1. Investing in Health Systems of the Future Budapest, Hungary 10 – 12 May 2011

2. European EHR Market Analysis The EuroRec Institute Jos Devlies, M.D.

3. Topics The EHR-Q TN project ▫ Purpose of the project ▫ Partners ▫ Main results The European EHR Market Analysis ▫ Methodology ▫ The EHR system suppliers overview ▫ The EHR stakeholders overview ▫ Cross – domain suppliers ▫ Cross – border suppliers May 12, 2011 3 European EHR Market Analysis - WoHIT2011 - Budapest

4. The EHR-Q TN Project May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 4

5. EHR-Q TN Thematic Network project : 238912 “The main objective of the Thematic Network is to better prepare the health community across Europe for systematic and comparable quality assurance and certification of e-Health products, more specifically of Electronic Healthcare Record systems.” Three years (February 2009 – January 2012) Budget: 789.000€ 28 partners in 25 countries May 12, 2011 5 European EHR Market Analysis - WoHIT2011 - Budapest

6. Partners May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 6 European Institute for Health Records ProRec AustriaProRec Belgium RAMITProRec Bulgaria Hrvatsko drustvo za medicinsku informatiku Cypriotic Society for Medical Informatics České národní fórum pro eHealth, o.s MEDIQ A/S Eesti E-tervise Sihtasutus Centro Poliklinika Vilnius – Lithuania ProRec Germany Foundation for Research and Technology – Hellas National Institute for Strategic Health Research - ESKI ProRec Ireland - Irish Centre for Health Telematics Ltd ProRec ItalyCRP Henri Tudor - SANTECStichting ProRec Nederland KITH AS Marshal's Office of the Lodz Region Administraçao Central do Sistema de Saúde, I. P. ProRec Romania - Romanian Association for Electronic Registration of Medical Data ProRec Serbia - Srpsko udruženje za elektronski zdravstveni karton ProRec Slovakia Ustanova - ProRec Slovenia Hospital Universitario de Fuenlabrada Instituto de Salud Carlos III ProRec United Kingdom

7. Main Results of the EHR-Q TN Awareness (72 National Workshops) Validation of the EuroRec Descriptive Functional Statements (+1.700) and the Certification Procedures Translation of the Statements in 19 languages EuroRec Seal Level 1 and Level 2 definition Quality labelling of EHR Market Products EHR Market Overview Roadmap towards Sustainable Pan-European Certification of EHR Systems May 12, 2011 7 European EHR Market Analysis - WoHIT2011 - Budapest

8. The European EHR Market Analysis May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 8

9. May 12, 2011 9

10. Methodology Data collection per country ▫ Template ▫ Web Questionnaire ▫ Completed by the EHR-Q TN partner Where feasible: strict inclusion criteria: ▫ Suppliers based on market share. Goal: > 90% of the market ▫ Other stakeholders: “decisional impact”  Authorities  User groups ( mostly on demanding side but also possible obstructers ) May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 10

11. Origin of the information Not so easy to collect Either not available as such or considered as “classified” Possibilities: ▫Official list of labelled applications (a few countries for a limited number of domains of application) ▫Expertise of the partners ▫Web searches (e.g. professional organisations) ▫Health Ministries ▫Health IT suppliers organisations May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 11

12. Result 24 National Market Overviews Two Deliverables ▫ Del. D3.1 Part I: Suppliers and Supplier Organisations: 1.019 supplier / product ID ▫ Del. D3.2 Part II: Authorities and important stakeholders: 663 addresses May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 12

13. Suppliers and their products May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 13

14. EHR Market Overview: Suppliers 849“Commercial” EHR systems 25“in house” large HIS with EHR 101health IT service providers (health telematics, privay enhancing etc…) 44eHealth / Health IT representative organisations Total: 1.019 addresses, contact persons etc… May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 14

