The eHealth Landscape

Veronique Lessens / Dirk De Langhe

Agfa HealthCare, Market Intelligence

Healthcare trends

3

World population is growing expanding the number of “health” consumers

Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat,

World Population Prospects: The 2004 Revision and World Urbanization Prospects: The 2003 Revision

9,075,9032050

8,907,4172045

8,701,3192040

8,463,2652035

8,199,1042030

7,905,2392025

7,577,8892020

7,219,4312015

6,842,9232010

Population

(in thousands)Year

Population(in billions)

World

Asia

Africa

Latin Am.& Car.

Europe

Northern Am.

4

World population is ageing, especially in developed countries

World

population

is ageing

Global

Explosion of

over 60

years -olds

Ageing is

especially

pronounced

in Europe

x

Source: Long-Range World Population Projections: Based on the 1998 Revision. The Population Division,

Department of Economic and Social Affairs, United Nations Secretariat; US Census Bureau

1 0 %

1 5 %

2 0 %

2 5 %

3 0 %

0 %

5 %

E u ro p e N o rth A m e r ic a A s ia La tin A m e r icaP e rce n t 6 0 y e a rs a n d o ld e r , 2 0 3 0 p ro je c t io n

1 0 %

1 5 %

2 0 %

2 5 %

3 0 %

0 %

5 %

E u ro p e N o rth A m e r ic a A s ia La tin A m e r icaP e rce n t 6 0 y e a rs a n d o ld e r , 2 0 3 0 p ro je c t io n

6.98.1

10

22.1

28.1

0.0

5.0

10.0

15.0

20.0

25.0

30.0

1900 1950 2000 2050 2100

Pe

rce

nta

ge

60

ye

ars

or

old

er

5

Changing patterns of diseases: 60% of all deaths are due to chronic diseases

• 35.000.000 people died from chronic diseases in 2005 in the world.

• The highest chronic diseases prevalence are for:

• Cardiovascular disease, mainly heart disease, stroke

• Cancer

• Chronic respiratory diseases

• Diabetes

• Without actions to address the causes, deaths from chronic diseases will increase by 17% over the next 10 years.

• In the USA, 85% of all hospital costs and 69% of all physician costs go to treat chronic diseases

Source: WHO (2006)

6

Number of procedures increases with age putting pressures on HC expenditures

Number of

procedures

increases

with age

putting

pressures

on HC

expenditures

Ageing

Population is

consuming

more

healthcare

and

diagnostic

services

!Medical advancements result in people living longer

!The elderly consume even greater amounts of healthcare delivery

services.

!When people are above 65 years old, they receive four times the number

of diagnostic procedures as others receive

!Annual rate of growth in the number of images radiologists must interpret

– estimated at 6% to 12%

Increasing

age profiles

put pressure

on public

health

expenditures

x

Av

era

ge

ex

pe

nd

itu

re p

er

he

ad

ex

pre

ss

ed

as

a s

ha

re o

f G

DP

pe

r c

ap

ita

A g e g r o u p s

Av

era

ge

ex

pe

nd

itu

re p

er

he

ad

ex

pre

ss

ed

as

a s

ha

re o

f G

DP

pe

r c

ap

ita

A g e g r o u p s

Av

era

ge

ex

pe

nd

itu

re p

er

he

ad

ex

pre

ss

ed

as

a s

ha

re o

f G

DP

pe

r c

ap

ita

A g e g r o u p s

Source: Economic Policy Committee (2001) “Budgetary challenges posed by ageing populations”

7

1 10 100 1 000 10 000 100 000 1 000 000 10 0000 000

10

100

1 000

10 000

100 000

Dangerous

(>1/1 000)

Regulated Ultra-Safe

(>1/100 000)

Number of encounters for each fatality

Tota

l lives

lost

per

year

HealthcareDriving

ScheduledAirlines

MountainClimbing

ChemicalManufacturing

EuropeanRailroad

BungeeJumping

CharteredFlight

NuclearPower

Healthcare delivery… a very risky activity

More deaths per encounter than for any other activities ! Adverse events carry a high financial cost, £2 billion a

year in additional hospital stays alone in the NHS !

