THE E-HEALTH PANORAMA by Christian FOURY

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THE E-HEALTH PANORAMA

Christian FOURYOfficial Representative of

the International Research ofthe Mission for European and International Relation and

Cooperation (MREIC) ofthe French National Health Insurance Fund (CNAMTS)


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The E-Health Panorama

The Electronic Medical Prescription of Medicines

The Electronic Medical Record and the Shared Electronic Patient Summary Record

The Software Editors offers either in the Gp’s practices/healthcare centres and in the hospitals


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The Electronic Medical Prescription of Medicines (PEM)

Synthesis of the international comparative study


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Synthèse de l’étude internationale

CNAMTS/Programme 2

Prescription électronique de médicaments

The Electronic Medical Prescription of Medicines

The methodology used

1

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3 The main conclusions

4 The Analysis by Countries


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The Medical Electronic Prescription of Medicines

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• In FranceThe dematerialization project of the Prescription of Medicines has been initiated at the beginning of 2012.

Before the target, foreseen to start in 2014, a functional prototype of Medical Electronic Prescription of Medicines will be realized in the course of 2013.

The Medical Electronic Prescription of Medicina is an important stake to enhance the efficiency of the Heathcare system

• AbroadThe dematerialization of the prescription of the Medicines is also an important stake in several European

Countries and already a reality in some of these Countries.

The level of progree of these projects are nevertheless different according to the Countries. Some of them are in course of deployment and in some others the system is already operational since many years.

Many Countries have also initiated some works but are still in phase of definition of the project


CNAMTS/Programme 2



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The Methodology used

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• Identification of any relevant Foreign Insitutions and or Foreign ExpertsAn Intenatioal comparative study has been undertaken by the International Research of the Mission for European

and International Relations and Cooperation (MREIC) of the French National Health Insurance Fund to identify either the Most advanced Countries regarding the Projects of the Electronic Medical Prescription and the relevant foreign institutions/experts with whom to exchange.

• Note of issue and paper based questionnairePaper based questionnaires have been sent to all the Countries identified with some specific questions regarding the

state of progress of the project to the perimeter retained, to the referential used, to the technical environment of the project…

The feedback from the following countries have already been analyzed : Denmark, Spain (Andalousia), Italy (Emilia-Romagna), Italy (Lombardy), Great-Britain, Finland, Norway, The Netherlands, Switzerland.

The other answers received will be analysed in a second stage

• Videoconferences/audioconferencesIn order to analyse more deeply the answers to our initial questionnaire, some videoconferences, audioconferences

have been organised with the most advanced Countries and having some similarities with the French Context Project.


CNAMTS/Programme 2


Denmark • Sweden • Spain (Andalousia) • Italy (Emilia-Romagna) • Italy (Lombardia)


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The Main Conclusions (1/3)

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• Main gains expected from the project For the Doctors : Reliabilisation of the prescription, more simple renewal prescription by incentive the use of the Help

Prescription Softwares. Reduction of the theft of the prescription receipt. For the Pharmacists : times savings thanks to the automatic data integration, more readable prescriptions… For the Reimbursement organisms : gains in Work Full Time Staff and this when the invoice process is linked to the Electronic

Medical Prescription. Improvement of the Fight against the fraud. For the narcotics prescription : reduction of the misappropriations, traceability either of the prescription and of the

deliveries.

• Points of attention- Name of the medicines The medicine codification is not similar in all the Countries. In some countries the GP’s prescribe in using only the Trade

Medicine Name and somewhere else the prescriptions are made in International Common Name. It does not exist any codified and shared nomenclature for the International Common Name.

- Sizing of the infrastructure The volume of data is important in all the Countries studied. the Healthcare professionals expectations in terms of availability

and times of answers are strong. The technical dysfunctioning are the majorn risk of the project. An inadequate infrastructure and or under sized including at

the beginning of the project could put in danger the use of the system.


