THE E-HEALTH PANORAMA by Christian FOURY

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THE E-HEALTH PANORAMA
Christian FOURY
Official Representative of
the International Research of
the Mission for European and International Relation and
Cooperation (MREIC) of
the French National Health Insurance Fund (CNAMTS)

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The E-Health Panorama
The Electronic Medical Prescription of Medicines
The Electronic Medical Record and the Shared Electronic
Patient Summary Record
The Software Editors offers either in the Gp’s
practices/healthcare centres and in the hospitals

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The Electronic Medical Prescription of Medicines (PEM)
Synthesis of the international comparative study

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4
Synthèse de l’étude internationale
CNAMTS/Programme 2
Prescription électronique de médicaments
The Electronic Medical Prescription of Medicines
The methodology used
1
2
3 The main conclusions
4 The Analysis by Countries

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The Medical Electronic Prescription of Medicines
5
• In France
The dematerialization project of the Prescription of Medicines has been initiated at the beginning of 2012.
Before the target, foreseen to start in 2014, a functional prototype of Medical Electronic Prescription of
Medicines will be realized in the course of 2013.
The Medical Electronic Prescription of Medicina is an important stake to enhance the efficiency of the
Heathcare system
• Abroad
The dematerialization of the prescription of the Medicines is also an important stake in several European
Countries and already a reality in some of these Countries.
The level of progree of these projects are nevertheless different according to the Countries. Some of them
are in course of deployment and in some others the system is already operational since many years.
Many Countries have also initiated some works but are still in phase of definition of the project
CNAMTS/Programme 2

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The Methodology used
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• Identification of any relevant Foreign Insitutions and or Foreign Experts
An Intenatioal comparative study has been undertaken by the International Research of the Mission for European
and International Relations and Cooperation (MREIC) of the French National Health Insurance Fund to identify
either the Most advanced Countries regarding the Projects of the Electronic Medical Prescription and the
relevant foreign institutions/experts with whom to exchange.
• Note of issue and paper based questionnaire
Paper based questionnaires have been sent to all the Countries identified with some specific questions regarding the
state of progress of the project to the perimeter retained, to the referential used, to the technical environment
of the project…
The feedback from the following countries have already been analyzed : Denmark, Spain (Andalousia), Italy (Emilia-
Romagna), Italy (Lombardy), Great-Britain, Finland, Norway, The Netherlands, Switzerland.
The other answers received will be analysed in a second stage
• Videoconferences/audioconferences
In order to analyse more deeply the answers to our initial questionnaire, some videoconferences, audioconferences
have been organised with the most advanced Countries and having some similarities with the French Context
Project.
CNAMTS/Programme 2
Denmark • Sweden • Spain (Andalousia) • Italy (Emilia-Romagna) • Italy (Lombardia)

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The Main Conclusions (1/3)
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• Main gains expected from the project
 For the Doctors : Reliabilisation of the prescription, more simple renewal prescription by incentive the use of
the Help Prescription Softwares. Reduction of the theft of the prescription receipt.
 For the Pharmacists : times savings thanks to the automatic data integration, more readable prescriptions…
 For the Reimbursement organisms : gains in Work Full Time Staff and this when the invoice process is linked to
the Electronic Medical Prescription.
 Improvement of the Fight against the fraud.
 For the narcotics prescription : reduction of the misappropriations, traceability either of the prescription and of
the deliveries.
• Points of attention
- Name of the medicines
 The medicine codification is not similar in all the Countries. In some countries the GP’s prescribe in using only the
Trade Medicine Name and somewhere else the prescriptions are made in International Common Name.
 It does not exist any codified and shared nomenclature for the International Common Name.
- Sizing of the infrastructure
 The volume of data is important in all the Countries studied. the Healthcare professionals expectations in terms of
availability and times of answers are strong.
 The technical dysfunctioning are the majorn risk of the project. An inadequate infrastructure and or under sized
including at the beginning of the project could put in danger the use of the system.
CNAMTS/Programme 2

