Market Overview

Legacy hospital information systems based on relational database management systems and COBOL architecture developed in the 1980s have, in the 1990s, been gradually giving way to more sophisticated CORBA and Java-based systems. These newer systems are laying the foundations upon which more integrated and "intelligent" healthcare systems are being created and utilised by physicians, nurses and other key personnel in the healthcare delivery chain. CORBA and Java-based systems along with XML are allowing healthcare information to be passed in a more efficient, controlled and secure manner across not only the internal players in hospitals but also the external healthcare providers. The backbone of HIS systems is no longer the Financial and basic Patient Administration System of the past but the EPR which will form the basis of the EHR of the future. With the EPR, newer HIS systems are making the care process of health and well-being the central position, around which administration tasks and general services, including the lab and medical examination procedures are generated. EPR software allows the interaction between various work-flow components, such as authorised agents, resources, outcome, and knowledge which leads to the provision of a completely computerised hospital wide solution. With an understanding of the way in which primary and secondary healthcare need to have an increased symbiotic relationship, all HIS vendors are looking to develop their web-enabled features.

Further to this increased need for remote access and remote dissemination of patient information is the role that the next generation HIS systems will play in promoting the use of evidence-based medical practice. Enhanced physician workflow does not only mean acting faster but also means learning faster. As scientific and medical advances continue to move forward the amount of information being made available to physicians is increasing. IHCS systems (the next generation healthcare information systems) are becoming user driven with the result that the unstructured presentation of patient data based around the paper system is giving way to menu-based clinical data. In this scenario data classification means patient data is presented in a manner that makes diagnosis and treatment clearer and faster.

Structured presentation is also destined to become a factor in improving the patient-physician relationship with both the patient and physician being armed with only the relevant concise information necessary for informed and rapid treatment. IHCS solutions should be based on knowledge and components, with the EPR being a dynamic component which not only reacts to the fluid needs of the patient??s care pathway. This includes diagnosis to treatment and monitoring of response and also to interruptions to work-flow as a consequence of a temporary pause or exceptional termination of the care process. EPR models should become and be developed as active objects, providing time management for patient and intervention referrals, messaging, task management per service in the hospital and patient lists, thus allowing physicians and nurses to view the patient situation on their individual workstation.

In effect, modern HIS implementation will be comprised of intelligent layers for medical decision-making both in diagnosis and actions for treatment. Functional integration of individual components and applications will increase and security (a top concern) will be addressed by common models and standards.

The winners in the new IHCS market will be those companies which can elegantly convey their visions and strategies, drive cross-industry standardisation where it is required and boldly express to those fearful of change in medical practice the fact that without change there is no way forward for improvement in healthcare delivery. The wise and continued use of IT solutions in healthcare is the message for the healthcare provider.

Market Dynamics

HBS market intelligence forecasts estimate that the European HIS market will have a market value of $3.09bn in 2001 and the slow growth rates for the remaining forecast period are reflected in the 2005 estimate for this market of $3.75bn..2. Introduction to the European HIS/IHCS

Market

2.1 Report Coverage

2.1.1 Methodology

The forecast period is from 1999 to 2005, with the base year starting at 2001. Definitions for the report are contained within the section below. The report covers the western European market for Hospital Information Systems. The countries included in the report are as follows: Benelux (Belgium, Luxembourg and the Netherlands), France, Germany, Spain, Italy, UK, Scandinavia (Denmark, Finland, Norway, Sweden) and the Rest-of-Western Europe (Austria, Greece, Ireland, Portugal and Switzerland).

HBS TekPlus have conducted in-depth face-to-face and phone based interviews with executives across the industry. Interviews included quantitative and qualitative information and covered vendors and hospitals across Europe.

2.1.2 Report contents

There are 8 sections that cover the Hospital Information System market report:

?FMarket Overview ?V The overview of the market is just that, providing a summary of the main findings of the hospital information systems (HIS) market.

?FIntroduction to the HIS Market ?V Definitions for the report are contained within this section and issues pertinent to the HIS market.