8

New trend: the patient has a voice and choice

Engaged patient Empowered patient

Financialresponsibility

Publicpolicy

Comparativequality

indicators Connectivity

Social / demographic

changes

• Patient empowerment is a increasingly undisputed fact

• Patients are more informed and thus more opinionated

• Informed patients will shop for healthcare providers that meet their specific

needs and expectations

• Informed patients want more customization and move convenience

9

Quality Access

Efficiency

ACCESS

" “Consumer led” delivery service

" Supporting increased demand for services (in volume and sophistication)

" Meeting 24hour/7days a week service expectation

" Facing ageing population and new pattern of diseases

" Facing individualism and diminishing

family care potential

" Avoiding waiting time

" Increasing private care

" Increasing patient’s co-payment

QUALITY OF CARE

" Patient oriented care/Clinical pathways

" Collaborative care/Continuum of care

" Disease management programmes

" “Voluntary” gatekeeper approach (Global Medical Record)

" Continuous medical education (Accreditation) & Peer Review initiatives

" Increasing attention to medical/medication errors

" Patient satisfaction

" More evidence-based medicine (outcomes based)

Efficiency

" Matching capacity to demand

" Deploying resources more effectively

" Avoid abuse (multiple exams/acts, etc.)

" Reducing costs of well-established procedures

" Controlling escalation of costs

" Transforming healthcare (process & workflows)

" Using new ICT technology to support transformation

Public authorities search for answers to increased demand and cost escalation: Better quality can cost less !

10

Public authorities need to do things differently: « Good health can save costs »

From «late disease» To «early health»

• Symptom based

• Data silos

• Managing illness

• Average therapies

• Prevention / prediction

• Detailed patient info

• Early diagnosis

• Targeted therapies

Critical information whenever and wherever it’s needed

INFORM & SHARE

Prevent Diagnose Treat Monitor

Identify at risk patients earlier

Earlier, more accurate diagnosis

Earlier, more targeted treatment

Track efficacy of treatment

11

New ways of working opening doors to collaborative platforms (eHealth)

Collaborati

on

More and

more

collaboration

is required

“Early

Health”

breaking the

hospital

boundaries

x

0 % 9 0 %8 0 %7 0 %6 0 %5 0 %4 0 %3 0 %2 0 %1 0 % 1 0 0 %

T o d a y 2 0 0 2

0 % 9 0 %8 0 %7 0 %6 0 %5 0 %4 0 %3 0 %2 0 %1 0 % 1 0 0 %

T o d a y 2 0 0 2

S o u r c e : T h e F u tu r e o f H e a lth C a r e 2 0 0 5 , D e lo it te D e v e lo p m e n t L L C .

L a b re s u l ts

In s u ra n c e in fo r m a t io n

D ia g n o s t ic im a g in g

S c h e d u lin g

P a t ie n t h is to r y

M e d ic a l r e c o rd s ( E M R )

S o u r c e : T h e F u tu r e o f H e a lth C a r e 2 0 0 5 , D e lo it te D e v e lo p m e n t L L C .

L a b re s u l ts

In s u ra n c e in fo r m a t io n

D ia g n o s t ic im a g in g

S c h e d u lin g

P a t ie n t h is to r y

M e d ic a l r e c o rd s ( E M R )

Source: The Future of Health Care 2005, Deloitte Development LLC.

R ad io lo gy

in fo rm atio n

system s and

m ed ical

techno lo g ies

@ H osp ita l

R ad io lo gy

in fo rm atio n

system s and

m ed ical

techno lo g ies

@ H osp ita l

@ G P

@ S p ec ia lis t

@ T e le ra io lo g y co m p an@ P riva te R ad io lo g y ce n tres

@ L o c a l fac ilities

P rov id er/P a tien t

@ G P

@ S p ec ia lis t

@ T e le ra io lo g y co m p an@ P riva te R ad io lo g y ce n tres

@ L o c a l fac ilities

P rov id er/P a tien t

12

Summary: The Healthcare paradigm is evolving …

TODAY TOMORROW

ParadigmTreatment of

patientsHealth of citizens

Focus Provider centric Patient centric

Time ScopeEpisodic approach,

curativeLifetime care, preventive

Space Scope Hospital basedDecentralized,

community based

Treatment &

imaging scope

Invasive,

uncomfortable

Less invasive visualization

& treatment

Workflow Fragmented Integrated & automated

Transforming healthcare…

14

The Problem…

15

And…

16

Data Access Limited, Difficult to Access Ready Real Time Access

Technology Disparate Information Systems Connected Information Systems

Care Delivery Individual Experience Adoption of Clinical Best Practices

Patient Record Multiple Sources, Incomplete Single Integrated / Complete Source

Ordering Process Manual, Multiple Hand-Offs Automated, Minimal Hand-Offs

Decision Support Personal Preference Rules / Evidence Based

OutcomeMeasurement

No Linkage to Care Delivered

Structured Data Repository Linking Outcomes to Care Delivered

Data Accuracy / Completeness

Manual Systematic Controls / Checks

Today Tomorrow

Defining a Vision of the Future: eHealth

The eHealth market

18

Global Healthcare IT (eHealth) market worth €55 Billion…but representing only 1.5% of HC spending

