Insights201211 13577439780007d0472770e PP

T H E I N F O R MAT I O N T E C H N O L O G Y J O U R N A L F O R H E A LT H C A R E L E A D E R S | V O L .
O N E | N U MB E R O N E
WHAT NOW,
EUROPE?
HOSPITAL IT IN TIMES OF CRISIS
+ How IT drives US healthcare reforms
+ Identity and access management
+
Financial impact of HIT
P R E M I E R I S S U E
WWW. HI MS S I NS I G HT S . E U NOVEMBER 2012
WELCOME
A Crisis? Where? Yes, there is the debt problem in
Greece and the banking problem in Spain. There is the unemployment prob-
lem in the south of Europe. And, as in every crisis, there is irrational anxiety.
On the other hand, the German economy grew at 3% in 2011; a modest
rate compared to the 7.6% growth in Estonia. Spains 0.7% growth is at the
same level as growth in the UK. And the European Union? With an economic
growth of 13.9% between 2000 and 2011 and a GDP of 12.629trillion, it is still
the largest economy in the world.
As always, there are different perspectives to every crisis and we
should remember Einsteins ground-breaking insight: it all depends on
where you are standing.
Its the same with the healthcare IT industry; there are two sides to
every coin.
For twenty years the European Commission has ploughed over 1.5 billion
euros into innovative eHealth and healthcare IT projects with the aim of
ensuring the free movement of patients within the European Union [p. 21]
and the technical superiority of the EU. Some of these projects are seen as a
waste of time and money; some have led to innovation and some promised
to make a signicant impact and force long-term change.
One of the largest and most signicant of these projects is epSOS [p. 26].
Designed to support interoperable electronic health records among Mem-
ber States, it will enable doctors in France, for example, to understand the
ndings of their colleagues in Slovenia. Some European countries have
embraced epSOS. Others, like Germany, have not. But its biggest advocate
surprisinglyis Spain, a country plagued by 50% youth unemployment and
a banking sector in need of intensive care.
Likewise, half of the European hospitals which have achieved Stage 6 or 7
on HIMSS Analytics EMRAM Scale are from Spain; EMRAM Stage 6 hospitals
are less prone to medication error, and Spain has equipped 96% of its hospitals
with pharmaceutical clinical information systems. In Portugal, this gure is
94.2%, whereas German hospitals are way behind with only 51% [p. 28].
These examples show that change in European countries does not happen
at the same time, at the same speed and in the same way. Chacquun son
gotthats Europes approach to digitizing its healthcare systems; but, we
can learn from each other and pool all the available knowledge. This is one of
the reasons why epSOS is on its way to becoming a successful cross-border
eHealth initiative.
There is no doubt that the road towards highly digitized healthcare sys-
tems is a bumpy one, but if healthcare IT is able to deliver on its promise of
economic benets [p. 14], the current austerity measures across Europe could
even give the sector a boost. This will require the involvement of powerful
individuals who are commited to developing, implementing and using infor-
mation technology; people capable of recognizing its potential for patient
care and who are willing to change their perspective in order to drive forward
innovation, to make budgets available or to adopt best practices.
It is for these people we have created this magazine.
Armin Scheuer, Head of HIMSS Media Europe
armin.scheuer@himssmedia.com
HIMSS Europe_mag_v15.indd 1 11/1/12 11:08 PM
PORTRAI T: Victor Dubois-Ferriere
2 | himss europe | I N S I G H T S | november 2012
CONTENTS
What Now, Europe? [pg. 8]
As our governments struggle to restore economic prosperity, grand plans for national
integrated health IT systems no longer have a place. Are politicians missing an opportunity
to bothsave cost and improve their societies?
THE BRIEFING
[pg. 6] Europes Investments in Research
POLITICS & ECONOMICS
[pg. 8] Hospital IT in Times of Crisis
THE DEBATE
[pg. 14] Healthcare ITIs it Worth the Cost?
SPECIAL FEATURES
[pg. 21] Towards an Ever Closer Union
[pg. 24] Healthcare Must Innovate to
Address Changes in Society
[pg. 26] Making Travel in Europe Safer
the EPSOS Way.
STRATEGY
[pg. 28] CLOSING THE LOOP:
A Strategy to Adopt Best Practices
in Medication Administration
[pg. 34] IDENTITY & ACCESS MANAGEMENT:
On the Safe Side with IAM Solutions
INTERVIEW DELL: Is the image data in your PACS growing faster than your IT budget? pg. 61
INTERVIEW IMPRIVATA: Speeding up EMR adoption by means of security pg. 64
CASE STUDY TIETO: High-quality IT delivering quality care at Finlands Savonlinna Central Hospital pg. 66
INTERVIEW QUALCOMM LIFE: Mobilising healthcare Interview pg. 68
INTERVIEW TPP: One patient, one record is becoming a reality pg. 70
INTERVIEW NUANCE: Speech recognition is more than a reduction in costs pg. 71
GLOBAL TRENDS
[pg. 40] NATIONAL HEALTH IT WEEK:
A Snapshot of US Healthcare Reform
LEADERS OF CHANGE
[pg. 46] WOMEN: The Glass Ceiling
is Preventing Healthcare IT from
Reaching its Potential
[pg. 48] VICTOR DUBOIS-FERRIERE:
Directing an Orchestra of Images
[pg. 50] JACQUELINE SURUGUE:
No Future Without IT!
[pg. 52] GALICIA: Leading the Way with EHRs
STANDARDS
[pg. 56] HL7: A Work in Progress
STANDARDS
[pg. 58] NURSING: Using Standardised
Language in Intelligent Electronic
Healthcare Documentation
4 | himss europe | I N S I G H T S | november 2012 | the briefing
THE BRIEFING
HIPAA Compliance
Enforce passcode andencryption
Distribute andmanage mobile
applications
Remotely wipe sensitive information
Detect jailbroken or rooted devices
Continuously monitor and report
on compliance
Gain control with MaaS360:
Try it now @ http://www.maas360.com/HiMSS
Prof Christian Lovis, MD MPH, University Hospitals of Geneva
& President of the Swiss Society of Medical Informatics
in his keynote speech at the Swiss eHealth Summit 2012.
Eureka
IT systems can heal patients and
they can kill them. Healthcare IT
is not about opinion but about
facts, its not a game but science.
Only with a full electronic medi-
cation process can we implement
alerts for drug-drug interactions,
drug-allergy interactions and for
dose- and range-check. This is the
way to reduce medication errors.
Vicent Moncho Mas, CIO, Hospital de
Dnia, Marina Salud S.A., SPAIN
Experience from the past decade
has shown that erros and misun-
derstandings during the medication
process can be avoided through
CPOE. Processes are more ecient,
safer and more transparent. How-
ever, both the introduction and
implementation of CPOE have to be
managed professionally and critically,
because otherwise new and ofen
serious mistakes can be made.
Dr. Marc Oertle, Medical Director IT,
spital STS AG, Thun, SWITZERLAND
Perspectives
Q. Can IT systems help reduce medication errors?
All eorts for reducing medication
errors must be a part of an inte-
grated EMR system. This includes
clinical decision-support during
drug prescription, unit-dosing with
barcode and RFID during medica-
tion administration or the control
of the medication management
process in dierent phases.
Alessio Gasparetto, IT Project Manager
Engineer, Rovigo Local Healthcare
Authority, ITALY
There are many ways: computers
remove the pen from prescribing to
reduce errors caused by poor hand-
writing; robots in pharmacy depart-
ments can reduce errorswhen
picking medication from the shelves
fordispensing. Care has to be taken
to ensure thatIT systems donot
create new errorsand anyone install-
ing a new system mustread the
research and consult the medication
safety experts as part of their
implementation process.
Susan Burnett, Programme Lead,
Organisation and Health Systems
Group, Centre for Patient Safety and
Service Quality, Imperial College
London, UK
HIPAA Compliance
Enforce passcode andencryption
Distribute andmanage mobile
applications
Remotely wipe sensitive information
Detect jailbroken or rooted devices
Continuously monitor and report
on compliance
Gain control with MaaS360:
Try it now @ http://www.maas360.com/HiMSS
THE BRIEFING
Cloud
Services
SECURE AND RELIABLE.
HIMSS Insight
Trim Size: 297 mm x 210 mm
With Bleed: 303 mm x 216 mm

C
a
r
e
s
t
r
e
a
m

H
e
a
l
t
h
,

I
n
c
.
,

2
0
1
2
.

CLOUD
SERVICES.
DIAGNOSIS,
VIEWING,
OFF-SITE
ARCHIVING.
Integrity, storage, review and availability of
all clinical data without capital investment.
V UE F OR C L OUD S E R V I C E S
A smarter way for secure data management.
www.carestream.com/cloud
E..
October 2012
RSNA2012BOOTH2636
SOUTH HALL
EU Investments in Research
The European Unions Framework Programme for Research and Technological Development
(FP) co-finances research, technological development and demonstration projects.
Funds are assigned on the basis of calls for proposals and a peer review process.
The seventh Framework Programme started in 2007 and will end in 2013.
It total budget is 50.000.000.000 .
FUNDING OF eHEALTH RESEARCH
FP6 VS FP7
RESEARCH FUNDING BY FP7 IN 2012,
IN MILLION
FP7
(2007-2013)
FP6
(2003-2006)
+115%
433.000.000
200.800.000
7
Cloud
Services
SECURE AND RELIABLE.
HIMSS Insight
Trim Size: 297 mm x 210 mm
With Bleed: 303 mm x 216 mm

C
a
r
e
s
t
r
e
a
m

H
e
a
l
t
h
,

I
n
c
.
,

2
0
1
2
.

