eHealth Toolkit LINK2

8/6/2019 eHealth Toolkit LINK2

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COCIRSUSTAINABLE COMPETENCE IN ADVANCING HEALTHCARE

European Coordination Committee of the Radiological, Electromedical and Healthcare IT Industry

COCIReHEALTH TOOLKITFOR ANACCELERATED DEPLOYMENT

ANDBETTER USE OF eHEALTH MAY 2011


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Eurpen Crdintin Cmmittee f the Rdigic,

Eectrmedic nd Hethcre IT Industry

1 CoCIR eHEalTH ToolkIT 2011

Part 1

COCIr POsItIOn PaPr 3

Three priority areas or a dynamic Healthcare IT market in Europe

Part 2

Markt IntllIgnC OvrvIw 13

Hospital IT market in Europe: Facts, fgures and recommendations

Part 3

COCIr glOssary Of trMs 25

While the benefts o eHealth - the use o inormation and communications technologies (ICT) in the feld o healthcare are not

disputed, the eHealth market remains ragmented at both country and regional levels in Europe and is not benefting rom efcient

deployment today. Still, times change and the new decade seems to be bringing with it a new and more positive landscape or

eHealth.

Since 2007, the European Commission has publicly-recognised ICTs ability to drive the EU economy and indeed its economic

recovery in the Europe 2020 vision. The Digital Agenda too sets ambitious goals or the deployment o eHealth and more recently,

the Innovation Union promises to launch partnerships to support active and healthy ageing. The eHealth Governance initiative is

strengthening cooperation between the Member States and last but not least, the Directive on Patients Rights in Cross-border

Healthcare sets out a legal basis or using eHealth in Europe or the frst time.

As an organisation which very much values a partnership approach, COCIR is ollowing these developments closely and is

committed to contributing over 20 years o expertise and experience in the feld to ensure a better eHealth uture or Europe and

its citizens.

why ehalth Mattrs tO COCIr?

As the leading European trade organization in the feld o eHealth, representing the Radiological,

Healthcare IT and Electromedical industry, COCIR welcomes the European Commissions increasing

support or eHealth, a technology which has been gaining ground over the last twenty years and is

now recognised as one o the most benefcial tools in the healthcare arena.

Nicole Denjoy

COCIR Secretary General


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CoCIR eHEalTH ToolkIT 2011 2


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3 COCIR eHEALTH TOOLKIT 2011

COCIR POSITION PAPER 1


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COCIr PrIOrItIs 4

Three priority areas or a dynamic Healthcare IT market in Europe

DtaIlD brIfIng

What is eHealth? 5Benefts o eHealth 6

DtaIlD brIfIng On th thr PrIOrItIs

Develop an innovative and sustainable business model 7Foster standards and interoperability 9Enable market development 11

1

COCIR advocates the deployment o Healthcare IT as being crucial or improving healthcare and ensuring the continuum o care

as stated in COCIRs whIt PaPr1 towards a sustainable healthcare model.

In 2007, COCIR developed 10 rCOMMnDatIOns2 to accelerate the deployment o eHealth. Given the constant evolution in

this domain and ongoing debates, COCIR has concentrated its eorts on three major priority areas out o the 10 recommendations

or a dynamic healthcare IT market in Europe.

1 COCIR White Paper Toward sustainable healthcare model (November 2008)http://cocir.org/uploads/documents/-34-cocir_wp_on_sustainable_hc_-_released_on_19_nov._2008.pd

2 COCIR Ten Recommendations on eHealth (October 2007)http://www.cocir.org/uploads/documents/-24-cocir_pp_ehealth_rel_short.pd


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what Is ehalth?3

eHealth describes the application o inormation and communications technologies across the whole range o unctions that

aect the health sector.

eHealth includes tools or health authorities and proessionals as well as personalised health systems or patients and citizens.

eHealth can thereore be said to cover the interaction between patients and health-service providers, institution-to-institution

transmission o data, or peer-to-peer communications between patients and/or health proessionals. It can also include health

inormation networks, electronic health records, telemedicine services, and personal wearable and portable communicable

systems or assisting in the prevention, diagnosis, treatment, health monitoring and liestyle management o patients.

3 See COCIR Glossary o terms

eHEATH COMPRISES FIE TPES OF SSTEMS:

Hospital inormation systems (HIS)

Clinical inormation systems (CIS)

Telemedicine

Integrated health inormation networks

Secondary-usage non-clinical systems

eHEATH COERS THE FOOWING FUNCTIONS:

Data exchange

Health education

Health inormation

Public health research support

Healthcare delivery support

Remote healthcare services social care support

eHealth is the application o ICTs across the whole range o unctions that aect the health sector.

It encompasses fve types o systems and covers various unctions:


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bnfIts Of ehalth

The benefts o eHealth are widely recognised. The European Council Conclusions4 on Sae and Efcient Healthcare through

eHealth (December 2009) recognise the importance o eHealth as a tool to improve quality and patient saety, to modernise

national healthcare systems, to increase their eectiveness and make them better adapted to meet the individual needs o

patients, health proessionals and the challenges o an ageing society.

Below is a non-exhaustive list o the recognised benefts o eHealth.

1 fciie cce o ece

eHealth can help deliver care to people located in remote

places and who do not have access to a hospital, or

example through a tele-consultation.

2 Impoe qui o ce

eHealth can help improve the quality o care by providing

easier, saer and aster access to patient data, thereby

allowing the healthcare proessional to access the right

data at the right time and make an inormed-based

diagnosis.

3 Impoe qui o ie o pie

eHealth in general and telemedicine in particular can help

improve the quality o lie o patients by, or example,

monitoring the condition o the patient at distance at home,rather than in a hospital. This is particularly relevant or

elderly, chronically ill persons and people living in remote

regions.

4 Impoe pie e

The availability o inormation on the patient such as

his medical history, past diseases and interventions,

allergies, reaction to medications in an electronic health

record (EHR) allows healthcare proessionals to deliver a

treatment tailored to the needs o the patient and thereby

reduce risks o complications, adverse drug reactions etc.

5 se ime o ece poeio d epod

o e oe o quied

Adequate eHealth tools such as electronic health records

allow healthcare proessionals to access inormation on

the patient aster and thereby avoid losing time compiling

inormation rom dierent location/sources. By allowing

healthcare proessionals to save time, eHealth tools also

address the issue o shortage o healthcare proessionals.

With the increase o chronic diseases and the ageing

population, healthcare proessionals will be required to

monitor more patients. eHealth tools can help them work

more efciently, by storing patient inormation in a singlelocation, taking medical decisions better and aster with

the support o decision support systems.

6 se co

eHealth can help reduce costs (clinical and administrative

costs) by, or example, avoiding the duplication o medical

examinations and unnecessary visits to the general

practitioners / hospitals.

7 Modeie d impoe eciec o ece

deie

Integrating eHealth in healthcare delivery brings a degree

o sophistication to healthcare systems by allowing a aster

ow o inormation and helping transorm healthcare

systems, rom a ragmented approach (prevention, primary

care, treatment, rehabilitation) to a seamless continuum o

care where all these levels are closely interlinked.

8 Impoe d ecue e o pie iomioWhere patient data used to be stored on a hand-

written piece o paper handled by nurses, doctors and

administrative sta, it is now stored on a centralised

electronic fle, protected with adequate identifcation and

authentication processes.

9 reduce co oopi o ece

By using inormation technologies, eHealth allows the move

rom paper-based to electronic fles. eHealth also reduces

the need or travel or patients, healthcare proessionals

and other actors resulting in lower CO2 emissions.

10Coiue o e compeiiee o e U

ecoom

eHealth is the astest growing health sector in Europe and

contributes to the creation o jobs and to the innovation

capacity o the European economy, as recognised by the

EU2020 strategy.

4 Council Conclusions Sae and Efcient healthcare through eHealth (December 2009)


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1 DvlOP an InnOvatIv sUstaInabl bUsInss MODl

CHAENGES

eHealth is an important tool to achieve the sustainability o healthcare systems, but an innovative business model or eHealth is

needed urgently.

The WHO Global Observatory on eHealth5 report stresses that even the most progressive eHealth policies are at risk i not

supported by an adequate and complementary unding environment. The current payment systems oten do not encourage care

providers to invest in eHealth and do not reward providers or improving quality o care via ICTs. In addition, the costs and benefts

o adopting new technologies are not shared equally among the stakeholders: investments which are cost-eective rom the point

o view o the system as a whole are thereore not automatically going to be undertaken. Reducing the fnancial barriers, shitingor sharing the fnancial risks and providing more evidence on the benefts o eHealth can accelerate the adoption o eHealth.