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The main conclusions (2/3)
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• Proposal of evolution
- For the Doctor :
 Access to all the Electronic Medical Prescriptions of the patient : this would allow to fight against
the therapeutic redundancy.
 Visual display of the deliveries made on its Electronic Medical Precriptions : Thus, the Doctor could
ensure that the patient has well withdrawn the prescribed medicines instead of being able to
ensure that he takes correctly his treatment.
- For the Pharmacist :
 Access for the Pharmacist to all the prescriptions of the patient : This allow to make sure that
there is no risk of incompatibility and or adverse effect between several treatments in process for
the patient.
 Possibility for the Pharmacist to suspend an Electronic Medical Prescription : In case of risk for the
patient, after advise of the GP, the pharmacist can suspend the Electronic Medical Prescription.
.
CNAMTS/Programme 2

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The main conclusions (3/3)
- For the patient :
 Identification of the patient : Many functionnalities can not be offered if the patient is
not identifiable in a unique way with a high level of security and condidentiality for the
access of the medical data.
Today and regarding the French Situation : Our Social Security Card is not personal due to
the fact that it contains also the data of the beneficiaries. The Number of Registration in
the Directory called NIR is predictible and does not offer a high level of security and
confidentiality.
 A web interface allow a patient to access to its Electronic Medical Prescriptions. Different
functionalities are proposed according toe the Countries studied. A single account by
patient is essential to guarantee the confidentiality of the Electronic Medical
Prescriptions.

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Analysis by Countries
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CNAMTS/Programme 2
• Key figures
France Denmark Sweden
Spain
(Andalousia)
Italy (Emilia-
Romagna)
Italy
(Lombardia)
Population
(in millions
of
inhabitants)
65 6 10 8 4 10
Medicines
expenditure
s
(in euros by
year and
per capita)
437 219 277 218 NC NC
Number of
prescription
s
(in millions
by year)
Env.
600
Env. 25 36 180 70 140
Number of
Doctors
120
000
20 500 38 000 NC 4000 NC
Number of
Pharmacists
22 000 250 900 3600 NC NC

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Analysis by Countries
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CNAMTS/Programme 2
Denmark
• Decentralized Healthcare system.
• Decentralized reimbursement system
• Project started in the 1990’s
• Up to 2007, around 97% of the prescriptions was sent and exchanged
electronically that it to say around 25 millions of prescriptions by year.
Gains of the project :
• For the Doctors : Reliabilisation of the prescription due to the use of an informatic module allowing to
detec any medicines interactions.
• For the Pharmacists : times savings by avoiding to enter again the data and reduction of the calls to the
prescriber in order to obtain any confirmation regarding the elements contained on the prescriptions
Difficulties met :
• Initial process insufficiently flexible : the patients should choose the pharmacy during the consultation.
This system has been reviewed to answer to the patient expectations. Today the system looks like to this
one we would like to implement and to generalize in France.
• Under sizing of the infrastructure : Problems of availability have been occured at the beginning of the
deployment of the project which has delayed anc complicated the build up process of the project.
Elements of reflection :
• Important penetration of the system, due to an important « accompanying measures ».
• The patient has an important role in the process. He controls the access of its Electronic Medical
Prescriptions.

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Analysis by Country
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CNAMTS/Programme 2
Sweden
• Decentralized Healthcare System.
• Centralized Reimbursement System.
• Projet started in the 1990’s
• In 2010, 80% of the prescriptions (that means 2,6 millions by month)
have been electronically sent and exchanged.
• For the Doctors : Decrease of the insecurity linked to the drug addicts, The theft of the secure medical
receipt have totally disappeared.
• For the Pharmacists : times savings by avoiding to enter again the data and reduction of the calls to the
prescriber in order to obtain any confirmation regarding the elements contained on the prescriptions
• For the patients : possibility to go to any pharmacy with only an Identity Document for the delivery of the
medicines which has increased the flexibility of the process.
• Reliabilisation of the prescriptions : The Electronic Medical Prescription has allowed an enhancement of
the quality of the prescriptions (reduction of 10% of the prescriptions which should be reviewed by the
pharmacist) thanks to the use of the referentials and a more readable writing.
Difficulties met :
• Insufficient gains for the prescribers : the prescribers find that the Electronic Medical Prescription does
not improve their medical practices. They blame the absence of visibility on the Electronic Medical
Prescription of the patient and the deliveries made on their Electronic Medical Prescriptions.
• Technical environment : The Electronic Medical Prescription has been taking place in an informatic
environment containing several bricks of Information System not coherent according to the Counties.
Problems of compatibiliy between the systems have delayed the deployment in several County Counties.