CLOUD
SERVICES.
DIAGNOSIS,
VIEWING,
OFF-SITE
ARCHIVING.
Integrity, storage, review and availability of
all clinical data without capital investment.
V UE F OR C L OUD S E R V I C E S
A smarter way for secure data management.
www.carestream.com/cloud
E..
October 2012
RSNA2012BOOTH2636
SOUTH HALL
8 | himss europe | I N S I G H T S | november 2012 | politics & economics
POLI TICS & ECONOMICS
As the EU struggles to restore economic
prosperity, grand plans for national integrated
health IT systems no longer have a place. Are
politicians missing an opportunity to both
save cost and improve their societies? The
reality is more complex, say experts: health
IT does have a role to play in fixing the mess
were inbut not at the level you may think.
FOUR YEARS INTO THE WORST economic contrac-
tion since the Second World War, light may nally be
visible at the end of the Eurozone crisis tunnel. Last
month the EU ocial measurement service, Eurostat,
said the aggregate budget decit in the 17 countries
using the currency nally fell to 4.1% of GDP in 2011
from 6.2% in 2010.
But its not all good news yetand may not be for
quite a while longer. Eurostat also said that although
annual budget decits had fallen, public debt in the
What Now, Europe?
Hospital IT in Times of Crisis
By Gary Flood & Philipp Grtzel von Grtz
Eurozone rose to 87.3% of GDP in 2011 from 85.4%. Greece,
where the sovereign currency crisis hit rst in 2010, still
sees national debt levels at 170.6% of GDPor 355bn.
US commentators believe that with Brussels unable to
accelerate progress towards scal and banking sector
union, a recession of 2.5% may be possible next year,
while nations formally outside the Zone, such as the UK,
continue to struggle with poorly performing economies.
In response, many European nations have inaugu-
rated tough spending plans designed to bring down their
debt mountains, even as their politicians seem caught up
in an endless round of nal crisis summits. Meanwhile,
there is nothing like the appetite in forward investment
in health systemslet alone their IT componentthat
we saw across the Continent in the last decade.
But even as heads of state demand the brakes get put
on social spending, are policy-makers guilty of missing
a gigantic opportunity to both meet their tight budget-
ary targets and improve the lives of their citizens? Step
forward the promise of integrated, national health infor-
matics programmes that could boost eciency, save
9
precious taxpayer money and potentially add years of
healthy, active lives to Europeans.
Sounds great. The problem is that important quali-
cation, promise. While on paper, integrated health IT
seems a no-brainer, theres just not evidenceat least
the kind that persuades tough-minded Chancellors
and Prime Ministersthat it really will work. Its all
very well for US numerical sofware analysis rm SAS
to forecast that the UKs healthcare system could ben-
et to the tune of 1.9bn if it maximised the use of its
Big Data, or that the same countrys recent telehealth
trial showed an astonishing 45% fall in mortality rates
among patients with long-term conditions, a 20% fall in
emergency admissions and reduced time spent in hos-
pital. If the politiciansespecially in a context of one
too many high-prole project failuresdont think its
worth the risk, then such projects are going back in the
cupboard, perhaps for a generation. To quote Uwe Bud-
drus, MD of HIMSS Analytics Europe, There just isnt
the empirical evidence that healthcare IT does automati-
cally lower national social care costs.
Nonetheless, common sense suggests that the right
application of technology to healthcare could deliver
huge benets. It has long been recognised that early
intervention strategies are the future of healthcare,
points out David Downing, healthcare specialist, SAS UK.
Not only does the intervention approach signicantly
improve patient wellbeing, it also relieves the pressure
on acute care and reduces nancial burden overall. If the
question is what is the solution to healthcare in times of
austerity, the answer is early intervention.
Downingand many otherspoint to the success
of countries in Denmark, where the overall annual pub-
lic spending associated with hospitals is around 6.7bn
and where there are major plans to boost the sectors
eciency. One of the newer political incentives for
optimising the hospital system, for instance, is to link
sections of the hospitals funding allocations directly to
the hospitals activities, and the Danish National Board
of Health is pursuing an active IT strategy to help it
achieve that, of which big data analytics is a part. Among
other benets being delivered by IT, Danes are now using
analytics to open up statistical information on health
and illness, allowing the public to search for data relating
to such subjects as hospital treatments, cancer incidence
rates, number of births and causes of death.
Lets look at three major European economies to get a
sense of what is happening in terms of any sort of coor-
dinated approach to geting maximum social benets
out of useful healthcare IT.
Germany: A national healthcare platform
by accident?
German policy-makers have a very dierent set
of problems, economically, than their EU colleagues.
Unemployment has shrunk more than 50% in recent
years, down to levels last seen in the early 1990s. As a
result, the robust economy has taken politicians by
surprise. Two years ago, several new laws were pushed
through which aimed at keeping healthcare spending
in check. But since unemployment remains low, much
more money is going into the welfare system than
anticipated. The result: the German public health insur-
ance system has accumulated a surplus of an estimated
22bn in recent years.
Berlins discussions are focused, then, unlike its
neighbours, on what to do with all that money, not how
to make scarce resources go further. However, there
is no sign that any of it
might be used to accel-
erate the build-up of a
national healthcare
IT infrastructure. In
fact, the German gov-
ernment elected in
2009 of has buried more ambitious applications of the
electronic health card than the ones currently being dis-
tributed nationwide. And no one is talking about any
kind of federal electronic health record any more. The
same is true for electronic prescriptions.
What remains on the agenda: an online update of
administrative patient data on patient smartcards.
Insurance companies want these updates to take place
every time a patient sees a doctor, for example. The
second application in the development pipeline is a qual-
ied electronic signature for health professionals, which
could be used, for example, to underwrite more secure
doctor-to-doctor digital communication.
As it stands, several industry-led consortia are apply-
ing to run the pilot tests of these two applications. The
tests will take place in two regions and encompass at
least 500 health professionals each, notes Arno Elmer,
head of the healthcare IT organisation gematik, run
jointly by the governing bodies of health insurance
companies, doctors, hospitals, and pharmacists. Elmer
foresees awarding of contracts to the bidders in the sec-
The German public health
insurance system has accumulated
a surplus of an estimated 22bn
in recent years.
10 | himss europe | I N S I G H T S | november 2012 | politics & economics
ond quarter of 2013, with a goal of pilot stage testing of
online updating towards the end of 2013.
Meanwhile, doctors and hospitals are already
actively networking, creating links that could arguably
act as the basis of a future truly national healthcare IT
platform. In fact, say some, with Germanys KV SafeNet,
run by the Kassenrztliche Vereinigungen, the gov-
erning body of more than 100,000 doctors in private
practice who work under the umbrella of the German
public healthcare system, the country already has such
infrastructure in place. KV SafeNet claims to have more
than 20,000 users, allowing doctors to submit their reim-
bursement les, while the system can also be used for
doctor-to-doctor communication.
At the same time, German hospitals have quietly
been working on an electronic patient record standard,
elektronische FallAkte (eFA) for some time. Though
atracting some criticism for its alleged proprietary
approach towards interoperability, eFA can be used by
hospitals to connect digitally with referring doctors or
by doctors in integrated care networks to connect with
each other. Now, eFA proponents have teamed up with
the healthcare IT industry association bvitg in order
to adapt the edgling standard to IHE standards. This
cooperation has been very successful so far, and we
expect to be able to present results early in 2013, claims
the later bodys director, Siemens Bernhard Calmer.
Germany seems to be on the road, then, perhaps not
consciously, to the kind of truly national healthcare IT
system experts say is an important part of the route to
greater social eciency and cost savings. But it does
seem to be very much the exception, not the rule, in
Europe at the moment.
France: Stasis
If theres one word that sums up the state of French
healthcare IT, its paused. The countrys ambitious Hpi-
taux 2012 project and legislation to reform the countrys
health administration, la loi HPST, have gone as far as
they canbut no successor projects have so far taken
their place. The result, says Jean-Pierre Thierry, a close
observer of the French healthcare technology scene
and a member of HIMSS Europes governing body, is a
kind of depression; the Hospital plan did not achieve
the results envisaged, for example, and what had been
a projected 1.5bn investment in French health IT infra-
structure somehow shrunk to more like 400m.
There is a denite fear that any new healthcare IT
plan simply wont be suciently funded to work, he adds.
Yes, there is a next phase of investment on the table,
the French Ministry of Healths Hpital numrique. But
there is a lack of clarity and agreement about its possible
contribution, warns Thierry, and though the Eurozone
crisis is not being specically used as the reason so far,
there is a clear feeling that public purse-strings wont
be opened that much for any kind of national Gallic IT
health plan at the moment.
The French health system has had to deal with a lot,
like the move to mutualisation and the enforcement of
the rules of the new legislation, he told HIMSS Insights.
Many French hospitals are also dealing with debt. At
the same time, in terms of national priorities, though its
a new Socialist administration, Paris is still very com-
mited to meeting the EU target of reducing state debt
to only 3% of GDP. This all makes routing of money for
health IT quite problematic at the moment.
The result is something of a paradox. France has long
been a recognised leader in terms of the successful appli-
cation of technology to citizen health, starting with its
Carte Vitale smartcard system that helped enable elec-
tronic billing of healthcare services and which currently
processes around a billion claim reimbursement forms
per year. There is also agreement about the possible bene-
ts of a national digital medical record for patients, as well
as telemedicine. But, as Thierry puts it, How to pay for it?
Some experts say a move away from big centrally-
driven state programmes and more encouragement of
local initiatives might work. But as it stands, France
seems very unlikely to push for any equivalent to its
national smartcard project any time soonor at least
until the decit is dealt with, it seems.
The UK: Struggling to deal with the national
programmes crash
As far as the UKs healthcare IT scene is concerned,
its the afer shock of the perceived failure of the Blair
governments National Programme for IT (NPfIT), a
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to more like 400m.
11
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12bn (15bn) atempt to deploy a national electronic
health record (EHR), as well as a number of other key
systems for the countrys National Health Service
(NHS), that still dominates the scene. At the same time,
the NHS is being subject to a complex re-organisation
programme that critics say is puting it under too much
pressure to successfully plan ahead, all part of the Coali-
tion Governments austerity programme.
As a result, an existing climate of uncertainty when
it comes to investment in IT is just geting worse, say
commentators. Purchasers on the care provider side of
the NHS in particular struggle to fund larger and long-
term IT investments when they are forced to re-compete
for contracts on a regular basis and are paid against tar-
gets that can change abruptly from year to year. Add to
that, say insiders, the current emphasis on cost-cuting
and eciency savings, its no wonder many acute hospi-
tals are struggling to nd the up-front funding needed
to invest in projectseven when that investment could
deliver substantial savings and eciencies down the line.
Another factor is the legacy, of course, of NPfIT. Fol-
lowing the launch of the Programme ten years ago, indi-
vidual NHS organisations were eectively encouraged to
put their own IT strategies and investments on hold until
the national and centralised procurements outlined in
the strategy were awarded. As a result, information and
IT concerns slipped down the agenda at board level, while
sta with expertise in procuring and deploying IT sys-
tems ofen found their skills were no longer required and
moved on to new roles, too ofen outside the NHS. Ven-
ables warns, It will take time to rebuild both leadership
and detailed expertise and vendors are currently having
to work harder to compensate for the lack of both.
Thats not to say all UK healthcare IT stakeholders see
the situation as desperate. For Mathew Swindells, chair
of BCS Health, a section of the countrys organisation
for IT professionals, the BCS/Chartered Institute for IT:
The end of NPfIT has placed responsibility for IT back in
health users organisations, where it rightly belongs. We
are seeing Boards around the country respond by raising
the prole of their internal clinical and non-clinical lead-
ership, through the creating of CCIOs (Clinician CIOs)
and CIOs into the senior management team.
As a result, the organization believes Teams all over
the NHS are developing strategies that align informa-
tion and IT with their productivity and quality objectives
and the rst of those are coming out to tender for solu-
tions where none have been provided in the past 7 years.
Overall, although it is too early to be sure, the end of
NPfIT seems to have revivied IT in the NHS.
However, even if all the money issues went away,
warn suppliers, the NHS is still far o from any kind of
national IT platform for solid technical reasons. While
there is much talk about standards and frameworks,
there is ofen very litle concrete detail, they argue,
drawing atention to the Department of Healths IT
strategy that includes an action to agree a single process
to set standards by 2013, together with a ve-year route
map for the standards to be set. In practical terms, that
means it could easily be another ve years before there
are agreed standards for systems in a particular area.
Vendors claim they must ofen make a best guess at
which standards to use, or develop systems that cover as
many bases as possible while they wait for the NHS to
decide on a nal standard.
Conclusion
Though politicians arent listening at the momentat
least in the majority of countries, at national levels
healthcare IT experts are convinced that IT can and
does make a dierence. Its just that these will be more
likely to be locally driven, decentralized successesnot
national visions any more.
If you look at Spain, which has 17 very autonomous,
dierent regions, each is doing very well driving local,
holistic plans for things like EMR, says HIMSS Analyt-
ics Europes Uwe Buddrus. Equally, the UKs failure to
build a national EHR might be compensated by a more
successful locally driven round of IT spending; we see
tremendous interest in lower-cost EHR systems like
Meditech, for example. Its possible that the smaller
the country or region trying to build an EMR, the more
chance it has of success.
Buddrus also draws an analogy with the US, which has
thrown enormous sums at healthcare but which is now
also trying to foster a more local approachnotably, the
Meaningful Use approach that was introduced with the
Obama governments American Recovery and Reinvest-
ment Act. Its not going to be at the national or the hospital
level but the regional level that we think IT is really going
to contribute to cost savings in health, he oers.
The point is that projects dont have to be Big Bang,
multi-year, nation-wide plans to make a dierence. As
Downing says Data management and analytics tech-
nologies can be quickly and seamlessly integrated into
existing systems to drive evidence-based decisions and
eective interventions, saving both lives and money.
Teams all over the NHS are develop-
ing strategies that align information
and IT with their productivity and
quality objectives.
13
David Downing
It has long been recognised
that early intervention
strategies are the future of
healthcare.
Matthew Swindells
The end of NPfIT has placed
responsibility for IT back in
health users organisations,
where it rightly belongs.
And while nding the budget to ensure investment
in IT might be dicult in the grip of austerity, there are
plans in motion to address that. The EU Structural Funds
package, once ratied by the European Parliament and
the Council, may prove to be an invaluable resource for
Member States wishing to invest in eHealth and health
technology, for instance.
The verdict is stark. Healthcare IT needs to accept the
days of big central spending have goneand concentrate
on building successful transformation of society proj-
ects through beter integrated data sharing of health and
social care information at much more local levels. Thats
the way, it seems, the case can be proven for the Big Bang
projects, when the debts are paid and the crisis is nally
overas, believe it or not, one day it really will be.
All application capabilities within
each stage must be operational before
that stage can be achieved. All lower
stages must have been achieved before
a higher level will be considered as
achieved. A hospital can achiev stages
3-6 if it has met all of the application
requirements for a single patient care
service (e.g. single nursing oor,
cardiology service).
Source: HIMSS Analytics Europe
HIMSS Analytics Europe scores hospitals based on their progress in completing the eight stages
of the Electronic Medical Record Adoption Model (EMRAM).
Operating expense
per hospital per year in (average)
IT budget per hospital in (average)
Annual budget
per hospital bed in (average)
% of operating budget spend on IT
per hospital per year (average)
HOW MUCH ARE HOSPITAL SPENDING ON IT?
WHAT IS THE AVERAGE DIGITIZATION LEVEL OF HOSPITALS?
1.32
1.17
0.34
2.05
2.97
EMRAM SCORE (min: 0, max: 7)
Germany Italy Poland Portugal Spain
7
6
5
4
3
2
1
0
Germany Italy Poland Portugal Spain
THE DEBATE
14 | himss europe | I N S I G H T S | november 2012 | the debate
THE DEBATE
Healthcare IT: Is It Worth the Cost?
THE DEBATE
15
Massive investments in healthcare IT
have been justied in the political arena
on the assumption they are essential to
keep healthcare costs down in the long run.
Analysts, consultants, CEOs of healthcare
IT providersas well as CIOs of hospitals
and care networksall share this view.
Given the current Euro crisis, the points
they are making are starting to sound
convincing. But are all these healthcare
IT proponents right? By Philipp Grtzel von Grtz
THERE ARE TWO POSSIBLE VIEWS.
First, we could argue that investing in
healthcare IT is worth it provided it is done
wisely and under idealized circumstances.
This, though, would not necessarily mean
that sweeping investments in healthcare
IT are the right way to go as well. Second,
we could argue that healthcare IT could
increase eciency within individual institu-
tions. However, while healthcare IT may
make a hospital more competitive, it does
not necessarily reduce (and may in fact
increase) the overall cost of care for a
healthcare system.
Healthcare IT: Is It Worth the Cost?
Both points are valid. But they also illustrate
how dicult it is to discuss the issue of
costs in relation to healthcare IT. It is impos-
sible to talk about healthcare IT without
talking about both proper design of the IT
solutions and quality of care. It is naive to
think that a reimbursement system that
encourages medical institutions to increase
the number of interventions will not aect
the way medical institutions use healthcare
IT solutions. Insights talked to two experts
who are looking at healthcare IT-related
costs from dierent perspectivesand
who have arrived at totally dierent con-
clusions. It is safe to predict that the dis-
cussion outlined by these interviews will
continue in healthcare IT for years to come.
Q. How did you become interested in healthcare IT?
I had the opportunity to be part of a team of experts
working for US senator Ted Kennedy when, in 2005, he
drafed a precursor bill of what today is referred to as
the High-Tech Act. This law, passed in 2009, provided a
dramatic expansion of funding to accelerate the adop-
tion of health information technology. On this team, I
was responsible for health information technology. As
the director of the Division of Social and Community
Medicine at Cambridge Health Alliance, I am also inter-
ested in broader questions of healthcare systems and
healthcare nancing. And one point where these two
interests come together is the widespread assumption
that healthcare IT will bail us out of the cost crisis that
healthcare systems are facing. The basic question that
we asked ourselves was: Is this true?
Q. The RAND Corporation claims to have answered
the question some years ago. They are talking about
potential savings in the region of 80 bn US-$ per year in
the US alone. Are you skeptical about this gure?
It is di cult for me to comment directly on this
estimate, since in our study we only looked at two
categories of expenditure: ordering of imaging and
ordering of lab tests. However, contrary to the RAND
study which predicted decreased ordering of both
of these types of test with healthcare IT, our study
showed that both types of testing actually increased
with healthcare IT. So based on our study and other
recent studies, savings of 80 bn US-$ per year would
seem to be quite improbable.
Q. In your study, you analyzed the records of nearly
29,000 patient visits to a representative sample of nearly
1,200 o ce-based physicians. The main result was that
access to computerized imaging results and lab test
results was associated with a greater likelihood of such
tests being ordered by the physician, 40 to 70 percent
greater in the case of imaging. This sounds prety
counter-intuitive...
It does, and it implies that access to computerized test
results would increase overall costs for testing. There
are some studies out there with dierent results. But
these studies all took place in highly idealized circum-
stancescuting-edge academic medical centers with
skilled teams of physicians who are also health IT
designers who built IT systems from scratch and care-
fully tailored them to the needs of the medical sta. The
strength of our study is that we can provide data on
what is actually happening in the real world in outpa-
tient practices across the US where most doctors are not
specically trained in healthcare IT and who ofen dont
have qualied people to help them. Our ndings suggest
that, at least for the moment, the results obtained in ide-
alized setings do not translate to real-world outpatient
practice. The question is whether we will ever get there.
Q. Issues with suboptimal usability of electronic patient
records might explain why access to imaging data doesnt
reduce image ordering. But does it also explain the mas-
sive increase in image ordering that you have witnessed?
It is really di cult to know for sure why the orders go up.
We dont have direct data that explains this nding. So we
can only speculate. I would suggest that there are clear-
cut cases in which everyone will agree that, say, an MRI is
necessary or that no imaging is necessary at all. In these
cases, having access to data wont make a dierence. But
there is a large grey area where some judgment is made.
In these cases, it might be that having access to imaging
results makes the decision to actually order an examina-
tion easier for the doctor, because he knows he will get the
results automatically, without having to track them down
the next day or to call across town. This may subtly shif
physician behavior towards ordering a test. When you
make something easier to do, people do it more ofen.
Idealized results
do not translate to
the real world
Implementing healthcare IT solutions can
help to solve the financial crisis which is
plaguing healthcare systems. This view is
held by advocates of incentive programs
for electronic patient records and has been
called into question by a recent study which
showed a positive correlation between the
availability of healthcare IT solutions and
the number of diagnostic tests being ordered
by physicians. Healthcare IT, in other words,
was associated with increased costs for
diagnostics. Danny McCormick, MD, MPH,
at Harvard Medical School advises analysts
to make more modest claims in the future.
And he suggests a rethink in the way health-
care IT solution are brought to market.
H
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RIGHT TIME.
Its time to guide your organization to the next level. HIMSS13 promises to inspire and
deliver with ground-breaking education, proven results and up-to-the-minute resources.
RIGHT PLACE.
HIMSS13 is the one place where the industry meets to survey the landscape, connect with
peers, share knowledge and experiences, identify challenges and uncover solutions.
HEALTH IT: ITS ON.
Harnessing the power and promise of health IT is about doing exceptional work to
advance your organization. HIMSS13 provides you with what you need to impact the
future: a week of dynamic programs, speakers and solutions.
Dynamic and thought-provoking, HIMSS13 keynote
speakers will engage and enlighten with their insights
on healthcare, the November 2012 elections and
whats ahead for our nation.
HIMSS13 | March 3-7, 2013 | New Orleans
Get all the information and register NOW for early
bird discounts at www.himssconference.org.
Technology, mandates and reform are converging.
We have new challenges to face.
Our time is critical. Our time is now.
HIMSS13
KEYNOTE SPEAKERS
This is your conferenceyour forum for connecting with your community and
strengthening your commitment to the unsurpassed quality of patient care.
ERIC J. TOPOL, MD
West Endowed Chair
of Innovative Medicine,
Scripps Health and
Professor of Genomics,
The Scripps Research
Institute; Cardiologist
WARNER THOMAS
President and
Chief Executive Ofcer,
Ochsner Health System
PRESIDENT
BILL CLINTON
Founder of The William J.
Clinton Foundation
42nd President of the
United States of America
JAMES CARVILLE
Political Consultant
KARL ROVE
Fox News Contributor
& Wall Street Journal
Columnist
Former Deputy Chief of
Staf and Senior Advisor to
President Bush
J oi nt l y sponsor ed/Co-provi ded by Postgr aduate
I nsti t ute for Medi ci ne and HI MSS.
t r a n s f o r mi n g h e a l t h c a r e t h r o u g h I T
ARGUMENT 1
17
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M
E
.

R
I
G
H
T

P
L
A
C
E
.

I
T
S

O
N
.
RIGHT TIME.
Its time to guide your organization to the next level. HIMSS13 promises to inspire and
deliver with ground-breaking education, proven results and up-to-the-minute resources.
RIGHT PLACE.
HIMSS13 is the one place where the industry meets to survey the landscape, connect with
peers, share knowledge and experiences, identify challenges and uncover solutions.
HEALTH IT: ITS ON.
Harnessing the power and promise of health IT is about doing exceptional work to
advance your organization. HIMSS13 provides you with what you need to impact the
future: a week of dynamic programs, speakers and solutions.
Dynamic and thought-provoking, HIMSS13 keynote
speakers will engage and enlighten with their insights
on healthcare, the November 2012 elections and
whats ahead for our nation.
HIMSS13 | March 3-7, 2013 | New Orleans
Get all the information and register NOW for early
bird discounts at www.himssconference.org.
Technology, mandates and reform are converging.
We have new challenges to face.
Our time is critical. Our time is now.
HIMSS13
KEYNOTE SPEAKERS
This is your conferenceyour forum for connecting with your community and
strengthening your commitment to the unsurpassed quality of patient care.
ERIC J. TOPOL, MD
West Endowed Chair
of Innovative Medicine,
Scripps Health and
Professor of Genomics,
The Scripps Research
Institute; Cardiologist
WARNER THOMAS
President and
Chief Executive Ofcer,
Ochsner Health System
PRESIDENT
BILL CLINTON
Founder of The William J.
Clinton Foundation
42nd President of the
United States of America
JAMES CARVILLE
Political Consultant
KARL ROVE
Fox News Contributor
& Wall Street Journal
Columnist
Former Deputy Chief of
Staf and Senior Advisor to
President Bush
J oi nt l y sponsor ed/Co-provi ded by Postgr aduate
I nsti t ute for Medi ci ne and HI MSS.
t r a n s f o r mi n g h e a l t h c a r e t h r o u g h I T