15. May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 15 Extract of the list (ambulatory care) per country

16. Extract of Hospital Systems (Alphabetically) May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 16

17. EHR Overview : Suppliers May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 17 GPHospitalHome / Nursing Para- medical Dental Suppliers240262877360 Applications290320918761 Applications/Supplier1,20831,22141,04601,19181,0167 International Applications261028119 Intern./National Applicat.8,97%31,88%8,79%12,64%14,75% Countries Reported2224171415 Average Applic. / Country13,1813,335,356,214,07 Average Supplier/Country10,9110,925,125,214,00 Average Internat. Applic.1,184,250,470,790,60

18. Some conclusions International applications/suppliers: ▫ rather limited ▫ most in Hospital Care and in Dental Care Number of applications: most “medical” applications … easiest to get the information Most suppliers support ONE application only (and in the same domain). Average 1,21 for ambulatory systems, 1,22 for hospital systems. May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 18

19. Suppliers per domain of application May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 19 Suppliers GPHospitalHome / Nursing Para- medical DentalTotal Austria 402001768 Belgium 1782519473 Bulgaria 630009 Croatia 7100614 Cyprus 031015 Czech Republic 4831117 Denmark 1784161257 Estonia 3511010 Germany 431000053 Greece 172541754 Hungary 3630315 Ireland 5813017 Italy 103850154 Luxembourg 6522015 Netherlands 621125044 Norway 3735119 Poland 070007 Portugal 121100023 Romania 9610319 Serbia 330006 Slovakia 111422433 Slovenia 5511112 Spain 824106452 United Kingdom 516910545 Total 240262877360722

20. Applications per domain May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 20 Applications GPHosp.Home / Nursing ParamedDentalTotal Austria 442201774 Belgium 21182724494 Bulgaria 630009 Croatia 7100614 Cyprus 031015 Czech Republic 6731118 Denmark 1784221263 Estonia 3511010 Germany 601500075 Greece 172541855 Hungary 3630315 Ireland 5813017 Italy 144250162 Luxembourg 6522015 Netherlands 1025125052 Norway 81538135 Poland 010000 Portugal 13 00026 Romania 12710323 Serbia 330006 Slovakia 111722436 Slovenia 5511113 Spain 1035106465 United Kingdom 9221110557 Total 290320918761849

21. International / Cross- border applications May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 21 Cross Border / International Applications GPHospitalHome / Nursing Para- medical DentalTotal Austria 4600212 Belgium 170008 Bulgaria 000000 Croatia 000000 Cyprus 020002 Czech Republic 311016 Denmark 2416114 Estonia 000000 Germany 050005 Greece 000000 Hungary 020002 Ireland 060006 Italy 31100115 Luxembourg 051006 Netherlands 1810010 Norway 030014 Poland 010001 Portugal 320005 Romania 110002 Serbia 000000 Slovakia 1511210 Slovenia 000000 Spain 41800022 United Kingdom 31534126 Total 261028119156

22. International suppliers / applications International = ▫ Product used in more than one country ▫ Product owned by an entity in another country Countries with most international systems: United Kingdom, Spain, Italy, Denmark and Austria. Domains with most international systems: ▫ Hospital systems31,88% ▫ Dental systems14,75% ▫ Paramedical systems12,64% ▫ GP – Ambulatory systems 8,97% May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 22

23. Cross-Border & Cross-Domain International suppliers: ▫ 6 in Primary / Ambulatory Care ▫ 19 in Hospital Care (… hardware oriented?) Cross-Border applications ▫ None or nearly no applications in primary care / ambulatory care ▫ Same “product names” in several countries: same application ??? (Alert, Clinicom, HP-HCIS, Impax, Lorenzo, Maxims Clinical, Orbis, PCS, Sorian, StaproAkord, Cerner) Cross-Domain suppliers: 89 (at least in one country more than one target market) May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 23