COCIR PROPOSAS

) Coide ehe oie ieme, o co

The lack o unding is a major barrier to eHealth deployment. According to the WHO report on eHealth6, public unding is by ar

the biggest source o fnance or eHealth. However, as government budgets are continually stretched, eHealth must compete with

other public services or its share o limited resources. In order to win such unds, governments must be convinced that money

allocated to eHealth will not only improve health services in the short-term, but will be a solid investment or the uture healthcare

system and that the expected benefts will outweigh the cost.

Examples o the economic benefts o eHealth include minimising the duplication o medical tests, reducing the administrative cost

o billing, patient scheduling, and paper orms, reducing time spent collecting patient inormation, improving sta productivity and

increasing healthcare efciency (through reduced utilisation o healthcare services)7.

Canada Inoway estimates that the creation o electronic health records or all Canadians will cost about $10 billion - which

translates to a one-time cost o approximately $350 per Canadian - while the estimated savings to the Canadian healthcare

system will amount to $6 to $7 billion a year, every year 8. However, the time anticipated between the initial investment and the

actual savings are made is still unclear.

Many studies point to the act that the return on investment is not immediate it can take a ew years to materialise - and is

difcult to anticipate.

The shortage o robust studies documenting the economic benefts and cost-eectiveness o eHealth is a challenge. Industry

encourages governments and payers to fnance such studies and to study existing evidence when considering investments oneHealth.

) Meue e o-ci impc o ehe o me iomed udi deciio

The scale o most eHealth projects and the important sums o taxpayers money invested in them, make it crucial or governments

and payers to evaluate the impact o eHealth programmes.

The Report o the Swedish Presidency o the EU eHealth or a Healthier Europe9 recognises three major non-fnancial benefts

o eHealth: improved patient saety, improved quality o care and improved accessibility o care. Collecting evidence on the non-

fnancial benefts o integrating eHealth in healthcare systems should thereore be a crucial part o decision-making.

5 Building Foundations or eHealth: progress o member state: report o the Global Observatory or eHealth, WHO, 2006

6 Idem

7 Improving Health Sector Efciency the Role o inormation and communication technologies, OECD health policy studies, 2010

8 Canada Health Inoway, http://www.knowingisbetter.ca/#aq

9 eHealth or a Healthier Europe! Opportunities or a better use o healthcare resources, Gartner, 2009


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The lack o data on the benefts o eHealth is a major barrier to its widespread adoption. Industry encourages governments andpayers to support independent and reliable evaluation o eHealth programmes and, in parallel, to engage in the deployment o

eHealth on the basis o existing evidence and successul projects.

c) fice e depome o ehe

arge scale deployment o eHealth in Europe requires political will and unds. Politicians need to explore new avenues to fnance

the integration o eHealth in healthcare systems. COCIR recommends exploring the ollowing three options:

Improving public procurement

Procurement policies directly impact the unding available or eHealth systems and services. They can streamline ICT business

processes and can lead to signifcant cost savings, while eeding a ruitul dialogue with the providers. The eHealth industry has

considerable experience in analysing procurement strategies to see what works and what does not and is happy to initiate a

dialogue with the public authorities to devise a strategy on how to accelerate the deployment o eHealth through innovative andefcient procurement strategies.

Financial incentives to support the adoption and use o eHealth

A general practitioner will hesitate beore investing money in electronic health records, and will be reluctant to spend time updating

patient fles i this additional work does not generate additional income.

A recent study by the OECD10 demonstrates that fnancial incentives are critical in promoting the implementation and eective

use o eHealth tools: grants, subsidies, bonuses or add-on payments that reward providers or adopting eHealth are eective,

in particular in countries where physicians are remunerated on a ee-or-service basis. However, a one-o subsidy will support

the initial set-up phase but will not encourage the ongoing use o eHealth. A reexion is needed on what steps should be taken

to ensure that the ongoing costs o eHealth systems are being met with sufcient unding, and that those who bear the fnancial

investment (implementation and maintenance) also see a return on investment.

In 2009, the United States adopted an incentive programme to support the adoption o eHealth by the healthcare sector over the

ollowing fve-year period. The industry recommends that the European Union and Member States closely monitor the impact this

stimulus plan has on the eHealth market and draw learnings to be applied to the EU market.

Finance eHealth through the Structural Funds

With national budgets under pressure, authorities need to fnd additional resources to support the implementation o eHealth in

Europe. The healthcare IT industry recommends that authorities earmark a signifcant share o Structural Funds to fnance eHealth

deployment on the EU market or the orthcoming fnancial perspective 2014-2020. This dialogue needs to involve all relevant

stakeholders: EU institutions, regional and national authorities, patients, healthcare proessionals, care providers etc and should

be part o the discussions within the eHealth governance initiative.

d) Deeop eimueme mecim o ehe eice

Most current reimbursement schemes do not cover eHealth-based services: or example an online consultation or a discussion

at distance between two healthcare proessionals on a patients case. Medical proessionals are not encouraged to make use o

eHealth, even i this could result in improved quality o care or their patients and savings or the healthcare system.

This is a critical barrier to the use o eHealth: a new approach is needed to integrate eHealth in routine reimbursement schemes.

Public authorities need to be ready to incentivise and reimburse more outcome-based care processes covering the entire care

value chain.

Dierent systems have been tested in dierent countries, such as:

Payment dierentials: bonuses and add-on payments that reward providers or adopting IT in relation to quality improvements

targets (pay or perormance) Direct reimbursement o eHealth-based services

Tax incentives

Financial penalty or not using IT

10 Improving Health Sector Efciency The role o Inormation and Communication Technologies, OECD, 2010


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Evidence shows that each o these mechanisms - either used in combinaison or separately - have a positive eect on the adoptionand use o healthcare IT, but have not yet been tested on a sufciently large scale and or long enough to considered a sustainable

business model. Industry thereore strongly encourages urther research in this area.

2 fOstr stanDarDs anD IntrOPrabIlIty

Foster international user-driven standards and proles for eHealth interoperability, and leverage self-declaration of

interoperability performance based on conformance testing processes.

CHAENGES

Standards are necessary to secure three crucial aspects o eHealth: interoperability, patient saety and privacy. These are pre-

requisites or the development o eHealth in Europe.

Additionally, standards have a strong impact on eHealth costs, as the process o transerring data between dierent systems

responding to the same standards becomes more economical.

However standard setting is a complex activity, which does not always address market needs. Standards can be complex to

implement and the lack o interoperability standards and profles contributes to market ragmentation in Europe, with its many

small, dierentiated markets. This inevitably results in a lack o economies o scale or companies which oer eHealth-related

goods and services. This in turn leads to higher costs or users, and a slow take-up o eHealth solutions as experience is

transmitted slowly between markets in dierent countries.

COCIR PROPOSAS

) foe ieio dd

Standardisation is the process o agreeing on technical specifcations, criteria, methods, processes, or practices with a view to

secure compatibility, interoperability, saety, repeatability and other related qualities. Standards are thereore the best way to

guarantee innovation and open access to the market or users and industry. This creates a level playing feld which strengthens

competition or the beneft o consumers and the competitiveness o European industry in the global market.

This virtuous cycle can be hindered by the existence o national or local standards. To access a national market, companies are

oten obliged to adapt their products to the national requirements, creating additional costs or the industry and or the healthcare

system as a whole. The healthcare IT industry thereore advocates or international standards to enable manuacturers to reuseexisting solutions which allow or the reduction o costs in the design, development and deployment o products.

In this regard, COCIR welcomes the Digital Agendas objective to oster EU-wide standards by 2015, but encourages the

Commission to go one step urther towards international standards.

) foe ue d me-die dd

Industry advocates that standards should be user-driven and market-driven to be eective. All too oten, the standard development

process is too slow and market-agnostic. Many published standards do not ulfl the requirements o the market players and users,

as technology and users wishes have moved along.


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c) Pomoe ieopeii U d ieio ee

Interoperability is the ability o systems and organisations to work together11. In the last years, many eHealth programmes have

been implemented in various regions in Europe without coherence, hence resulting in a myriad o small-scale systems based on

local standards which cannot communicate with each other. The lack o interoperability is a major barrier to the development o

eHealth in Europe. COCIR thereore applauds the numerous initiatives taken by the European Commission and Member States to

improve interoperability12 in Europe and would like to draw the Commissions attention to IHE.