Q. So healthcare IT makes life easier for doctors,
and this in turn increases their willingness to order
additional diagnostics?
As I said, we are speculating. There is no data that
would support this hypothesis at the moment. What
we know from experience in my own hospital, though,
is that decisions of doctors can be inuenced by the
way an IT system presents certain information. When
an IT system provided the doctor with a long list of dif-
ferent diagnostic tests, doctors were far more likely to
order an MRI when it was placed right at beginning of
the list, rather than at the end.
Q. A dierent explanation for your results would
be that the additional tests were in fact appropriate.
Doctors who have access to data are beter informed,
and for this reason they order more tests.
It is correct to say that we do not know if doctors with
health IT were overusing tests or if doctors without
health IT were underusing them. But either way, it
would not undermine the conclusion: more tests are
ordered, and thus test-related costs increase. We did
try to take into account potential dierences between
doctors with health IT in our analysis, but we were not
able to assess quality of care in any way in this study.
Q. Lets get back to the convenience hypothesis: if
convenience issues lead to overutilization of tests in
situations where healthcare IT is available, one might
solve the issue by oering guidance, for example, with
decision support sofware. Is more IT the answer to
IT-related problems?
There is evidence from several studies that thought-
fully designed decision support tools can indeed
change a physicians ordering behavior to ordering
fewer tests. One reason why we havent seen this in our
Danny McCormick, MD, MPH is an Assistant Professor
of Medicine at Harvard Medical School and Director of the
Division of Social and Community Medicine at the Cambridge
Health Alliance in the United States
. . . decisions of doctors can be
infuenced by the way an IT system
presents certain information.
When an IT system provided the
doctor with a long list of dierent
diagnostic tests, doctors were far
more likely to order an MRI when
it was placed right at beginning of
the list, rather than at the end.
study is that, by and large, these sophisticated decision
support tools are not part of an average outpatient IT
system in the US. I dont know whether this is dierent
in Europe. But it leads to an important issue: there are
2,000 or so electronic patient record vendors out there
in the US. The US governments incentive program has
led to a huge market with only minimal regulation.
There is absolutely no way at the moment to guarantee
that only well-designed IT products that could reduce
test ordering are implemented. Many doctors in small
practices dont have the technical knowledge to even
judge whether a system is well-designed or not.
Q. How would you change healthcare IT policy?
First of all, we need additional research. We should not
make big policy decisions based on a single study such
as ours. Then there is a practical problem: we have
pulled the trigger and made huge investments. Per-
sonally I think that an alternative vision could have
been to develop one high quality product and make
it available open source instead of encouraging 2,000
companies to oer products that have both quality
and interoperability problems. One thing that I de-
nitely recommend is to be a bit more modest when it
comes to claims that healthcare IT will solve all the
nancial problems of our healthcare systems. The evi-
dence suggests this is very unlikely. We will have to
turn to other healthcare system nancing changes to
accomplish that.
19
Q. In the face of the Euro crisis, healthcare systems
throughout Europe are having to tighten their belts.
Competition between medical care providers is rising.
Hospitals are being closed down. Analysts tend to argue
that, for hospitals, adopting healthcare IT solutions is a
survival strategy. Do you agree?
Denitely. We need modern IT solutions in order to
support and stabilize care processes, accounting pro-
cedures and supply chain workows. IT is absolutely
essential to increasing ecacy without compromising
on quality of care. A situation where care sta have to
search for paper-based patient records several times a
day has nothing to do with ecient processes. In our
hospital, all relevant patient information is available
digitally as soon as it is needed. There is no such thing
as a doctor who is desperately looking for a radiological
report or a patient whose surgery is postponed because
the paper-based record is untraceable.
Q. Critics argue that making medical information
available electronically does not necessarily lead to cost
savings. A recent study from Harvard Medical School
showed that doctors actually order more radiological
or laboratory diagnostics when they have access to
electronic patient data.
I think it is very challenging to interpret these kinds
of results correctly. I have the impression that the
number of medical diagnostics ordered has increased
considerably in recent years. The question is why.
It could well be a mater of quality of care. Doctors
know more about diseases. They have more treat-
ments available, and so they order more diagnostics.
To adjust for this confounding factor, one would have
to compare not only the number of examinations, but
also quality of care. And this is where it becomes really
dicult. At uke, we have not analyzed diagnostics spe-
cically, but we have made an observation concerning
clinical specialist consultations. The number of these
consultations increased considerably afer we went
from being a paper-based to an increasingly digital
hospital some years ago. But the reason for this is not
digitization per se, but the fact that the hospital has
redesigned its care processes in a way that supports
interdisciplinary work.
Q. So you have more consultations, but you also
improved quality?
At least this is what our doctors tell us. I think it is
important to always look at the big picture. One detail
does not always tell the full story. When we ask our
doctors how much time they spend preparing a clinical
consultation, they say that it takes them longer today
than before. The reason is that far more patient infor-
mation is available these days. But the doctors also tell
us that they feel beter informed and more condent in
the recommendations they make to their colleagues.
And they tell us that almost no consultation has to be
repeated these days. In the past, this happened fairly
frequently whenever patient information was not
available for whatever reason. So when we look at the
whole picture, the clinical consultation business has
become far more ecient and the quality of consulta-
tions has improved. No doctor has ever told us that he
wants a return to paper-records.
Q. Did uke have nancial or medical reasons for
transforming itself from a paper-based to a fully
digital hospital?
It all started with a nancial problem. Back in 2004,
we really had our backs against the wall. Our hospi-
tal posted an annual loss in the region of around 35
million. So we had no choice than to take a radically
dierent approach. What was done at that time was
to analyze the strengths of a university hospital such
as uke. And this hospitals strength was to deal with
complex diseases that require interdisciplinary work.
A hospital like ours that is heavily involved in research
Our hospital posted an annual loss
in the region of around 35 million.
We had no choice than to take a
radically dierent approach.
ARGUMENT 2
One detail does
not always tell the
full story
As CIO of one of the most digitized hospitals
in Europe, Henning Schneider is experiencing
the benets of healthcare IT on an almost dai-
ly basis. With the help of IT solutions in medi-
cine, administration and logistics, University
Hospital Hamburg-Eppendorf (uke) managed
to go from near-bankruptcy to break-even
within six years.
and education will nd it more dicult to compete, in
terms of eciency, with a small private hospital that
is specialized in only one ofen repeatable procedure
such as knee surgery, for example. But we can com-
pete and are superior when it comes to dealing with
patients who have complex diseases. So what we did
was to rethink our processes with the overall goal of
making the interdisciplinary care of patients with
complex illnesses more ecient. An important step
in achieving this goal was to standardize our process
and organization and to have a new building that
brings people together. But the universal introduc-
tion of IT systems was at least as important, because
it helped us to stabilize the ecient processes that we
had already implemented. And it worked: We reached
break-even in 2010.
Q. Can you pinpoint specic IT solutions that have
contributed to the nancial success of uke in recent
years?
I think it is really the whole package. We have not
analyzed the nancial impact of individual solutions.
I dont think that this is possible. What I do have is
numbers on overall eciency. The number of employ-
ees at uke increased by 10% between 2004 and 2010. In
the same period, the number of patients increased by
60%. So we are vastly more ecient today. Healthcare
IT has contributed to this. We saw evidence of this a
year ago, when there was an EHEC outbreak in many
parts of Europe. Sta in our emergency department
had to deal with 130 additional patients per day at that
time. Together with our experts, we set up an IT pro-
Henning Schneider is CIO at the University Hospital
Hamburg-Eppendorf (uke), Germany
cess within hours to help our nurses deal with EHEC
patients. This is a very good example of how IT can
increase eciency and, at the same time, contribute to
best possible quality of care.
Q. Today, many hospitals in Europe are in the same
kind of nancial situation experienced by uke in 2004.
What advice would you give to CIO colleagues who do
not know where to start with the digitization agenda?
Introducing a hospital-wide IT solution is no ordinary
IT project! 30% is process management, 30% is change
management and only 30% is actually about IT. The
remaining 10% is a mixture of luck and power of endur-
ance. So it is mostly a hospital-wide project which has
to be managed by all of the board members. The rst
step is to standardize processes. You have to get to a
point where all departments organize recurring pro-
cesses in a similar way. If this can be achieved, I would
start by establishing an electronic patient record and
an electronic order entry system. Granted, dierent
departments will need specialized systems later on.
But to start with the electronic patient record and
order entry has the advantage that the standardized
processes that were dened initially are being applied
hospital-wide. And this hospital-wide coherence in some
of the most fundamental documentation processes will
make additional digitization steps far easier. A very
important point is to avoid dual documentation as early
as possible. As long as doctors have to work with paper
records and digital records in parallel, there is no gain in
eciency whatsoever. You can only reap the benets of
healthcare IT if you are successful in eliminating paper.
The number of employees
at uke increased by 10% between
2004 and 2010. In the same period,
the number of patients increased
by 60%. We are vastly more
ecient today.
21
SPECI AL FEATURE
THE EUROPEAN UNION RECEIVED the Nobel Peace
Prize 2012 for its contribution to a stable and peaceful
Europe, once by far the most violent continent in the
world. Peace and stability have been achieved by inte-
grating the national economies and by enabling closer
cooperation in nearly every eld, be it politics, culture,
education or infrastructure.
While healthcare policy remains the responsibil-
ity of the individual Member States, eHealth has been
a pan-European topic almost from the beginningfor
several reasons. In 2010 over 12 million EU citizens were
estimated to be living in another EU Member State .
The more common it becomes for European citizens to
work and travel outside of their home country, the more
important it becomes to make healthcare-related data
available whenever these data are needed and indepen-
dently of where a person happens to fall ill.
Economically, there are also good reasons for a
Europe-wide approach towards eHealth: healthcare has
become an increasingly important sector of the economy
of industrialised nations all over the world. Demographic
ageing is among the broader societal trends that con-
tribute to this shif. At the same time, we are seeing an
increasing desire from citizens to be pro-actively involved
in their healthcare processes. Similar to pharmaceuti-
cals and medical technology before, healthcare-related
information technology is on the verge of becoming a
globalised market with a promising outlook for European
companies willing to invest in eHealth innovation early
on. Now is the time for businesses to seize the opportuni-
ties oered by European initiatives in eHealth.
The New eHealth Action Plan: Towards a
Digital Europe
It is this broad picture that serves as a background
for the new European eHealth Action Plan which will
be published later this year. Building on the progress
of the rst eHealth Action Plan which was launched in
2004, the new Action Plan outlines the eHealth policy
framework of the European Commission for the years
to come. It will address key issues which were consid-
ered important by stakeholders in a public consultation
process. They include increasing awareness of the ben-
ets and opportunities of eHealth throughout Europe,
and empowering citizens, patients and healthcare pro-
fessionals by supplying them with the information
they need.
Over the years, the European Commission
has developed a broad vision for eHealth
and well-being that includes funding
research into areas such as personal health
systems and the personalised medicine of
the future, promoting the deployment of
eHealth solutions all over Europe, support-
ing the development of a European market
in eHealth and bringing together relevant
stakeholders in order to encourage coopera-
tion and best practices.
Healthcare IT in Europe:
Towards an Ever
Closer Union
Supported by
The issue of eHealth interoperability also remains
high on the agenda. In particular, the new eHealth
Action Plan will focus on both technical and legal fac-
tors that are currently impeding interoperability in
Europe. Another key topic is the continuing support of
research and innovation in eHealth with the overall goal
of paving the way for a competitive European market
with eHealth companies that are willing and able to take
a global lead in their respective elds.
eHealth Task Force Report: The Need for
Integrated Care
The eHealth Action Plan not only builds on rec-
ommendations by stakeholders, it also draws on the
results of the European eHealth Task Forces report
Redesigning Health in Europe for 2020 released
in May 2012. Chaired by the President of the repub-
lic of Estonia, Toomas Hendrik Ilves, the Task Force
brought together experts from across the health and
technology spectrum, including healthcare profes-
sionals, representatives of patients and of the medical,
pharmaceutical and ICT industries, legal experts
and policymakers. It was tasked with reporting to
the Commission on how to tap into the potential of
eHealth for safer, better and more efficient healthcare
in Europe. Its recommendations include unlock-
ing health data while ensuring strong safeguards,
improving digital health skills among health and care
workers and citizens, and ensuring that every Euro-
pean citizen can benefit from a real digital healthcare
revolution.
The eHealth Task Force report also argues in
favour of an interconnected and highly transpar-
ent healthcare system in which ambulatory care and
hospital-based care are closely interwoven. Such an
integrated care structure is an enabler for eHealth
solutions, because initial investments in eHealth and
subsequent financial benefits from eHealth do not
necessarily always happen in the same place.
While eHealth is an important aspect of shaping a
digital society in Europe, it is certainly not the only
one. From a broader perspective, eHealth is only one
aspect of the Digital Agenda for Europe, a flagship
initiative under the European Commissions Europe
2020 Strategy.
Deploying eHealth solutions in Europe will make
it possible to provide every European citizen, regard-
less of location, with better and more personalised
healthcare and at the same time lead to cost savings
for patients and society as a whole. The new eHealth
Action Plan marks the next important step towards
reaching this goal.
The European Innovation Partnership
on Active and Healthy Ageing
Europe is facing a demographic challenge with a
huge economic and social impact: more people are get-
ting old, while fewer young people are entering the
labour market. Consequently, there are more people to
care for, but fewer people to provide that care. With
the European Innovation Partnership on Active and
Healthy Ageing (EIP-AHA) the European Commission
wants to turn this challenge into an opportunity. New
ICT-based services and products will help Europeans
to lead more healthy and independent lives for longer.
This is beneficial for individuals and for society, since
it will make health and social care more sustainable
and affordable. Furthermore, the economy and soci-
ety will benefit from innovation, economic growth
and better jobs.
The EIP-AHA was launched in April 2012. It is not a
funding programme but aims to help overcome borders
and barriers and create scale. It does so by bringing
together consumers with researchers, industry and
healthcare sector representatives; 261 consortia from all
over the EU commited to one of six action points. They
represent nearly 1,000 regions and municipalities and
over 3,000 stakeholders. Over 4 million European citi-
zens could directly benet from this partnership. Six
groups are currently working on action plans that will
be presented in detail later this year, including quanti-
ed objectives for 2015.
Action A1 is on medication adherencea major
problem for older and chronic patients. The aim is to
deliver tangible prescription adherence approaches
for various chronic diseases in at least 30 EU regions.
Action A2 is on fall prevention and early diagnosis,
another major cause of injury and death among older
people. It draws up validated and operational pro-
grammes in at least 10 European countries. Action A3
tackles the persisting problem of malnutrition and
frailty among older people, which is often the cause
of functional decline. With a validated programme
for the prevention of functional decline and frailty
among the elderly, it will reach at least 1,000 care pro-
viders by 2015.
Action B3 seeks to ease the life of patients with
chronic conditions by applying integrated care
solutions, including remote management and tele-
monitoring. The aim is to reach more than 10% of the
target population in over 50 regions by 2015. Action C2
develops interoperable solutions for independent liv-
ing, including interoperable platforms, guidelines for
business models and new evidence on the return on
investment. Action D4 builds on the WHO age-friendly
23
cities initiative to establish a cooperation agreement
with all parties involved, and a covenant of major cit-
ies, regions and municipalities.
Renewing Health: Delivering Evidence for
Telemedicine
The large-scale telemedicine project RENEWING
HEALTH (REgioNs of Europe WorkINg together for
HEALTH) is a European project aimed at implement-
ing large-scale, real-life test beds for the validation
and evaluation of innovative telemedicine services by
means of a patient-centred approach and a common rig-
orous assessment methodology. It involves 9 of Europes
most advanced regions in the implementation of health-
related ICT services.
Renewing Health is among the largest telemedi-
cine projects ever launched worldwide. It focuses on
the use of personal health systems in the management
of chronic patients in home setings in the treatment
of chronic patients suering from diabetes, chronic
obstructive pulmonary or cardiovascular disease.
On a small scale, telemedicine and personal health
systems have been used for many years. Most projects,
though, involve only small numbers of patients, last
only short periods of time or are being criticised for a
lack of evidence. Renewing Health uses the randomised
controlled trials (RCT) methodology, with almost 8,000
patients recruited for the intervention group and 18
pilots running in parallel in 9 European regions. The
study has the potential to provide the hard evidence
that decision-makers are waiting for. The objective is
not only to demonstrate the medical benet, but also to
clarify organisational aspects, technological challenges
and cost-eectiveness issues in dierent healthcare
systems. htp://www.renewinghealth.eu
STORK: Secure Identity Across Borders
The digital integration of healthcare systems in
Europe is not all about medicine. An important issue in
eGovernment scenarios in general is to identify digital
citizens (and patients) correctly. Most countries have
realised that this is crucial and have created national
electronic identities (eID).
The STORK project (Secure identity across boRders
linked) makes it easier for citizens to access online pub-
lic services (in healthcare or otherwise) by implementing
Europe-wide interoperable cross-border platforms for
the mutual recognition of national electronic identi-
ties between participating countries. Cross-border user
authentication solutions are being applied and tested in
various pilot projects. The overall goal is to enable Euro-
pean citizens to authenticate themselves and to provide
easy access to online government services through the
use of national eID systems.
Apart from the benets for individuals, interoperable
eID authentication will also enhance online security and
encourage the growth of online services across Europe.
Furthermore, it is a key enabler for the EU Services
Directive and Digital Agenda, helping Member States to
set up single points of contact for access to government
services. htps://www.eid-stork.eu
SPOCS: Making Business Easier
Conducting business in the digital world of Europe
is not always easy. Many companies struggle to comply
with all the necessary regulations. In healthcare, this is
especially dicult. SPOCS (Simple Procedures Online
for Cross-Border Services) is a large-scale pilot project
which was launched by the European Commission to
overcome these obstacles.
It draws on the European Services Directive that
requires all procedures involved in establishing a busi-
ness and providing services in another EU country to be
fully online. The SPOCS project is taking things a step
further by streamlining these procedures and oering
seamless cross-border technology. It aims to build the
next generation of online portals for the Points of Single
Contact (PSC) that are required by the Services Direc-
tive and that every European country now has in place.
htp://www.eu-spocs.eu
eHealth is only one aspect of the
Digital Agenda for Europe, a agship
initiative under the European
Commissions Europe 2020 Strategy.
24 | himss europe | I N S I G H T S | november 2012 | special feature
SPECI AL FEATURE
Q. Europe is facing an economic crisis that is also
aecting healthcare systems. How does healthcare have
to change in order to make healthcare systems stable
despite the economic turmoil?
If healthcare systems want to remain stable in the long
run, they will have to become more ecient, and they
will have to adjust to broader societal trends that more or
less all European countries are facing: an ageing society,
and an increasing willingness of patients to participate in
their care processes as active subjects. Addressing these
trends with smart innovation is interesting, as it opens
up a whole new market, so we tackle the ageing chal-
lenge by turning it into an opportunity.
Q. What is the role of healthcare information technol-
ogy in this context?
The role of healthcare IT can be substantial. First, it
supports gradual changes towards greater eciency.
This is especially true for administrative processes
that are becoming increasingly paperless and auto-
mated. A good example of what can be achieved is the
introduction of electronic prescriptions in parts of
Italy. It is documented that this step led to savings in
the magnitude of 2.5 billion annually. If this could
be scaled up and reapplied to other countries, it would
result in massive savings across Europe. A second area
where changes will be more radical is in the eld of
patient empowerment. We are already witnessing a
situation where patients are increasingly ready to use
mobile and web-based services for medical information
or advicea good example is iTunes, which has over
13,000 health and tness apps. This goes hand in hand
with a shif towards greater emphasis on prevention.
The Netherlands, for example, have a reimbursement
programme for obese patients. It is essentially a com-
bination of online support and a physical exercise
programme in a real-world tness club that also pro-
vides social contact. I am convinced that we will see
many more oers of this kind in the future.
Q. We have talked about healthcare IT as an adminis-
trative tool and about healthcare IT as a tool for em-
powering patients, especially in prevention scenarios.
What about healthcare IT and medical care?
This is the biggest eld, and also the most complex one.
There is currently a very widespread trend in health-
care, a shif away from institutional care and towards
homecare or integrated care scenarios involving vari-
ous medical specialties. Integrated care can benet
signicantly from healthcare IT solutions. Think of
telemedicine or telecare scenarios. There are examples
like Scotland, where telemedicine is oered on a broad
scale and generates a rapid return on investment. But
this success cannot be replicated everywhere. There
are several barriers: technical interoperability needs
to be addressed, as do issues relating to healthcare
nancing and policy, as well as digital skills for carers
(professionals or family members) and older adults.
Paul Timmers is Director for Sustainable
& Secure Society at the European Commis-
sion Directorate General for Communications
Networks, Content and Technology (DG
CONNECT). He sees healthcare information
technology as an enabler for broader changes
in healthcare systems towards more efficient,
more patient-centric and more integrated
care scenarios that will guarantee the stability
of national healthcare systems in tough
economic times and ensure their long-
term sustainability.
Healthcare Must
Innovate to Address
Changes in Society
By Philipp Grtzel von Grtz
25
Q. The European Commission launched the European
Innovation Partnership (EIP) on Active and Healthy
Ageing earlier this year. What relevance does integrated
care have to the EIP?
Integrated care is one of six action lines within the EIP.
It is generating tremendous interest. We have managed
to atract partners who together have commited more
than 1 billion in investments. And we are talking about
projects that in total involve over 4 million patients
in various scenarios. The intention is to measure how
patients experience quality of care and to demonstrate
savings and the sustainability of IT-assisted integrated
care scenarios. Finally, we would like to outline busi-
ness opportunities for European companies.
Q. Europe is considered a dicult terrain for health-
care IT, mainly because the market in this particular
eld remains fragmented. Is this a handicap or an
opportunity for European companies?
Larger IT companies are certainly interested in mov-
ing towards less fragmentation. Smaller companies, by
contrast, see many opportunities in the diverse market.
We can see evidence of this in the European Commis-
sions AAL programme, where more than 40% of the
partners are small companies, and 20% of them have
already found the capital to progress to the next stage
of market rollout. These are high numbers. I expect
the demand for standardisation and interoperability
to increase once the AAL companies are faced with the
challenge of addressing the issue of scaling up their
services. So yes, fragmentation and lack of interoper-
ability remains a problem that needs to be addressed.
If we succeed, it would be a huge benet, not least for
the patients.
The epSOS project, which is beginning to pilot
interoperable patient summaries and ePrescription
across 23 European countries, is a good example of
what we can achieve in todays Europe, where citizens
regularly travel across borders and where interoper-
ability can facilitate access to healthcare and reduce
the costs of medical intervention while improving
patient safety.
Q. How can the European Commission help to
overcome this fragmentation for the benet of both
businesses and patients?
From the perspective of innovation, the rst thing we
can do is bring people together to develop a joint vision.
This is what we are trying to achieve with the EIP.
Secondly, the European Commission can give nan-
cial support to research, development and evidence
building. The Commission can also help in the eld
Paul Timmers, Director for Sustainable & Secure Society
at the European Commission Directorate General for
Communications Networks, Content and Technology.
of standardisation. With the epSOS project, we are
encouraging the development of standards for a Euro-
pean eHealth infrastructure. And with the Renewing
Health project, we are about to generate evidence on
telemedicine. The next step should be to progress from
pilots and support deployment nancially. This could
be done by including the cross-border interoperability
of electronic patient records in the Connecting Europe
Facility (CEF) that is currently under discussion in
the European Parliament and among the Member
States. The CEF is a nancing instrument that aims
to make Europe digitally modern. I see it as the digi-
tal counterpart to the trans-European road system.
If we are successful in deploying interoperable elec-
tronic patient records, it will become far easier to treat
European citizens who fall ill abroad. Think about the
millions of cross-border workers in Europe. The CEF
is about building a modern, competitive Europe, and
healthcare should be part of it.
With the epSOS project, we are
encouraging the development
of standards for a European
eHealth infrastructure.
26 | himss europe | I N S I G H T S | november 2012 | special feature
SPECI AL FEATURE
to important information they need to treat a patient,
reduce unnecessary repetition of diagnostic procedures
and in emergency situations could save lives.
epSOS started in 2008 and currently 20 member
countries of the European Union have joined the initia-
tive, plus three non-membersTurkey, Switzerland and
Norway. In September this year, two more countries,
Latvia and Croatia, took the rst formal steps to joining.
The project is progressing steadily and has taken great
strides forward despite facing a variety of technical
issues aecting interoperability.
Building on secure foundations
The project has achieved signicant successes in a
wide range of areas, including: agreement on a minimum
dataset for the patient summary and e-prescription; a
legal framework; a model for semantic interoperability;
a minimum set of requirements for access to informa-
tion; and security issues. It has also contributed to the
epSOS Participating Nations
Making Travel
in Europe Safer