CNAMTS/Programme 2



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The main conclusions (2/3)

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• Proposal of evolution

- For the Doctor : Access to all the Electronic Medical Prescriptions of the patient : this would allow to fight against

the therapeutic redundancy. Visual display of the deliveries made on its Electronic Medical Precriptions : Thus, the Doctor could

ensure that the patient has well withdrawn the prescribed medicines instead of being able to ensure that he takes correctly his treatment.

- For the Pharmacist : Access for the Pharmacist to all the prescriptions of the patient : This allow to make sure that

there is no risk of incompatibility and or adverse effect between several treatments in process for the patient.

Possibility for the Pharmacist to suspend an Electronic Medical Prescription : In case of risk for the patient, after advise of the GP, the pharmacist can suspend the Electronic Medical Prescription.

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CNAMTS/Programme 2



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The main conclusions (3/3)

- For the patient : Identification of the patient : Many functionnalities can not be offered if the patient is

not identifiable in a unique way with a high level of security and condidentiality for the access of the medical data.

Today and regarding the French Situation : Our Social Security Card is not personal due to the fact that it contains also the data of the beneficiaries. The Number of Registration in the Directory called NIR is predictible and does not offer a high level of security and confidentiality.

A web interface allow a patient to access to its Electronic Medical Prescriptions. Different functionalities are proposed according toe the Countries studied. A single account by patient is essential to guarantee the confidentiality of the Electronic Medical Prescriptions.


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Analysis by Countries

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CNAMTS/Programme 2


• Key figures

France Denmark SwedenSpain

(Andalousia)Italy (Emilia-

Romagna)Italy

(Lombardia)

Population (in millions of inhabitants)

65 6 10 8 4 10

Medicines expenditures

(in euros by year and per capita)

437 219 277 218 NC NC

Number of prescriptions

(in millions by year)Env. 600 Env. 25 36 180 70 140

Number of Doctors 120 000 20 500 38 000 NC 4000 NC

Number of Pharmacists

22 000 250 900 3600 NC NC


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Analysis by Countries

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CNAMTS/Programme 2


Denmark

• Decentralized Healthcare system.• Decentralized reimbursement system • Project started in the 1990’s • Up to 2007, around 97% of the prescriptions was sent and exchanged

electronically that it to say around 25 millions of prescriptions by year.

Gains of the project : • For the Doctors : Reliabilisation of the prescription due to the use of an informatic module allowing to

detec any medicines interactions.

• For the Pharmacists : times savings by avoiding to enter again the data and reduction of the calls to the prescriber in order to obtain any confirmation regarding the elements contained on the prescriptions

Difficulties met : • Initial process insufficiently flexible : the patients should choose the pharmacy during the consultation.

This system has been reviewed to answer to the patient expectations. Today the system looks like to this one we would like to implement and to generalize in France.

• Under sizing of the infrastructure : Problems of availability have been occured at the beginning of the deployment of the project which has delayed anc complicated the build up process of the project.

Elements of reflection : • Important penetration of the system, due to an important « accompanying measures ».• The patient has an important role in the process. He controls the access of its Electronic Medical

Prescriptions.


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Analysis by Country

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CNAMTS/Programme 2


Sweden

• Decentralized Healthcare System.• Centralized Reimbursement System.• Projet started in the 1990’s • In 2010, 80% of the prescriptions (that means 2,6 millions by month)

have been electronically sent and exchanged.

Gains of the project : • For the Doctors : Decrease of the insecurity linked to the drug addicts, The theft of the secure medical

receipt have totally disappeared.• For the Pharmacists : times savings by avoiding to enter again the data and reduction of the calls to the

prescriber in order to obtain any confirmation regarding the elements contained on the prescriptions

• For the patients : possibility to go to any pharmacy with only an Identity Document for the delivery of the medicines which has increased the flexibility of the process.

• Reliabilisation of the prescriptions : The Electronic Medical Prescription has allowed an enhancement of the quality of the prescriptions (reduction of 10% of the prescriptions which should be reviewed by the pharmacist) thanks to the use of the referentials and a more readable writing.

