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

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. 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. 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. 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. 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. 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. 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. 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. 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 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. Appendix

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. 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. 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