the EPSOS Way
By Rosalia Sierra Fernandez
& Harry Wood
EpSOS aims to provide a platform
for providing seamless healthcare
services to European citizens when
they travel to other countries
in Europe.
Millions of European citizens travel to other
countries each year, but at the moment there is
no fast, secure way for their medical records to
follow them. To solve this problem, the Euro-
pean Patients Smart Open Services (epSOS)
project is piloting technology to ensure that
every persons important medical details can
be instantly available if they fall ill in Europe
so that the local doctors can make beter deci-
sions on treatment. As one of the continents
favourite holiday destinations, Spain is rolling
out the epSOS system to health centres in
some of its most popular holiday spots.
EPSOS IS A 36.5 MILLION CO-FUNDED initiative
between the European Commission and participating
partners that aims to provide a platform for providing
seamless healthcare services to European citizens when
they travel to other countries in Europe. The project is
developing an electronic healthcare record framework
and communications infrastructure that will enable
secure communication of patients summary health-
care records between dierent European healthcare
systems. The ability to access patients healthcare infor-
mation will provide medical personnel with quick access
27
established a central data transmission nodeinstead
of a server or centralised database that could encounter
back-up, security or interoperability problems.
When epSOS was launched, the Patient Summary
requirements resembled those of the HCDSNS. EpSOS
was in line with what we were doing, but, instead of
between regions, it was between European countries.
So we started to lead the Patient Summary Working
Group, explained Icar Abad from the Deputy General
Directorate for Health Information and Innovation at
the Ministry of Health, Social Services and Equality.
Beneting tourists
Another key aspect in Spains leadership is that two
of the regions that were most advanced in the develop-
ment of the HCDSNS and integrated into the central node
receive a large number of European touristsmainly from
the UK, Germany, France and the Netherlandstherefore
their access to the Patient Summary was particularly
important for providing healthcare to these tourists.
The Community of Valencia and the Balearic Islands
currently hosts all the epSOS pilot schemes in the Patient
Summary areaalthough three more regions are ready
to join the project: Catalonia, Andalucia and Castilla-La
Mancha. These ve regions will also be gradually inte-
grated into the ePrescription pilot schemes in the next
few months and throughout 2013.
The Community of Valencia has nine healthcare
centres authorised to access the Patient Summary and
the Balearic Islands have 39. But in reality we are in a
position to submit information and receive it at all the
centres because they are already connected to the cen-
tral node for HCDSNS, explained Carlos Bermell from
the Oce of Technology and Communication for the
Balearics Health Service (Ib-Salut). This is also the case
for all the hospitals and healthcare centres in Valencia.
The real access to the system will start at the end
of autumn. The pilot has already demonstrated that the
exchange of healthcare information between countries
is possible, Bermell added. A real European healthcare
network starts with the rst steps and that is what we
are doing now. epSOS has highlighted the importance
of interoperability, standardised clinical terms and data
protection, and there is a perceived need for this net-
work in all countries.
A real European healthcare
network starts with the rst steps
and that is what we are doing now.
development of interoperability standards and EU pol-
icy objectives.
The rst phase of piloting started in April this year,
to test the technical, semantic and legal solutions devel-
oped by epSOS over a one-year period. At present, only
11 countries are involved in the pilots for the rst two
phases of epSOS, which are: patient summary (access
to a summary of a patients medical history) and cross-
border e-prescription. However, according to project
co-ordinator Fredrik Lindn of the Swedish Ministry of
Health and Social Services, services are being extended
to new areaseg. patient accessand new countries
are joining the current e-prescription and patient sum-
mary services.
The main success is in building trust between coun-
tries as well as try out the legal surroundings at the same
time as implementing the Directive on Patients Rights.
On the more technical side it has, of course, created big
gains in implementing standards across the dierent
countries, Lindn said.
Countries hindered by slow IT adoption
The key factors for taking part in the pilots are an
ICT infrastructure and the construction of multiple
fully-digitised healthcare centres, both of which would
need signicant investment. Other countries havent
completely adopted these systems, therefore there are
many diculties related to actively participating in
the pilots, explains Juan Carlos Nez, from Indra, a
technology company involved in the Spanish project.
The company is one of the participants in epSOS, con-
tributing to various project work packages, in particular
the analysis of the current situation in the participat-
ing countries in relation to the patient summary and
eprescription exchange services, and denition of the
specications for the exchange of these services.
The Spanish experience
The nal wave of pilot projects, which began in July
this year, saw Spain launch 28 new pilots. The reason for
the high rate of participation lies in a decision made in
2006, when the Spanish Ministry of Health and the 17
autonomous communities comprising the Spanish State
decided to launch a large-scale project to computerise
the National Health System.
As the regions health systems were at dierent stages
of digitisationhealthcare is devolved to the regions
in Spaina National Strategy was put in place for the
interoperability of regional healthcare services and the
exchange of a compatible summary of patients medi-
cal history (HCDSNS). The project, therefore, started to
work with Snomed-CT on clinical coding standards and
28 | himss europe | I N S I G H T S | november 2012 | strategy
STRATEGY
Closing the Loop:
HIMSS ANALYTICS LATEST DATA suggests that Euro-
pean hospitals lag behind their US equivalents in terms
of eective use of systems for curbing needless patient
death or incorrect medication, that there are too many
discrepancies in terms of the way pharmacists and cli-
nicians work togetherand that healthcare IT leaders
need to step up to the challenge, and soon.
In a 2007 study, an expert advisory commitee of
the German Federal Government estimated that of all
cases treated in German hospitals per year, 5-10% lead to
undesirable events, 2-4% avoidable harm, 1% treatment
errorsand 0.1% death.
Take the specic case of illegible prescriptions, i.e.
where clinician hand-writing is hard to read and there-
fore causes problems with interpretation by colleagues.
Based on the above mentioned study, the impact of such
illegibility means at the very least 5-10% of cases where
clarication had to be sought, leading to administrative
delay in treatment, 2-4% of cases see incorrect dosage
being applied, 1% simply wrong medication being applied
leading to adverse reaction in the patientand at least
0.1% of cases a life would be needlessly lost, simply due
to bad handwriting.
As a result, given the key role medication obviously
plays in patient safety, care providers need to move to
minimise as far as they can all medication-related risks.
Experts are adamant: treatment errors reduce the qual-
ity of care and life for far too many patients, leading
to longer average length of stay (and therefore higher
costs of care), quite apart from these highly regretable
needless mortalities. According to a series of studies per-
formed by Bates in the US in the 1990s and early 2000s,
the vast majority of medication-related errors occur
during prescribing and administering (e.g. 39% at pre-
scription time, 12% in transcribing, 11% at the dispensing
stage and 38% in administering the medication).
In response, many commentators suggest beter
computerised physician order entry (CPOE) and more
use of eMARs (electronic Medication Administration
Record) might help. But a clear understanding of where
problems might occur is also helpful.
The process that delivers currently-recognised high-
est medication safety support through IT is known to
practitioners as the Closed Loop in Medication Adminis-
tration (CLMA) approach:
The key components of successfully implementing
an eective CLMA process are installing an ePrescrip-
tion or an ePrescription/CPOE system, a Pharmacy
Information System and a fully-functioning eMAR. In
turn, a good ePrescription/CPOE system should be one
that enables the electronic transmission of an accurate,
error-free and understandable prescription data directly
to a pharmacy from the point-of-care. A top-line system
in this class should also automatically update the eMAR.
If it does, then such a system would also help deliver
other important benets of decision support, such as
allowing physicians to review patient history and rec-
ommended dosage.
A strategy to adopt
best practices in medication
administration
By Uwe Buddrus
29
In the eld, ePrescription/CPOE systems should
be used in conjunction with other technologies, such
as mobile devices, bar coding, radio-frequency iden-
tication (RFID) tagging, and automated dispensing
machines, in order to most eectively feed the patients
active medication list.
What would a good Pharmacy Information System
look like? This has to be an application that provides
complete support for the pharmacy department from an
operational, clinical and management perspective, help-
ing to optimize patient safety, streamline workow and
reduce operational costs. It also allows the pharmacist to
enter and ll physician orders. As a byproduct, modern
Pharmacy Information Systems should also perform all of
the related functions of patient charging, General Ledger
updating, re-supply scheduling and inventory reduction/
statistics maintenance. During order entry, a good Phar-
macy Information System should also automatically check
for Drug-Drug and Food-Drug Interactions as well as
monitor for any possible allergy contraindications. Mainte-
nance of an on-line patient medication prole also allows
easy access for the pharmacist and may be viewed by nurs-
ing stations, ancillary departments and physicians.
The nal piece of the puzzle is that much-desired
electronic Medication Administration Recorddened
as an electronic record keeping system that documents
when medications are given to a patient during a hos-
pital stay. This application must also support the Five
Rights of top-class medication administration: right
patient, right medication, right dose, right time, right
route of administration.
In terms of the specic hardware for such a congu-
ration, what would be needed? HIMSS Analytics Europe
research identies bar coding and RFID as central, as
well as Automated Dispensing Machines (ADM), espe-
cially at the nursing stage, in order to accurately identify
the patient, the nurse administering the medication,
plus of course the medication itself.
How best to set up CLMA in terms of good design,
beyond all these necessary components? Best practice
observations suggest, tightly-integrated data ows be-
tween the prescribing physician, the pharmacywhich
may include automated dispensing machines and robot-
ic devicesand nursing.
If done well, CLMA can then bring many benets to
the hospital thats created it. There is signicant poten-
THE CLOSED LOOP IN MEDICATION ADMINISTRATION (CLMA)
Electronic
Prescription /
Computerised
Physician
Order Entry
(CPOE)
Electronic
Validation
Electronic
Documentation
IT Supported
/ Automated
Dispensing
& Tracking
Update of the electronic Medication
Administration Record (eMAR) for review,
override management and future Clinical
Decision Support interactions
Electronic 2nd line validation
of all prescriptions by
(clinical) pharmacists prior
to dispensing
Dispensing of Unit Doses by Pharmacy or Ward (e.g. by Automated Dispensing MachinesADM)
with bar code or labels with complete information
tial, for example, to reduce costs directly or indirectly;
then there are the intangible benets of much-improved
medical sta, family and patient satisfaction. In terms of
cost alone, reductions can primarily be achieved through:
Workow improvements, through the elimination
of processing steps such as transcription, scanning
and storage of paper-based prescriptions
Reducing or avoiding the costs of medication
errors and Adverse Drug Events
Avoiding duplicate medication orders
Reduction of drug inventory costs
More accurate billing.
Where is Europe in the CLMA picture?
Factors aecting whether or not a CLMA gets put
in include, for example, the availability (or not) of elec-
tronic pharmacopeias including drug-drug, drug-allergy
interaction, and dosing information; if no such medica-
tion database exists at national level, e.g. in Portugal, it is
very dicult to implement full ePrescribing functional-
ity, the study warns. At the same time, use of an in-house
pharmacy versus use of an external (e.g. community)
pharmacy, ofen the case in Sweden, for example, means
that such use may mean that electronic order validation
occurs only in the ePrescribing system, with no pharma-
cist involved in second line validation, unless Clinical
Pharmacists are employed by the hospitalor the exter-
nal pharmacy is able to access and process patient data,
which is not always the case.
Other factors that can operate against CLMA deploy-
ment are whether or not medication orders are compiled
in the pharmacy by pharmacists or are handled as stan-
dard medications at the ward level by nurses. If that is
the case, patient-specic medication orders may, again,
completely bypass the pharmacy, making CLMA that
harder to deploy. Finally, there is the issue of the avail-
ability of labeled Unit Doses for medications; if that is
the case, medications would need to be repackaged to
enable unit-dose level bar coding.
However, improvements in medication-related pro-
cesses and safety can also be achieved with external
pharmacies, if healthcare information exchange takes
place. An optimal scenario to do this would be a combina-
tion of a network of national electronic pharmacopeias,
ePrescription systems and consolidated national elec-
tronic medication administration recordsas being
established, for example, in some Nordic countries.
Pharmacies can also deliver an important contri-
bution to quality and risk management by providing
second-line validation for every prescription they issue.
This is especially useful if no Clinical Decision Support
is available to the prescribing physician; in such cases,
The Key to
Breakthroughs
in Patient Care
InterSystems HealthShare
is a
strategic informatics platform.
It connects applications, creates a
unified view of every patient, enables
rapid development of new functionality,
and provides insights based on real-
time active analytics. Across a hospital
network, or a community, or a nation.

InterSystems.co.uk/HIMSS989
2012 InterSystems Corporation. All rights reserved.
InterSystems HealthShare is a registered trademark of InterSystems Corporation.
HealthShare HIMSS989_a4.indd 1 24/10/2012 14:39
pharmacists should validate prescriptions for poten-
tially adverse drug-drug and drug-patient interactions.
This is already common practice across the Atlantic,
where Pharmacy Information Systems are installed in
almost all acute hospitals. Such systems, during order
entry, automatically check for Drug-Drug and Food-Drug
Interactions and monitor for allergy contraindications.
In Europe, again, the situation is much more diverse
and complicated. Deployment rates of Pharmacy Infor-
mation Systems are generally lower, for example, than in
the US; just 51% in Germany, 74% in Poland, 75% in Italy,
versus a much higher 96% for Spain. Plus, most European
Pharmacy Information Systems are more focused on
order logistics and material management than on sup-
port of clinical processes, such as second line validation.
Europe is certainly well behind on the other big com-
ponents of the ideal CLMA: ePrescription and eMARs.
In Germany and Italy, just one third of acute hospitals
The Key to
Breakthroughs
in Patient Care
InterSystems HealthShare
is a
strategic informatics platform.
It connects applications, creates a
unified view of every patient, enables
rapid development of new functionality,
and provides insights based on real-
time active analytics. Across a hospital
network, or a community, or a nation.