Difficulties met : • Insufficient gains for the prescribers : the prescribers find that the Electronic Medical Prescription does

not improve their medical practices. They blame the absence of visibility on the Electronic Medical Prescription of the patient and the deliveries made on their Electronic Medical Prescriptions.

• Technical environment : The Electronic Medical Prescription has been taking place in an informatic environment containing several bricks of Information System not coherent according to the Counties. Problems of compatibiliy between the systems have delayed the deployment in several County Counties.


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Analysis by Country

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CNAMTS/Programme 2


Spain (Andalousia)

• Healthcare system is managed by the Autonomous Community, the doctors are salaried of the Andalousian Public Healthcare System.

• Centralized Reimbursement system.• Project started in the 2000. • In 2011, 71% of the prescriptions (that means 127 millions par an) are

electronically exchanged.Gains of the project :The project Receta XXI has been realized with the European funding. An evaluation of the benefits brought

by the project has been performed by the European Commission (Study EHRimpact).12 years after the launch of the first works, the analyse cost-advantage show a net cost benefit ratio of 1.12. In 2006, 3 years after the beginning of the implementation of Receta XXI, the earnings exceed the costs.Notably thanks to the reduction of the consultations of the patients having a chronic diseases, the reduction

in the use of the paper, the increase of the generic prescriptions and the improvement of the quality prescriptions.

Difficulties met : • Lack of flexibility for the patient : the delivery of the medicines is only possible if the patient have with

him its Social Security Card. The patients wish to have a dispensation system based only on an identity control.

• Realization of a medicine nomenclature : A codification table of medicines in Common Name has been realized in Andalousia and adopted later by the other Autonomous Communities. The doctors can prescribe among a list of 12 000 medicines (in trade name) and 3 000 active ingredients. In Andalousia, around 92% of the Electronic Medical Prescriptions are drawn up in active ingredients.


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Analysis by Country

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CNAMTS/Programme 2


Italy(Emilia-Romagna)

• Healthcare System managed by the Region.• Reimbursement System in course of centralization.• Project initiated in 2006, prototype foreseen for the end of 2012 and

target solution in 2014.

Gains of the project : •The project is in progress, No one benefits evaluation study has been undertaken at this date.

Difficulties met : •Under Healthcare Professionals informatics equipment : The acquisition cost and or the renewal of the informatic equipment park can not be only supported by the Healthcare professionals.•The High number of softwares which has been modified in order to allow the emission of the prescription has got some consequences in terms of costs and time schedule.

Elements of reflection : •Two documents form the prescription : an order form destinate to the pharmacist containing the medicines to deliver (notably the number of packages) and a patient instructions for use in order to know how to take the prescribed medicines. The instructions for use is not sent electronically.


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Analysis by Country

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CNAMTS/Programme 2


Italy (Lombardia)

• Decentralized Healthcare System.• Reimbursement system in course of centralisation.• Project initiated in the 1990’s on a restrictive perimater (not delivery

possible). • In 2011, 86,5 millions of Electronic Medical Prescriptions have been

sent and exchanged from the doctors to the pharmacists.

Gains of the project : • The project is in progress, no one evaluation benefits study has been undertaken at this date .

Difficulties met : • The high number of softwares which has been modified to allow the emission of the prescription has got

some consequences in terms of costs and time schedule. • The project is introduced by legislation, any healthcare professionals accompanying measures are

foreseen. The Healthcare Professionals adhesion is the main risk of the project.

Elements of reflection : • Two documents form the prescription : an order form destinate to the pharmacist containing the

medicines to deliver (notably the number of packages) and a patient instructions for use in order to know how to take the prescribed medicines. The instructions for use is not sent electronically.


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The Electronic Medical Record and the Shared Electronic Patient Summary Record



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The Electronic Medical Record


The main conclusions

1

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3 The analysis by Countries


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●In FranceIn France, the initiative was officially launched at national level in 2004 in

the context of the law introduced by Health Minister Philippe Douste-Blazy bearing on reform of the Social Security system. Major return on investment was expected, but today it must be said that a good deal more reserve is called for, with focus first of all on development of uses.