24. Authorities, users and other stakeholders May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 24

25. Importance of stakeholders Involvement of all important stakeholders is vital to the success of implementation and use of EHR systems. (EHR-Implement project) Listed stakeholders are ▫ Health authorities ▫ Healthcare insurance organisations ▫ Public health organisations ▫ Research organisations – Academic institutes ▫ Healthcare institutes (associations) ▫ Healthcare professionals organisations May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 25

26. Selection criteria Do they actually have an active role in quality assurance of EHR systems, if any in the country? Did they manifest a particular knowledge of the domain (certification / quality labelling) in the past? Is their approval or at least their cooperation essential in order to introduce successfully certification and quality labelling of EHR systems? Is there a risk of obstruction not including them in the process of certification and quality labelling? Are they representative or an important party in the particular EHR market, addressing a specified group of users? May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 26

27. Authorities May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 27 CountryNumber of Authorit. National Ministry Contact Person Departm. Identified Other Public National Organisat. Specific Responsible Entity Regional Organis. National MinistryNational Public Entity Austria 7YYY6Y- Belgium 5YYY1Y3 Bulgaria 2YYY1Y- Croatia 1Y----- Cyprus 1YY---- Czech Republic 2YYY1Y- Denmark 6YY-3Y2 Estonia 4Y3Y- Germany 18Y(2)YY-Y16 Greece 14Y--6-7 Hungary 2Y--1-- Ireland 3YYY2Y- Italy 26Y(2)YY1Y22 Lithuania 1YY---- Luxembourg 1YY---- Netherlands 3YYY2Y- Norway 2YYY1Y- Poland 7YY-1-5 Portugal 2YY-1Y- Romania 2YY-1Y- Serbia 1YYY-Y- Slovakia 3YY-2-- Slovenia 1YY---- Spain 19YYY1Y17 England (UK) 2Y----Sev [1] [1] Not all the regional health authorities and regional organisations are listed; [2] [2] Specific for England

28. May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 28 AuthorityH. InsurancePublic HealthResearchH. InstituteHC Prof.Total /Country Austria 72 1 21127 50 Belgium 53 2 5620 41 Bulgaria 216 1 226 29 Croatia 14 1 647 23 Cyprus 12 2 3-3 11 Czech Republic 28 1 326 22 Denmark 62 1 1-3 13 Estonia 42 1 218 18 Germany 185 8 659 51 Greece 141 1 12168 52 Hungary 21 2 -195 29 Ireland 33 - 926 23 Italy 261 4 225 40 Lithuania 1 1 Luxembourg 13 1 226 15 Netherlands 31 - 2212 20 Norway 21 1 247 17 Poland 72 4 6126 37 Portugal 23 2 426 19 Romania 26 1 447 24 Serbia 11 1 254 14 Slovakia 36 1 418 23 Slovenia 14 1 238 19 Spain 198 - 1269 54 England (UK) 2 2 2 228 18 1358739114 174663 EHR Overview Stakeholders

29. (e)Health authorities May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 29

30. Role of Stakeholders (also regarding EHR and EHR Certification) May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 30

31. Market Fragmentation… Not only a problem of the market Internationally operating trusts ▫ Not per definition leading to product consolidation… even differentiating the same product in different countries. ▫ More interested (actually) in  Market presence  Making use of the outcome of EHR systems: clinical content More consolidation within one area (country / region) between the domains than cross-border consolidation within the same domain. May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 31

32. And now? Maintenance is an important issue Maintenance requires resources Involve the market to maintain the database Use the database to promote quality labelling and certification Make the data available to the market (restricted) May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 32

33. Exploitation of the Overview Mail to National Health Authorities ▫ EuroRec Letter ▫ National Partner Letter End of April: mail to the Suppliers about ▫ Importance of quality ▫ Importance of quality assessment ▫ The EuroRec Seal May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 33

34. Thank you May 12, 2011European EHR Market Analysis - WoHIT2011 - Budapest 34