InterSystems.co.uk/HIMSS989
InterSystems HealthShare is a registered trademark of InterSystems Corporation.
HealthShare HIMSS989_a4.indd 1 24/10/2012 14:39 HIMSS Europe_mag_v15.indd 31 11/1/12 11:08 PM
have these systems installed. While Polish hospitals
also seem to be still far from widespread use, over half
of Spanish acute hospitals use the former, while a high
proportion (88%) have electronic medication administra-
tion records in place.
However, an eMAR can only be used to its full
potential, says HIMSS Analytics Europe, if it is avail-
able at the bedside for last-minute verication prior to
administration, real-time documentation and override
management. This is the case in just 14% of German
hospitals which say they have an eMAR installed, while
the benets of documentation at the point-of-care are
realized by around three quarter of the hospitals with
eMARs in Spain and Italy.
Where is Europe versus the US in terms of CLMA-
friendly hardware? While the use of Automated
Dispensing Machines (ADM) is very common in the US
and increasingly also in Spain, they are hardly used in
Germany and Italy:
By contrast, barcoding is clearly more established
than RFID this side of the Pond and widely used in
most European countries; still, though the number of
European hospitals using barcodes on medication is
quite high, its still signicantly lower than in the US.
Plus, while bar codes on medication in America is ofen
applied to tag unit doses of medication for verication
prior to administering, this is still very rare in Europe,
where the primary use of barcodes on medication is on
packages for stock control and tracking purposes, not
primarily patient safety.
As the above table shows, while around one third of
US and Spanish hospitals have made signicant prog-
ress towards or already achieved CLMA, this is the case
in still far too few acute hospitals in Germany and Italy.
Polish hospitals still lack the IT infrastructure to imple-
ment CLMA at all.
Where next for European CLMA eorts?
In order to get information technology online as a
tool to cut down on medication and treatment errors
and prevent any more needless deaths or adverse reac-
tions in our hospitals, Europe, says the study, has to
make more determined moves to get to CLMA.
But to do this, European IT leaders need to ght to
ensure they get:
Enough funding for their hospital IT infrastruc-
ture to deploy the required key IT and hardware
components
Conduct Business Process Re-engineering exercise
where necessary, for example to get pharmacists
more integrated in the prescription process
Look to change culture and role-perception on the
side of prescribers, pharmacists, and nursing sta
to boost safety disciplines
Work to make sure interoperable or fully integrated
IT system and hardware solution portfolios to
support CLMA are made more available.
Surely worth doing to stop any more avoidable
deaths in our hospitals?
The Key to
Breakthroughs
in Patient Care
InterSystems TrakCare
is a unified
healthcare information system based on the
most advanced technologies. TrakCare creates
a complete view of each patients history,
provides secure access to records at every
point of care and on any Internet-connected
device, integrates easily with other applications,
and delivers real-time active analytics that
drive informed actions. To achieve breakthroughs
in clinical outcomes, this is the key.
InterSystems.co.uk/TrakCare
InterSystems TrakCare is a registered trademark of InterSystems Corporation.
TrakCare HIMSS990_a4.indd 1 24/10/2012 14:41 HIMSS Europe_mag_v15.indd 32 11/1/12 11:08 PM
The Key to
Breakthroughs
in Patient Care
InterSystems TrakCare
is a unified
healthcare information system based on the
most advanced technologies. TrakCare creates
a complete view of each patients history,
provides secure access to records at every
point of care and on any Internet-connected
device, integrates easily with other applications,
and delivers real-time active analytics that
drive informed actions. To achieve breakthroughs
in clinical outcomes, this is the key.
InterSystems.co.uk/TrakCare
InterSystems TrakCare is a registered trademark of InterSystems Corporation.
TrakCare HIMSS990_a4.indd 1 24/10/2012 14:41 HIMSS Europe_mag_v15.indd 33 11/1/12 11:08 PM
STRATEGY
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0
The time when speed was more important
than security is over. More hospitals are
managing to balance data protection and
operating efficiency thanks to ID and
access management software and single
sign-on solutions.
IN MANY HOSPITALS you can still see yellow Post-
it notes stuck to computer monitors in the wards. Too
ofen, These notes contain passwords used by nurs-
ing sta. When things become hecticas is ofen the
caseyou cannot aord to enter the wrong password.
If there is an emergency, locking out the user afer too
many failed login atempts would be nothing short of
a disaster. But it is not just medical employees who are
constantly working under time pressure. IT depart-
ments are always busy maintaining user accounts and
have to ensure that any ex-employees are denied further
access to hospital data.
This problem can be resolved with ID and access
management solutions, which largely automate user
administration. They are ofen combined with an auto-
mated log-on process such as single sign-on, which
allows medical professionals to access the system
quickly and easily while simultaneously fullling the
applicable requirements for data protection and IT
security. According to a 2011 survey by the consult-
ing firm IDC Health Inside, 36 percent of hospitals in
the UK, Germany, France, Italy and Spain have not
yet installed any kind of ID and access management
(IAM) solution. The survey reveals that IAM solu-
tions are most widespread in Germany (88 percent),
followed by the UK (77 percent), Italy (53 percent) and
Spain (52 percent). Of these five countries, France has
the most catching up to do; only 46 percent of the hos-
pitals surveyed have implemented an IAM solution.
Interestingly, the survey found that only 23 percent
of French hospitals were planning to invest in an IAM
solution. The willingness to invest is lower only in
Spain (by 10 percent)probably due to the ongoing
economic crisis there.
Successful IAM solutions should ideally use the HR
system as the basis for user administration. Since the
HR department knows precisely which employees join
or leave the company and also has accurate informa-
tion regarding the correct spelling of each employees
namethus ruling out mistaken identitiesa connec-
36 percent of hospitals in
the UK, Germany, France, Italy
and Spain have not yet installed
any kind of ID and access
management (IAM) solution.
On the Safe Side
with IAM Solutions
By Michael Lang
35
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0
tion between the HR system and Active Directory has
proven the best way to ensure eective user administra-
tion. Active Directory is a service used to administer both
user accounts and access rights for programs and data.
Feels like an eternity
The introduction of an IAM system addresses most
user administration issues. It is no longer possible to
mistake employee names and former employees are
denied external access to hospital data. However, the
problem remains that many physicians and caretak-
ers still have to juggle multiple passwords for various
applications. When a physician logs on today, he needs
to open up several portals in order to nd out every-
thing he needs to know about a certain patient, says Dr.
Sebastian Krolop, Health Sector Manager at Accenture.
Thus, the physician in charge would need to individu-
ally launch several dierent portals, e.g. for radiology,
ultrasound, the laboratory results, the patient le or the
surgery report as none of these portals are linked. We
once measured how long it took to load all the individual
portals each morning, says Krolop, a medical and eco-
nomics graduate. It took 7.5 minutes in total, he says,
yet even if it were only three minutes, it would still
feel like an eternity standing there and waiting. Single
sign-on procedures allow users to log on just once with a
smart card and a PIN code; they can then access all data
and applications without any further authentication.
From a single hospital to a hospital chain
The Villach state hospital in Austria, with almost 800
beds and 1,600 employees, started planning an IAM and
SSO solution back in 2009. It opted for an o-the-shelf
product, which subsequently had to be adapted to on-site
conditions. The most important aspect here is organisa-
tional planning, says Herbert Stangl, Deputy IT manager.
The technical implementation was less of a problem.
The main focus was on creating a clear authorisation con-
cept. Furthermore, the project team had to inspect the
range of installed applications and check if the necessary
interfaces were available. Access authorisation concepts
also had to be claried. Our aim was to achieve the high-
est possible degree of automation, says Stangl. Just about
every application had its own user administration pro-
cess; there was no synchronisation with the HR database.
This meant that IT department employees had to manu-
ally process each and every member of sta who joined or
lef the hospital.
In turn, medical personnel were forced to memorise
a dierent password for every application installed.
Users found it dicult to do that. We were confronted
with security issues. By implementing the new solution,
we also wanted to take the pressure o medical employ-
ees so they could focus on their actual work, explains
Stangl. Whenever a new employee joins the hospital,
the currently installed solution automatically sets up a
new employee ID in the HR system and this ID is then
automatically transferred to the hospitals information
system. When an ID is deactivated in the HR system
e.g. because the employee leaves the hospitalemployee
access to all other systems is deactivated as well. The
transition to the new IAM solution was scheduled to be
implemented in stages. Afer the administration was
largely transferred to the new system and with rollout
in the medical area still undergoing trials, the Villach
state hospital was incorporated into Carinthias State
Hospital Operating Association (KABEG). Since other
hospitals belonging to KABEG still didnt have any IAM
solutions, rollout was suspended. Experts are currently
planning a unied solution for all hospitals of KABEG
based on the Villach solution.
Two identities in the same context
An o-the-shelf solution was out of the question
for the Essen University Hospital. This German hospi-
tal, with approximately 1,290 beds and 5,300 employees,
is planning to implement an SSO procedure rst and
then follow up by installing an IAM solution. During
implementation of its electronic documentation system,
the hospital carried out tests to nd out if single-fac-
tor authentication was suciently secure. If damage
claims are led, we must be in a position to nd out
which employee made what entries in the digital le.
Such lookups have to be veriable, legally reliable and
available even if the investigation takes place many
years afer the actual event, explains Christian Dahl-
mann, IT Maintenance Manager. Both internal and
external reviews of the legal situation led to the replace-
ment of the previous one-factor authentication with a
two-factor authentication featuring an access card and
a PIN code. In addition to enhancing the hospitals legal
certainty, this approach is also expected to make the
process easier for medical sta.
Single sign-on procedures
allow users to log on just once
with a smart card and a PIN code;
they can then access all data
and applications without any
further authentication.
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However, we soon found out that the SSO solutions
available on the market were not compatible with sev-
eral characteristics of our hospital information system,
Siemenss medico, which were particularly important to
us here in Essen, for example with regard to contextual
user switching, explains Gerald Hoch, an IT employee
in the Clinical Systems Department. Thus, if a surgi-
cal nurse is working on a PC and if a physician wishes
to record his services on the same PC and for the same
patient, e.g. in the surgery area, the nurse would have to
sign o using the traditional SSO process and can only
reconnect to the system afer the physician has signed
on and o. A sofware company based in Berlin created
a solution enabling the system to administer two identi-
ties in parallel. Thanks to this context-sensitive SSO, the
surgical nurse remains logged in even if the doctor logs
in with his own credentials on the same computer. Afer
the doctor signs o, the nurse can immediately resume
working on the computer.
Essen atached great importance to making the log-
on and log-o processes as swif as possible. The initial
registration in the system takes less than 30 seconds and
the session is terminated immediately when users pull
out their cards. Reconnecting on a new system takes a
mere ve seconds. Session roaming, where a user can
transfer his current session along with all open appli-
cations to another computer, was set up so that sta
members can easily switch from thin clients to mobile
devices (Toughbooks). In such cases, it is necessary to
appropriately adjust the screen resolution for all open
programs, which was not an easy task, explains Hoch.
The Essen University Clinic also implemented printer
mapping. This means that a physician can use dierent
devices to write a medical report and then print out the
information on the locally assigned printer.
IAM tool as a central point of reference
Another problem that will be solved eciently at the
Essen University Clinic is the issuance of cards outside
of business hours. If, for instance, an employee loses his
ID card at night, he cant just call in and request a new
card because the 24-hour IT support division would be
unable to uniquely identify the caller. The planned solu-
tion stipulates that the employee himself would create
a new time-limited ID using a blank card. A colleague
would then act as a guarantor by using his own card to
conrm the identity of the person on site. The usability
of this solution will soon be tested in the scope of the
pilot project. At the next stage, the Essen University
Clinic plans to introduce an IAM solution.
The Hamburg-based clinic group Asklepios took a
dierent approach and put the SSO solution on the back
burner for now. We have launched an identity system
because we want to bring order to the system, explains
Thomas Steen, Infrastructure Department Manager in
the groups IT Division. A unied naming convention
serves to improve the security of the system and cre-
ate a corporate identity for the approximately 30,000
employees of the group. In this way, Asklepios laid the
foundations for greater transparency and traceability
in the area of electronic documentation.
Our aim is to ensure that all an employee has to do is
set up a new ID in the HR system; everything else should
take place automatically, says Steen. However, we are
currently still at an intermediate stage. This means that,
for new employees, the authorisation administrator uses
the HR system (SAP) to dene which data can be accessed
by the employee. However, all the actual IT-related user
administration takes place within the hospitals informa-
tion system. We used to fax user credentials, explains
Steen, Nowadays, the IAM tool represents the central
point of reference as an interface between the hospitals
Our aim is to ensure that all an
employee has to do is set up a new ID
in the HR system; everything else
should take place automatically.
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for Healthcare Data Management
information and HR systems. Therefore, if an employee
leaves the group, the IT employee at the respective hos-
pital deactivates the user account in the IAM tool. Afer a
predened period of time has passed, the account is auto-
matically deleted from the system.
Changing departments with just a few clicks
An IAM solution can also be used by the IT depart-
ment to more easily reassign doctors within the hospital.
The Baden Canton Hospital in the Swiss canton Aargau
has been running a comprehensive IAM sofware suite
for several years now. Medical assistants, who have to
go through several hospital departments in the scope
of their training, can now be administrated more e-
ciently. We used to have to painstakingly update all
authorisations by hand; today, all departmental changes
take just a few mouse clicks to complete, says IT Man-
ager Adrian Seiler.
Thanks to the direct link between the IAM system
and the HR departments SAP sofware, helpdesk employ-
ees are also notied whenever they need to set up or
deactivate an ID for a particular physician. When an ID
is initially set up, it is only assigned basic functionality.
Helpdesk employees are informed about further authori-
sation for special data, registers or programs via the ticket
procedure. The sources of error during the assignment
of rights have been greatly reduced because employees
implement all entries directly in the IAM sofware and no
longer have to modify Active Directory permissions. The
integration of IAM and the SAP sofware also permits the
unambiguous identication of employees in Baden Can-
ton Hospitals IT system. This enables us to document all
processes thoroughly and in line with the applicable regu-
latory requirements, says Seiler.
From Switzerland to The Netherlands: the privacy
of patients was the main driver for Lentis, a mental
healthcare organisation with many psychiatric clin-
ics in The Netherlands and based in Zuidlaren . Lentis
is very well known in The Netherlands. We have to
ensure that only authorised persons have access to
patient information, says Eppe Wols, IT-Manager at
Lentis. In order to enhance patient privacy, the man-
agement of Lentis decided to install a standard ID
Management solution. This was in parallel with the
rebuild of the network at Lentis. The aim is to manage
all parts of the company from one central point. The
ID Management system will also be centralised, with
IDs for all employees created by the HR department.
The system is currently being tested and is set to go
live in 2013. The new ID Management systems com-
ply with NEN 7510, a Dutch standard for Information
Security in Health Care published as NEN-ISO/IEC
27002. With this standard, Lentis is prepared for the
upcoming privacy standard the European Commission
will introduce in 2014.
Identity Out of the Cloud?
Some hospitals already operate their IAM solutions
according to the sofware-as-a-service (SaaS) model.
With regard to data protection, cloud computing is still
a large grey area at the moment, according to Martin
Kuppinger, Founder and Principal Analyst at Kupping-
erCole, a leading analyst enterprise for information
security and cloud computing. As long as the servers are
located in Europe, the situation is straightforward, even
though there are some challenges here too as is usually
the case with any type of commissioned data process-
ing. However, if the cloud provider is based outside of
the EU, we would most certainly face signicant prob-
lems. Nonetheless, the expert says that the outsourcing
of parts of the IT processincluding IAMto cloud-
based solutions can denitely be of interest, especially
to smaller hospitals. A professionally operated large data
centre would oer not only economic benets but also
beter security.
Kuppinger is condent that cloud-based ID admin-
istration could also become increasingly important in
terms of interdisciplinary cooperation. One conceivable
future outcome would be a universal Healthcare ID,
valid not only across all hospitals, but also throughout
the healthcare sector. Such an ID would, for instance,
be issued by an identity federation provider and enable
a physician to conduct research by connecting to the
server of a pharmaceutical company directly from his
workstation. Physicians could also log into the computer
of a rehab facility with the same ID to check the current
lab values for one of their patients.
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40 | himss europe | I N S I G H T S | november 2012 | global trends
GLOBAL TRENDS
National Health IT Week
Provides a Snapshot of
US Healthcare Reform
By Mary Mosquera
WASHINGTON, DCThe activities taking place around
this years National Health IT Week demonstrated how
far doctors and hospitals in the United States have come
in instituting both legislative and market-based health-
care reform measures.
Participating healthcare organisations reected the
network eect of groups taking steps by themselves and
with others to establish meaningful use of electronic
healthcare records (EHRs), and to experiment with pay-
ment reform, healthcare information exchange, and
new technologies that improve the quality of care and,
ultimately, lower costs.
Sponsored by HIMSS, Health IT Week also oered a
series of hands-on demonstrations of technologies and
applications, presentations about innovation, and lessons
from those who have accomplished technical and work-
ow milestones. Of course, lobbying federal lawmakers
for more healthcare IT support was also on the agenda.
But the celebration was not conned to Washing-
ton, DC. Events during Sept 10-14 included a site visit
to a state-of-the-art federal health community clinic
where providers use healthcare IT daily; demonstra-
tions by New Jersey Institute of Technology students
geting connected to their electronic healthcare record;
physicians and patients discussing how to bridge the
digital divide; a summit to make EHRs more usable;
and a demo of a privacy and security training game for
safety net providers.
Signicant progress:
Federal EHR meaningful-use incentives
The US governments eorts to drive the adoption
of IT in the healthcare sector got its authority and
seed funding from the HITECH Act, part of the 2009
stimulus lawlegislation distinct from the Patient
Protection and Aordable Care Act thats come to be
known as Obamacare.
Under the HITECH Act, healthcare providers receive
incentive payments for adoption and meaningful use of
EHRs that have been certied to perform the necessary
functions. The incentive programme is exible, however,
both in regard to when providers feel they are ready to
begin, and how they achieve requirements. Doctors and
small practices can even receive onsite technical assis-
tance from regional healthcare IT extension centres
that the Oce of the National Coordinator for Health IT
(ONC) has established in every state.
Providers, health plans, and insurers will also rely on
healthcare IT to put in place many of the elements of the
2010 healthcare reform law, such as new models for care
delivery and payment.
Indeed, providers already have taken great steps
with the meaningful-use incentive programme, said Far-
zad Mostashari, MD, the national health IT coordinator
at ONC, and the project promises to spur further prog-
ress when the next stage begins in 2014.
US legislation is driving the rapid adoption of
electronic healthcare records across primary
care and hospitals through the use of nancial
incentives. Over 140,000 doctors and hospitals
have been paid 9bn for meaningful use of
healthcare IT since 2009. Providers, health plans
and insurers are encouraged to work together
to improve quality and reduce costs. Now in its
second phase, the patient is taking centre
stage, with not just a requirement for beter
patient engagement but patient-controlled
medical records by 2014. Afer playing catchup
with some parts of Europe in the use of health-
care IT, the US is rapidly forging ahead.
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The meaningful-use programme is intended to
enable providers to collect data and measure quality at
the start, he said at the HIMSS Policy Summit during
Health IT Week, and to advance ultimately to account-
ing for population health.
Recounting a recent visit to the Cleveland Clinic,
an early adopter of healthcare IT, Mostashari said he
observed healthcare data exchange between the clinic
and other local facilities using compatible coding that
transferred the data easily.
Two years ago, the industry couldnt manage those
transactions so seamlessly. Patient information wasnt
packaged and ready to code medications and lab reports
in the same record. But government and industry forged
a consensus, establishing pilot projects and working
groups, which resulted in the meaningful-use Stage 2
rule, Mostashari added.
ONC serves to convene federal advisory groups com-
prised of representatives from the healthcare industry,
healthcare IT suppliers, government, academia and
consumer groups to build consensus on policy and stan-
dards. Mostashari believes meaningful-use Stage 2 will
necessitate industry agreeing on healthcare informa-
tion exchange standards.
9bn billion in incentives paid to date
Up to the end of August 2012, the Centers for Medi-
care and Medicaid Services (CMS) has distributed almost
9bn in meaningful-use incentives to 143,800 doctors
and hospitals. In August alone, CMS paid some 650 mil-
lion in incentives, with 423 million going to Medicare
providers and 227 million to Medicaid providers, said
Robert Anthony, a specialist in CMS Oce of eHealth
Standards and Services.
The payment increases have been steady. In July,
incentive payments totalled US$6.6 billion since the pro-
grammes start, paid to 132,511 eligible providers. About
18% of Medicare-eligible providers had achieved mean-
ingful use of EHRs by July 2012 and 25% of Medicare and
Medicaid-eligible providers had made a nancial com-
mitment to an EHR, Anthony added. Additionally, 55%
of eligible hospitals have received an EHR incentive pay-
ment for meaningful use.
In total, 271,105 Medicare and Medicaid doctors and
hospitals have registered to participate in the incen-
tive programme, increasing by about 10,300 monthly,
Anthony said. That is composed of 180,513 Medicare doc-
tors, 86,708 Medicaid clinicians and 3,884 hospitals.
Among the chief criticisms of the incentive pro-
gramme is that, despite the impressive numbers, the
actual percentage of eligible doctors achieving mean-
ingful use of EHRs remains somewhat low. It has been
dicult for ocials to gauge how many doctors had
previously installed EHRs and are collecting reim-
bursement, as opposed to those doctors who were
otherwise lagging and were inspired to adopt by the
federal initiative.
High level of performance
But as more doctors and hospitals participate in
the incentive programme, their level of performance
remains high, as reected in the atestation data. Pro-
viders declare that they have met meaningful-use
requirements and calculate the percentage of patients
for whom they have performed selected measures at a
CMS website.
The longer we go on saying that not much has
changed, the more encouraging that trend actually is,
because it is an indication that more and more providers
are coming in, yet everybody is performing at a statisti-
cally high level, Anthony said.
Providers tend to exceed the required threshold of
performance for recording objectives for problem lists,
medications lists, or medication-allergy lists, Anthony
explained. And there is litle dierence in performance
among doctors and hospitals.
Were no longer looking at just the early adopters,
were looking at people who may still be in their rst
year of meaningful use, but theyre not necessarily the
people who are at the beginning of the curve, he said.
Yet we continue to see very high performance across
the board on all the objectives.
Emphasis moves to the consumer
Now that providers are making headway on digitis-
ing the American healthcare system, Mostashari said it
will be important in the near future to tap into the big-
gest underused resource: the patient.
Doctors will have to atract patients to their services
as government and industry-driven standards enable
more data exchange and interoperability to free patients
from the providers holding their healthcare datapart
of a movement that US Chief Technology Ocer Todd
Park and others champion as Data Liberacin.
Mostashari, in fact, has challenged healthcare IT
suppliers to make it easy for consumers by early 2013
to view, download and transmit to another party their
healthcare information in the form of a Blue Buton fea-
ture. Implementing the functionality for view, download
and transmit (VDT) to a third party, is under-appreci-
ated for how signicant thats going to be to the concept
of consumer-mediated health information exchange,
Mostashari said at the ONC summit on consumer health
IT during Health IT Week.
43
Blue Buton was developed rst for US military
veterans to access their information through their My
HealtheVet personal record in a simple ASCII text le.
More than one million veterans have downloaded their
information. Military service members and Medicare
beneciaries also have a Blue Buton capability, and it
is beginning to be deployed in the private sector.
It moves us from personal health records tethered
to this particular provider or that particular health
plans data source to the concept of a personally con-
trolled health record, Mostashari said, adding that it
will accelerate capabilities for stage 2 meaningful-use
requirements in 2014 for patient engagement and health
information exchange.
Give me my data
Healthcare IT companies, providers, and healthcare
organisations can oer patients access to and a copy
of their electronic information through patient portals
linked to their EHRs, a Blue Buton feature on their per-
sonal health record (PHR) sofware or other applications
on patients computers.
Blue Buton has evolved from veterans geting
their own data, and is now a national conceptgive me
my data, Mostashari said. Among the goals for ONCs
consumer health IT programme is to nudge patients to
access their data and, ultimately, take action with it.
Surveys have shown that patients want their
information but are unaware that they can ask for it,
according to Lygeia Ricciardi, acting director of ONCs
O ce of Consumer eHealth. One year ago, 30 organisa-
tions that are data holders and non-data holders pledged
to make it easier for patients to gain access to their
information, Ricciardi said, and now more than 400
organisations have commited to doing so.
Data holders are pledging to make the informa-
tion easily electronically available, while the non-data
holders, a broader category, is helping to spread the
word to go out there and do it, and also building the
tools that are going to make it appealing and useful to
people, she said.
ONC also wants to help change atitudes of patients.
Have you ever felt a litle uncomfortable asking your
doctor for your information? Ricciardi posed. Part
of what were doing to encourage people is to let them
know that its acceptable to ask for your records.

