UK Health Care and ICT Current market intelligence report* December 2013

passion for international business development Trade & Foreign Direct Investment Ltd UK Health Care and ICT Current market intelligence report* December 2013 Contents 1. METHODOLOGY... 1 2. SUMMARY OF INTERVIEWS WITH INDUSTRY EXECUTIVES... 1 3. UK TWO TIER HEALTHCARE SYSTEM... 4 4. ABOUT THE NATIONAL HEALTH SERVICE (NHS)... 5 5. EXHIBITIONS... 7 6. RECOMMENDED SOURCES OF REFERENCE... 7 *The information contained in this document was current at the time of writing and is not exhaustive research. Tel: +44 (0)1544 327 061 Email: info@tfdi.co.uk

1. METHODOLOGY Initial desk research identified a number of potential distributors and also NHS trusts in various stages of implementing and optimising Electronic Record Management systems, in most cases the CTO was the key contact. We followed up all leads to identify levels of interest in the Washington State Company (undisclosed) products and/or developing a relationship either at Health 2.0 or outside of the event. 2. SUMMARY OF INTERVIEWS WITH INDUSTRY EXECUTIVES Our research found that many of the key decision makers in the NHS, not so much in the private sector, are also actively practising medicine as well as sitting on review panel s, executive boards etc. There is no doubt that the health service is working hard to become paperless, however there are so many different arms to the service it is hard to see how this will be achieved. In several cases, where EMR is in use their system appears to be under review or newly implemented and in some cases entire systems are being considered for complete replacement due to failure. Some would say the failure is due to a lack of understanding at the outset as to what a system could achieve and also a lack of commitment by users to embrace EMR, and an expectance that an EMR system will be fully operational overnight. The Chartered Institute of IT - The Chairman mentioned the following during our meeting - The UK health technology adoption is pretty advanced, GP's have had their own patient record system in place for many years, Secondary Care is now playing catch up. HIMMS, the authority s source on EMR Adoption trends, devised the EMR Adoption Model to track EMR progress/implementation within hospitals and health systems - It is graded from 0 where hospitals may have some clinical automation right through to level 7 where the hospital has achieved full paperless EMR environment. It s felt that the majority of hospitals, community and mental health operations are only a third to half way through their journey, most being stuck at level 3-4 which is Order Communications (e.g. X-ray ordering /PACS etc. and Clinical Documentation (e.g. clinician workflow, electronic prescribing, scanning patient forms etc.). The government have introduced a technology stimulus tech fund, which means Hospital Trusts have around GBP 1-2 million to introduce new projects to help automate/capture information into their EMR systems, to help them mature their EMR system. Hospitals aim for '2018 paperless challenge'. The BCS Health Chair also commented that the Government is no longer buying centrally, allowing hospitals to buy directly with hospitals outsourcing their IT including EMR system - IT companies they might purchase from include IBM and Capita. The Chair also mentioned that the decentralisation of purchasing allows SME entrepreneurial companies to sell their services, he recommended companies first approach hospitals with a view to developing Pilot schemes, proving a need for a product, before approaching the big EMR vendors. WHO ARE THE BIG NAMES IN EMR - some specialise in GP and some specialise in Hospital or Community and Mental health 1. EMIS has largest share of UK GP surgery market probably about 60% 2. TPP (Phoenix Partnership) 2nd biggest in the GP market TFDI 1