?FTotal HIS Market ?V The forecast period is from 1998 to 2005, with the base year starting at 2001. The main market challenges and opportunities are provided in this section together with a breakdown of revenues by region/country and by segment. A historical perspective of the HIS market is discussed and what role it will play on the provision of healthcare in the future..

?FCompetitive Positioning ?V We discuss the shape of the HIS industry structure and how this is likely to change in the future. We also provide detailed profiles of a number of significant or interesting market participants and provide our view of their strengths and weaknesses. An indication of where new competition and threats to present day vendors in the HIS market is also discusses.

?FCustomer Interaction ?V We discuss the relationship of HIS vendors with their customers and how this is expected to change in the future.

?FImpact in the Healthcare IT market ?V This section covers HIS role in the overall Healthcare IT market.

?FCountry Forecast ?V We provide a list of tables showing individual country and region forecasts of the HIS market.

?FStrategies and Recommendations ?V HBS TekPlus provides discussion on our recommendations and strategies for different types of market participants involved in the HIS market.

2.1.3 Definitions

Hospital Information Systems comprise of:

?FPatient Administration Systems ?V patient information relating to admission, discharge and transfer dates; information relating to registration and allocation of medical treatments and nursing personnel; patient invoicing, insurance details etc; reimbursement systems (internal and external). The systems empower information transfer between inpatient and outpatient environments of the hospital in which the system is installed and also with other healthcare institutions. More complex systems also link into Picture Archiving and Communications Systems (PACS), containing digital images of x-rays, ultrasounds or other diagnostic images. Please refer to the North American and European PACS report by HBS TekPlus for more details.

?FHospital Administration (HA) ?V accounting systems; inventory management and purchasing; human resource management and payroll..?FIntegrated Systems -these systems are integrated systems including both hospital administration and patient administration systems.

?FClinical systems - the information components offered by these modules dictates that they are used almost exclusively by doctors, nurses and other health professionals. The need for management and administration personnel to access them is limited. Clinical modules allow the recording and review of patient consultations and update of patient clinical information.

Additionally, physicians are given the capability to request diagnostic tests and procedures online and to access results of such tests through a secure channel. Clinical systems play an increasingly important role in providing physicians the ability to make knowledge-based diagnosis and treatment decisions by providing them with access to updated care guidelines and clinical information.

?FOther Systems ?V this includes support for on-line healthcare, telemedicine, and links to primary healthcare systems, such as GP information systems. The cost of HIS systems includes hardware, software and maintenance. One HIS unit equates to an HIS deployment within a hospital irrespective of size. The average cost of a system is taken as the total revenues divided by the total number of deployed HIS systems.

2.2 Market Factors

2.2.1 Security issues

The flow of information within hospitals and between hospitals and GPs has traditionally been paper based and that information has been reasonably secure. As hospitals bring more integrated IT systems into use the free-flow of information will increase and so will access to that information. In 1995, the European Commission defined the EU Directive on Data Protection, this includes the personal health information. The directive was to be enforced by the 15 members by October 1998. The main purpose of the directive was to standardise country regulations to enable the flow of data across borders. This issue has become increasingly important given the increasing numbers of people living or working throughout Europe or travelling from country to country within Europe. By the end of 1998, about half of the member countries had created or updated laws to meet the directive's requirements. In 2001, European countries are at various stages of completion. The Netherlands, for example is expected to have a 1-year implementation window; others, such as Denmark, are just starting to assess implementation issues based on the law finalised in July 2000. To add to the complexity the EC has continued to look to improve on the 1995 directive. New privacy directives are expected in early 2002, starting the cycle again.

Health data is a special category on its own and the directive generally prohibits the processing of health data unless an individual has given his explicit consent to do so. The exceptions to this include:

?FProcessing of health data is necessary to carry out rights of organisations under employment law

?FThe individual is physically or legally incapable of giving his consent

?FThe data are expressly made public by the individual

?FProcessing of data is required for the purposes of preventive medicine, medical diagnosis, the provision of care or treatment or the management of healthcare services.