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Analysis by Country
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CNAMTS/Programme 2
Spain (Andalousia)
• Healthcare system is managed by the Autonomous Community, the
doctors are salaried of the Andalousian Public Healthcare System.
• Centralized Reimbursement system.
• Project started in the 2000.
• In 2011, 71% of the prescriptions (that means 127 millions par an) are
electronically exchanged.
The project Receta XXI has been realized with the European funding. An evaluation of the benefits brought
by the project has been performed by the European Commission (Study EHRimpact).
12 years after the launch of the first works, the analyse cost-advantage show a net cost benefit ratio of 1.12.
In 2006, 3 years after the beginning of the implementation of Receta XXI, the earnings exceed the costs.
Notably thanks to the reduction of the consultations of the patients having a chronic diseases, the reduction
in the use of the paper, the increase of the generic prescriptions and the improvement of the quality
prescriptions.
Difficulties met :
• Lack of flexibility for the patient : the delivery of the medicines is only possible if the patient have with
him its Social Security Card. The patients wish to have a dispensation system based only on an identity
control.
• Realization of a medicine nomenclature : A codification table of medicines in Common Name has been
realized in Andalousia and adopted later by the other Autonomous Communities. The doctors can
prescribe among a list of 12 000 medicines (in trade name) and 3 000 active ingredients. In Andalousia,
around 92% of the Electronic Medical Prescriptions are drawn up in active ingredients.

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Analysis by Country
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CNAMTS/Programme 2
Italy
(Emilia-Romagna)
• Healthcare System managed by the Region.
• Reimbursement System in course of centralization.
• Project initiated in 2006, prototype foreseen for the end of 2012 and
target solution in 2014.
•The project is in progress, No one benefits evaluation study has been undertaken at this date.
Difficulties met :
•Under Healthcare Professionals informatics equipment : The acquisition cost and or the renewal of the
informatic equipment park can not be only supported by the Healthcare professionals.
•The High number of softwares which has been modified in order to allow the emission of the prescription
has got some consequences in terms of costs and time schedule.
•Two documents form the prescription : an order form destinate to the pharmacist containing the medicines
to deliver (notably the number of packages) and a patient instructions for use in order to know how to take
the prescribed medicines. The instructions for use is not sent electronically.

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Analysis by Country
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CNAMTS/Programme 2
Italy (Lombardia)
• Decentralized Healthcare System.
• Reimbursement system in course of centralisation.
• Project initiated in the 1990’s on a restrictive perimater (not delivery
possible).
• In 2011, 86,5 millions of Electronic Medical Prescriptions have been
sent and exchanged from the doctors to the pharmacists.
• The project is in progress, no one evaluation benefits study has been undertaken at this date .
Difficulties met :
• The high number of softwares which has been modified to allow the emission of the prescription has got
some consequences in terms of costs and time schedule.
• The project is introduced by legislation, any healthcare professionals accompanying measures are
foreseen. The Healthcare Professionals adhesion is the main risk of the project.
• Two documents form the prescription : an order form destinate to the pharmacist containing the
medicines to deliver (notably the number of packages) and a patient instructions for use in order to
know how to take the prescribed medicines. The instructions for use is not sent electronically.