Insurers need consistent payment models
Buy-in from health insurance companies is pivotal
to transforming payment models from fragmented fee-
for-service to paying for quality and improved patient
outcomes. Many payers have their own demonstration
projects for care co-ordination and the patient-centred
medical home, and are involved in CMS pilots for shared
savings and accountable care organisations.
Providers, especially small practices, are strug-
gling to adopt healthcare IT, redesign how they
deliver care and configure workflow. At the same
time, they must meet quality and population health
requirements for multiple payers versions of similar
payment models.
Mostashari has appealed to health insurance plans
to accelerate shared savings and other reforms and to
minimise the variations in their individual approaches
to payment models. The transition from fee-for-service
payments to alternative models needs to be quick and
smart to eliminate uncertainty for providers, he said at a
conference of Americas Health Insurance Plans (AHIP)
during Health IT Week.
Insurers need to agree on some standards in
shared savings instead of each having their
own design.
Can we please agree on a few core quality measures
across all approaches that really get at the important
issues and do it consistently? Mostashari asked of the
payers. The risk on the payment side is how fast and
how smart we do it.
He suggested starting with quality measures from
the Million Hearts campaign sponsored by CMS to pre-
vent heart atack and stroke through the ABCs, which
include aspirin therapy, blood pressure control, choles-
terol management, and smoking cessation.
Mostashari also urged payers to relieve some of the
administrative burden on practices. For example, in
Minnesota, payers, plans, and providers agreed to sim-
plify the process for prior authorisation for ordering
Lygeia Ricciardi, acting director
of ONCs O ce of Consumer eHealth.
Blue Buton Download My Data
The Blue Button feature, rst developed
by the VA Health System but expanding
now to the private sector, gives patients
the ability to download their entire elec-
tronic health record.
patient diagnostic scans. Instead of a 10-minute prior
authorisation for each scan, they have a 10-second deci-
sion support in the electronic health record, he said.
About 45% of the market was able to implement
electronic decision support that incorporated best prac-
tice, which was opaque and made the rules transparent
and obvious.
Reduce re-admissions
Hospitals must see it is in their interest to reduce
re-admissions and establish a business model where co-
ordinating care is incentivised.
Mostashari told of a visit to a hospital in Cincinnati,
Ohio, which was focusing on asthma prevention and
control to reduce the number of children being admited
or re-admited. The facilitys chief nancial ocer told
him that it was beter to have the beds lled with really
complicated cases that require the kinds of resources
that hospitals have instead of the uncomplicated cases.
You have got to have a system of payment whereby
not having those admissions doesnt kill the hospitals
revenues because theyve been smart about control-
ling their capacity and their costs, Mostashari told the
insurers. You have to have a system of payment that
takes advantage of some shared savings.
Beacon communities as healthcare
IT incubators
Communities that are models of using healthcare IT
are important incubators for the transformation of US
healthcare. ONC has funded 17 Beacon Communities
across the US to tackle dicult health problems, such as
diabetes and other chronic conditions.
These communities are discovering that a co-
ordinated approach among providers, payers, healthcare
IT suppliers and consumer groups can improve quality
of patient care and population health and reduce hospi-
tal re-admissions.
Take the Hawaii Island Beacon Community, for
instance. The beacon on the Big Island is helping doc-
tors, community clinics and hospitals to embrace EHRs
and health information exchange, and engaging doctors
to transform their practices into patient-centred medi-
cal homes. Hawaii Beacon is beginning to exchange data
with geographically dispersed clinics and hospitals on the
island to co-ordinate care so patients can avoid the onset
and advancement of diabetes and related conditions.
Healthcare IT infrastructure is the bridge for clini-
cal intervention and co-ordination, said Je Jendrysik,
the Hawaii Beacon project manager. The objective is
to get 60% of the islands primary care providers and
nurse practitioners to adopt and use EHRs in a mean-
ingful fashion so they have a digital foundation for
exchanging data.
North Hawaii Community Hospital, for example,
has put in place hospital discharge planning to get
patients connected with care co-ordinators at a com-
munity clinic when they leave the hospital. Both
providers will share the same technology platform. So
we can take clinical interventions and start overlaying
them on top of the technology were building, Jendry-
sik said. Hospital and care co-ordinators on the same
platform are sharing the same data across their EHRs
with all that data connected.
Beacon provider partners have also registered about
500 patients with diabetes and other chronic conditions
and matched them with care co-ordinators to help them
manage their care, and are forming a care co-ordination
neighbourhood that includes some non-medical services,
including transportation to providers.
To boost consumer interest and engagement in EHRs
and healthcare information exchange, Hawaii Beacon
started with non-tech community activities about well-
Sta of Hawaii Island Beacon Community.
Hilo Medical Center is one of the hospitals in Hawaii that
are beneting from the work of the Hawaii Island
Beacon Community.
45
ness, healthy eating, exercise and gardening, according to
Jessica Yamamoto, Hawaii Beacons community engage-
ment manager.
If we need to come in and talk about health infor-
mation exchange, then they will listen to us, Yamamoto
said. We have earned that trust by developing a rela-
tionship with the community.
Bipartisan support in Congress
Healthcare IT advancement is one of very few issues
on which both political parties in Congress historically
agree and promise to do so moving forward.
In the most recent measure of healthcare IT biparti-
sanship, lawmakers passed Senate Resolution 562. Intro-
duced by Senators Debbie Stabenow (Democrat-Michigan.)
and Olympia Snowe (Republican-Maine), Resolution 562 Diana Manos contributed to this article.
Through the end of August, the Centers for Medicare and Medicaid Services (CMS) distributed almost 9bn
in meaningful-use incentives to 143,800 US physicians and hospitals.
recognised the value of healthcare information technol-
ogy in improving care quality by designating Sept. 10-14
as National Health IT Weekseting it aside to celebrate
healthcare IT every year.
Resolutions supportive of healthcare IT are one thing,
but adequate nancial appropriations are another. Still,
despite federal budget concerns, CMS anticipates that
it will distribute about US$20 billion in meaningful-use
incentives before the programme shifs to a penalty stage
in 2015, although there is no xed budget determined in
the HITECH Act that mandated the programme.
Nonetheless, Mostashari doesnt anticipate any
administrative or legislative action to limit rewarding
providers who meaningfully adopt and use EHRs.
KEY FACTS: [1] The US HITECH act provides for incentive payments for adoption and mean-ingful use of certied EHR by
healthcare providers. [2] Almost 9bn has been distributed to over 140,000 doctors and hospitals since 2009, with the num-
bers registering for payments rising steadily. [3] In stage 2, the emphasis is on providing patients with access to their own
medical records by 2014. [4] The ONC is seting up Beacon communities across the US as models for tack-ling dicult health
problems to stimulate best use of IT. [5] Healthcare IT is one of very few issues on which both political parties in Congress
generally agree on, and with both celebrating Health IT Week each year.
MAP OF MEDICARE AND MEDICAID INCENTIVE PAYMENT TOTALS THROUGH AUGUST 2012
MARSHALL
ISLANDS
WEST
VIRGINA
VIRGINA
PENNSYLVANIA
NEW YORK
VERMONT
NEW HAMPSHIRE
MASSACHUSETTS
RHODE ISLAND
NEW JERSEY
DELAWARE
MARYLAND
WASHINGSTON D.C.
MAINE
CALIFORNIA
OREGON
WASHINGTON
MONTANA
IDAHO
NEVADA
UTAH
WYOMING
NORTH
DAKOTA
SOUTH
DAKOTA
NEBRESKA
COLORADO
KANSAS
ARIZONA
NEW
MEXICO
TEXAS
ARKANSAS
LOUISIANA
MISSOURI
IOWA
MINNESOTA
WISCONSIN
ILLINOIS
OHIO
INDIANA
MICHIGAN
KENTUCKY
TENNESSEE
ALABAMA
MISSISSIPPI GEORGIA
FLORIDA
SOUTH
CAROLINA
NORTH
CAROLINA
OKLAHOMA
PUERTO
RICO
GUAM
HAWAII
VIRGIN
ISLANDS
PALAU
NORTHERN
MARIANA ISLANDS
FEDERATED STATES
OF MICRONESIA
$0-50 million
$51-$100 million
$101-150 million
$151+ million
ALASKA
LEADERS OF CHANGE
46 | himss europe | I N S I G H T S | november 2012 | leaders of change

HIMSS Europe Members receive the digital
edition of HIMSS Insights and many other
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Learn more about HIMSS Europe
Membership including the free-of-charge
Online Membership at www.himss.eu.
A mere four of the 21 European hospitals at
EMRAM Stage 6 or 7 have female IT leaders.
Its particularly odd to see so few women suc-
ceeding in healthcare IT, traditionally a con-
text with a high female component. In the
UKs National Health Service, women have
become the majority of entrants to medical
school in the last 20 yearsbut still only
make up 38% of GP partners, 31% of hospital
consultants and 11% of consultant surgeons.
Q. Are women simply not going for tech roles or are
they being actively barred from them?
Petra Wilson, HIMSS Europes Governing Council
chair and a holder of a top job in network leader Cisco,
seems to veer more to the former; she has recently told
the British Journal of Healthcare Computing (www.bj-hc.
co.uk) she thinks computer technologys image problem
has a lot to answer for: A lot of people still think those
in IT sit in a room on their own all day writing sofware.
This doesnt appeal to the majority of women, who ofen
prefer more people-oriented roles.
But there are structural issues at play here too. Girls
dont ofen chooseand arent encouraged to choose
the subjects at school that will lead into ITand the
industry has done litle to challenge this. And even
though healthcare IT is still a relatively young profession,
It has taken on many of the bad habits of other profes-
sions and suers from old boys networks, glass ceilings
and xed atitudes that can prevent women from rising
up the ranks within the profession, she worries.
If the healthcare IT community is to help our indus-
try reach its potential, we need to do something about
this, says Wilson. Its not just about geting more
women engineers inthough that would be a good
start, she says. Its about creating an ecosystem in the
workplace which atracts men and women from many
diverse backgrounds, so that their rich experience can
help grow ideas and innovation in a company, hospital
or any other healthcare IT seting.
What can be done to bring about a beter gender bal-
ance within healthcare IT? We need to make sure that
healthcare IT is atractive to women as well as men:
that the brightest and the best see it as a career option,
says British Computer Society Vice Chair Sheila Bullas.
Its also about raising the whole prole of informatics
as a career.
All healthcare IT professionals can, for example,
reach out into the educational system to bring more
women into healthcare IT and encourage more young
women to consider a tech route for their career. IT is
a growing area, a fun and exciting oneand one very
heavily dependent on the skills of transformation and
engagement which many women have.
Perhaps. But the gures, with their sharp imbal-
ance between genders in the modern workplace, suggest
there may also need to be eort in educating our peers
about the value of diversity and balance in teams.
Sheila Bullas
We need to make sure that
healthcare IT is attractive
to women as well as men.
Petra Wilson
Healthcare IT has taken
on many of the bad habits
of other professions.
The Glass Ceiling is
Preventing Healthcare IT
from Reaching its Potential
By Gary Flood
Mobile solutions for healthcare, elderly and homecare
www.tieto.com/healthcare
Tietos mobile solutions provide you
with immediate access to patient vital data.
Tieto Ad 1.indd 1 2.11.2012 16:10:17
LEADERS OF CHANGE
Directing an
Orchestra of Images
By Philipp Grtzel von Grtz
Every time Victor Dubois-Ferrire came across
a video game with gesture navigation, the orthopaedic surgeon
would become jealous: if you can compete in the Olympics
on screen without actually touching anything, why do surgeons
have to navigate with a computer mouse wrapped in a sterile
plastic bag through a set of DICOM images in an operating room?
Dubois-Ferrire proposed a solution to the problem with a little
help from some friends in the engineering world. Today, he and
his colleagues from Geneva University Hospital are proudly
conducting their own private DICOM orchestra
wearing sterile gloves.
49
IN THE NON-DIGITAL AGE of medicine, life was easy
for a surgeon who needed access to radiographs or CT
images while performing surgery. There was always
some assistant available who would take the lm out of
its brown paper bag and pin it onto the light box. Times
have changed, though. In times of austerity, there are,
on average, fewer people in the operating theatres today.
And to retrieve digital images from a picture archive
is something that cannot easily be delegated to, say, a
medical student during his internship. This is really a
problem, says Dubois-Ferrire. Sometimes the people
available dont know how to use the system. Sometimes
they dont know the anatomy well enough to provide the
right picture instantly. Time passes and the patient is
lef waiting and waiting under anaesthetic.
For surgeons like Dubois-Ferrire, a beter way to
solve this problem would be through the use of gesture
navigation, but there was no easy-to-use tool available.
We really would have liked to use Nintendos Wii, for
example. But you cannot simply take a proprietary box,
connect it to the PC that carries our DICOM systems and
start to play. The situation changed when the chief resi-
dent of the division of Orthopaedic Surgery at Geneva
University Hospital learned that there was an open
source driver available for a dierent gesture navigation
system from the world of video gamingMicrosofs
Kinect system for the Xbox console.
Having learned about this open source driver,
Dubois-Ferrire became really excited. In early 2011, he
teamed up with two young engineers, Thomas Stagr
and Kamran Ahmed from the Geneva-based engineer-
ing school HEPIA, and with Francis Klumb, an engineer
in radiological imaging technology at the Geneva
School of Health (HEdS). And so the KiOP project was
born. We had to start from scratch, explains Dubois-
Ferrire. First, every single gesture was documented
by our medical team. Then we asked the engineers
whether it was possible to teach this gesture to the sys-
tem. Gestures had to be easy, obviously. But they also
had to full some other requirements that are very spe-
cic for the situation in an operating theatre. Surgeons,
for example, are not allowed to raise their sterile hands
high above their heads. Touching the face or even com-
ing close to it is strictly forbidden: the head is germ
territory. Needless to say the region below the bellybut-
ton is prohibited, too.
To be on the safe side, we decided to stay in the
horizontal plane. We use only very few gestures, and
all of them are horizontal. There is one wiping ges-
ture to activate the system. Once activated, the doctor
chooses the tool he needs by simply pointing at it.
He can select modalities, image sets and individual
images. And, most importantly on a day-to-day basis,
the surgeon can zoom in and out of a picture by mov-
ing his hand in the horizontal plane from lef to right
or from right to lef.
And yes, it does look odd. Dubois-Ferrire stands
in front of the monitor like a conductor in front of his
orchestra, with the tailcoat replaced by sterile blue
garments, of course. The Kinect box is placed directly
below the monitor. Its camera is able to recognize the
surgeons hand and follow it once the system is acti-
vated. Choosing pictures and zooming in and out of
regions of interest doesnt take long. The performance
is convincing enough that doctors like Dubois-Ferrire
have embraced it; doctors who belong to a speciality
that has a reputation for atracting people who are
allergic to waiting.
A key factor in the success of the system was that
the engineers managed to enable surgeons to interact
directly with the DICOM viewer. This is the truly inno-
vative part of what we do. It is a great thing for us and
makes life a lot easier, says Dubois-Ferrire. Most other
groups that try to establish gestures as a means of navi-
gating through image databases use them to move a
cursor across a screen. They blend conventional naviga-
tion with gestures and simply imitate what they are used
to doing with a computer mouse. This approach might
be straight-forward, but it is not very practical. Interact-
ing directly with the DICOM viewer is a totally dierent
experience: It really makes us a part of the system.
For Dubois-Ferrire and his colleagues, KiOP is work
in progress. Few operating rooms are equipped with
the system at the moment. We always try to make it
even more user-friendly. And in order to provide proper
data, we are performing a clinical trial at the moment to
evaluate usability, feasibility and user satisfaction and
to see whether the system changes our habits of using
pictures intraoperatively.
Keeping up with the video gaming industry is also
an issue. The second version of the Kinect software
will be available soon, with a far better resolution.
There is no question that Dubois-Ferrire is keen to
implement it as soon as possible. After all, why should
a grown-up surgeon have to play second fiddle to
games-addicted teenagers?
Interacting directly with the
DICOM viewer is a totally dierent
experience: It really makes us
a part of the system.
LEADERS OF CHANGE
Jacqueline Surugue, Co-Chair for Users of IHE
Europe, is not only one of the most important
pharmacists in Europe, she is also a prominent
promoter of eHealth.
WHEN JACQUELINE SURUGUE began her career in
the 1970s, there were no thoughts of information tech-
nology. She wanted to become a doctor or a pharmacist.
There is no beter job than helping patients, she says.
Interested in chemistry, she decided to study pharmacy
and graduated from the University of Tours in the Loire
Valley in 1974. She thought about working in a pharmacy
or going into industry, but then she discovered that
working in a hospital was a fascinating worldand
she has never lef. She gained the qualication as hospi-
tal practitioner which, in France, aords pharmacists at
hospitals the same status as medical doctors. Today, she
is Chief of the Pharmacy Department of Centre Hospit-
alier Georges Renon, a 1,200-bed hospital in the city of
Niort, approximately 400 km south of Paris.
All through her career she has been involved with
international organizations and associations. In 2002,
afer 3 years on the Board of the European Association
of Hospital Pharmacists, she was elected President of
the association, a position she held for 7 years. At the
time she wondered why hospitals were not making bet-
ter use of information technology. There is no future
without IT, she says. As President, she founded an IT
group within the European Association of Hospital
Pharmacists. We started by creating a website for the
association, she remembers with a smile.
When Karima Bourquard, current IHE Europe
Director of Interoperability, invited her to talk about
pharmacy in Berlin in 2007 at a meeting of IT represen-
tatives (who became the core of IHE Europe a year later),
the plenum was convinced that pharmacy should stand
as an independent IHE domain alongside cardiology,
radiology and pathology. The following year, on 2 April,
2008, IHE Europe was ocially founded in Brussels,
Belgium, as the European branch of IHE International,
with Mrs Surugue as a co-founder. Today, pharmacy is
an important IHE domain on a global level.
In 2009, Jacqueline Surugue was elected Co-Chair
for Users for both the IHE Europe Steering Com-
mitee and IHE Pharmacy Group. But these are not
her only responsibilities; in 2010 she was nominated
No Future Without IT! By Michael Lang
President of the Hospital section of the International
Pharmaceutical Federation (FIP), the global federation
of pharmacists and pharmaceutical scientists which
works closely with the World Health Organization
(WHO). In this position I try to promote the importance
of information technology in pharmacy, she says.
Her aim is to advocate the interoperability of health
information systems in order to ensure the optimiza-
tion of treatments and subsequently the best possible
outcome for patients. Seamless care should eliminate
all barriers in terms of access to patient data across
the healthcare sectors. When a patient is referred to
the hospital, she explains, for various reasons they
are ofen unable to provide precise information about
their treatment.
The new eHealth Stakeholder
Group of the European Commission
was asked to identify potential
barriers preventing patients
from accessing their electronic
health records and to propose
practical solutions.
The hospital doctor should be able to retrieve the
patient data from the electronic health record, and
add any new data collected during hospitalization to
the record. The same applies when the patient is dis-
charged from hospital. The medical doctor and the
pharmacist, together with all the health professionals
caring for the patient outside of the hospital, should
be able to access the patients electronic health record.
Hospitalization and discharge are critical steps in
the management of the patients treatment, she says,
because they are at the interface of two dierent
worlds: hospital and community. Every eort should
51
be made to ensure smooth communication between
these two worlds, and this is what we are trying to do
in the IHE Pharmacy Group.
She has also identied weaknesses within hospitals.
The hospital is a patchwork of specialized wards, each
with specic sofware. But these IT applications do not
communicate with each other. This makes life dicult
for the hospital IT departments, who try to nd solu-
tions ofen at a high cost for the hospital budget.
In her position as President of the European Associa-
tion of Hospital Pharmacists she is involved in the new
eHealth Stakeholder Group of the European Commis-
sion. In the interests of seamless care, this group was
asked to identify potential barriers preventing patients
from accessing their electronic health records and to
propose practical solutions. A very sensitive topic is the
condentiality of patient data, which is obviously open
to further discussion.
Work is in progress at European level and gradually
extending to other continents. But to nd solutions on a
worldwide scale is dicult. We need political support,
says Mrs Surugue. The commitment of the European
Commission to the development of eHealth is a great
help, and the IHE Europe Steering Commitee is involved
in all the eHealth projects that the Commission has initi-
ated, like epSOS, Hitch, Mandate. I hope that as President
of the Hospital Section of the International Pharmaceu-
tical Federation I can contribute, too, she says.
It is hard to believe, but despite all her pharmacy
and eHealth responsibilities, Jacqueline Surugue also
has a private life which she spends with her husband,
a busy anesthesiologist, and her three sons. And she
loves to relax by listening to the music of Diana Krall,
her favorite singer.Michael Lang is a science writer in
Mannheim, Germany. He was editor of E-HEALTH-COM
and has writen for the German Cancer Research Cen-
ter and Sddeutsche Zeitung. Mr. Lang received his PhD
from Karlsruhe Institute of Technology.
Founding members of IHE Europe in 2008.
Jacqueline Surugue, co-chair of the IHE Europe Steering
Committee and IHE Pharmacy Group, and president of the hos-
pital section of the International Pharmaceutical Federation.
LEADERS OF CHANGE
MANY EUROPEAN NATIONS would like to see greater
use of so-called Electronic Health Records (EHR), which
promise both greater e ciencies but also bring medi-
cine rmly into the 21st century as far as many patients
are concerned. None more so than the UK, which has
had to abandon its eort to roll out a national sys-
tem with the costly failure of the 12bn National
Programme for IT.
Administrators still struggling to roll out EHRs
can learn from the success in Galicia, Spain. Afer
seven years, Galicia can boast of results other authori-
ties would envy: no less than 2.7 million patients now
have easy access to their electronic records; nearly 60
million electronic prescriptions were issued and just
under 17 million primary care specialist observations
have been entered.
The Galician experiment seems to be paying o in
economic terms as well. Local government says it has
saved no less than 6.8m in lm printing since 2006,
728,000 in prescription paper forms in 2011 alone, while
an estimated 102m was saved using electronic prescrip-
tion system to obtain the most e cient medicine for
individual patients. Meanwhile, some 2 million routine
prescription or treatment patient renewal visits have
been avoidedfreeing up more than 150,000 hours of
physicians time now spent on more value-added time
with their patients.
Even beter, say practitioners, the vast majority of
patient information is digitally stored, allowing profes-
sionals, patients and managers the benets of a common
source of information and knowledge.
A locally developed solution
What did Spain do right that other countries havent
been able to? The IANUS project created their solution
locally, rather than relying on an o-the-shelf package.
Galicia is Spains most north-westerly region with a
population of nearly three million; one in ve are over
65. In Spain, healthcare policies are assigned to regional
authorities, with services mainly provided by public
institutions covering primary, secondary and tertiary
care activities. In Galicia specically, public health-
care services are provided by Galician Health Service
(Servizo Galego de Sade/SERGAS), which seven met-
ropolitan hospitals trusts with tertiary care services
and the same number of rural hospitals with secondary
care services.
Employing 38,000 professionals, SERGAS dedicates
about 1%, or just under 40m, of its operating budget
to healthcare informatics, with technology policy co-
ordinated from a central unit, highly synchronised
with individual hospitals IT departments. A 10 Gbps
backbone interconnects the main data processing cen-
tre with seven data processing centres in each of the
main hospitals, using a high-availability star cong-
uration model in a private network. Business critical
data processing is based on Unix clusters in the eight
distributed data centres. All these facilities contain
more than 1,100 servers, with storage capacity of over
1,100 Terabytes.
These IT resources were all focused on the initia-
tive, partly funded by the Commission through Galicia
ERDF 2007-2013 program, to roll out electronic health
records and e-prescription applications for the region.
Information is always available, either in hospitals or
in primary care support for the IANUS users, whether
they are in radiology, pharmacy, laboratory, outpatient
scheduling, nursing care reports or other applications.
Any user can see all information recorded about their
journey, either in primary care or at their assigned
hospitals, while information from other hospitals are
online and easily reachable.
At the same time, the new e-Prescription system is
completely integrated into the EHR; for any registered
Galicia Leads the Way with
a Successful EHR Deployment
What can other European
countries learn from
Spains IANUS project?