3. INPS (In Practice System) 3rd biggest in GP market 4. Cerner - in the UK Cerner focus on the Hospital market (in 20 hospitals) in the US they focussed on GP s and Mental Health 5. isoft (CSC) focussed on Hospitals 6. Rio (CSE healthcare systems) focussed on mental health Other EMR systems: Lorenzo - Derby hospital have delayed their go live date for the Lorenzo electronic patient record system until February 2014 due to negative feedback of the system by staff at the Birmingham Women s NHS Foundation Trust. Staff engagement and complications around data migration appear to be the main hurdles. The trust is one of eight trusts signed up to take Lorenzo since CSC and the Department of Health reached an interim agreement last September, after a long contract negotiation. http://www.isofthealth.com/en/solutions/lorenzo/lorenzocaremanagementuk.aspx http://www.youtube.com/watch?v=7ackdcvq94k&feature=youtu.be VistA - NHS England has decided not to pay 7m to anglicise the US Veterans Health Association s open source electronic medical record system VistA. Instead, it will create a framework for NHS trusts to buy open source system support, hosting and change management. Link to article. http://www.ehi.co.uk/news/ehi/8923/nhs-england-says-no-to-vista Nine London trusts that have Millennium or are planning to deploy it this year under NPfIT contracts went out to tender for a replacement system in February 2012. EHI (Ehealth Insider Magazine) said that Cerner, InterSystems and Epic have been shortlisted for that framework contract. Oceano & PIC These systems are produced by CSE HealthcareSystems - http://www.csehealthcare.com/products/oceano.html, a UK company based in the north of England providing PICS, RIO, Oceano and Acumen. The PICS and Oceana Systems have been adopted by The Queen Elizabeth Hospital, Birmingham. http://www.executiveinterviews.com/delivery/v1/mini/default.asp?order=uk06123a Mobius - www.fortrus.com/solutions/electronic-medical-record.php, The Mobius Electronic Medical Record system is provided by Fortrus, a UK company based in Hertfordshire. The Mobius front end system sits over the top (OTT) of any system, providing a solution to clunky generalised systems currently in use by the health service. The Business Development Director of Fortrus advised that Mobius has been adopted by St Georges Hospital, London, it sits on top of their Cerner system a system which was proving problematic as it wasn t focused sufficiently on the user s needs; the Fortrus system has been adopted by about 18,000 NHS users. Fortrus, were recent winners of the 2013 Document Manager Award www.dmawards.com/ for Public Sector Project of the Year, achieving success in their work thus far with South Essex Partnership NHS Foundation Trust (SEPT), on their journey to deliver an Integrated Digital Care Record system. Through the use of the innovative Fortrus Unified Health Record, SEPT are meeting many of the requirements for Digital Care Plans, and will exceed all requirements TFDI 2

ahead of 2015 says the Deputy Medical Director for Essex Partnership Foundation University Trust. Fortrus s Mobius digital patient record system is being used by the Basildon and Thurrock University Hospitals NHS Foundation Trust. The Royal Devon & Exeter NHS Foundation Trust has piloted the Fortrus' enotes system. Whittington Health, St George s Healthcare NHS Trust, Mid Essex Hospital Services NHS Trust and South Essex Partnership NHS Trust are all customers of Fortrus. The Mobius Cloud solution is available on the Government Cloud Store (G-Cloud iii). Mobius Cloud is an Electronic Document Management System hosted on a hybrid and/or private cloud, the system gives users fast access to scanned documents and allows them to record information on electronic forms (eforms) and disseminate information via integrated workflows. At the Mobius back end is a comprehensive Electronic Document Management (EDM) system optimised for scanning and categorising records from any type of organisation. A meeting with Fortrus has been arranged. Royal College of Psychiatrists The organisations Chair mentioned that they don t use Cerner they use an electronic patient record system called RiO provided by CSE Healthcare Systems (www.csehealthcare.com/newsroom/ntwselectscsehealthcareforcontinuationanddevelopmentofeprs trategy.html). The system is widely used by the mental health community in the UK; Under the National Programme for IT Rio has been rolled out by BT to 62 sites and is used by about 110,000 healthcare professionals across London and the South of England, as well as 25 other organisations nationwide. The Chair said the next stage will be integrating apps, they have introduced a patient app which is available for patients to download free of charge from the Apple istore providing patients with a range of free self-help leaflets. Royal College of Physicians Director of Health Informatics Unit. Oxford NHS Trust Oxford University Hospital confirmed that they have implemented the Cerner Millennium EPR System. Other Cerner users include NHS South East Coast Trust, Surry & Sussex Healthcare NHS Trust, Milton Keynes Hospital NHS Foundation Trust, Buckinghamshire Hospitals Trust, Hampshire Hospitals NHS Foundation and Weston Area Health NHS Trust. Royal Free Hampstead Trust the CEO s assistant confirmed that Cerner was implemented in 2008. The CEO was unavailable for further comment. Taunton & Somerset NHS Foundation Trust A colleague of the Head of IMT confirmed their implementation of the Cerner EMR system in December 2007, deployed under the now defunct National Program for IT. The current contract is due to end in Oct 2015. The trust are currently at the competitive procurement stage, they have shortlisted 5 suppliers Cerner their incumbent is one of them (he declined to confirm the other supplies). We were told that in their opinion CERNER and EPIC are probably the biggest global players in 3