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The Electronic Medical Record and the Shared Electronic
Patient Summary Record

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The Electronic Medical Record
The main conclusions
1
2
3 The analysis by Countries

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● In France
In France, the initiative was officially launched at national level in 2004 in
the context of the law introduced by Health Minister Philippe Douste-
Blazy bearing on reform of the Social Security system. Major return on
investment was expected, but today it must be said that a good deal
more reserve is called for, with focus first of all on development of uses.
● Abroad
Electronic Health Records have been in use in a variety of forms in many
countries for several years now

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● First step :
We need to work closely an directly with the Healthcare Professionals and notably with
the Gp’s in order to help them to buy a computer and to use any compatible
Professional EMR Softwares – PROFESSIONAL EMR SOFTWARES
● Second step :
We need to work closely and directly with the Healthcare Professionals and notably with
the Gp’s in order to identify all the documents that they would accept to share with the
other Healthcare Professionals and Hospital Establishments and this in the framework
of the Shared Medical Electronic Patient Summary Record – SHARED MEDICAL
ELECTRONIC PATIENT SUMMARY RECORD

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● Third step :
We should determine in the framework of the Shared Electronic Patient Summary Record
which categories of documents the most important put at the disposal of each patient
and this through a dedicated secure internet portal. ACCESS FOR THE PATIENT TO ITS
EMR THROUGH A SECURE INTERNET PORTAL
● Fourth step :
● Regarding the EMR of the chronic diseases patients and in the framework of the Global
Healhcare Pathway we should provide all the information needed by all the Healthcare
Professionals concerned. FOR CHRONIC DISEASES PATIENTS PROVIDE TO ALL THE
HEALTHCARE PROFESSIONNALS CONCERNED ALL THE DOCUMENTS NEEDED IN ORDER
TO OFFER A COMPREHENSIVE ANSWER TO ALL THEIR HEALTHCARE PROBLEMS

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Analysis by Country
● Germany
- The Electronic Medical Record does not exist at the Federal/National Level at this date.
Nevertheless, it exists some pilot projects at the Lander Level which have not for aim to implement
a unique solution at the Federal/National Level
- In the Primary Care Sector the GP’s use a Professional Electronic Medical Record to register either
administrative and clinical data. These Electronic Medical Records are under the control of the GP’s
themselves
- In the hospital Care Sector the Information System are used to register the similar data at those
registered in the primary care sector. The Hospital Information System are also under the control
of the Healthcare professionals.
The data and categories of documents contained in the Electronic Medical Record vary according to
the Software editors.

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Germany
● Germany (to continue)
According to a recent publication from a multidisciplinary working group, the Electronic Medical Record should contain :
• A certain number of clinical documentation on the healthcare events :
- Medical measures,
- Symptoms,
- Diagnostics,
- Therapeutic objectives
• A special documentation :
- Laboratory test results,
- Documentation on the medications.
• A certain number of complementay documents :
- Documents provided by the other medical specialists
• Virtual views :
- Set of data from the Emergency Care,
- Basic clinical information
- Source : ZTG Zentrum fûr Telematik und Gesundheitswesen GMbh : Electronische Akten im Gesundheitswesen –
Ergebnisse des bundesweiten Arbeitskreises EPA/EFA, 2011.

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Germany
● Germany (to continue and end)
- The prior objective before the implementation of the Electronic Medical
Record is to deliver to all the patients insured by The German Health Insurance
Funds an Electronic Healthcare Card (70 %) in the framework of the basic
deployment which should have been started at the end of 2012
- The Electronic Medical Record should be available at the Federal/National Level
up to 2019

24
Austria
● Austria
- The Austria is currently working on the implementation of an Electronic Medical Record which
should be generalized in 2016.
- In the Primary Care Sector the GP’s use a Professional Electronic Medical Record to register either
administrative and clinical data. These Electronic Medical Records are under the control of the GP’s
themselves
- In the hospital Care Sector the Information System are used to register the similar data at those
registered in the primary care sector. The Hospital Information System are also under the control
of the Healthcare professionals.
- A certain number of patient data and documents should be available to these one (first step) :
*Discharge letters delivered by the hospitals,
* Laboratory test results,
* Hospital, Gp’s and Pharmacies prescriptions,
*Medical and or Clinical register.