ICT market

= $2,490 billion

IT market

= $1,129 billion

GDP

= $46,305 billion

HC market

= $4,581 billion

HC IT market* (per year)

= $68 billion

9.9% GDP5.4 % GDP

45.3% ICT market

6.0% IT market 1.5% HC market

Source: European Information Technology Observatory in co-operation with IDC (2006): Cutler & McClellan;

Health Industry Insights, an IDC company (2006); Clinica (2003); Espicom; Agfa’own estimates.

* HC IT market includes Government, Payers and Providers

19

Healthcare currently one of the lower IT spending sector although urgent need for transformation

• Currently one of the lower IT spending sector with 1.5% average

(w.r.t. revenues) compared to retail (~4%) and financials (10+%)

• Set to increase at an annual growth rate of ~9%

Source: European Information Technology Observatory in co-operation with IDC (2006): Cutler & McClellan;

Health Industry Insights, an IDC company (2006); Clinica (2003); Espicom; Agfa’own estimates.

% of IT spending on total revenues

1.50%

3.90%

11.10%

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

Healthcare Retail Financial

20

Busin

ess

serv

ices

Annual spend per employee (UK only)£8,790

£5,538

£4,333£3,833

£3,393£3,017 £2,920

£979

Fin

ance

Dis

trib

ution

Oth

er

serv

ices

Utilities

Manufa

ctu

ring

Govern

ment

Health

Although one of the most complex and information-intensive, spend per employee are far behind other sector domains

Source: HINE (2004)

21

European end-users also lacking behind … with 70% of EU hospitals spending less than 2% of revenues

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

IT Budget as % of total budget

EU 70.4% 10.9% 6.8% 5.9% 6.1%

USA 24% 25% 18% 19% 9%

2% or less 2.1 - 2.5% 2.6 - 3% 3.1 - 4% >4%

• In Europe, 70% of the hospitals spend less than 2% of their total

revenues, while 70% of their US colleagues were spending more than

2% in 2004.

• But spending are on the increasing pattern.

Source: HINE 2005&2006; HIMSS Analystics 2005&6

22

eHealth creating tremendous opportunity for Europe at the crossroads of Health and Technology

Healthcare

Responding to healthcare challenges for the citizens

• Escalating demands

• Labour shortage

• Higher quality health services

• Patient safety imperative

• At a ‘contained’ cost level

Health is important to a country’s economy.

• Health employs currently 10% of Europe’s workforce

• Health represents 8.6% of the EU-15’s economy

• Health is expected to triple by 2020 and reach 16% of GDP.

Health infrastructure is key

• Health infrastructure which improves health and supports strategic objectives of prosperity, solidarity and security is needed.

Health is wealth.

• A society in good health leads to higher productivity, increased labour supply, better education and contributes to sustainable long-term growth.

Health is Wealth

Healthcare IT

Demand for automation solutions

• Eliminate manual, error-prone workflow

• Improve clinical productivity

• Re-allocate resources; emphasize revenue generating opportunities

Digital medical record initiatives

• Must be multimodal

• Workflow includes clinical patient data

• Maximize value of IT investments

Government initiatives

• National/Regional programs

• E-Health

• Disease management/Population Management

A tool for transformation

Innovation supporting paradigm shift from “sick care” to “health care”,

the so-called Continnum of Care

Source: Agfa’own estimates

23

But … Key issues to address

• eHealth currently treated as an add-on rather than part of an integrated

eco-system.

• Standards for interoperability of ICT, being adopted consistently, should

be further encouraged.

• Increased funding and alignment of Incentives between who pays and

who benefits from ICT in health should be undertaken.

• People, processes and change management should receive more

attention for implementation.

• The involvement of end users (health professionals and patients) is

essential for developing ICT solutions.

• An emerging challenge is coming to widely held concepts of privacy and

confidentiality.

• Innovation and research should be stimulated and better coordinated at

crossroads of social, health, ICT and life science aspects.

•

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