1. The eHealth Landscape
Veronique Lessens / Dirk De Langhe
Agfa HealthCare, Market Intelligence
Healthcare trends

2. World population is growing expanding the number of
“health” consumers
Population Population
Year (in billions)
(in thousands)
2010 6,842,923
World
2015 7,219,431
Asia
2020 7,577,889
Africa
2025 7,905,239
2030 8,199,104 Europe
Latin Am.
2035 8,463,265 & Car.
2040 8,701,319 Northern Am.
2045 8,907,417
2050 9,075,903
3 Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat,
World Population Prospects: The 2004 Revision and World Urbanization Prospects: The 2003 Revision
World population is ageing, especially in developed
countries
30.0
28.1
25.0
Percentage 60 years or older
20.0 22.1
Global
Explosion of 15.0
over 60 10.0
years -olds 10
8.1
5.0 6.9
0.0
1900 1950 2000 2050 2100
World
population x
is ageing
30%
25%
20%
Ageing is
15%
especially
pronounced 10%
in Europe
5%
0%
E u ro p e N o r t h A m e r ic a A s ia L a t in A m e r ic a
P e r c e n t 6 0 y e a r s a n d o ld e r , 2 0 3 0 p r o j e c t io n
4 Source: Long-Range World Population Projections: Based on the 1998 Revision. The Population Division,
Department of Economic and Social Affairs, United Nations Secretariat; US Census Bureau

3. Changing patterns of diseases: 60% of all deaths are
due to chronic diseases
• 35.000.000 people died from
chronic diseases in 2005 in the
world.
• The highest chronic diseases
prevalence are for:
• Cardiovascular disease, mainly
heart disease, stroke
• Cancer
• Chronic respiratory diseases
• Diabetes
• Without actions to address the
causes, deaths from chronic
diseases will increase by 17% over
the next 10 years.
• In the USA, 85% of all hospital
costs and 69% of all physician
costs go to treat chronic diseases
Source: WHO (2006)
5
Number of procedures increases with age putting pressures
on HC expenditures
ƒMedical advancements result in people living longer
Ageing
ƒThe elderly consume even greater amounts of healthcare delivery
Population is
consuming services.
more
healthcare ƒWhen people are above 65 years old, they receive four times the number
and
of diagnostic procedures as others receive
diagnostic
Number of services
procedures ƒAnnual rate of growth in the number of images radiologists must interpret
increases – estimated at 6% to 12%
with age
x
putting
pressures
on HC
expenditures
expressed as a share of GDP per capita
Increasing
Average expenditure per head
age profiles
put pressure
on public
health
expenditures
A g e g ro u p s
6 Source: Economic Policy Committee (2001) “Budgetary challenges posed by ageing populations”

4. Healthcare delivery… a very risky activity
Dangerous Regulated Ultra-Safe
Total lives lost per year (>1/1 000) (>1/100 000)
100 000
Healthcare
Driving
10 000
1 000 Scheduled
Airlines
100 Mountain Chemical European
Climbing Manufacturing Railroad
10 Bungee Chartered Nuclear
Jumping Flight Power
1 10 100 1 000 10 000 100 000 1 000 000 10 0000 000
Number of encounters for each fatality
More deaths per encounter than for any other activities !
Adverse events carry a high financial cost, £2 billion a
year in additional hospital stays alone in the NHS !
7
New trend: the patient has a voice and choice
Comparative Social /
Financial Public quality demographic
responsibility policy indicators Connectivity changes
Engaged patient Empowered patient
• Patient empowerment is a increasingly undisputed fact
• Patients are more informed and thus more opinionated
• Informed patients will shop for healthcare providers that meet their specific
needs and expectations
• Informed patients want more customization and move convenience
8

5. Public authorities search for answers to increased demand
and cost escalation: Better quality can cost less !
ACCESS
„ “Consumer led” delivery service
QUALITY OF CARE „ Supporting increased demand for
services (in volume and sophistication)
„ Patient oriented care/Clinical pathways „ Meeting 24hour/7days a week service
„ Collaborative care/Continuum of care Quality Access expectation
„ Disease management programmes „ Facing ageing population and new
„ “Voluntary” gatekeeper approach pattern of diseases
(Global Medical Record) „ Facing individualism and diminishing
„ Continuous medical education family care potential
(Accreditation) & Peer Review „ Avoiding waiting time
initiatives „ Increasing private care
„ Increasing attention to Efficiency „ Increasing patient’s co-payment
medical/medication errors
„ Patient satisfaction Efficiency
„ More evidence-based medicine
(outcomes based)
„ Matching capacity to demand
„ Deploying resources more effectively
„ Avoid abuse (multiple exams/acts, etc.)
„ Reducing costs of well-established procedures
„ Controlling escalation of costs
„ Transforming healthcare (process & workflows)
„ Using new ICT technology to support transformation
9
Public authorities need to do things differently: « Good
health can save costs »
From «late disease» To «early health»
• Symptom based • Prevention / prediction
• Data silos • Detailed patient info
• Managing illness • Early diagnosis
• Average therapies • Targeted therapies
Critical information whenever and wherever it’s needed
INFORM & SHARE
Prevent Diagnose Treat Monitor
Identify at risk patients earlier
Earlier, more accurate diagnosis
Earlier, more targeted treatment
Track efficacy of treatment
10