25
Austria
● Austria
It is also foreseen in a second step of the deployment of the Electronic Medical Record to
to have a Shared Medical Electronic Patient Summary Record.
In the first sept of the development of the Electronic Medical Record, the patients are not
authorized to register their own documents and or to put them available.
The informatic equipment being different from a doctor to another one the necessity to
fund partly the modernization of the equipment has been recognized by the Austrian
Authorities.

26
Belgium
● Belgium
- The Electronic Medical Record should be seen here as a Shared Electronic Patient Summary Record
which should contribute to the enhancement of the healthcare quality and safety
- The Belgium authorities will is to allow thanks to the implementation and the real use of the
Professionals Electronic Medical Records the access of the data in a Shared way :
* Contained in the Professional EMR software of the Healthcare professionals-Gp’s,
* Contained in the hospital establishments servers.
- It is important to notice that at this date the EMR is not yet available.
- Existence of the E-Health box tool, which is a secure electronic mailboxes offer for free at all the
healthcare professionals includind the hospital establishments. This allow at the hospitals for
example to send for free the discharge letters (encrypted) to the Gp’s.

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Belgium
● Belgium (To continue) :
- It is foreseen to open the Shared Medical Electronic Patient Summary Record to the
patients/citizens.
- To allow the Belgium Healthcare professionals to buy an EMR Software the Belgium Authority have
decided to delivrer a grant of 850 euros by professional (Gp’s, Nurses and Physiotherapists).
- The process of labelisation/credentialing process enhance the quality of the softwares but does
not incentive the real use of these ones by the Healthcare professionals mentioned above.
Taking into account this fact, the belgium authorities have decided to measure the good use of the
EMR Software by the Healthcare Professionals concerned and to ensure if these one have an EMR
Software and if they use them really.

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Belgium
● Belgium (To continue)
The Belgium authorities have therefore decided to help to the development and
to the concrete use of the Professionals EMR :
- By allocating a lump sum payment of 80 euros by year and by doctor for the
management of the Professional EMR and this in the interest of the patient,
- To incentive financially the patients to have a referent Gp’s in charge of
managing his EMR by reducing the outpocket co-payment for each patient.

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Belgium
- According to the Belgium Authorities the Hospital Informatisation System is not
performant in the sense they produce only summary of hospitalization documents and
the consultation of the clinical biological test results. These documents being then
storage in a result server.
To address this problem the Belgium Authorities allocate each year and by hospital the
amount of 12 000 euros.
- The Belgium authorities are in favour of gathering all the regional existing results servers
in one server in which we will find the all the relevant documents concerning a patient.
The GP’s could connect him thus at this regional network wich would allow at this one
to access to a list of documents for a patient and if there are several regional servers to
collect all the documents known in these ones for a patient.

30
Belgium
-In the Dutch Community, there are 4 regional results servers,
- In Brussels capital there is 1 regional result server,
- In the French Community, there is 1 regional result server.
The French Community for example offer to their hospitals to be interconnected with a
unique results regional server to allow the Gps and the other Healthcare professionals
to access to any relevant documents for any patient.

31
Spain
● Spain
The Electronic Medical Record is still not available at the National Level
They are many initiatives undertaken by each Autonomous Community
Example : The Autonomous Community of the Catalogna
- A Professional EMR is used by almost all the Healthcare professionals and the Hospitals (88 %) :
* 7,9 Millions of Professional EMR existing including 40 M of clinical documents - the Catalogna have
7,5 Millions of inhabitants,
* 50 500 Healthcare Professionals access to these Professional EMR through a dedicated Professional
Portal : In 2012 there are been 1,74 Billions of consultations.
- All the Medical Imaging are stored in a Regional PACS Server,
- The Electronic Medical Prescription is already operational between the prescribers and the
pharmacists. This project is deployed since 2008.

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Spain
● Spain (To continue)
- Each citizen/each patient can consult some of their medical
informations on a dedicated and secure Internet Portal. A version for
smartphone is in progress in the framework of a pilot test.
- It is foreseen to have an Shared Medical Electronic Patient Summary
Record as it exist in the Autonomous Community of Catalunya at the
National Level.

