Spain and Turkey: Two markets with high achievements in EMR maturity. John Rayner Regional Director Europe and Latin America HIMSS Analytics

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 www.himss.eu 4

MARKET CONTEXT Transforming health through IT www.himss.eu 5

MARKET CONTEXT Transforming health through IT www.himss.eu 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 www.himss.eu 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 www.himss.eu 8

AGREGATED EMR MARKET PROFILE Transforming health through IT www.himss.eu 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 www.himss.eu 10

MEDICATION SAFETY Transforming health through IT www.himss.eu 11

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 www.himss.eu 12

IMAGE MANAGEMENT Transforming health through IT www.himss.eu 13

IT BUDGET Transforming health through IT www.himss.eu 14

Thank you! Korhan An, MD Country Director (Turkey) HIMSS Europe korhan@himss.org

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 5 th most efficient health care country in 2014 Hospital Demographics Total Small Medium Large Public Private Total number of acute care hospitals, of which 581 382 129 70 301 280 University hospitals 55 - - - - - 52% Public Hospitals 48% Private Hospitals Sample, of which 164 89 47 28 118 46 Average # of hospital beds (from sample) 301 113 315 875 349 177

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% With a mean EMRAM of 3,6 Spanish hospitals are among the best in comparison to other European countries (3,0) 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

Software Market Penetration and Integration grouped by Clusters Maturing; 29% Growing; 4% The findings suggest there is Saturated; 38% opportunity for vendors and consultants to assist hospital leaders in fully leveraging their EMR capabilities. Mature; 29%

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 Medication Reconciliation Medications at admission and discharge emar Complete medication administration documentation PoC Administration Secure identification of nurse, patient and medication at Point-of- Care (PoC) Barcode scanning or RFID Registration in emar at POC Pharmacy / Nurse CPOE and/or e-prescribing Medication orders pass clinical decision support @ the point-of-care Validation of order and dispensing of Unit Doses or 1 day multi-dose sachet (e.g. by ADM) Automated Dispensing Machines (ADM) Optional

Clinical Decision Support Features Drug / Drug Dose range checks, incl. cumulative Drug / Allergy Drug / Laboratory Drug / Patient contraindication Support of clinical protocols or 48% 38% 43% 32% 34% 39% 0% 20% 40% 60% 80% 100% Most common decision support feature are drugdrug interactions (available in 48% of all hospitals)

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) (e.g. Pharmacy Management System) Right channel Right person Right time and place (e.g. during order verification in Pharmacy) (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 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 12Octubre/Page/H12O_home 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 Stage Stage 7 Cumulative Capabilities 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 HIMSS LATIN AMERICA: Brazil, Chile, Costa Rica. Stage 3 Stage 2 Stage 1 Stage 0 Clinical Documentation as well as Electronic Ordering of Physician and/or Nursing Care services; includes tracking of Medication Administration (emar) Clinical Data Repository / Electronic Patient Record allows collection and normalization of data from disparate clinical sources throughout the hospital Information Systems for major ancillary departments (Laboratory, Radiology, Pharmacy) are installed or data output from external service providers are processed electronically 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