Integrating the Healthcare Enterprise (IHE) plays an important role by publishing standardised profles or healthcare IT interoperability

scenarios. IHE is a user-vendor initiative which develops and publishes detailed rameworks or implementing relevant eHealth

workows to meet specifc healthcare needs. IHE supports interoperability testing, demonstration and educational activities to

promote the deployment o these rameworks by vendors and users. The profles that IHE generates are internationally accepted

and recognised as state o the art in the context o eHealth. IHE organises annual Connect-a-thons, which are multi-vendorinteroperability testing sessions. Proven experience with these IHE conormity testing process beore and during IHE Connect-

a-thons makes IHE an important best practice or European policymakers to consider. To pursue these activities, IHE engages

numerous stakeholders, including care providers, medical and IT proessionals, proessional associations and vendors.

COCIR welcomes the Digital Agendas objective to oster interoperability testing by 2015 through stakeholder dialogue, and

encourages the Commission and Member States to recognise in a European interoperability ramework a core set o IHE profles.

COCIR recommends that clear requirements or internationally recognised standards and profles or interoperability be included

in public procurement policies. This applies to EU unds as well (FP, CIP, structural unds).

COCIR also encourages the European Commission to maintain its support or the development o semantic and unctional

interoperability, based on real applications rom large-scale pilot projects in a frst phase, and to support large-scale implementation

in a second phase.

d) reduce e euo ude

A balanced and efcient regulatory approach is needed to allow or innovation but also to create confdence among customers.

Industry recommends a prudent use o regulatory initiatives in the areas o certifcation and interoperability conormity testing in

order to minimise additional regulatory burdens.

COCIR recommends developing interoperability conormity testing and certifcation as related but independent activities.

In the area o ieopeii coomi, COCIR recommends leveraging the long experience o the industry applying sel-

declaration o interoperability conormance based on the proven IHE experience and conormity testing processes.

In the area o ceicio, COCIR encourages public or private certifcation entities to make use o the openness o IHEs exibleand proven solutions to adapt conormity testing to local needs. Certifcation processes careully consider audit programmes o

the quality system o the vendor based certifcation as a superior alternative to third party certifcation. I third party certifcation

entities are created, those should not be regulated entities, but market driven voluntary programmes.

ast but not least, in order to preserve market dynamics and to ensure innovation the governmental ocus lies on involvement in

becoming a partner in the public/private certifcation process, linked to interoperability conormance testing activities.

In the area o data protection, COCIR encourages the certifcation o security procedures, based on industry best practice (e.g.

ISO2700x-amily) and recommends using public/private certifcation auditors or these certifcation activities.

11 See COCIR eHealth Glossary o Terms or more defnitions.

12 Commission action plan on eHealth (2004), Commissions report on Connected Health (September 2006), Commissions communication on eHealth interoperability (2007), theead Market Initiative (2007), the Commissions communication on Telemedicine (2008), the epSOS large scale project, the Calliope Thematic Network, the Digital Agenda (2010),article 13 o the directive on patients rights in cross-border healthcare (2010) and the eHealth Governance Initiative.


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3 nabl Markt DvlOPMnt

Enable the creation of a competitive eHealth market across Europe by removing institutional, legal and social barriers.

CHAENGES

eHealth is the astest growing industry o the healthcare sector. COCIR estimates the global eHealth market at 55 billion o which

Europe represents one third. All market players and observers agree that eHealth is set or explosive growth but that many actors

hinder the development o the eHealth market in Europe.

Besides the lack o an adequate economic model (see section 1) and technical barriers (see section 2), other barriers which

hinder the development o the eHealth market include lack o legal clarity, slow adoption o eHealth by healthcare proessionals

and societal challenges.

COCIR PROPOSAS

COCIR calls or the creation o a single, leading and competitive eHealth market in Europe. This can only be achieved by creating

the same market conditions across Europe. This is an enormous challenge and requires open and continuous dialogue involving

all stakeholders, rom policymakers at national and European level, patients, health proessionals to payers and industry.

) bi e ci

eHealth is a ast-moving technology which is evolving aster than legislation. This results in legal uncertainties which hinder the

adoption o eHealth solutions.

Healthcare proessionals and patients will not have confdence in and will not use eHealth i they cannot reer to a comprehensiveand clear legal ramework covering among others the liability o healthcare proessionals, rights o patients, responsibilities in

case o cross-border healthcare, data protection, licensing and accreditation o healthcare proessionals, etc.

Regarding data privacy13, a balanced approach to privacy and security is essential to establish the high degree o public confdence

needed to encourage the widespread adoption o eHealth, and particularly o electronic health records.

Industry is very conscious o the sensitivity o medical data and has incorporated these concerns in the design o eHealth structures

and systems (privacy by design, privacy enhancing technologies etc). However, data protection is a collective responsibility and

industry cannot act alone:

Data protection authorities need to allow the availability o medical data at the point o care to secure patient saety.

Healthcare providers using ICTs need to implement controls to regulate the adequate and sae use o healthcare inormation

technology. Public authorities need to harmonise the dierent national data protection rules to allow a secure ow o data, increase citizens

confdence and eliminate the current barriers to trade in the internal market.

A genuine dialogue is needed between the dierent actors to establish reliable and coherent privacy and security rameworks.

) buid It i mo ece poeio

Health proessionals do not always have the necessary IT skills to use eHealth solutions. This results in a limited use o these

solutions when they are available14. The adoption o eHealth by healthcare proessionals is slow. This can be explained among

other things by resistance to ICT caused by a lack o IT skills and a lack o time to learn how to use these new tools. This lack

o understanding should be addressed by embedding IT skills in the medical curriculum and by providing IT training to healthcare

proessionals and change management training to healthcare managers.

13 See COCIR contribution to the Communication on Strengthening Personal Data Protection in the EU
http://www.cocir.org/uploads/documents/10-1138-cocir_contribution_to_the_communication_on_personal_data_protection_in_the_eu.pdfhttp://www.cocir.org/uploads/documents/10-1138-cocir_contribution_to_the_communication_on_personal_data_protection_in_the_eu.pdfhttp://www.cocir.org/uploads/documents/10-1138-cocir_contribution_to_the_communication_on_personal_data_protection_in_the_eu.pdf


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c) mpoe pie d oo pie-ceic ece em

By acilitating connections between people and systems, eHealth can support the shit rom provider-centric care to patient-centric

care. However, this can only happen i actors (patients, citizens, physicians, care providers, payers) also adopt this new paradigm

and agree to change the way they used to provide and receive healthcare.

With eHealth, patients have ar more possibilities to manage their own health instead o relying entirely on the amily physician or

the local hospital. However this is not always easy in a ast-moving environment. The move rom provider-centric care to patient-

centric care will only be successul i all actors are ully involved and inormed.

Healthcare proessionals and care providers need to be part o the change process, involved in each step, and should also fnd

their place and interest in the new process.

Industry eels strongly that the eHealth market will take o once the move towards patient-centric care has made some signifcant

progress.

14 See Part II: Market Intelligence Overview or more detail.


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European Coordination Committee of the Radiological,

Electromedical and Healthcare IT Industry


MARKET INTELLIGENCE OVERVIEWHOSPITAL IT MARKET IN EUROPE:

FACTS, FIGURES AND RECOMMENDATIONS 2


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ky fInDIngs Of th COCIr Markt IntllIgnC PrOgraMM 14

DtaIlD brIfIng

Why measuring Healthcare IT adoption matters? 15eHealth in hospitals: a market on the increase but acing signifcant hurdles 15Healthcare transormation calls or higher IT budgets in European hospitals 16Healthcare transormation calls or more investmentin clinical inormation systems in European hospitals 19Faster adoption o healthcare IT by healthcare proessionals is necessary to reap the ull benefts o eHealth 22

annx: COCIr Markt rsarCh MthODOlOgy 24

COCIR believes that sharing data on the limited use o Healthcare IT in European hospitals will help policymakers, health

proessionals and other stakeholders realize there is a gap to be flled and encourage them to invest in Healthcare IT, in order

to progress towards a better integrated and sustainable healthcare system. COCIR has thereore developed eorts to provide

accurate and reliable data on the availability and use o healthcare IT in Europe, and more particularly in European hospitals.