●AbroadElectronic Health Records have been in use in a variety of forms in many

countries for several years now


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● First step :

We need to work closely an directly with the Healthcare Professionals and notably with the Gp’s in order to help them to buy a computer and to use any compatible Professional EMR Softwares – PROFESSIONAL EMR SOFTWARES

● Second step :

We need to work closely and directly with the Healthcare Professionals and notably with the Gp’s in order to identify all the documents that they would accept to share with the other Healthcare Professionals and Hospital Establishments and this in the framework of the Shared Medical Electronic Patient Summary Record – SHARED MEDICAL ELECTRONIC PATIENT SUMMARY RECORD


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● Third step :

We should determine in the framework of the Shared Electronic Patient Summary Record which categories of documents the most important put at the disposal of each patient and this through a dedicated secure internet portal. ACCESS FOR THE PATIENT TO ITS EMR THROUGH A SECURE INTERNET PORTAL

●Fourth step :● Regarding the EMR of the chronic diseases patients and in the framework of the Global

Healhcare Pathway we should provide all the information needed by all the Healthcare Professionals concerned. FOR CHRONIC DISEASES PATIENTS PROVIDE TO ALL THE HEALTHCARE PROFESSIONNALS CONCERNED ALL THE DOCUMENTS NEEDED IN ORDER TO OFFER A COMPREHENSIVE ANSWER TO ALL THEIR HEALTHCARE PROBLEMS


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Analysis by Country

●Germany- The Electronic Medical Record does not exist at the Federal/National Level at this date. Nevertheless,

it exists some pilot projects at the Lander Level which have not for aim to implement a unique solution at the Federal/National Level

- In the Primary Care Sector the GP’s use a Professional Electronic Medical Record to register either administrative and clinical data. These Electronic Medical Records are under the control of the GP’s themselves

- In the hospital Care Sector the Information System are used to register the similar data at those registered in the primary care sector. The Hospital Information System are also under the control of the Healthcare professionals.

The data and categories of documents contained in the Electronic Medical Record vary according to the Software editors.


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Germany

●Germany (to continue)According to a recent publication from a multidisciplinary working group, the Electronic Medical Record should contain :• A certain number of clinical documentation on the healthcare events :- Medical measures,- Symptoms,- Diagnostics,- Therapeutic objectives• A special documentation :- Laboratory test results,- Documentation on the medications.• A certain number of complementay documents :- Documents provided by the other medical specialists• Virtual views :- Set of data from the Emergency Care,- Basic clinical information

- Source : ZTG Zentrum fûr Telematik und Gesundheitswesen GMbh : Electronische Akten im Gesundheitswesen – Ergebnisse des bundesweiten Arbeitskreises EPA/EFA, 2011.


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Germany

●Germany (to continue and end)

- The prior objective before the implementation of the Electronic Medical Record is to deliver to all the patients insured by The German Health Insurance Funds an Electronic Healthcare Card (70 %) in the framework of the basic deployment which should have been started at the end of 2012

- The Electronic Medical Record should be available at the Federal/National Level up to 2019


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Austria

●Austria

- The Austria is currently working on the implementation of an Electronic Medical Record which should be generalized in 2016.

- In the Primary Care Sector the GP’s use a Professional Electronic Medical Record to register either administrative and clinical data. These Electronic Medical Records are under the control of the GP’s themselves

- In the hospital Care Sector the Information System are used to register the similar data at those registered in the primary care sector. The Hospital Information System are also under the control of the Healthcare professionals.

- A certain number of patient data and documents should be available to these one (first step) :*Discharge letters delivered by the hospitals,* Laboratory test results,* Hospital, Gp’s and Pharmacies prescriptions,*Medical and or Clinical register.


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Austria

●Austria

It is also foreseen in a second step of the deployment of the Electronic Medical Record to to have a Shared Medical Electronic Patient Summary Record.