Learn more here: speechrecognition.healthcare@nuance.com
www.nuancehealthcare.eu
Speech recognition capabilities seamlessly
embedded within your healthcare application.
Now also available in the cloud.
Dictate
ON ANY DEVICE
ANYWHERE
AT ANY TIME
A natural extension of your interface.
Improved usability for the clinician.
Increased effciency of information capture.
By Javier Quiles del Rio MSc, Benigno Rosn Calvo, & Jorge Prado Casal
53

Learn more here: speechrecognition.healthcare@nuance.com
Speech recognition capabilities seamlessly
embedded within your healthcare application.
Now also available in the cloud.
Dictate
ON ANY DEVICE
ANYWHERE
AT ANY TIME
A natural extension of your interface.
Improved usability for the clinician.
Increased effciency of information capture.
LEADERS OF CHANGE
clinical problem, physicians can associate an electronic
prescription, selecting the indicated medicine, dose,
frequency of administration and period of time for treat-
ment for up to a year for patients with chronic disease.
The system also automatically calculates the packages
that the patient should pick up each time they visit the
pharmacy and makes this information available to the
pharmacy oce system.
The e-Prescription system has been complemented
with a business intelligence and data mining tool to
explore and detect how prescription could be improved
and optimised. Several clinical programs have been
launched using data analysis results so as to control and
improve medical treatment of patients who use more
than 10 dierent prescription medicines at once. From
these data analyses, deviations on cost of several medi-
cines can be beter detected and controlled.
Change management challenges
Other benets have included the wide availability of
information to healthcare professionals and avoidance
of repeating procedures potentially harmful to patients.
But geting to this position has not been without its
challenges; quite apart from the technical diculties in
building such a system, cultural and change manage-
ment issues have been just as formidable, report IANUS
stakeholders. For example, over 16,000 training hours
had to be dedicated to explaining the new way of regis-
tering and accessing clinical information to 22,000 users
in both primary care and hospitals.
Another innovation crucial to the rapid take up of EHR
has been the introduction of speech recognition technol-
ogy, rst installed in Galician radiology departments
and now fully integrated with the reporting system. As a
result, the average time for radiology reporting has been
cut from three to less than one day, and the number of
procedures with digital report available rose from 40% to
more than 55% afer two years. There are plans to extend
the use of voice recognition to provide complete EHR
control. This feature would allow clinicians to use voice
commands to control the EHR functionalities and, for
example, introduce patient identication data to access
the patient record without typing, or create e-prescrip-
tions by using only voice commands.
Next steps
With Spain in a period of economic belt-tightening,
will all this great work be lost? SERGAS says its next
priority is to build on its achievements and use technol-
ogy to support healthier life choices and beter empower
health service users. A new Innova-sade innovation
plan envisions nothing less than a complete transfor-
mation to a new patient-centred approach, including
support for telehealth, telemonitoring and Web 2.0
portals for patients and professionals, as well smarter
services to meet optimum quality and security needs.
Aerial view of Hospital Meixoeiro in Vigo, Spain, one of Galicias biggest cities.
55
Global Master Patient Index [MPI]
Modules Data Points
Common
Antecedentes e Reaccions
Adversas
Persoais
Familiares
Xineco-Obstetricos
Socio-Laborales
Neonatais
Vacinas
Clinical
Diagnostic procedure reports
Digital Imaging
Inpatients ePrescriptions
Nursery care Actions
Rehabilitations
Legacy Reporting Systems
Screening Programs
Vaccines register and Planning
Medical Problems
Episodes
Allergies
Ambulatory ePrescription
Odontology
Radiology and Pathology
Laboratory Results
Ordering Lab, Rad and Pathology
Administrative
Patient Identity and Data
Register for Labour Illness
Sanitary Transport Request
Hospital Visits and Episodes
Anticipatory Procedure
Exception Request
Primary Care
Primaria
Condicionantes e Problemas
Episodios
Plan de Actividades
Pediatria
Secondary Care
Especializada
Hospital 1
Hospitalizacions
Consultas externas
Outros Estudos
Hospital 2
Hospitalizacions
Urxencias
Consultas Externas
Outros Estodus
Hospital 3
Urxencias
Consultas Externas
IANUS means Unied Electronic Health Record System
IANUS Project
Scheme of Clinical Information Presentation in IANUS
TECHNOLOGY UPDATE
56 | himss europe | I N S I G H T S | november 2012 | technology update
THOUGH IT MAY SOUND like the name of a food
additiveor perhaps the atomic name for some new
substance HL7 is neither but is actually one of the
most important standards to boost interoperability
among IT-based healthcare systems we have. But will
recent changes to the way the framework works with
the market nally bring it out of relative obscurity into
the prominence its supporters say it deserves?
Amazingly enough, the HL7 (Health Level Seven)
informatics information exchange standard celebrates
25 years of existence in 2011. One benchmark of its prog-
ress: the successful 13th international Interoperability
Conference, held last September in Vienna, atracted
100 participants from 20 countries. Key highlights at the
conference included Edgar De La Cruz of the Univer-
sity of Cauca, Colombia, accepting the special Joachim
W. Dudeck Award for his outstanding contribution on a
national reference architecture for sharing CDA (Clini-
cal Document Architecture) documents in his country,
as well as 18 scientic presentations.
All that activity seems to suggest healthy develop-
ments in the sector. But while some may be toasting
HL7s 25 years of existence, there are undoubtedly HL7
skeptics out there, too. Its prety much accepted now
that earlier releases of Version 2 (V2) were, to quote one
supplier white paper, vague and under documented
when compared to later releases, for example, while
work on the newest version, Version 3 (V3), a complete
re-write, has been underway since 1996and is still not
nished to everyones satisfaction.
Some wonder if funding for the the non-prot par-
ent of the famously non-standard standard will be
sucient to guarantee its long-term viability. For all its
potential, the fact remains that HL7 is not a universally
used healthcare IT standard. And there were quite a few
raised eyebrows in the community about the organisa-
tions decision to make its standards freely available
from next yearsomething of a volte face, given the
fact that charging for use of its intellectual property has
been the norm. Does this suggest some kind of weaken-
HL7 Standards:
A Work in Progress
By Gary Flood
ing or deviation from its original vision, and how will
these changes aect healthcare IT practitioners?
Given the central importance of HL7 in many coun-
tries healthcare informatics structuresin the US,
a 2009 Act specied two HL7 V2.x releases as key to
compliance, while almost all Dutch hospitals utilise it
to support internal information workow and Finland
is basing a promised national ePrescribing and patient
record archival service on the thingit is important
that the system does indeed have a secure future.
HIMSS Insights spoke with Dr. Stefan Sabutsch, a
member of Austrias ongoing ELGA electronic health-
care records project and who is also chair of that nations
local HL7 aliate, to get a snapshot ofwhich HL7 devel-
opments the get-together showcased.
Sabutsch is dismissive towards HL7s critics, brushing
aside the question about any potential funding problems
(HL7 International... [has] enough funds to nance [its]
activities) and convinced the decision to open up the
standard for free use is a positive step, too (It will be a
great benet. We expect that the adoption of HL7 stan-
dards will be much broader than today [as a result]).
He also clarifiesto some extent?how
announced HL7 organisational changes made earlier
this year will play out for European healthcare IT
vendors. Thats important, of course, for all those that
may have plans to develop products based on HL7, as
well as for medical customers (hospitals, other forms
of medical entity) that want to connect their existing
solutions based on HL7. In his view at least, The scope
of membership will change; access to the standards
was just one of many advantages.
What might such advantages look like? Members
will now have the possibility to take part in working on
developing HL7 standards, participating in ballots and
elections, get up-to-date information on the standards
and educational material and support, as well as have
the chance to atend working group and educational
meetings plus participate in certication and eLearn-
ing-courses, says the organisation.
Will opening up
the interoperability
standard give it
the momentum
it needs to reach
broad acceptance?
57
However, to help with the markets transition to HL7
3 from 2.x, he adds, there is also lots of work underway in
the HL7 world on managing that complexity, as well as
initiatives on the use and reuse of templates, especially
within CDA, as well as eort on beter integration of
healthcare devices.
These developments do seem to suggest a viable
future for the standard. Whether these statements will
completely satisfy those who wonder if HL7 is going the
right way is, of course, another mater.
A specic HL7 issue has been, of course, how usage of
some of the standards in the ambulatory context could
be boosted: for instance, in the important German mar-
ket, there are currently almost zero solutions that are
HL7- compliant. Could this be improved? For Sabutsch, I
believe this will change in the next years, when the need
for interconnecting the ambulatory IT-systems will
grow. This process will be facilitated by the free avail-
ability of HL7 standards.
If the move to making HL7 more open comes with all
these potential positives, what of the technical aspect
what is the state of play around progress regarding
functionality, in other words? Sabutsch told us that
while Version V2.x is still being heavily used and indeed
is still evolving, Version 3 (V3) is denitely a factor, with
a focus on CDA Release 3 in particular. The Vienna con-
ference, he says, highlighted work on something called
FHIR (Fast Healthcare Interoperability Resources),
which is designed to overcome the complexity (Herr
Sabutschs adjective) of V3.
The Vienna conference highlighted work on FHIR, Fast Healthcare Interoperability Resources.
There were quite a few raised
eyebrows in the community about
the organisations decision to make
its standards freely available.
TECHNOLOGY UPDATE
For too long, the vital work performed by nurses
has been invisible to even the most comprehen-
sive EHRs. Use of standardised nursing language
(SNL) could help, say expertsthough a lot of
research still needs to be done.
ELECTRONIC HEALTH RECORDS (EHRS) may be miss-
ing proper capture of a vital element in patient care:
what nurses do. Until now, its been very dicult to
measure nurses contribution to the health of patients
in any computerised system. To understand just why
nursing-sensitive patient outcomes are hard to describe
and measure, remember:
Nurse entries in the patient record are in mostly
narrative form, unstructured, full of redundancies and
not representing which nursing-sensitive outcomes are
obtained in a present patient situation.
A standardised way of coding nursing diagnoses,
interventions and outcomes for all kinds of analyses is
not yet implemented in practice, let alone into EHRs.
Nurses currently lack training and education
to work with any standardised language in actual
patient situations.
Nurses dont have regular access to a (computer-
based) tool that enables them to document the nursing
process, assess ndings, interventions and outcomes in
any kind of a structured way. The majority of nursing
documentation is hand writen.
Some fear that until we nd a way to map nursing
expertise into EHRs, vital clues into how to propagate
best clinical practice will continue to be missed. But
proponents of SNLthe Standardised Nursing Lan-
guagesay that by providing a means to clearly name
and label nursing diagnoses, interventions and out-
comes, huge progress could be made.
Making nursing knowledge explicit
and beter documented
Research is now underway into how to get nurses
talking SNL at the ward level to feed into such records.
That research suggests the introduction of SNL-
based, uniform accreditation criteria to assess nursing
documentation may indeed provide both hospital man-
agement and nursing sta a great tool for measuring
nursing documentation quality across hospitals, as well
as opportunities to do hospital benchmark research.
Successful SNL introduction, however, requires
questioning long-held sta assumptions and beliefs
about patient care, the nursing process, nursing as a
disciplineeven on the overall treatment goals the
institution has set out. On the technology side, articial
Using Standardised
Nursing Language (SNL)
in Intelligent Electronic
Health-Care
Documentation
By Gary Flood
This article is a summary of a
research paper writen by Dr.
Wolter Paans, PhD, RN, a lecturer
and researcher at the School of
Nursing, Hanze University of
Applied Sciences, Groningen, the
Netherlands and Dr. Maria Mller-
Staub, PhD, EdN, RN is a professor
in Acute Care and Senior Research-
er, ZHAW University & Director,
Pege PBS, Bronschofen, Switzer-
land. For a link to the full version,
visit htp://himssinsights.eu
Intermitent acute
pain in the right knee
Warm to the touch.
INCORPORATING:
hc2013.bcs.org
BCS Health, part of the Chartered Institute of IT,
has been organising the leading conference for HIT
professionals since 1983. For 2013, the BCS has joined
with HIMSS, a leading not-for-prot society dedicated
to advancing healthcare through information technology.
Working together, we have created an unprecedented conference and exhibition
with unparalleled dedication, professional resources and access to the leaders and
ideas that are transforming healthcare. HC2013 will deliver more new information
and professional networking opportunities than any prior event:
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hours of conferencing content
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debate over two days
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nationally and internationally
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access to recorded sessions and
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E: ben.webber@citadelevents.co.uk
Delegates can register FREE
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hc2013.bcs.org
16-17 APRIL 2013 ICC BIRMINGHAM UK
The National
Health IT
Conference &
Exhibition
HC2013_0032945685-HIMSS-A4-Ad-2-Nov12.indd 1 01/11/2012 13:58 HIMSS Europe_mag_v15.indd 58 11/1/12 11:09 PM
59
INCORPORATING:
hc2013.bcs.org
BCS Health, part of the Chartered Institute of IT,
has been organising the leading conference for HIT
professionals since 1983. For 2013, the BCS has joined
with HIMSS, a leading not-for-prot society dedicated
to advancing healthcare through information technology.
Working together, we have created an unprecedented conference and exhibition
with unparalleled dedication, professional resources and access to the leaders and
ideas that are transforming healthcare. HC2013 will deliver more new information
and professional networking opportunities than any prior event:
More Information - Around 65
hours of conferencing content
across fourteen lively streams of
debate over two days
More Speakers Around 300
nationally and internationally
recognised key notes and experts
More Value - Free access to
conferences and exhibition, free
access to recorded sessions and
free HIMSS membership
More networking opportunities -
fringe events, skills zone and
social events
TOGETHER WE GIVE YOU MORE
For information about exhibiting contact:
Ben Webber, Sales Director, Citadel Events
T +44 (0) 1423 526971
E: ben.webber@citadelevents.co.uk
Delegates can register FREE
online here -
hc2013.bcs.org
16-17 APRIL 2013 ICC BIRMINGHAM UK
The National
Health IT
Conference &
Exhibition
HC2013_0032945685-HIMSS-A4-Ad-2-Nov12.indd 1 01/11/2012 13:58 HIMSS Europe_mag_v15.indd 59 11/1/12 11:09 PM
intelligence in the form of expert systems are also seen
as making an important contribution to eective SNL
introduction. Such systems contain pre-dened, correct
linkages between diagnoses, interventions and out-
comes and can guide nurses in diagnostic reasoning, in
choosing and evaluating evidence-based interventions
and outcome indicators.
They could be even more powerful if they could
beter model nursing knowledge, where good team
work with IT can play a role. Successful, sustainable
implementation therefore depends on whole team
developmentbringing together nursing SNL experts,
nursing informaticians and IT developers, clinicians
and hospital management.
Applying systems and organisational learning theory
is also crucial for successful SNL implementation. The
relationships between nursing diagnoses, nursing-sensi-
tive patient outcomes and the best sort of interventions
are key topics for successful implementation of SNLs
into an EHR. To get there, training to skill-up nurses in
SNL is highly recommended.
New ways for more eective auditing
Researchers have also uncovered issues around
auditing. When documentation is assessed, all too
ofen its against standards that dont take into account
nursing-specic approaches. In response, use of quality
indicators based on nursing documentation standards
for international accreditation programmes is highly
recommended. That way, both procedures and the
quality of the documentation content should be easier
measurable and more accurately audited.
If that doesnt happen, incomplete or incorrect
accreditation criteria in nursing that misses evidence-
based diagnoses, interventions and outcome indicators
could end up negatively impacting documentation accu-
racy. Accreditation based on uniform, standardised
criteria, by contrast, provides hospital managers much
beter data to drive improvement. Thats why an SNL-
based accreditation approach may mean much safer
patient handling.
That means that there could be a policy advantage
to local or state governments in pushing for SNL intro-
duction. Since healthcare spend can vary greatly due to
dierent healthcare setings, populations, diseases and
other factors, the more information administrators have
to help route funds, the beter. SNL could be the basis
for building regional or national medical and nursing
data databasesa highly useful tool for retrospective
quality analysis, safety assurance strategies and nan-
cial modelling. SNL-based research, meanwhile, oers
the possibility of ne-grained insight into the nature of
costs of nursing care by scientic benchmarking of hos-
pital expenditures.
The known unknowns of SNL research
It is, however, still early days in some ways on how
to best integrate SNLs into EHRs. Further research on
meaningful use of SNL in the EHR is needed to provide
guidelines for sofware developers, while beter deci-
sion-support tools for prompting higher documentation
accuracy also need to be developed and tested. User ori-
entation and friendliness of applications, information
clustering, data storage and retrieval, interdisciplinary
and cross-disciplinary data exchange among setings
and sites, use of clinical terms communicating critical
information, patients access to their own healthcare
record and means to track critical incidence and patient
safety issues are also at very early stages of understand-
ing. Good examples of areas worth atention; beter
ways of understanding SNL into practice, such as use-
ful applications of SNL in the EHR at shif-turns and/or
hand-over eectiveness, or on the benets of nursing
SNL in the EHR on e ciency of multi-professional co-
operation, for example. Meanwhile, research in multiple
(digital) resources is also needed to show how the use of
documentation standards aects length of stay, quality
of care, or the prevalence of adverse events.
By investing in educated and well trained nurses,
then, using SNL supported by the right IT, feasible,
reliable and valid data suggesting new possibilities for
beter control of medical cost and improving e ciency
could be on the horizon. Still, there are just too few stud-
ies as yet on using SNL in an EHR context. For instance,
the eects of the implementation of such a system on
the accuracy of the nursing documentation itself in
the long-term, and on quality of care, patient safety,
and cost-e ciency in general, remains unknown, while
metrics for scientic assessment of the eect of such
content and system innovations are missing and need
to be developed.
Relocation stress
syndrome
Elevated
respiratory rate
HealthTech Wire talked to Dr Mohammed Hussein, Ra-
diologist and Dell UK Healthcare Imaging & UCA Lead,
about the best options for IT managers, clinicians and
senior executives to cope with this growing demand while
maintaining their budgets and future-proofng their infra-
structure.
What are the main drivers behind the data explosion in
medical imaging?
It has been estimated that already 45% of data storage
capacity in healthcare is dedicated to medical imaging.
Diagnostic Imaging is indeed growing at an unprece-
dented rate and complex digital modalities are creat-
ing even larger studies, while healthcare providers are
acquiring more advanced diagnostic imaging systems
and carrying out more complex procedures than ever
before. These newer imaging systems have higher
resolution and generate more images. This results in
a signifcant impact on storage requirements as a patients
study that used to be measured in megabytes has grown
to gigabytes.
Due to the intricacy of implementing retention policies
and disaster recovery strategies for these images/studies,
most healthcare providers are retaining the digital data
forever and/or using unreliable media such as tapes or
DVDs, which has added to the challenge. Meanwhile soft-
ware applications are changing as technology advances
and the adoption of digital imaging beyond just radiology
and cardiology is increasing. This creates overwhelming
and immediate needs for migrating data between storage
solutions to accommodate new formats.
Currently there is a PACS in most hospitals across Eng-
land, with regional data stores implemented as part of
the National Programme for IT, has this not solved the
hospitals data storage problems?
PACS solved the problem of workfow and ease of ac-
cess. We used to use flm, which obviously is very limiting
because you have to physically carry it around and have
large flm rooms to store them. With PACS, the workfow
becomes much easier as storage is on disk and images
can be viewed easily across sites.
As for storage and central data stores, the challenge is
that the data is stored in silos and usually locked in with
the PACS that put the images on the archive, so accessing
and viewing these images by other systems presents a
challenge.
Silos are certainly a challenge from a clinical and IT per-
spective. Other ologies besides radiology such
as pathology, cardiology, oncology, mammography and
dental, with each running their own proprietary infra-
structure and storage system adds signifcant cost
and management overhead, as well as a far from seam-
less clinical access to the full patient record. Add to the
mix separate locations with multiple healthcare
Medical imaging is driving a data storage explosion in hospitals. This requires innovative
solutions to manage the growing demands of the future.
Is the Image Data in your PACS
growing faster than your IT budget?
Dr Mohammed Hussein, Radiologist and
Dell UK Healthcare Imaging & UCA Lead
HealthTech Wire talked to Dr Mohammed Hussein, Ra-
diologist and Dell UK Healthcare Imaging & UCA Lead,
about the best options for IT managers, clinicians and
senior executives to cope with this growing demand while
maintaining their budgets and future-proofng their infra-
structure.
What are the main drivers behind the data explosion in
medical imaging?
It has been estimated that already 45% of data storage
capacity in healthcare is dedicated to medical imaging.
Diagnostic Imaging is indeed growing at an unprece-
dented rate and complex digital modalities are creat-
ing even larger studies, while healthcare providers are
acquiring more advanced diagnostic imaging systems
and carrying out more complex procedures than ever
before. These newer imaging systems have higher
resolution and generate more images. This results in
a signifcant impact on storage requirements as a patients
study that used to be measured in megabytes has grown
to gigabytes.
Due to the intricacy of implementing retention policies
and disaster recovery strategies for these images/studies,
most healthcare providers are retaining the digital data
forever and/or using unreliable media such as tapes or
DVDs, which has added to the challenge. Meanwhile soft-
ware applications are changing as technology advances
and the adoption of digital imaging beyond just radiology
and cardiology is increasing. This creates overwhelming
and immediate needs for migrating data between storage
solutions to accommodate new formats.
Currently there is a PACS in most hospitals across Eng-
land, with regional data stores implemented as part of
the National Programme for IT, has this not solved the
hospitals data storage problems?
PACS solved the problem of workfow and ease of ac-
cess. We used to use flm, which obviously is very limiting
because you have to physically carry it around and have
large flm rooms to store them. With PACS, the workfow
becomes much easier as storage is on disk and images
can be viewed easily across sites.
As for storage and central data stores, the challenge is
that the data is stored in silos and usually locked in with
the PACS that put the images on the archive, so accessing
and viewing these images by other systems presents a
challenge.
Silos are certainly a challenge from a clinical and IT per-
spective. Other ologies besides radiology such
as pathology, cardiology, oncology, mammography and
dental, with each running their own proprietary infra-
structure and storage system adds signifcant cost
and management overhead, as well as a far from seam-
less clinical access to the full patient record. Add to the
mix separate locations with multiple healthcare
Medical imaging is driving a data storage explosion in hospitals. This requires innovative
solutions to manage the growing demands of the future.
Is the Image Data in your PACS
growing faster than your IT budget?
Dr Mohammed Hussein, Radiologist and
Dell UK Healthcare Imaging & UCA Lead
providers and the challenge becomes more signifcant.
There is a global move towards HIE (health information
exchange) and we want to help healthcare organisations
move away from expensive silos to more cost-efective,
vendor neutral image stores while having access to all of
the patient data in one system and viewing through one
unifed portal.
How do you solve these challenges while reducing the
fnancial impact on healthcare providers?
The Dell Unifed Clinical Archive (UCA) solution is a medical
data management and archiving solution that enables health-
care organisations to optimally manage, archive and retrieve
fxed content such as medical images and patient informa-
tion. It does this in a manner that is cost-efective, secure
and compliant with healthcare regulatory guidelines. We rec-
ognize that the healthcare ecosystem has several vendors
and interoperability and information sharing between stake-
holders is key for delivering quality care. So we approach
this connected health strategy in two ways. First, we provide
a secure, cloud-based platform for better integration and
co-ordination. Dell has the capability to deliver cloud-
based data archiving and management solutions we
have over 12 years experience, managing over 5 bil-
lion medical imaging objects and 72 million studies in the
cloud across 800 clinical sites. You can actually see a live
count on the Dell website at www.dell.com/UCA-ticker
Our work in delivering the London PACS programme
has given us extensive experience in large-scale deploy-
ments. In fact, we manage the largest number of con-
current systems integrated into a secure, cloud-based
archive delivery model with over 28 PACS and hundreds of
modalities, DICOM versions and associated non-imaging
data sources.
Second, we provide a truly vendor neutral archive (VNA).
Being locked into a single vendor or a proprietary system
is not a fexible, scalable solution. Our approach is to com-
bine best-of-breed components from multiple vendors,
along with our own Dell image archiving technology, and
ofer choice that fts with a customers goals and needs,
not ours. Success with a complex, multivendor system re-
quires skilful integration and sophisticated back-end sup-
port and Dell does of all that integration for the customer.
A true VNA, one that is capable of handling current and
future requirements for image management and storage,
must integrate disparate components and systems. Be
wary of a system that doesnt.
What are the advantages of implementing a cloud-based
VNA solution and how can it help hospitals deliver with
decreasing budgets and increasing requirements?
There are several advantages: IT, clinical and fnancial.
From an IT managers perspective the advantage is
Our UCA solution is focused on meeting your needs, at your speed. Choice and exibility are built in, giving
you a range of options that help you easily adapt to ever-changing workow technologies and business models.
It starts with Clinical Data Management for data consolidation. We ofer a choice of multiple VNA software
partners for managing data based on your requirements, matching their features and capabilities to your needs.
Choice and exibility are built into how the solution is deployed, as well. We can implement an On-Premise
Clinical Archive using the DX6000 platform which features Intel
Xeon
processors, or implement it of-site with