2


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1 why MasUrIng halthCar It aDOPtIOn Mattrs?

All healthcare inormation technology providers will easily agree that there is a lack o reliable data on the availability and use o

Healthcare IT in Europe. COCIR believes that providing data on the availability, use and benefts o Healthcare IT will encourage

policymakers, health proessionals and other stakeholders to invest in Healthcare IT, and thereby improve and transorm healthcare

and ensure its long-term sustainability across European countries and beyond.

With this in mind, and building on its 20 years experience in monitoring the medical imaging market, COCIR launched in 2008

the eHealth intelligence process to monitor the availability, use and investment plans or eHealth in European hospitals 15. In

parallel, COCIR issued the eHealth glossary o terms to provide a clear and comprehensive defnition or eHealth and or healthcare

IT solutions and services.

2 ehalth In hOsPItals: a Markt On th InCras bUt faCIng sIgnIfICant hUrDls

The Hospital IT market totaled 2.4 billion in 2008, with a 4% growth prospect by 2012 (see table 1). This fgure covers healthcare

IT solutions used in hospitals: administration inormation systems, clinical inormation systems, laboratory inormation systems

and imaging inormation systems (in the feld o radiology and cardiology) in Western and Eastern Europe16.

These fgures reveal interesting trends concerning the availability, use and investment plans or eHealth in European hospitals,

amongst which:

Insufcient IT budgets available in European hospitals

Unequal availability and limited investment plans or clinical inormation systems

Slow adoption o healthcare IT by healthcare proessionals

tabl 1 hOsPItal It Markt sIz In 2010 In M anD xPCtD grOwth as stIMatD by COCIr

Source:COCIR, Western Europe: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Norway, Portugal, Spain,

Sweden, Switzerland, The Netherlands, United Kingdom; and Eastern Europe: Bosnia, Bulgaria, Croatia, Czech Republic, Estonia, Hungary,

Latvia, Lithuania, Poland, Romania, Serbia, Slovakia, Slovenia, Ukraine.

15 See the annex or the methodology o the market monitoring programme.

16 Western Europe: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Norway, Portugal, Spain, Sweden, Switzerland, The Netherlands, United Kingdom;and Eastern Europe: Bosnia, Bulgaria, Croatia, Czech Republic, Estonia, Hungary, atvia, ithuania, Poland, Romania, Serbia, Slovakia, Slovenia, Ukraine.


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3 halthCar transfOrMatIOn Calls fOr hIghr It bUDgts In UrOPan hOsPItals

) fc d ue

Hospitals IT budgets17 vary rom country to country: rom 0.9% in Poland to 4.1% in Sweden. Despite these variations, a strong

common pattern is the low level o IT budgets compared to other inormation intensive sectors such as airways and banking. It

is worth highlighting that countries with a higher level o clinical sophistication have the highest IT budgets, e.g. the Netherlands

and the Nordic countries (see Graph 2).

Another strong common pattern is the limited share o hospitals IT budget or external IT purchases (hardware, sotware, technical

and proessional services). Hospitals external IT budget range rom a maximum o 54% in Spain to 32% in Denmark and Sweden.These fgures reect the low level o external IT expenditures o European hospitals (see Graph 3).

graPh 2 It bUDgt as % Of tOtal hOsPItal bUDgt Pr COUntry

Source:dii for COCIR (2008); HIT.net for COCIR (2009)

5%

4%

3%

2%

1%

0%

POlanD

0,9%

1,4%

1,7% 1,7%1,8% 1,9% 1,9%

2,0%

2,5%

3,2%

4,1%

Italy

franCe

sPaIn

aUstrIa

gerMany

swItzerlanD

DenMark

nOrway

thenetherlanDs

sweDen

17 Operational and investments as a percentage o total hospital revenues


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Hospitals have dierent views on the evolution o their IT budget. In answer to the question How do you see your IT budget

evolving or the next three years, 45% o Hospital CIOs18 in France and 48% in Germany did not expect any change to their ITbudget, while 38% and 39% respectively expected an increase. The reverse trend was observed in Spain and Italy (see Graph 4).

graPh 3 xtrnal It bUDgt as % Of tOtal hOsPItal It bUDgt Pr COUntry

graPh 4 xPCtD vOlUtIOn Of hOsPItals It bUDgts Ovr th PrIOD 2008-2012



Icee i e It ude epeced

no ce i e It ude epeced

Decee i e It ude epeced

60%

40%

20%

0%

POlanD

32% 32%

41%43% 44%

45%47%

50%53% 53%

54%

Italy

franCe

franC grMany Italy sPaIn

sPaIn

aUstrIa

gerMany

swItzerlanD

DenMark

nOrway

thenetherlanDs

sweDen

0%

20%

40% 45% 48%42%

32%

17% 13% 10% 10%

38% 39%47%

58%

60%

80%

100%

120%

18 Chie Inormation Ofcer


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Overall IT budgets in European hospitals are expected to rise but in a very contained way, ranging rom 7.5% in Italy, 4.7% inSpain to 2.9% in Germany and 1.8% in France (see Graph 5).

The survey shows that the current economic downturn cannot explain the low level o investment in IT nor the moderate growthprospects. For the vast majority o the hospitals surveyed in various countries, the current economic recession has a very limited

impact on their current IT budget with the exception o Italy and Spain where 65% and 71% o hospitals surveyed reported a direct

impact. (see Graph 6).

graPh 5 xPCtD grOwth Of hOsPItals It bUDgts Ovr th PrIOD 2008-2012

graPh 6 PrCIvD IMPaCt by hOsPItals CIOs Of th COnOMIC DOwntUrn On It InvstMnt In UrOPan

hOsPItals

no impc o e cii

Impc o e cii

Source:HIT.net for COCIR (2009)


20%

80%70%

35%29%

30%

65% 71%

franC grMany ItalysPaIn0%

1,8%2,9%

4,7%

7,5%

8%

7%

6%

5%

4%

3%

2%

1%

grMany franC Italy sPaIn0%

20%

40%

60%

80%

100%

120%


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) siuio i d COCIr popo

Government objectives or healthcare transormation and the provision o seamless healthcare imply the availability o adequate

healthcare IT tools. Todays limited IT budgets combined with limited growth prospects delay the deployment o these innovative

tools in hospitals and thereby delay the healthcare transormation called or by doctors, patients, insurers and industry.

Policymakers have a role to play. Healthcare IT requires the political will to invest sufcient resources in efcient healthcare

support systems. For more detailed recommendations see COCIRs recommendations to develop an innovative economic model

or eHealth (see page 7).

4 halthCar transfOrMatIOn Calls fOr MOr InvstMnt In ClInICal InfOrMatIOnsystMs In UrOPan hOsPItals

) fc d ue

The availability o Clinical Inormation Systems19 (Clinical IS) is insufcient. From a total Hospital IT market o 2.4 billion in 2008,

Clinical IS represented only 31%, a value o 735 million (see Graph 7). This is particularly low in comparison to Administrative

Inormation Systems, which represented more than 37% o the total market, accounting or 903million o the overall spend.

Without taking into account service departments such as aboratory Inormation Systems and Radiology Inormation Systems, the

availability o Clinical IS remains low considering its signifcant potential to improve healthcare delivery efciency.

graPh 7 hOsPItal It Markt Pr Markt sgMnt In 2008 In M

Source:COCIR eHealth Intelligence Focus Group (2009) including Western Europe: Austria, Belgium, Denmark, Finland, France, Germany,Greece, Ireland, Italy, Norway, Portugal, Spain, Sweden, Switzerland, The Netherlands, United Kingdom; and Eastern Europe: Bosnia,

Bulgaria, Croatia, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Serbia, Slovakia, Slovenia, Ukraine.

labOratOry Is

220 M CarDIOlOgy Is

51 M

raDIOlOgy Is

498 M

ClInICal Is

735 M

aDMInIstratIOn Is

903 M

19 e.g. electronic patient records, radiology inormation systems, computerised physician order entry, decision support inormation systems, etc.See the Glossary o terms or a more detailed defnition.


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The availability o Clinical IS is uneven both at the application level and across countries.

loo departments are overall well-equipped with IT systems (with 100% o laboratory departments in French hospitals

equipped and 90% in Italy) but less than 1% o hospitals in France, Germany, Italy and Spain are equipped with medic deciio

uppo em (see Table 8).

ecoic Pie recod Iomio sem are available in at least 50% o hospitals across major European countries

with the exception o France ranking behind with 35%. However, while the availability o EPR systems is on the rise, their use by

medical proessionals is still insufcient, as is documented in the next section.