In the first sept of the development of the Electronic Medical Record, the patients are not authorized to register their own documents and or to put them available.

The informatic equipment being different from a doctor to another one the necessity to fund partly the modernization of the equipment has been recognized by the Austrian Authorities.


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Belgium

●Belgium- The Electronic Medical Record should be seen here as a Shared Electronic Patient Summary Record

which should contribute to the enhancement of the healthcare quality and safety

- The Belgium authorities will is to allow thanks to the implementation and the real use of the Professionals Electronic Medical Records the access of the data in a Shared way :

* Contained in the Professional EMR software of the Healthcare professionals-Gp’s,

* Contained in the hospital establishments servers.

- It is important to notice that at this date the EMR is not yet available.

- Existence of the E-Health box tool, which is a secure electronic mailboxes offer for free at all the healthcare professionals includind the hospital establishments. This allow at the hospitals for example to send for free the discharge letters (encrypted) to the Gp’s.


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Belgium

●Belgium (To continue) :

- It is foreseen to open the Shared Medical Electronic Patient Summary Record to the patients/citizens.

- To allow the Belgium Healthcare professionals to buy an EMR Software the Belgium Authority have decided to delivrer a grant of 850 euros by professional (Gp’s, Nurses and Physiotherapists).

- The process of labelisation/credentialing process enhance the quality of the softwares but does not incentive the real use of these ones by the Healthcare professionals mentioned above.

Taking into account this fact, the belgium authorities have decided to measure the good use of the EMR Software by the Healthcare Professionals concerned and to ensure if these one have an EMR Software and if they use them really.


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Belgium

●Belgium (To continue)

The Belgium authorities have therefore decided to help to the development and to the concrete use of the Professionals EMR :

- By allocating a lump sum payment of 80 euros by year and by doctor for the management of the Professional EMR and this in the interest of the patient,

- To incentive financially the patients to have a referent Gp’s in charge of managing his EMR by reducing the outpocket co-payment for each patient.


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Belgium

● Belgium (To continue)

- According to the Belgium Authorities the Hospital Informatisation System is not performant in the sense they produce only summary of hospitalization documents and the consultation of the clinical biological test results. These documents being then storage in a result server.

To address this problem the Belgium Authorities allocate each year and by hospital the amount of 12 000 euros.

- The Belgium authorities are in favour of gathering all the regional existing results servers in one server in which we will find the all the relevant documents concerning a patient. The GP’s could connect him thus at this regional network wich would allow at this one to access to a list of documents for a patient and if there are several regional servers to collect all the documents known in these ones for a patient.


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Belgium

●Belgium (To continue)

-In the Dutch Community, there are 4 regional results servers,- In Brussels capital there is 1 regional result server,- In the French Community, there is 1 regional result server.

The French Community for example offer to their hospitals to be interconnected with a unique results regional server to allow the Gps and the other Healthcare professionals to access to any relevant documents for any patient.


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Spain

●Spain The Electronic Medical Record is still not available at the National Level

They are many initiatives undertaken by each Autonomous Community

Example : The Autonomous Community of the Catalogna

- A Professional EMR is used by almost all the Healthcare professionals and the Hospitals (88 %) :

* 7,9 Millions of Professional EMR existing including 40 M of clinical documents - the Catalogna have 7,5 Millions of inhabitants,

* 50 500 Healthcare Professionals access to these Professional EMR through a dedicated Professional Portal : In 2012 there are been 1,74 Billions of consultations.

- All the Medical Imaging are stored in a Regional PACS Server,- The Electronic Medical Prescription is already operational between the prescribers and the

pharmacists. This project is deployed since 2008.


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Spain

●Spain (To continue)

- Each citizen/each patient can consult some of their medical informations on a dedicated and secure Internet Portal. A version for smartphone is in progress in the framework of a pilot test.

- It is foreseen to have an Shared Medical Electronic Patient Summary Record as it exist in the Autonomous Community of Catalunya at the National Level.


