Spain and Turkey: Two
markets with high
achievements in EMR
maturity.
John Rayner
Regional Director
Europe and Latin America
HIMSS Analytics
Plan for the session
• Introduction and welcome
John Rayner
• Essentials of the Turkish Hospital IT Market
Dr Korhan An
• Short Q&A
John Rayner
• Essentials of the Spanish Hospital IT Market
Edmundo Ramirez
• Short Q&A
John Rayner
• Final comments
Dr Korhan An & Edmundo Ramirez
• Summary and Close
John Rayner
Essentials of the Turkish
Hospital IT Market
Korhan An, MD
Country Director (Turkey)
HIMSS Europe
MARKET CONTEXT
• Market Context and Hospital Demographics
•
Hospital Infrastructure
•
IT Infrastructure in Hospitals
• EMRAM Scores
•
Opportunities in terms of software deployment
Transforming health through IT
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MARKET CONTEXT
Transforming health through IT
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5
MARKET CONTEXT
Transforming health through IT
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6
MARKET CONTEXT
• Stage 6 Hospitals:
–
–
–
–
–
–
2013: 1 Hospital
2014: 4 Hospitals
2015: 6 Hospitals
2016: 4 Hospitals (until today)
Validation visit planned until June 2016: 4 Hospitals
TOTAL = 15 Hospitals + 4 Candidates
• One Stage 7 Candidate until now and the on-site validation will
be done on April 26th by HIMSS Analytics
Transforming health through IT
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7
AGREGATED EMR MARKET PROFILE
• Market Penetration
• Deployment Scope
• Integration with EMR
• Age Profile
–
–
Software Age
Remaining Lifespan
• Key Vendors and Competition
–
–
–
Vendor Market Shares
Number of hospital customers
Market Concentration (HHI Score)
• Market Opportunity
–
–
Type of Investment Plans
Focus Areas in EMR Adoption
Transforming health through IT
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AGREGATED EMR MARKET PROFILE
Transforming health through IT
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9
AGREGATED EMR MARKET PROFILE
• Only 13% of the Hospital IT
market has maturized
• 1 in every 3 hospitals has a
plan for a First Time
Investment (FTI)
Transforming health through IT
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MEDICATION SAFETY
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IMAGE MANAGEMENT
•
Type of Image Management Systems
•
Single versus multiple Image Management Solutions
•
Integration with the EMR and external access to images
•
Imaging Standards
•
Amount of Medical Images managed by an IMS
Transforming health through IT
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12
IMAGE MANAGEMENT
Transforming health through IT
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13
IT BUDGET
Transforming health through IT
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14
Thank you!
Korhan An, MD
Country Director (Turkey)
HIMSS Europe
[email protected]
Question Time….
Moderated by John Rayner
Essentials of the Spanish
Hospital IT Market
Edmundo Ramirez
Business Development Manager
Southern Europe and Latin America
HIMSS Europe
Current Market
GDP Growth
2011
2012
2013
2014
2015f
2016f
Percentage change from previous year
-0.6
-2.1
-1.2
1.4
2.9
2.8
Nominal expenditure (in 1 Million EUR)
1,151
1,154
1,163
1,181
1,215
1,249
Europe’s 5th most efficient
health care country in
2014
Hospital Demographics
Total number of acute care hospitals, of which
University hospitals
Sample, of which
Average # of hospital beds (from sample)
Total
Small
Medium
Large
Public
Private
581
382
129
70
301
280
55
-
-
-
-
-
164
89
47
28
118
46
301
113
315
875
349
177
52% Public Hospitals
48% Private Hospitals
The EMR Adoption Model and Results
Stage
Total
Small
Medium
Large
Public
Private
Europe
Stage 7
1%
0%
2%
0%
1%
0%
0.2%
Stage 6*
7%
2%
6%
25%
10%
0%
2.6%
Stage 5*
41%
44%
47%
25%
38%
52%
27.3%
Stage 4
4%
4%
6%
0%
2%
10%
6.6%
Stage 3
2%
2%
2%
0%
2%
0%
5.0%
Stage 2
26%
21%
26%
39%
32%
7%
34.1%
Stage 1
9%
8%
9%
11%
9%
7%
8.5%
Stage 0
10%
18%
2%
0%
6%
24%
15.7%
N
164
89
47
28
122
42
1,660
Mean
3.6
3.3
4.1
3.9
3.7
3.5
3.0
With a mean EMRAM of
3,6 Spanish hospitals are
among the best in
comparison to other
European countries (3,0)
Software Market Penetration and Integration
grouped by Clusters
Growing;
4%
Saturated;
38%
Maturing;
29%
Mature;
29%
The findings suggest there is
opportunity for vendors and
consultants to assist hospital
leaders in fully leveraging their
EMR capabilities.
The key challenge of Closed Loop Medication
Process and Clinical Decision Support
Systems
1. A closed loop medication administration (i.e. protecting the five rights of
medication administration - the right patient, the right drug, the right route,
the right time, the right dose)
2. And advanced physician documentation capabilities that interact with Clinical
Decision Support (CDS) functions providing guidance in the form of clinical
pathways or treatment recommendations.