The availability o rdioo Iomio sem also varies rom country to country. Some countries are well-equipped

(e.g. Germany with 70% o hospitals equipped), while other countries show a 60% equipment rate (Italy, Spain) and even 30% in

France. COCIR expects this market to grow by 10% over 2012.

The availability o Cdioo Iomio sem is still limited, ranging rom 10% to 30% o hospitals equipped, but COCIR

expects this market to develop on the short/mid-term.

tabl 8 aras whr hOsPItals hav It systMs In PlaC (aggrgatIOn Of rsPOnss)

Source:COCIR eHealth Intelligence Focus Group (2009) based on recalculated universe at service and clinical department level


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graPh 9 aras whr hOsPItals hav It systMs In PlaC (aggrgatIOn Of rsPOnss)

) siuio i d COCIr popoed cio p

The current level o availability o Clinical Inormation Systems combined with the level o investment in clinical systems is not

enough to deliver the promised improvements in healthcare. Real healthcare transormation cannot happen without scaling up

the inormation capacity at the level o health proessionals. In a complex world o continuous medical innovation, inormation

load and rapid change, healthcare proessionals need adapted medical decision support tools to help them make the right medical

decisions, based on the right inormation, at the right moment.

Policymakers have an important role to play in encouraging and supporting - including fnancially - hospitals and other stakeholders

towards a wider adoption o Clinical Inormation Systems. The ocus should be on in-depth institutional solutions and clinical

richness to allow cross-sharing and decision support at the point o care.

For more detailed recommendations see COCIRs recommendations to develop an innovative economic model or eHealth and to

enable market development.

Source:dii for COCIR (2008)

aDMInIstratIOnIs

raDIOlOg

yIs

CarD

IOlOgy

Is

labO

ratOry

Is

OPerat

IngtheaterIs

CPOe eP

r

DeCIsIOn

sUP

POrt

Is0%

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

grMany

franC

Italy

sPaIn


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graPh 11 hOsPItals MaIn MDIa fOr stOrIng anD arChIvIng MDICal rCOrDs

Source:dii for COCIR (2008)

Healthcare IT is not only about technology but also about change and human behaviour. The CIOs interviewed identifed twomain barriers to the clinical adoption o healthcare IT: healthcare proessionals time constraints and change management issues.

Ieei, i 19% d 18% o opi ueed i fce d gem, e oe idiced e

did o eed hece It. This clearly shows a need or more education and building trust and confdence in the benefts o

Healthcare IT.

) siuio i d COCIr popo

Adoption o Healthcare IT is the shared responsibility o policymakers, health proessionals and other stakeholders including

industry. National and European administrations need to put orward strong scientifc evidence on the benefts o Healthcare IT,

both at the medical and economic level. The European Commission should support research which demonstrates the benefts

o Healthcare IT solutions and services, and address the concerns o healthcare proessionals. It should coordinate eorts atinternational level in partnership with proessional medical associations (e.g. medical guidelines decision-makers).

For more detailed recommendations, see COCIRs recommendations to develop an innovative economic model or eHealth (see

page 7) and to enable market development. (See page 11)

westerneU-8

DenMark

franCe

gerMany

Italy

nOrway

POlanD

sPaIn

sweDen

thenetherlanDs

0%

80%

70%

60%

50%

40%

30%

20%

10%

PaPr-basD as MaIn MDIUM

fOr PatInt rCOrD

MICrOfICh

sCannD

COMPUtr as MaIn MDIUM

fOr PatInt rCOrD


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ae: COCIr me eec meodoo

The fgures provided in this paper are based on a survey o CIOs (Chie Inormation Ofcers) rom acute care hospitals in Europe.

CIOs were interviewed on the availability, use, replacement and investment plans or ourty-one inormation systems in their

hospital.

The data collected through the survey is analysed by COCIR members.

The methodology was tested through a pilot project in 2008. The ongoing research programme started in 2009 with a ocus on

seven countries: Germany, France, Italy, Spain, The Netherlands, Switzerland and Austria. The 2010 research programme covers

Portugal, Belgium, Denmark, Sweden, UK and one emerging market: Poland.

DATA COECTION METHODOOG:

The data is collected by an external market research company through interviews o hospital CIOS (Chie Inormation Ofcer) via

a mix o online questionnaires and a ollow-up telephone interview to ensure completeness and accuracy. The data is collected

rom acute care hospitals only.

The questionnaire has been developed by COCIR in partnership with the market research company and is refned on a regular

basis to reect market evolution.

The defnitions or each o the ourty-one inormation solutions have been developed by COCIR members and are updated on a

continuous basis. They are available in the COCIR eHealth Glossary o terms.

The research sample is randomly drawn rom the total universe o acute care hospitals in each country: it includes small,

medium, large, public and private hospitals and represents a minimum o 16% o the total number o acute care hospitals in

the country.


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European Coordination Committee of the Radiological,

Electromedical and Healthcare IT Industry


3COCIR GLOSSARY OF TERMS


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IntrODUCtIOn: skIng ClarIty On halthCar It 26

Part 1: DfInIng halthCar It / ehalth 27

Part 2: gnral ehalth rlatD DfInItIOns 27

Part 3: hOsPItal InfOrMatIOn systMs (hIs) 32

Part 4: ClInICal InfOrMatIOn systMs (CIs) 35

Part 5: tlMDICIn 41

COCIR advocates the deployment o Healthcare IT as being crucial or improving healthcare in Europe.

Beore going any urther, it is important to defne healthcare IT.

eHealth, healthcare IT, health ICTs, health inormatics are synonymous. While eHealth is the term most commonly used, COCIR

uses preerably healthcare IT and organisations such as the OECD use preerably the term health ICTs. Despite these semantic

habits it is worth noting that these terms represent the same concept and reer to the application o inormation and communication

technologies to deliver healthcare.

Healthcare IT is a ast-evolving feld, with many new ICT based solutions appearing on the market. It can be difcult to keep track

with these developments, understand the purpose o each new solution and to put the right name on the right product. What is

an Electronic Patient Record? What is the dierence with Electronic Health Record? What is a PACS? What is a Decision Support

System? What do we mean by Clinical Inormation Systems?

The lack o common understanding makes the dialogue between healthcare stakeholders difcult.

COCIR has developed a set o defnitions to bring clarity to the feld. The COCIR Glossary o Terms provides the ollowing defnitions:

a general defnition or eHealth (part 1)

defnitions or terms commonly used in relation to eHealth (part 2)

technical defnitions or systems used in hospitals : clinical inormation systems (part 3) and hospital inormation systems (part 4)

defnitions or telemedicine (part 5)

The COCIR glossary o terms aims to be a ounding block or a better dialogue and cooperation between stakeholders to improve

healthcare delivery in Europe and worldwide. It is a living document which will be enriched on a regular basis.

3


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eHealth describes the application o inormation and communications technologies (ICTs) across the whole range o unctions thataect the health sector. eHealth, healthcare IT, health ICTs and health inormatics are synonymous.

eHealth includes tools or health authorities and proessionals as well as personalised health systems or patients and citizens.

eHealth can thereore be said to cover the interaction between patients and health-service providers, institution-to-institution

transmission o data, or peer-to-peer communications between patients and/or health proessionals; it can also include health

inormation networks, electronic health records, telemedicine services, and personal wearable and portable communicable

systems or assisting prevention, diagnosis, treatment, health monitoring and liestyle management.

eHealth comprises fve types o systems:

Hospital Inormation Systems

Clinical Inormation Systems Telemedicine Solutions and Services

Secondary-Usage non-Clinical Systems

Integrated Health Inormation Networks

aMbInt assIstD lIvIngSystems, services and devices providing unobtrusive support or daily lie depending on the context and the situation o the

assisted persons.

aUthntICatIOn20

Authentication, in the context o eHealth inormation security, reers to the confrmation o the identity o a user requesting access

to eHealth services and/or patient data. Its purpose is to veriy whether or not the user really is who they claim to be. Authentication

is not be conused with Authorisation, which deals with rights particular users or user groups may or may not have.

While Authentication deals with questions like: Is this person really Dr. X?, Authorisation might ask Does Dr. X have the right

to access this specifc kind o data?.