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Italy

●Italy – National Level and Emilia-Romagna Region

In Italy the Healthcare System is managed by each Region and consequently the EMR is therefore build up with each Italian Regions hereby certify by the EMR study within the Emilia-Romagna Region

It does not have an EMR at the National Level. Nevertheless there are the will of the Italian Public Authorities to have at the National Level a Shared Medical Electronic Patient Summary Record called « Fascicolo Sanitarie Elettronico ».


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Italy

●Italy – Emilia-Romagna Region

- In the Primary Care Sector and concerning the GP’s, there are 16 Professionals EMR Softwares. On this subject, the Emilia Romagna Region is currently in the way to proceed to a call for tender in order to retain only and at the end of the process a unique EMR Software editors.

- In the Hospital Care Sector we find too the existence of compatible Professionals EMR Softwares.

- All the Healthcare Professionals of the Italian Emilia-Romagna Region are computerized and this thanks to :

* First the creation of a regional server called « SOLE-SANITA ON LINE – HEALTH ON LINE » implemented since 2003 and up to 2005 among which the main objective was to build up a informatized network in the framework of the individual clinical pathway of the patient and to share all the relevant clinical documents contained in the Professional EMR of the GP’s, Paediatrists with all the Healthcare Structures of the Emilia-Romagna Region.


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Italy

●Italy – Emilia-Romagna Region - And secondly through the financial participation of the Healthcare Regional Directorate :• in the Gp’s and Healthcare Professionals training,• Cost of the 16 Professionals EMR maintenances,• The cost of connexion of the GP’s computer,• The Online Help Desk Service for the Gp’s, the Healthcare Professionals and the citizens,• The purchase of the informatic material (Personal Computer and Printers) for the GP’s


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Italy

● The Shared Medical Electronic Patient Summary Record is managed by the Italian Minister of Health at the National Level and by each Italian Region at the Local Level – Example of the management of this project by the Emilia-Romagna Region :

- The Facicolo Sanitarie Elettronico FSE– Shared Medical Electronic Patient Summary Record is a Secure Internet Portal containing all the data of the patient which has been developed within the Emilia-Romagna Region from 2008 to 2010. There have been an experimentation stage launched in 2011 and a generalization stage since 2012.

- The Healthcahre Professionals who have the responsibility of the healthcare of their patients in the Public Structures can access to the FSE.

- The Healthcare Professionals should send any relevant clinical documents in the FSE and this by the intermediate of the corporate software user integrated to the Sole Infrastructure.


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Italy

● Shared Electronic Patient Summary Record managed by the Italian Minister of Health at the National Level and by each Italian Region at the Local Level – Example of the management of this project by the Emilia-Romagna Region ( to continue) :

- The Gp’s through their own Professionals EMR can see all the referral documents produce by the Public Structure, the Specialists Pharmaceutical Prescriptions and send the « Patient Summary » of the Patient with the information of their own Professionals EMR Sofwares.

- The patient have an access to his FSE and he is free to add any paper documents by scan.

- At the 31st of December 2012, there have been :• Created 13 500 actives FSE,• Stored in the Regional Data Server around 19 millions of clinical documents and around 33

millions of specialists pharmaceutical prescriptions,• Consulted by the patients : 63.500 clinical documents and prescriptions.


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Switzerland

●Switzerland

In Switzerland, the Healhcare System is managed par each County called the Swiss Cantons. The EMR is therefore build up at a Local Level

It does not have an EMR at the Federal Level. Nevertheless there are the will of the Swiss Public Authorities to have at the Federal Level a Shared Medical Electronic Patient Summary Record.


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Switzerland

●The EMR managed by the Geneva Canton

- A Shared Medical Patient Summary Record exist as one of the pilot project in Switzerland. It is called « E-Toile Project ».

- In Switzerland around 20 % of the doctors have and use a compatible Professionals EMR Software and it is the situation in the Geneva Canton too.

- The originality of the E-Toile Project is that E-Toile does not store any information but allow (or not) the access for any request of all the databases of all the stakeholders involved in this project (clinics, radiologists, pharmacists, hospitals, doctors, etc).