Closed Loop Medication Process
… a process overview highlighting the key challenges
CPOE and/or
Medication
e-prescribing
Reconciliation
Medications at admission
and discharge
Medication orders pass
clinical decision support
@ the point-of-care
Pharmacy /
Nurse
eMAR
Complete medication
administration
documentation
Validation of order
and dispensing
of Unit Doses or 1 day multi-dose sachet
(e.g. by ADM)
PoC Administration
Secure identification of nurse,
patient and medication at Point-ofCare (PoC)
 Barcode scanning or RFID
 Registration in eMAR at POC
Automated Dispensing
Machines (ADM)
Optional
Clinical Decision Support Features
Drug / Drug
48%
Dose range checks, incl. cumulative…
Most common decision
support feature are drugdrug interactions
(available in 48% of all
hospitals)
38%
Drug / Allergy
43%
Drug / Laboratory
32%
Drug / Patient contraindication
34%
Support of clinical protocols or…
0%
39%
20%
40%
60%
80%
100%
The „Five Rights“ of Clinical Decision Support
The “CDS Five Rights” summarize the ideal delivery of CDS as a mechanism for providing information that can
effectively support and influence decisions.
The value of CDS increases as more discrete data is available to be used in the logic.
(e.g. Drug interaction alert)
(e.g. Drug database)
Right CDS
intervention
Right
Information
(source)
Right
channel
Right time
and place
(e.g. Pharmacy Management
System)
(e.g. during order verification
in Pharmacy)
Right
person
(e.g. Pharmacist)
Stage 6 and 7 Hospitals in Spain
STAGE HOSPITAL NAME
CITY
WEBSITE
6
Corporació de Salut del Maresme i La Selva
Calella
www.salutms.cat
6
Fundació Hospital Comarcal d'Inca - Tramuntana
Inca
www.ibsalut.es/hcin/
6
Hospital Clínic i Provincial de Barcelona
Barcelona
www.hospitalclinic.org
6
Hospital Municipal de Badalona
Badalona
www.bsa.cat
6
Hospital Son Llatzer
Palma de Mallorca
www.hsll.es
6
Hospital Universitari Son Espases
Palma de Mallorca
www.hospitalsonespases.es
6
Hospital Universitario 12 de Octubre
Madrid
www.madrid.org/cs/Satellite?pagename=Hospital
12Octubre/Page/H12O_home
6
Hospital Universitario Central de Asturias
Oviedo
www.hca.es
6
Hospital Universitario Puerta de Hierro de Majadahonda Majadahonda
www.madrid.org/cs/Satellite?pagename=Hospital
PuertaHierroMaja/Page/HPHM_home
6
Hospital Universitario Rey Juan Carlos
Móstoles
www.hospitalreyjuancarlos.es
6
Hospital Universitario La Fe
Valencia
www.dep7.san.gva.es/index1.asp
6
Hospital del Mar
Barcelona
www.parcdesalutmar.cat
7
Hospital Marina Salud de Dénia
Dénia
www.marinasalud.es
Spain and Latinamerica
 Stage 7 Hospitals: 1 (Spain)
 Stage 6 Hospitals: 13(Spain), 7(Brazil)
and 1 (Chile)
EMR Adoption Model SM
HIMSS LATIN AMERICA:
Brazil, Chile, Costa Rica.
Stage
Cumulative Capabilities
Stage 7
Complete EMR integrates all clinical areas (e.g. ICU, ED, Outpatient) displacing all
(medical) paper records in the hospital; Continuity of Care standards to exchange
data; Data Warehouse used as basis for clinical and business analytics
Stage 6
Clinical Documentation interacts with advanced Decision Support (based on discrete
data elements) AND Closed Loop Medication Administration
Stage 5
Integrated Image Management Solution (e.g. PACS) displaces all film-based images
throughout the hospital
Stage 4
Electronic Ordering provides Clinical Decision Support (based on rules engines) in at
least one clinical service area and for medication
Stage 3
Clinical Documentation as well as Electronic Ordering of Physician and/or Nursing
Care services; includes tracking of Medication Administration (eMAR)
Stage 2
Clinical Data Repository / Electronic Patient Record allows collection and
normalization of data from disparate clinical sources throughout the hospital
Stage 1
Information Systems for major ancillary departments (Laboratory, Radiology,
Pharmacy) are installed or data output from external service providers are processed
electronically
Stage 0
Information Systems for major ancillary departments (Laboratory, Radiology,
Pharmacy) are not installed or data output from external service providers cannot be
processed electronically
Thank you!
Edmundo Ramirez
Business Development Manager
Southern Europe and Latin America
HIMSS Europe
Question Time….
Moderated by John Rayner
Closing Comments…..
Edmundo Ramirez
Dr Korhan An
Summary and Close
John Rayner