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Italy
● Italy – National Level and Emilia-Romagna Region
In Italy the Healthcare System is managed by each Region and
consequently the EMR is therefore build up with each Italian Regions
hereby certify by the EMR study within the Emilia-Romagna Region
It does not have an EMR at the National Level. Nevertheless there are the
will of the Italian Public Authorities to have at the National Level a
Shared Medical Electronic Patient Summary Record called « Fascicolo
Sanitarie Elettronico ».

34
Italy
● Italy – Emilia-Romagna Region
- In the Primary Care Sector and concerning the GP’s, there are 16 Professionals EMR Softwares. On
this subject, the Emilia Romagna Region is currently in the way to proceed to a call for tender in
order to retain only and at the end of the process a unique EMR Software editors.
- In the Hospital Care Sector we find too the existence of compatible Professionals EMR Softwares.
- All the Healthcare Professionals of the Italian Emilia-Romagna Region are computerized and this
thanks to :
* First the creation of a regional server called « SOLE-SANITA ON LINE – HEALTH ON LINE »
implemented since 2003 and up to 2005 among which the main objective was to build up a
informatized network in the framework of the individual clinical pathway of the patient and to
share all the relevant clinical documents contained in the Professional EMR of the GP’s, Paediatrists
with all the Healthcare Structures of the Emilia-Romagna Region.

35
Italy
● Italy – Emilia-Romagna Region
- And secondly through the financial participation of the Healthcare Regional Directorate :
• in the Gp’s and Healthcare Professionals training,
• Cost of the 16 Professionals EMR maintenances,
• The cost of connexion of the GP’s computer,
• The Online Help Desk Service for the Gp’s, the Healthcare Professionals and the citizens,
• The purchase of the informatic material (Personal Computer and Printers) for the GP’s

36
Italy
● The Shared Medical Electronic Patient Summary Record is managed by the Italian Minister of
Health at the National Level and by each Italian Region at the Local Level – Example of the
management of this project by the Emilia-Romagna Region :
- The Facicolo Sanitarie Elettronico FSE– Shared Medical Electronic Patient Summary Record is a
Secure Internet Portal containing all the data of the patient which has been developed within the
Emilia-Romagna Region from 2008 to 2010. There have been an experimentation stage launched in
2011 and a generalization stage since 2012.
- The Healthcahre Professionals who have the responsibility of the healthcare of their patients in the
Public Structures can access to the FSE.
- The Healthcare Professionals should send any relevant clinical documents in the FSE and this by the
intermediate of the corporate software user integrated to the Sole Infrastructure.

37
Italy
● Shared Electronic Patient Summary Record managed by the Italian Minister of Health at
the National Level and by each Italian Region at the Local Level – Example of the
management of this project by the Emilia-Romagna Region ( to continue) :
- The Gp’s through their own Professionals EMR can see all the referral documents produce by
the Public Structure, the Specialists Pharmaceutical Prescriptions and send the « Patient
Summary » of the Patient with the information of their own Professionals EMR Sofwares.
- The patient have an access to his FSE and he is free to add any paper documents by scan.
- At the 31st of December 2012, there have been :
• Created 13 500 actives FSE,
• Stored in the Regional Data Server around 19 millions of clinical documents and around 33
millions of specialists pharmaceutical prescriptions,
• Consulted by the patients : 63.500 clinical documents and prescriptions.

38
Switzerland
● Switzerland
In Switzerland, the Healhcare System is managed par each County called
the Swiss Cantons. The EMR is therefore build up at a Local Level
It does not have an EMR at the Federal Level. Nevertheless there are the
will of the Swiss Public Authorities to have at the Federal Level a Shared
Medical Electronic Patient Summary Record.

39
Switzerland
● The EMR managed by the Geneva Canton
- A Shared Medical Patient Summary Record exist as one of the pilot project in Switzerland. It is
called « E-Toile Project ».
- In Switzerland around 20 % of the doctors have and use a compatible Professionals EMR Software
and it is the situation in the Geneva Canton too.
- The originality of the E-Toile Project is that E-Toile does not store any information but allow (or
not) the access for any request of all the databases of all the stakeholders involved in this project
(clinics, radiologists, pharmacists, hospitals, doctors, etc).
The partners themselves keep the control on their own data and decide which informations of their
Professionals EMR software they wish to put eventually at the disposal of E-Toile.