The partners themselves keep the control on their own data and decide which informations of their Professionals EMR software they wish to put eventually at the disposal of E-Toile.


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Switzerland

●The EMR managed by the Geneva Canton

E-Toile store only any pdf documents at this stage, at the exception of the medication informations which are codified (possibility to exchange information).

The project E-Toile is in a pilot project stage within a Region of 50 000 inhabitants in the Medical Center of the Onex Medical Group.

The Onex Medical Group is composed of 80 Gp’s who share at this date 280.000 Professionals EMR. These Professionals EMR contains : a synthesis, the medicines, the radiologies imaging, the laboratories results, the letters, the medical reports, the medical certificates for the population of the Onex Region.


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Switzerland

●The future Shared Medical Electronic Patient Summary Record by the Ministry of Health at the Federal Level and among which the example could be the Pilot Project of the Shared Medical Electronic Patient Summary Record fom the Geneva Canton

- The main objective of the E-Health Swiss Strategy is to encourage all the Swiss Cantons to implement an EMR and to have a Shared Medical Electronic Patient Summary Record if it is possible in 2015.

- The pilot projects of an EMR in the Swiss Cantons are : Canton of Geneva (E-Toile), Canton of Basel-Stadt, Canton of Wallis.

- It has not been yet defined at this stage the kind of documents we will find in the future Shared Medical Electronic Patient Summary at the Federal Level. The discussions around this issue will start in 2013. We think if we refer to the pilot projects of the Swiss Cantons that we will find the following documents : Medical Reports, laboratories tests, the e-prescription, the e-medication, the results.


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The Software Editors Offers either in the Gp’s practises/Healthcare Centres and in the Hospitals



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Software editors offers of the Gp’s practices

● The Results obtained show us a first classification in two categories of practices, that is to say :

- For the Software Editors offers of the Gp’s practices/Healthcare Centres :

- In one side, the Countries and or Regions, County Councils, Autonomous Communities ensuring themselves the healthcare dispensation : have a few number of house software developed internally and sometimes a unique one from a call for tender process :

• Canada (Alberta),• Spain (Catalogna),• Scotland,• United States (HMO Intermountain Healthcare and Kaiser Permanente),• Italy (Emilia-Romagna),• Sweden.


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Software editors offers of the Gp’s practices

• In an other side and similar to France, some Countries are leaving the free market and ensure nevertheless an homologation/labelisation/certification process of the softwares used :

*Austria,

*Belgium,

* United States (Federal Level),

* The Netherlands,

* Switzerland among which the Geneva Canton.


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Software editors offers in the hospitals

- For the Hospital Care Sector, the situations met in the other foreign Countries are relatively and or quite similar to what we meet in France :

• A small editors number cover the major part of the market,• Even if they do not cover all the needs from an hospital,• This conduct the hospital to launch a call for tender to many editors and softwares,• We find either some public offers and or Hospital Establishment Owners (again this

practice is less developed in France) and some national and international private offers,• To notice in some Countries a quicker start offer with external storage share the

Information System of several hospitals : type Saas and or Cloud

We do think that the Ambulatory/Hospital communication is everywhere at its beginning – except in any Integrated Healthcare System (USA Intermountain Healthcare, Kaiser Permanente, Spain Autonomous Community of Catalogna).


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Thanks for your attention

THANKS FOR YOUR ATTENTION


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Professionnal contact details

Christian FOURYOfficial Representative of

The International Research ofThe Mission of the European and International Relations and Cooperation

(MREIC) ofThe French National Healh Insurance Fund (CNAMTS)

CPAM de la Sarthe178 Avenue Bollée

72 033 Le Mans Cedex 9Telephone : + 33 2 43 50 74 89

Mobile : + 33 6 60 49 58 87E-mail : [email protected]

THE E-HEALTH PANORAMA by Christian FOURY

Health & Medicine

Transcript of THE E-HEALTH PANORAMA by Christian FOURY