6. New ways of working opening doors to collaborative platforms
(eHealth)
L a b r e s u lt s
I n s u r a n c e in f o r m a t io n
D ia g n o s t ic im a g in g
More and
S c h e d u lin g
more
collaboration P a t ie n t h is t o r y
is required M e d ic a l r e c o r d s ( E M R )
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Today 2002
S o u r c e : T h e F u t u r e o f H e a lt h C a r e 2 0 0 5 , D e lo it t e D e v e l o p m e n t L L C .
Collaborati
x
on
@ GP
“Early @ H o s p ita l @ L o c a l fa c ilitie s @ S p e c ia lis t
Health” R a d io lo g y P ro v id e r/
breaking the in fo rm a tio n P a tie n t
s y s te m s a n d
hospital m e d ic a l
boundaries te c h n o lo g ie s
@ T e le ra io lo g y c o m p a n
@ P riv a te R a d io lo g y c e n tre s
11 Source: The Future of Health Care 2005, Deloitte Development LLC.
Summary: The Healthcare paradigm is evolving …
TODAY TOMORROW
Treatment of
Paradigm Health of citizens
patients
Focus Provider centric Patient centric
Episodic approach,
Time Scope Lifetime care, preventive
curative
Decentralized,
Space Scope Hospital based
community based
Treatment & Invasive, Less invasive visualization
imaging scope uncomfortable & treatment
Workflow Fragmented Integrated & automated
12

7. Transforming healthcare…
The Problem…
14

8. And…
15
Defining a Vision of the Future: eHealth
Today Tomorrow
Technology Disparate Information Systems Connected Information Systems
Data Access Limited, Difficult to Access Ready Real Time Access
Data Accuracy /
Manual Systematic Controls / Checks
Completeness
Decision Support Personal Preference Rules / Evidence Based
Ordering Process Manual, Multiple Hand-Offs Automated, Minimal Hand-Offs
Care Delivery Individual Experience Adoption of Clinical Best Practices
Patient Record Multiple Sources, Incomplete Single Integrated / Complete Source
Outcome No Linkage to Care Structured Data Repository Linking
Measurement Delivered Outcomes to Care Delivered
16

9. The eHealth market
Global Healthcare IT (eHealth) market worth €55 Billion…
but representing only 1.5% of HC spending
GDP
5.4 % GDP = $46,305 billion 9.9% GDP
ICT market
= $2,490 billion
45.3% ICT market
HC market
= $4,581 billion
IT market
= $1,129 billion
6.0% IT market 1.5% HC market
HC IT market* (per year)
= $68 billion
* HC IT market includes Government, Payers and Providers
18
Source: European Information Technology Observatory in co-operation with IDC (2006): Cutler & McClellan;
Health Industry Insights, an IDC company (2006); Clinica (2003); Espicom; Agfa’own estimates.

10. Healthcare currently one of the lower IT spending sector
although urgent need for transformation
% of IT spending on total revenues
12.00% 11.10%
10.00%
8.00%
6.00%
3.90%
4.00%
1.50%
2.00%
0.00%
Healthcare Retail Financial
• Currently one of the lower IT spending sector with 1.5% average
(w.r.t. revenues) compared to retail (~4%) and financials (10+%)
• Set to increase at an annual growth rate of ~9%
19
Source: European Information Technology Observatory in co-operation with IDC (2006): Cutler & McClellan;
Health Industry Insights, an IDC company (2006); Clinica (2003); Espicom; Agfa’own estimates.
Although one of the most complex and information-intensive,
spend per employee are far behind other sector domains
£8,790
Annual spend per employee (UK only)
£5,538
£4,333
£3,833
£3,393
£3,017 £2,920
£979
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20
Source: HINE (2004)

11. European end-users also lacking behind … with 70% of EU
hospitals spending less than 2% of revenues
IT Budget as % of total budget
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2% or less 2.1 - 2.5% 2.6 - 3% 3.1 - 4% >4%
EU 70.4% 10.9% 6.8% 5.9% 6.1%
USA 24% 25% 18% 19% 9%
• In Europe, 70% of the hospitals spend less than 2% of their total
revenues, while 70% of their US colleagues were spending more than
2% in 2004.
• But spending are on the increasing pattern.
21
Source: HINE 2005&2006; HIMSS Analystics 2005&6
eHealth creating tremendous opportunity for Europe at the
crossroads of Health and Technology
Healthcare Healthcare IT
Health is Wealth A tool for transformation
Responding to healthcare challenges for the citizens
• Escalating demands
Demand for automation solutions
• Labour shortage
• Higher quality health services • Eliminate manual, error-prone workflow
• Patient safety imperative • Improve clinical productivity
• At a ‘contained’ cost level • Re-allocate resources; emphasize revenue
Health is important to a country’s economy. generating opportunities
• Health employs currently 10% of Europe’s
workforce Digital medical record initiatives
• Health represents 8.6% of the EU-15’s economy • Must be multimodal
• Health is expected to triple by 2020 and reach 16% • Workflow includes clinical patient data
of GDP.
Health infrastructure is key • Maximize value of IT investments
• Health infrastructure which improves health and
supports strategic objectives of prosperity, Government initiatives
solidarity and security is needed.
• National/Regional programs
Health is wealth.
• E-Health
• A society in good health leads to higher
productivity, increased labour supply, better • Disease management/Population Management
education and contributes to sustainable long-
term growth.
Innovation supporting paradigm shift from “sick care” to “health care”,
the so-called Continnum of Care
22
Source: Agfa’own estimates

12. But … Key issues to address
• eHealth currently treated as an add-on rather than part of an integrated
eco-system.
• Standards for interoperability of ICT, being adopted consistently, should
be further encouraged.
• Increased funding and alignment of Incentives between who pays and
who benefits from ICT in health should be undertaken.
• People, processes and change management should receive more
attention for implementation.
• The involvement of end users (health professionals and patients) is
essential for developing ICT solutions.
• An emerging challenge is coming to widely held concepts of privacy and
confidentiality.
• Innovation and research should be stimulated and better coordinated at
crossroads of social, health, ICT and life science aspects.
•
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