ClInICal Pathways

Clinical pathways, also known as care pathways, critical pathways, integrated care pathways, or care maps, are one o the main

tools used to manage the quality in healthcare concerning the standardisation o care processes. It has been proven that their

implementation reduces the variability in clinical practice and improves outcomes. Clinical pathways promote organised and

efcient patient care based on the evidence-based practice. Clinical pathways optimise outcomes in the acute care and homecare

settings.

Generally clinical pathways reer to medical guidelines. However a single pathway may reer to guidelines on several topics in a

well specifed context.

20 epSOS defnition, http://www.epsos.eu/glossary.html?tx_a21glossary%5Buid%5D=1072&tx_a21glossary%5Bback%5D=362&cHash=dbc5cbd23e


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ClOUD COMPUtIngCloud computing is internet-based computing, whereby shared servers provide computing power, storage, development platorms,

or sotware to computers and other devices on demand.

This requently takes the orm o Inrastructure as a Service (IaaS), Platorm as a Service (PaaS) or Sotware as a Service (SaaS).

Users can access web-based tools or applications through a web browser as i they were installed locally, eliminating the need to

install and run the application on the customers own computers and simpliying maintenance and support.

eDIsPnsatIOn (lCtrOnIC DIsPnsatIOn)

eDispensation -or eDispensing- is defned as the act o electronically retrieving a prescription and dispensing medicine to the

patient as indicated in the corresponding ePrescription. Once the medicine has been dispensed, the dispenser sends an electronic

report on the medicine(s) dispensed.

lCtrOnIC halth rCOrD (hr)

An electronic health record (EHR) is a record in digital ormat containing medical inormation about a patient. Such records may

include a whole range o data in comprehensive or summary orm, including demographics, medical history, medication and

allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and

billing inormation.

There are dierent types o electronic health records:

Electronic medical record / Electronic patient record

Patient summary

Personal health record

lCtrOnIC MDICal rCOrD (Mr) / lCtrOnIC PatInt rCOrD (Pr)

Electronic Patient Record (EPR), Electronic Medical Record (EMR), Computerised Patient Record (CPR) are synonymous.

They reer to an individual patients medical record in digital ormat generated and maintained in a healthcare institution, such as

a hospital or a physicians ofce.

Such records may include a whole range o data in comprehensive or summary orm, including demographics, medical history,

medication and allergies, immunization status, laboratory test results, radiology images, and billing inormation.

The purpose o an EPR/EMR can be understood as a complete record o patient encounters that allows the automation and

streamlining o the workow in health care settings and increases saety through evidence-based decision support, quality

management, and outcomes reporting.

COCIR proposes a more detailed and technical defnition describing EPR/EMR systems, as used in hospitals, in part 3 o this

glossary.

ntrPrIs It

Enterprise IT is synonymous with Hospital IT. See Hospital IT defnition.

ePrsCrIPtIOn (lCtrOnIC PrsCrIPtIOn)

An ePrescription is an electronic prescription: a medicinal prescription, e.g. a set o data like drug ID, drug name, strength, orm,

dosage and/or indication(s), provided in electronic ormat.

The term ePrescription may cover dierent unctionalities, and depending on national viewpoints, the defnition o ePrescription

may vary. In general, the term ePrescription may reer to the ollowing eatures:

electronic medication record o an individual

inormed prescription with electronic decision support

electronic transmission o a prescription.

21 epSOS defnition, http://www.epsos.eu/test/work-package-31.html


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In this ramework, the ePrescription service is understood as the prescription o medicines using sotware, the electronictransmission o the prescription rom the prescriber (the healthcare proessional) to a dispenser (e.g. pharmacy), where the

prescription is electronically retrieved, the medicine is given to the patient and inormation about the dispensed medicine(s) is

reported electronically21.

hOsPItal It

Hospital IT also oten reerred to as Enterprise IT- is a generic term reerring to ICT-based products, systems, solutions and

services used in hospitals to:

manage healthcare processes

manage the hospital administrative and business processes

Hospital IT includes Hospital Inormation Systems (Patient Administration Systems, Finance and Accounting Systems, Business

Process Support, ogistics and Resource Systems) and Clinical Inormation Systems (Radiology Inormation Systems, OncologyInormation Systems, Computerized Physician Order Entry Systems, Electronic Patient Records, etc.).

InfOrMatIOn systM22 (Is)

An Inormation System (IS) is any combination o inormation technology and peoples activities using that technology to support

operations, management, and decision-making. In a very broad sense, the term inormation system is requently used to reer to

the interaction between people, algorithmic processes, data and technology. In this sense, the term is used to reer not only to

the inormation and communication technology (ICT) an organisation uses, but also to the way in which people interact with this

technology in support o business processes.

InfOstrUCtUr

23

eHealth Ino-structure should be understood as the oundation layer containing all data structures, codifcations, terminologies

and ontologies, data interoperability and accessibility standards, stored inormation and data as well as rules and agreements or

the collection and management o these data and the tools or their exploitation. At European level, such a European inostructure

may be composed o biomedical and health/medical research and knowledge databases, public health data repositories, health

education inormation, electronic patient and personal health records systems, data warehouses, etc.

IntgratD halth InfOrMatIOn ntwOrks

Networks supporting the exchange, processing and storage o health inormation. Integrated means that these networks are part

o a broader IT inrastructure connecting dierent applications, servers or data centers, e.g. in a hospital or in a chain o hospitals,

or even in local/regional or national IT inrastructure.

IntrOPrabIlIty24

Interoperability is a property reerring to the ability o diverse systems and organisations to work together (inter-operate) without

any restricted access or implementation.

Health system interoperability means the ability, acilitated by ICT applications and systems to exchange, understand and act

on citizens/patient and other health related inormation and knowledge among linguistically and culturally disparate clinicians,

patients and other actors and organisations within and across health system jurisdictions in a collaborative manner.

Technical interoperability means the ability o two or more applications, to accept data rom each other and perorm a given task

in an appropriate and satisactory manner without the need or extra operator intervention.

22 Wikipedia defnition

23 European Commission defnitionhttp://ec.europa.eu/inormation_society/activities/health/glossary_o_terms/

24 epSOS defnition, http://www.epsos.eu/glossary.html?tx_a21glossaryadvancedoutput_pi1%5Bchar%5D=all&tx_a21glossaryadvancedoutput_pi1%5Bpointer%5D=3&cHash=7d686bc999


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Semantic interoperability means ensuring that the precise meaning o exchanged inormation is understandable by any othersystem or application not initially developed or this purpose. It also reers to the ability o two or more systems or components to

exchange inormation and to use the inormation that has been exchanged.

mhalth MObIl halth

mHealth (also written as m-health) is the use o mobile communications such as personal digital assistants and mobile phones

or health services and inormation. The mHealth feld has emerged as a subset o telemedicine. mHealth applications range

rom SMS medication reminders - based on existing mobile capabilities - to collecting community and clinical health data, delivery

o healthcare inormation to practitioners, researchers, citizens and patients, real-time monitoring o patient vital signs and direct

provision o care.

PatInt sUMMary25

A Patient Summary is a sub-set o an Electronic Medical Record.

A Patient Summary is a concise clinical document which provides an electronic patient health data set applicable both or

unexpected, as well as expected, health care contact.

The primary application o an electronic patient summary is to provide the healthcare proessional with a dataset o essential and

understandable health inormation needed in case o unexpected or unscheduled care (e.g. an emergency or accident) or in the

case o planned care (e.g., the patient is in another area and needs to consult a healthcare proessional other than their regular

contact person).

The Patient Summary does not include a detailed medical history, details o the clinical condition, or the ull set o the prescriptions

and medicines dispensed but includes data such as:

Patients general inormation (mandatory)

Medical summary (mandatory) Medication summary (mandatory)

A patient may have more than one electronic patient summary.

PatInt rgIstry

Patient registries are collections o secondary data related to patients with a specifc diagnosis, condition, or procedure. In its

most simple orm, a disease registry could consist o a collection o paper cards kept inside a box by an individual doctor. Most

requently, registries vary in sophistication rom simple Excel spreadsheets which can only be accessed by a small group o

doctors to very complex databases which are accessed online across multiple institutions. They can give healthcare providers (or

even patients) with reminders to check certain tests in order to reach certain quality goals.

