country to country Levels of sophistication Level 1Level 2Level 3Level 4 %#%#%#%# Germany99,47%144891,05%132622,63%3302,11%31 France97,76%88081,34%7325,22%470,75%7 UK/EIRE100,00%55597,22%54013,89%771,39%8 Italy96,77%77966,13%53212,90%1042,42%19 Spain100,00%416100,00%41626,00%1085,00%21 Belgium97,96%14193,88%13530,61%440,00%0 Netherlands100,00%127100,00%12731,11%402,22%3 Austria100,00%15295,56%14546,67%710,00%0 Switzerland100,00%15386,67%13324,44%374,44%7 Norway100,00%72100,00%7228,00%200,00%0 Sweden100,00%9088,00%7952,00%4712,00%11 Denmark100,00%81100,00%8115,00%120,00%0 Finland100,00%8195,00%775,00%40,00%0 Europe98,87%497587,34%439518,70%9412,13%107 Almost 100% of European hospitals have reached Level 1 and close to 90% Level 2. However, the results dropped significantly from Level 3 onwards. Only 2% of European hospitals have reached Level 4. Overall the same trends could be observed in USA. If we consider Level 4 in Europe as equivalent to the CPOE system in USA, then we could observe that the situation in USA (close to 2,5% of US hospitals reporting having CPOE systems in place) is not significantly different from the number of European hospitals at Level 4.

6. © 2005 Deloitte HINE (24 May 2005) 6 Main storage medium in medical records library 66% of medical records still held on paper

7. © 2005 Deloitte HINE (24 May 2005) 7 Hospital EPR performance in Europe Mature market Administrative solutions have been the main focus together with service departments. Painfully slow progress towards hospital EPR. ePrescribing (not ETP) still a pipe dream.

8. © 2005 Deloitte HINE (24 May 2005) 8 Decision support, ePrescribing Clinical orders, results, Advanced medical library Common MPI / integration around patient number PAS 43214321 Levels of sophistication Is the essential infrastructure in place? (1) 1614 585 536 282 2,5 2,9 3,7 5,1 EU Weighted Av. Nb. Workstations per Hospital EU Weighted Ratio Nb. Staff per Workstations 1,5 1,2 0,8 EU Weighted Ratio Nb. Workstations per Bed

9. © 2005 Deloitte HINE (24 May 2005) 9 Is the essential infrastructure in place? (2) – Fixed, mobile & wireless connected workstations DEFR UK/ EIREITESBENLAU CH NOSWDKFIN Workst ations - Mean 2943831297384423521105068059797720191555984 % Mobile 3%6% 4%7%2%4%7%8%17%11%12%6% % Wire- less 0,5%2,6%3,4%0,5%4,8%0,4%3,1%2,8%3,0%2,5%2,2%5,6%0,8%

10. © 2005 Deloitte HINE (24 May 2005) 10 ICT spending pattern 70% of European hospitals spend less than 2% of their budgets on ICT, while 70% of their US colleagues were spending more than 2% in 2004.

11. © 2005 Deloitte HINE (24 May 2005) 11 ICT spending patterns (2) ICT spending in %Increase foreseenRatio per staffRatio per bed Germany1,8%34%10202020 UK+EIRE1,7%73%12906040 France1,5%32%6801490 Spain1,4%69%5501490 Italy1,1%38%7902690 Belgium2,1%50%19304080 Netherlands3,3%53%17006340 Austria2,2%21%42003490 Switzerland2,0%47%24807540 Norway2,6%44%12506750 Sweden3,3%48%15708170 Denmark2,5%84%12406140 Finland2,8%80%23805420 EUROPE1,8%52%12803710

12. © 2005 Deloitte HINE (24 May 2005) 12 Market drivers – Currently Factors Driving Current Healthcare ICT Investments in Europe DEFR UK/ EIRE ITESBENDAUCHNOSWDKFINEU Meet legal requirements 16,6515,996,178,795,1615,1416,025,8913,598,6714,5810,0015,2811,69 Reduce avoidable medical errors 5,993,616,586,0613,5511,629,320,565,5313,6711,8811,431,677,81 Facilitate sharing of patient information 3,696,253,335,696,9414,0511,829,3310,295,3310,835,008,337,76 Comply with government funded policies 8,017,2512,003,233,688,519,434,4414,264,331,6710,7110,837,57 Improve security and privacy provisions 4,6913,013,0811,579,154,052,1614,805,1511,005,004,294,447,11 Increase clinical capacity and productivity 10,062,294,585,492,247,037,7313,335,4410,005,837,505,836,72 Improve overall quality of care 5,976,678,505,8013,035,005,913,444,1211,003,758,571,116,37 Improve control of costs 11,748,526,678,811,804,324,559,075,885,338,330,00 5,77 Enhance overall organisational performance 8,554,439,254,694,482,974,664,676,918,672,927,504,725,72 Improve access to care and reduce waiting lists 3,494,1710,428,499,323,514,663,365,007,333,755,711,115,41 Improve interaction with patients 3,383,336,178,949,437,162,954,226,261,005,007,140,005,00 Increase revenues and reduce costs 8,436,613,505,712,296,495,806,223,442,677,922,862,224,94

13. © 2005 Deloitte HINE (24 May 2005) 13 HINE 2004 eHospital Census reveals: Prevailing rate of IT spend around 1,8% of revenue Recognised lack of inhouse eHealth skills CIOs generally unwilling/scared to outsource support Failure of CIOs to recognise changing job role IT strategies disconnected from business objectives Lack of basic IT tools and essential infrastructure Operating efficiencies have been the main focus Painfully slow progress towards clinical buy-in Electronic prescribing (not ETP) still a pipe dream Little evidence of GP or consumer access facilities Reluctance to accept opportunity to address patient safety through ICT Call for Government intervention, guidance and support Hospitals are a key component of the health care system and are central to the process of health system reform. BUT as organisations, they have received too little attention. Policy makers embarking on eHealth should also focus on hospitals. Change will require investment and we should ensure that hospitals have access to these funds for future investment in eHealth. This will request high political profile and Government interest. Government and industry must collaborate.

14. For further information, contact Véronique Lessens, Manager (vlessens@deloitte.com)vlessens@deloitte.com Phone: + 32 2 800 28 49 … or visit the HINE website at: www.hineurope.com