EMR, other big names in the UK include ISOFT, SYSTEM C, ASCRIBE, ALLSCRIPT and a smaller company called CAMBIO (Scandinavian based company) is currently trying to enter UK market. He also thought that Cambridge Hospital Trust is the only trust in process of deploying EPIC. West Suffolk NHS Foundation Trust The IT Systems Development & Integration Manager confirmed that their Trust is currently out to tender to find a suitable platform for all their systems, Cerner and Epic are being considered. They have a 17 year old system. HR7 is used currently to link up all their system data. The exercise is expense; the belief is that all systems will never be able to run off one platform. They are currently trialing a glucose app, they were not willing to provide the name; this type of technology is of interest. Cerner Millennium Implementation at Kingston Hospital The CEO of the Kingston Hospital National Health Service Trust was quoted in E-Health Insider Magazine, in 2010 as saying the Cerner implementation at the hospital has gone remarkably well ; See the full article - www.ehi.co.uk/news/ehi/5944/kingston-ceo-two-times-cerner NHS Lancashire Trust Hospital - The Business Improvement & Performance Manager advised that the Chair of their IMNT group is a clinician and keen to promote EMR. They highlighted the importance of having a clinician on side, this helps greatly to facilitate a successful adoption within a hospital. The hospital is keen to launch eperscribe and are currently scanning records. They have 4000 clinicians with the Lancashire Trust and have in place two systems - evolve by Kainos for document management and QuadraMed for patient record management, both systems work together and have been in place for a few years. St Georges Hospital Trust The Head of Communications confirmed the hospital s adoption of the Cerner systems, there main use currently is to barcode equipment including beds and they may go onto track patients too. All their x-rays are digitized and many use electronic notes. She reported that in the main, although the systems are not without challenges the general feeling is that users wouldn't want to return to how documents used to be stored (paper). St Georges is currently looking at 3d bone printing and robotics. 3. UK TWO TIER HEALTHCARE SYSTEM The UK has a two tier healthcare system with the majority of the population in the UK using the NHS (National Health Service). People with a high disposable income add to their cover by having private health care/medical insurance. One of the main reasons for private medical cover has been to reduce the amount of time you have to wait to be seen by a doctor, diagnostic procedures and treatments. Interestingly, private healthcare in the UK is dominated by the NHS (the NHS has the largest number of private beds in its private patient units). In recent years there has been a significant and steady decline in the number of people paying for private health. This is thought to be particularly due to the economic climate but also could 4

be attributed to the increase in the quality of service provided by the NHS along with reduced waiting times. At the beginning of this year, 2013, the Secretary of State for Health set out his vision of a paperless NHS by 2018. No one doubts the scale of the challenge, and equally everyone is aware of the huge benefits it could bring. What is still being hotly debated is his how. 4. ABOUT THE NATIONAL HEALTH SERVICE (NHS) Since its launch in 1948, the NHS has grown to become the world s largest publicly funded health service. The NHS was born out of a long-held ideal that good healthcare should be available to all, regardless of wealth, a principle that remains at its core. With the exception of some charges, such as prescriptions and optical and dental services, the NHS remains free at the point of use for anyone who is resident in the UK. That is currently more than 63.2m people. It covers everything from antenatal screening and routine treatments for long-term conditions, to transplants, emergency treatment, and end-of-life care. Responsibility for healthcare in Northern Ireland, Scotland and Wales is devolved to the Northern Ireland Assembly, the Scottish Government and the Welsh Assembly Government respectively A. Scale The NHS employs more than 1.7m people. Of those, just under half are clinically qualified, including, 39,780 general practitioners (GPs), 370,327 nurses, 18,687 ambulance staff and 105,711 hospital and community health service (HCHS) medical and dental staff. The NHS in England is the biggest part of the system by far, catering to a population of 53m and employing more than 1.35m people. The NHS in Scotland, Wales and Northern Ireland employs 153,427; 84,817 and 78,000 people respectively. The NHS deals with over 1 million patients every 36 hours. B. Funding Funding for the NHS comes directly from taxation and is granted to the Department of Health by Parliament. When the NHS was launched in 1948 it had a budget of GBP 437 million (roughly GBP 9 billion at today s value). For 2012/13 it is around GBP 108.9 billion. C. Structure The NHS in England is undergoing some big changes; most took effect on April 1 2013. Including the abolition of primary care trusts (PCTs) and strategic health authorities (SHAs) and the introduction of clinical commissioning groups (CCGs) and Healthwatch England. For detailed information about all the changes, see the section about the NHS structure. 5