40
Switzerland
● The EMR managed by the Geneva Canton
E-Toile store only any pdf documents at this stage, at the exception of the medication informations
which are codified (possibility to exchange information).
The project E-Toile is in a pilot project stage within a Region of 50 000 inhabitants in the Medical
Center of the Onex Medical Group.
The Onex Medical Group is composed of 80 Gp’s who share at this date 280.000 Professionals EMR.
These Professionals EMR contains : a synthesis, the medicines, the radiologies imaging, the
laboratories results, the letters, the medical reports, the medical certificates for the population of
the Onex Region.

41
Switzerland
● The future Shared Medical Electronic Patient Summary Record
by the Ministry of Health at the Federal Level and among which
the example could be the Pilot Project of the Shared Medical
Electronic Patient Summary Record fom the Geneva Canton
- The main objective of the E-Health Swiss Strategy is to encourage all the Swiss Cantons to
implement an EMR and to have a Shared Medical Electronic Patient Summary Record if it is
possible in 2015.
- The pilot projects of an EMR in the Swiss Cantons are : Canton of Geneva (E-Toile), Canton of Basel-
Stadt, Canton of Wallis.
- It has not been yet defined at this stage the kind of documents we will find in the future Shared
Medical Electronic Patient Summary at the Federal Level. The discussions around this issue will
start in 2013. We think if we refer to the pilot projects of the Swiss Cantons that we will find the
following documents : Medical Reports, laboratories tests, the e-prescription, the e-medication, the
results.

42
The Software Editors Offers either in the Gp’s
practises/Healthcare Centres and in the Hospitals

43
Software editors offers of the Gp’s practices
● The Results obtained show us a first classification in two categories of practices, that is
to say :
- For the Software Editors offers of the Gp’s practices/Healthcare Centres :
- In one side, the Countries and or Regions, County Councils, Autonomous Communities
ensuring themselves the healthcare dispensation : have a few number of house
software developed internally and sometimes a unique one from a call for tender
process :
• Canada (Alberta),
• Spain (Catalogna),
• Scotland,
• United States (HMO Intermountain Healthcare and Kaiser Permanente),
• Italy (Emilia-Romagna),
• Sweden.

44
Software editors offers of the Gp’s practices
• In an other side and similar to France, some Countries are leaving the free market and
ensure nevertheless an homologation/labelisation/certification process of the
softwares used :
*Austria,
*Belgium,
* United States (Federal Level),
* The Netherlands,
* Switzerland among which the Geneva Canton.

45
Software editors offers in the hospitals
- For the Hospital Care Sector, the situations met in the other foreign Countries are
relatively and or quite similar to what we meet in France :
• A small editors number cover the major part of the market,
• Even if they do not cover all the needs from an hospital,
• This conduct the hospital to launch a call for tender to many editors and softwares,
• We find either some public offers and or Hospital Establishment Owners (again this
practice is less developed in France) and some national and international private offers,
• To notice in some Countries a quicker start offer with external storage share the
Information System of several hospitals : type Saas and or Cloud
We do think that the Ambulatory/Hospital communication is everywhere at its beginning –
except in any Integrated Healthcare System (USA Intermountain Healthcare, Kaiser
Permanente, Spain Autonomous Community of Catalogna).

46
Thanks for your attention
THANKS FOR YOUR ATTENTION

47
Professionnal contact details
Christian FOURY
Official Representative of
The International Research of
The Mission of the European and International Relations and Cooperation
(MREIC) of
The French National Healh Insurance Fund (CNAMTS)
CPAM de la Sarthe
178 Avenue Bollée
72 033 Le Mans Cedex 9
Telephone : + 33 2 43 50 74 89
Mobile : + 33 6 60 49 58 87
E-mail : christian.foury@cpam-lemans.cnamts.fr

THE E-HEALTH PANORAMA by Christian FOURY

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THE E-HEALTH PANORAMA by Christian FOURY