Patient registries are less complex and simpler to setup than Electronic Medical Records/Electronic Patient Records. An EMR/

EPR keeps track o all the patients a doctor ollows while a registry only keeps track o a small sub population o patients with aspecifc condition.

PrsOnal halth rCOrD

A personal health record -or PHR- is a health record that is initiated and maintained by an individual.

Other health records such as electronic patient record (EPR) or electronic medical record (EMR) are generated and maintained

within an institution, such as a hospital, clinic, or physician ofce.

25 epSOS defnition, http://www.epsos.eu/glossary.html?tx_a21glossary%5Buid%5D=542&tx_a21glossary%5Bback%5D=362&cHash=732dae584e



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PrsOnal halth systMs (Phs)Personal Health Systems (PHS) assist in the provision o continuous, quality controlled, and personalised health services, including

diagnosis, treatment, rehabilitation, disease prevention and liestyle management, to empowered individuals regardless o location.

PHS consist o: intelligent ambient and/or body devices (wearable, portable or implantable); intelligent processing o the acquired

inormation; and active eedback rom health proessionals or directly rom the devices to the individuals.

PrsOnalIsD MDICIn

Personalised medicine is a medical model emphasising the customisation o healthcare, with all decisions and practices tailored to

individual patients. Recently, this has mainly involved the systematic use o genetic or other inormation about an individual patient

to select or optimise the patients preventative and therapeutic care.

Traditionally, personalised medicine has been limited to the consideration o a patients amily history, social circumstances,

environment and behaviours in tailoring individual care. It is now extended to the individuals genomes to understand theindividuals susceptibility to diseases and possible reactions to treatment.

Fields o Translational Research termed -omics (genomics, proteomics, and metabolomics) study the contribution o genes,

proteins, and metabolic pathways to human physiology and variations o these pathways that can lead to disease susceptibility. It

is hoped that these felds will enable new approaches to diagnosis, drug development, and individualized therapy.

sCOnDary Usag nOn-ClInICal systMs

Secondary usage non-clinical systems include:

Systems or health education and health promotion o patients/citizens such as health portals or online health inormation

services.

Specialised systems or researchers and public health data collection and analysis such as bio-statistical programmes or

inectious diseases, drug development, and outcomes analysis.

sOftwar as a srvIC (ss)

Sotware as a service, sometimes reerred to as sotware on demand, is sotware that is deployed over the internet and/or is

deployed to run behind a frewall on a local area network or personal computer. With SaaS, a provider licenses an application to

customers either as a service on demand, through a subscription, in a pay-as-you-go model, or at no charge. This approach to

application delivery is part o the utility computing model where all o the technology is in the cloud accessed over the internet

as a service.

vIrtUal PhysIOlOgICal hUMan (vPh)27

irtual Physiological Human (PH) is a methodological and technological ramework, targeting multi-scale models and simulationaiming at personalised, predictive and integrative medicine and inormation inrastructures. Once established, it will enable

collaborative investigation o the human body as a single complex system.


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Part 3: hOsPItal InfOrMatIOn systMs (hIs)

Hospital Inormation Systems manage the administrative and fnancial aspects o a hospital (patient administration, fnance,

accounting, logistics, human resources, materials management etc). This includes paper-based inormation processing as well

as data processing machines. Hospital inormation systems include business process support systems, fnance and accounting

systems, logistics and resource systems, patient administration systems.

3.1. bUsInss PrOCss sUPPOrt

Systems designed to support the business processes o a hospital. They collect, integrate, analyse and present business

inormation to improve business decision-making.

bUsInss IntllIgnC systMs (bI)

Business Intelligence (BI) systems reer to technologies, applications and practices or the collection, integration, analysis, and

presentation o business inormation to improve business decision-making by using act-based/data-driven decision support

systems. BI systems provide historical, current and predictive views o business operations using data rom a (clinical) data

warehouse and operational data.

The emerging integrated clinical/fnancial BI systems approach thereore combines traditional sources (such as human resources,

cost accounting and fnancial reporting) with rich clinical data rom computer-based patient record/medical records (EPR/EMR).However, a BI system is much more than a data warehouse. Its purpose is to provide insights that aect and improve business/

clinical processes and all the associated outcomes (clinical, fnancial, etc.). BI also has a real-time, immediate dimension. Results

can be either predictive or correlative in nature.

ClInICal Data warhOUsIng systMs (CDw)

Data Warehousing Systems (CDW) are integrated systems o patient related clinical data allowing the collection and normalisation

o data rom disparate clinical sources into a database designed to support management clinical decision-making, perormance

analysis purposes or research. CDW can be stand-alone solutions based on database platorms and integration standards, or

integrated with an Electronic Patient Record/Electronic Medical Record (EPR/EMR) solution or built at regional level as is the case

in Norway and Sweden. In all cases, CDW are usually tied to the Master Patient Index (MPI).

QUalIty ManagMnt systMs (QMs)

Also called Assurance Inormation Systems, QMS support the monitoring o the overall perormance and quality o clinical care

by analysing, comparing and treating inormation o detailed clinical practices patterns and parameters. Quality Management /

Assurance IS might also include compliance/audit eatures, or example by asking i the care which was documented matched the

care given). It also has a real-time, immediate dimension. Results can be corrective and preventive in nature.



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hUMan rsOUrCs ManagMnt systMs (hrM)Human Resource Management Systems manage the administration o personnel, including personnel planning/sta/nurse

scheduling, employee time and attendance tracking/labour time assessment, payroll and controlling. Individual unctions may

be stand-alone solutions or part o an Enterprise Resource Planning (ERP) system including Payroll and Human Resources. In

healthcare delivery systems operated by government (e.g. national health systems), HRM systems may reside on government

systems.

sUPPly ChaIn ManagMnt (sCM)/MatrIals ManagMnt systMs

Supply Chain Management Systems manage the processes o planning, implementing and controlling all movement and storage

o materials and inventory rom point-o-origin to point-o-consumption. Key unctionalities include: purchase order processing,

inventory management, warehouse / materials management, supplier relationship management/sourcing. SCM are available as

stand-alone tools/systems or as part o an Enterprise Resource Planning (ERP) system. Stand alone systems/tools may also beintegrated with Enterprise Resource Planning (ERP) solutions. SCM require the integration with key clinical systems (orders, etc.).

3.4. PatInt aDMInIstratIOn systMs

A patient administration system is one o the earliest components o a hospital computer system which manages the administrative

side o the relations with a patient.

Patient administration systems include - among other things - admission, discharge and transer systems, master patient index

systems, patient relationship management systems, scheduling o critical resources or acilities systems.

aDMIssIOn, DIsCharg & transfr systMs (aDt)

Also called registration systems, ADT systems include pre-registration, patient history (administrative), patient admission and

discharge transer unctions. They are rarely stand-alone systems and are mainly part o an overarching Patient Administration

System (PAS).

Mastr PatInt InDx systMs (MPI Or MPI)

MPI systems maintain a unique patient identifer and a single master index o all patients, which reerences all patient indices

within a single acility (e.g. hospital or a group o hospitals) to correctly identiy and share patient inormation across linked IT

systems with multiple authorised users. MPI systems also provide additional search unctionality or specifc patients including

ull name, partial names, address, ID numbers, etc. MPI systems are rarely a stand-alone system and are very oten an integral

component o a Patient Administration System (PAS) or electronic patient records (EPR)/electronic medical records (EMR). MPI

is or a single acility whereas EMPI is a unique patient identifer or multi-acilities (who may each identiy patients non-uniquely

across acilities). To accurately match and link records across systems, a stand-alone EMPI has proven integration with these

systems, scalability to support real-time identifcation across millions o records and most importantly a matching algorithm that

can take data rom dierent systems and create a unifed view.

PatInt rlatIOnshIP ManagMnt systMs (PrM)

PRM reers to the use o IT or identiying and anticipating patient needs and preerences by providing a centralised view on

patient demographic inormation in order to tailor communications and programmes accordingly. PRM introduces the principles o

customer relationship management (CRM) into healthcare. It can be a stand-alone system (e.g. standard CRM solutions), part o

a Patient Administration System (PAS) or an ERP system (Enterprise Resource Planning), but it can also be a mix o stand-alone

solutions or individual aspects (e.g. patient questionnaires, direct marketing activities such as mailings, etc.).