Everyone with a long-term condition or disability must have a digital personalised care plan accessible online or via a mobile phone app by 2015, under a package of measures launched today by NHS England. Full article - http://www.ehi.co.uk/news/ehi/8912/digital-care-plans-by-2015 The Private UK Health Care System The largest players in the UK market are HCA, BMI, Spire, Ramsay and Nuffield Health. 1 in eight Britons are currently a member of a private health insurance scheme. Bupa, Axa PPP, Pru Health and Aviva all buy in medical care for customers from the private hospital networks. The following link provides a full list of Private and NHS Hospitals in the UK - www.drfosterhealth.co.uk/hospital-guide/full-hospital-list/ N3 (part of BT British Telecom)provides the National Broadband Network to the NHS, supporting IT infrastructure and networking ensuring the service is safe, fast, robust and appropriate in scale. E.g. the fast transmission of digital images via Picture Archiving and Communication Systems (PACS). N3 provides connectivity to all NHS organisations in England, as well as those non-nhs sites providing NHS care. N3 has 51,000 data connections connecting every hospital, GP surgery, mental health organisations etc. in England and Scotland. It is probably the largest virtual private network in Europe. It is an agnostic organisation, offering best value services so N3 network provision is procured at most competitive rates from BT, Cable & Wireless, Virgin Media etc. To date it has been running for 9 years, it was reviewed after 7 years, then extended a further 2 years and now adding another year. 6

Not just a broadband network, N3 offers added value services such as Voice, video conferencing and solutions for remote working. We asked the N3 Account Manager how our App companies will be able to offer their services if the network is private, he explained N3 is obviously heavily governed, however it s open to private healthcare companies and self-funding organisation to apply for access. US companies would probably need the Hospital Trust to 'sponsor' them; they would also need authorisation from HSCIC. http://www.hscic.gov.uk/ They also mentioned the possible replacement of N3 with the emergence of the Government s PSN (Public Services Network); however he remarked that N3 is compliant with PSN so services can become interoperable between the two current infrastructures. N3 confirmed they are not attending the Health2 conference, however we went onto speak with the VP Global Services, BT Global Health and have arranged to meet at BT s offices during November 2013. 5. EXHIBITIONS Noted here are a few events that may be of interest in the future, if not for attendance it might be that the information communicated around the event is informative. The National Health IT Conference & Exhibition www.hc2014.bcs.org Health Innovation Expo 2014 www.healthcareinnovationexpo.com Commissioning www.healthpluscare.co.uk Med Tech Innovation www.medtecukshow.com Healthcare Efficiency Through Technology Expo www.healthcareefficiencythroughtechnologyexpo.co.uk/ Innovation for Health - www.innovationforhealth.eu 6. RECOMMENDED SOURCES OF REFERENCE Fast-Cast Webinar Virtual Testing Center - Go Live with Confidence Date: October 17, 2013 Time: 1 pm ET / 10 am PT Duration: 30 minute lunch-and-learn Join Steve Lutfy, Managing Director in PwC's Health Industries Advisory Joe Poats, Director in PwC's Health Information Technology practice A discussion about the methodology of WCC s Virtual Testing Centre (VTC) the causes and structure of VTC and how it stretches beyond ICD-10 to help organisations accelerate other important IT projects. 7

Useful Web Links The Foundation Trust Network www.foundationtrustnetwork.org/events/ftn-conference-2013/programme/ NHS Supply Chain www.supplychain.nhs.uk/ Ehealth Insider Magazine (ehi) www.ehi.co.uk/ Accenture Report www.accenture.com/gb-en/landing-pages/health-public-service/pages/healthps-gb-electronicmedicalrecords.aspx?c=con_ukglohpsgs_1210&n=g_electronic_medical_records_(emr)/a_0_k/emr&kw_id =srcfvfeni_dc pcrid 33818743556 Himss Report www.himssanalytics.org/docs/emram.pdf Information and records management society www.irms.org.uk/about-us Technology Strategy Board www.connect.innovateuk.org/web/healthktn www.innovateuk.org/healthcare# 8