?FA person or organisation responsible for processing health data must provide information about the purposes of data, who has access to the data, and the right of the individual to access and correct any data.

In order to investigate any breaches to the above, the directive also requires each country to provide an independent body to investigate any problems or violations. Despite the directive??s attempt to harmonise standards across borders, laws vary in each country. One example is the frequency and nature of obtaining patient consent to obtain health data..2.2.2 Hospital ?V general practitioner interaction.

The deployment of HIS systems is a welcome addition and support to healthcare provided to patients, however this can be leveraged further if GPs and clinics had access to the same systems. There is great potential for growth in the primary healthcare sector and many people would benefit from such integrated roll-outs, possibly reducing the pressure on hospitals to provide care and move to a more distributed healthcare model rather than a more centralised one. This could have other benefits by improving the morale of GPs, a particular problem in the UK. Other direct benefits for GPs would be the ability to:

?Fcheck patient status

?Fconsult medical records

?Fassess availability of clinical treatments.

This could be reciprocated by the hospital having access to GP patient data, important in accident and emergency. However, this can only truly benefit the European market if standardisation is brought to the sector. For hospitals and GPs to be enable the free flow of information, systems must be able to interoperate and work across many different languages, possibly through integrated software translation packages. Interoperability between systems is already an extremely important requirement. This has tended not to be a problem with many vendors dominating their domestic markets, however with vendors looking to expand beyond their borders interoperability will be crucial.

With electronic health data becoming more prevalent it will be important for data to be able to move with people once they move districts or countries. If systems do not interoperate then the transfer of data will be no easier than it presently is in a paper-based environment.

2.2.3 Integration of HIS with mobile and wireless devices

Wiring up hospitals is not only an expensive task, but also impossible to deploy in many areas. For example clean rooms where dust caused by drilling would be a nuisance, or parts of the hospital would need closing while networks are deployed. The introduction of wireless networks is expected to become a feature of hospitals. This means that the software used by hospitals must also support them and this includes a whole variety of wireless devices..Vendors seeking to deploy any HIS system must ensure that the software they install can be accessed by mobile devices and is able to support all the different footprints and protocols. Different users within a hospital will require different devices, a laptop will not always be appropriate and something like a smartphone or a wireless PDA may be more functional.

HIS software vendors need also to consider how they will be able to support the distribution of information in the wireless setting. In order to develop HIS systems that truly bring increased value and ROI to hospitals, vendors in this market will need to partner with companies of the following type:

?FPDA, smartphone and laptop manufacturers

?FWireless LAN manufacturers

?FBluetooth developers

2.2.4 Purchasing IT infrastructure

The complexity and extensive sales processes to hospitals can be a hindrance more than an annoyance. A great deal of bureaucracy needs to be overcome and it is usual to have more than one person to say yes in order to OK the rubber stamp. Other factors that need to be overcome include:

?FIt is usual in some countries for physicians to control a large portion of hospital spending

?FEuropean Union regulations require public tenders for purchases greater than 200,000 Euros. In some countries, such as France, Italy and the U.K., tenders are required for smaller transactions..2.2.5 Liability and mistakes as a result of IT deployment.

Liability is an increasing problem in the provision of healthcare and a blame culture has become endemic in Europe. As a result there are bound to be mistakes made at hospitals as a result of implementation of HIS or of the HI systems themselves. Should an HIS system lead to a mistake being made then who is liable? Is it the practitioner, the HIS vendor, the SI or the hospital? HIS vendors will need to think about liability and about insurance packages designed to protect them and their customers. In September 2000 it was discovered in the UK that data fed into an IT system in relation to pregnant mothers was miss-segmented and a number of mothers were placed on a low priority list for giving birth to Downs Syndrome babies. However, as a result of the Millennium bug some mothers who should have been placed on a high priority list and weren??t, eventually gave birth to Downs babies.