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sChDUlIng Of CrItICal rsOUrCs Or faCIlItIs systMsPatient scheduling systems coordinate scheduling o all care providers resources or a specifc patient (inpatient or outpatient)

and identiy conicts with other appointments or the patients or provider resources. It may include sta, critical resources (beds,

surgery rooms, etc.), materials (diagnostic equipments) as well as preparation requirements (anesthesia consultation). It is rarely

a stand-alone system and is mainly part o a Patient Administration System (PAS). It may also be part o an Enterprise Resource

Planning (ERP) system including eatures which support clinical and enterprise scheduling. Patient scheduling systems are general

and thereore dier rom specialised scheduling systems such as Emergency/Operating Room/ICU scheduling systems. They also

dier rom resource planning or departmental scheduling.

Part 4: ClInICal InfOrMatIOn systMs (CIs)

Clinical Inormation Systems reer to comprehensive, integrated inormation systems designed to manage the clinical unctions

o a hospital.

Clinical Inormation Systems aim to increase the efciency o healthcare delivery by archiving patient data, providing aster

access to patient data between healthcare proessionals/hospital departments and guiding healthcare proessionals when making

medical decisions.

Clinical Inormation Systems can be composed o one or more sotware components with core unctions such as electronic patient

record inormation systems, medical document management inormation systems, computerised physician order entry as well as

a large variety o sub-systems in medical specialties (e.g. oncology inormation systems, orthopedic inormation systems, etc.) and

service departments (e.g. aboratory Inormation System, Radiology Inormation System).

Clinical Inormation Systems include clinical knowledge and decision support systems,clinical order communication management

systems, medical record systems, medico-technical service department systems.

4.1. ClInICal knOwlDg, DCIsIOn & PrOCss sUPPOrt InfOrMatIOn systMs

Systems designed to assist health proessionals with decision- making by linking dynamic individual patient health observationswith a common clinical knowledge management system. They include among others clinical decision support systems, clinical

workow management systems, etc.

ClInICal knOwlDg ManagMnt & ClInICal DCIsIOn sUPPOrt systMs (CDss)

Systems designed to assist health proessionals with decision- making by linking dynamic individual patient health observations

with a common clinical knowledge management system. They include among others clinical decision support systems, clinical

workow management systems, etc.

ClInICal knOwlDg ManagMnt & ClInICal DCIsIOn sUPPOrt systMs (CDss)

Clinical Decision Support Systems are an interactive computer program designed to assist doctors and other healthcareproessionals with decision-making tasks by linking dynamic individual patient health observations (e.g. monitored in an Electronic


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Patient Record) with a common clinical knowledge management system (e.g. a set o rules derived rom experts and evidence-based medicine). Decision support systems are based on knowledge management systems also named Rules Engines. Rules

Engines maintain complex rule sets designed by end users and acquired rom extra knowledge sources. Rules Engines are critical

to extending Electronic Patient Record systems beyond the capabilities o human cognition and enhancing collaboration. Because

medical knowledge has moved beyond the ability o unassisted human to track all relevant inormation, the use o clinical decision

support implemented in a rule engine is now necessary to practice state-o-the art medicine.

ClInICal wOrkflOw ManagMnt InfOrMatIOn systMs (CwMs)

Clinical Workow Management Inormation Systems optimally co-ordinate the multidisciplinary clinical processes rom admission

to discharge or each patient based on a single individual care plan by linking a complete view o the patients movement through

the hospital to clinical decision support. It involves the use o workow engines which support explicit clinical and operational

workows created by users and supported by scientifc literature using graphical design tools. It supports the practice o evidence-based medicine and provides the inrastructure necessary or an organisation to optimise its clinical activities.

These systems can be stand-alone solutions rom basic Therapy Planning sotware to departmental solutions integrated with

the dierent clinical inormation solutions or ultimately integrated solution with Knowledge Management Systems and Decision

Support Systems in an Hospital Inormation Systems/Clinical Inormation Systems (HIS/CIS).

DIsas ManagMnt InfOrMatIOn systM

Disease Management Inormation System support healthcare proessionals to manage patients who have one or more chronic

conditions. Such systems, unlike Electronic Patient Records, do not document the entire patients encounter, but rather ocus on

chronic disease and preventive care. The use and concept behind Disease Management Inormation Systems are not widespread,

hence relatively new with unclear boundaries. They might oten be conused with disease-specifc registry.

elarnIng aPPlICatIOns anD OnlIn traInIng Of staff

eearning enables the distribution and presentation o teaching materials or proessional education and training. eearning can

be based on a range o technologies and media (generally all digital media, here defned as computer and web based) and covers

a broad range o orms and applications.

4.2. ClInICal OrDr COMMUnICatIOn ManagMnt InfOrMatIOn systMs

Systems designed to place and share clinical orders between healthcare proessionals and hospital departments.

ClInICal OrDr ntry & rsUlt rPOrtIng/COMPUtrIsD PhysICIan OrDr ntry (CPO)

Clinical Order Entry/Results Reporting inormation systems allow or the placement o clinical service orders or patient services

or medications, including medications, procedures, examinations, nursing care, diets, laboratory tests, etc. - with subsequent

automated distribution o the clinical documentation processed as a result o this order. Order entry & result reporting can be a

stand-alone solution or part o RIS, IS or HIS.

CPOE systems have the same unctionality as a Clinical Order Entry/results reporting IS but in addition include special electronic

signature, workow, and rules engine unctions.

lCtrOnIC transMIssIOn Of PrsCrIPtIOns InfOrMatIOn systM (tP)

Electronic Transcription o Prescriptions Inormation System (ETP IS) acilitates the end-to-end medication management including

ordering, dispensing and administration. They are point to point systems and do not include decision support unctionalities. ETPIS can be a stand-alone solution or a module o Pharmacy inormation system.


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ePrsCrIbIng systMePrescribing Systems acilitate the end-to-end medication management including ordering, dispensing, and administration.

Compared to the ETP, it goes urther and updates the Medication Administration Record. It addresses large scale benefts o

decision support allowing physicians to review patient history and recommended dosage. ery oten, it works in conjunction with

other technologies, such as mobile devices, bar coding and automated dispensing machines. ePrescribing can be stand-alone

solutions or modules o Pharmacy Inormation Systems.

4.3. MDICal rCOrDs / lCtrOnIC PatInt rCOrD InfOrMatIOn systMs

Systems that record and/or host inormation about the patient on an electronic fle. They include digital dictation and transcriptioninormation systems, electronic patient records and medical document management systems.

DIgItal DICtatIOn & transCrIPtIOn InfOrMatIOn systM

A Digital Dictation Inormation System acilitates the management o voice-recorded notes and reports. It converts voice-recorded

notes and reports as dictated by physicians and/or other healthcare proessionals into computerized text ormat (i.e. Medical

Transcription). It can be stand-alone digital sound recording sotware and speech recognition sotware or integrated digital

dictation & transcription workow sotware.

lCtrOnIC PatInt rCOrD (Pr)/lCtrOnIC MDICal rCOrD (Mr)

Electronic Patient Record (EPR), Electronic Medical Record (EMR), Computerised Patient Record (CPR) are synonymous.

They reer to an individual patients medical record in digital ormat generated and maintained in a healthcare institution, such asa hospital or a physicians ofce (as opposed to a personal health record -PHR- that is generated and maintained by an individual)

Such records may include a whole range o data in comprehensive or summary orm, including demographics, medical history,

medication and allergies, immunization status, laboratory test results, radiology images, and billing inormation.

The purpose o an EPR/EMR can be understood as a complete record o patient encounters that allows the automation and

streamlining o the workow in health care settings and increases saety through evidence-based decision support, quality

management, and outcomes reporting.

EPR/EMR are made up o electronic medical records rom many locations and/or sources and a variety o healthcare-related

inormation to enable complete patient-centered documentation rom initial diagnosis and therapy through to continuity-o-care

planning. A graphical user interace on the clinical workstations allows authorized healthcare providers to retrieve/access, review

and update a single patients record at any linked department or acility. Medical technical devices may eed data automatically

into the patient record. EPR/EMR are included in an application environment which is composed o the clinical data repository,clinical decision support, controlled medical vocabulary, order entry and results reporting/CPOE, and clinical documentation

applications.

MDICal DOCUMnt ManagMnt InfOrMatIOn systM (MDM)

Medical Document Management systems mean a central repository system or disparate electronic/digital medical patient

documents/fles (e.g. care episodes, test results, diagnoses, reerrals, discharge letters,

Documents

eHealth Toolkit LINK2