the Cloud Clinical Archive that allows for instantaneous scaling along with reliable disaster recovery and business
continuity. This combination of Capex and/or Opex-based business models enables you to customise the solution
according to your operational and nancial requirements.
Then the Clinical Collaboration Portal ensures that you can directly access images in the archive in the event
of a disaster, providing the operational continuity so critical to healthcare environments. The Portal also facilitates
image enablement of Electronic Medical Records, and sharing of data through a Health Information Exchange.
Dells Unified Clinical Archive
Solution Offers Choice & Flexibility.
Scalable, Secure,
Recoverable and Compliant
Dells UCA solution is designed to be innitely scalable, yet secure and recoverable in the event of a disaster, while
maintaining compliance with regulatory standards.
Scalable Dells UCA solution integrates with industry leading PACS delivered either locally or remotely
through an Archiving-as-a-Service model. These solutions enable you to easily manage medical
imaging data objects that adhere to standards-based IHE (Integrating the Healthcare Enterprise)
protocols of DICOM and non-DICOM le formats (including XDS-I), providing ease of sharing and
exchange in an application-neutral enterprise archive. And Dells UCA solution provides a standards-
based approach to ensure high availability and full support for automated IHE integrated workow.
Secure and Recoverable The Dell On-Premise Clinical Archive can be paired with the Dell Cloud Clinical
Archive for of-site disaster recovery redundancy and instant capacity expansion. Two copies of every image are
stored in separate locations, providing robust and secure disaster recovery.
Compliant The intelligent data management system of the Dell UCA consolidates data for each
patient from all your PACS and proprietary clinical applications into a standards based platform that is
optimised for retention, recovery and distribution. This solution uses standards-based workow protocol
conforming to IHE guidelines. The archiving platform complies with IT needs as well, by providing
automated and secure policy-based retention, replication, distribution and self-healing, so IT staf will
spend less time on routine maintenance, while promoting compliance with regulatory guidelines.
Dells Unified Clinical Archive Solution
Simplified image archive storage, management and access
Dell On-Premise Clinical Archive
Object based storage platform
Dell Cloud Clinical Archive
Managed enterprise archive
Dell Clinical Data Management System
Data consolidation and information life cycle management
Dell Clinical Collaboration Portal
Cross enterprise data accesibility and distribution
Radiology Cardiology Pathology Other Imaging/Clinical Modalities
BRO_015_PUB_UnifiedClinicalArchive_Brochure_IMPOSED.indd 7-8 2/1/2012 12:21:15 PM
Dell
Dr. Mohammed Hussein
mohammed_hussein@dell.com
+44 207 892 1000
www.dell.co.uk/ClinicalArchiving
that it takes away the operational and cost impact of man-
aging all of the silos locally, then having to migrate them
to a new solution, then do it over again in a few years at
technology refresh/contract renewal time. A cloud-based
solution also answers any security, disaster recovery or
upgrade/update concerns as it is proactively monitored
and protected 24x7 to prevent against embarrassing med-
ical data breeches, expensive penalties, and ensure com-
pliance. It provides diferent healthcare organisations with
an efcient VNA solution to support healthcare IT budget
challenges while covering all the technology refreshes. Es-
sentially we take the cost and hassle out of managing the
archives for the IT department.
For clinicians it is critical to have access to patients imag-
es in a seamless, easy way, both when and where needed.
This is where having a vendor neutral archive with exten-
sive integration ability and unifed viewing ability comes in
to its own consolidating images onto a single platform
that can communicate seamlessly using industry stand-
ards to other clinical systems using DICOM, HL7, XDS-I
and HTTPS. Direct access is delivered by having a unifed
viewer for viewing all the images on the archive whether at
the bedside or on the go.
Planning future requirements and upgrades, it is always
quite tricky to try and forecast how many terabytes a
healthcare organisation will need the next year, but usually
straightforward to forecast how many studies are expect-
ed. With an OpEx-based pay-per-study model, healthcare
organisations dont have to pay a fortune in advance for
terabytes of storage. We make it easy to work out next
years storage budget and only pay for what you use.
What happens if there are problems on the network
connecting the cloud and the hospital?
There are multiple locations where the data is stored be-
cause redundancy is critical to the operation of the solu-
tion to safeguard the patient data. The overall solution has
several redundancies built into it with a local cache that is
confgurable depending on the customer requirement and
utilisation. The solution has multiple redundancies and
keeps several copies within its archives to guard against
any data loss.
Implementing technology in a clinical setting can be
tricky, is that why Dell is one of the few IT companies to
have a chief medical offcer?
For Dell its more than the technology, it is how technol-
ogy works in a clinical setting. We are not just looking at
selling a product to our customers but making sure that
the technology and end-to-end solutions we deliver are in-
strumental to patient care and help doctors focus on care
delivery rather than technology. We are thinking of the pa-
tient care pathway and how fast images can be accessed
at the point of care.
Having a chief medical ofcer makes sure that there is
continuous clinical focus and that we deliver solutions
that make a diference while implementing them in a way
that works for the hospitals. Dell has a deep understand-
ing and experience of implementing technology in a clini-
cal setting as clinicians make up 15% of our consultants.
This ensures we constantly deliver in the context of patient
care and clinical workfow. As a clinician I am quite excited
to work for Dell with its focus on Healthcare and transfor-
mation to end-to-end solutions that make a diference in
patient care.
Dr Hussein, thank you very much for the interview.
(HTW)
63
providers and the challenge becomes more signifcant.
There is a global move towards HIE (health information
exchange) and we want to help healthcare organisations
move away from expensive silos to more cost-efective,
vendor neutral image stores while having access to all of
the patient data in one system and viewing through one
unifed portal.
How do you solve these challenges while reducing the
fnancial impact on healthcare providers?
The Dell Unifed Clinical Archive (UCA) solution is a medical
data management and archiving solution that enables health-
care organisations to optimally manage, archive and retrieve
fxed content such as medical images and patient informa-
tion. It does this in a manner that is cost-efective, secure
and compliant with healthcare regulatory guidelines. We rec-
ognize that the healthcare ecosystem has several vendors
and interoperability and information sharing between stake-
holders is key for delivering quality care. So we approach
this connected health strategy in two ways. First, we provide
a secure, cloud-based platform for better integration and
co-ordination. Dell has the capability to deliver cloud-
based data archiving and management solutions we
have over 12 years experience, managing over 5 bil-
lion medical imaging objects and 72 million studies in the
cloud across 800 clinical sites. You can actually see a live
count on the Dell website at www.dell.com/UCA-ticker
Our work in delivering the London PACS programme
has given us extensive experience in large-scale deploy-
ments. In fact, we manage the largest number of con-
current systems integrated into a secure, cloud-based
archive delivery model with over 28 PACS and hundreds of
modalities, DICOM versions and associated non-imaging
data sources.
Second, we provide a truly vendor neutral archive (VNA).
Being locked into a single vendor or a proprietary system
is not a fexible, scalable solution. Our approach is to com-
bine best-of-breed components from multiple vendors,
along with our own Dell image archiving technology, and
ofer choice that fts with a customers goals and needs,
not ours. Success with a complex, multivendor system re-
quires skilful integration and sophisticated back-end sup-
port and Dell does of all that integration for the customer.
A true VNA, one that is capable of handling current and
future requirements for image management and storage,
must integrate disparate components and systems. Be
wary of a system that doesnt.
What are the advantages of implementing a cloud-based
VNA solution and how can it help hospitals deliver with
decreasing budgets and increasing requirements?
There are several advantages: IT, clinical and fnancial.
From an IT managers perspective the advantage is
Our UCA solution is focused on meeting your needs, at your speed. Choice and exibility are built in, giving
you a range of options that help you easily adapt to ever-changing workow technologies and business models.
It starts with Clinical Data Management for data consolidation. We ofer a choice of multiple VNA software
partners for managing data based on your requirements, matching their features and capabilities to your needs.
Choice and exibility are built into how the solution is deployed, as well. We can implement an On-Premise
Clinical Archive using the DX6000 platform which features Intel
Xeon
processors, or implement it of-site with

the Cloud Clinical Archive that allows for instantaneous scaling along with reliable disaster recovery and business
continuity. This combination of Capex and/or Opex-based business models enables you to customise the solution
according to your operational and nancial requirements.
Then the Clinical Collaboration Portal ensures that you can directly access images in the archive in the event
of a disaster, providing the operational continuity so critical to healthcare environments. The Portal also facilitates
image enablement of Electronic Medical Records, and sharing of data through a Health Information Exchange.
Dells Unified Clinical Archive
Solution Offers Choice & Flexibility.
Scalable, Secure,
Recoverable and Compliant
Dells UCA solution is designed to be innitely scalable, yet secure and recoverable in the event of a disaster, while
maintaining compliance with regulatory standards.
Scalable Dells UCA solution integrates with industry leading PACS delivered either locally or remotely
through an Archiving-as-a-Service model. These solutions enable you to easily manage medical
imaging data objects that adhere to standards-based IHE (Integrating the Healthcare Enterprise)
protocols of DICOM and non-DICOM le formats (including XDS-I), providing ease of sharing and
exchange in an application-neutral enterprise archive. And Dells UCA solution provides a standards-
based approach to ensure high availability and full support for automated IHE integrated workow.
Secure and Recoverable The Dell On-Premise Clinical Archive can be paired with the Dell Cloud Clinical
Archive for of-site disaster recovery redundancy and instant capacity expansion. Two copies of every image are
stored in separate locations, providing robust and secure disaster recovery.
Compliant The intelligent data management system of the Dell UCA consolidates data for each
patient from all your PACS and proprietary clinical applications into a standards based platform that is
optimised for retention, recovery and distribution. This solution uses standards-based workow protocol
conforming to IHE guidelines. The archiving platform complies with IT needs as well, by providing
automated and secure policy-based retention, replication, distribution and self-healing, so IT staf will
spend less time on routine maintenance, while promoting compliance with regulatory guidelines.
Dells Unified Clinical Archive Solution
Simplified image archive storage, management and access
Dell On-Premise Clinical Archive
Object based storage platform
Dell Cloud Clinical Archive
Managed enterprise archive
Dell Clinical Data Management System
Data consolidation and information life cycle management
Dell Clinical Collaboration Portal
Cross enterprise data accesibility and distribution
Radiology Cardiology Pathology Other Imaging/Clinical Modalities
BRO_015_PUB_UnifiedClinicalArchive_Brochure_IMPOSED.indd 7-8 2/1/2012 12:21:15 PM
Dell
Dr. Mohammed Hussein
mohammed_hussein@dell.com
+44 207 892 1000
www.dell.co.uk/ClinicalArchiving
that it takes away the operational and cost impact of man-
aging all of the silos locally, then having to migrate them
to a new solution, then do it over again in a few years at
technology refresh/contract renewal time. A cloud-based
solution also answers any security, disaster recovery or
upgrade/update concerns as it is proactively monitored
and protected 24x7 to prevent against embarrassing med-
ical data breeches, expensive penalties, and ensure com-
pliance. It provides diferent healthcare organisations with
an efcient VNA solution to support healthcare IT budget
challenges while covering all the technology refreshes. Es-
sentially we take the cost and hassle out of managing the
archives for the IT department.
For clinicians it is critical to have access to patients imag-
es in a seamless, easy way, both when and where needed.
This is where having a vendor neutral archive with exten-
sive integration ability and unifed viewing ability comes in
to its own consolidating images onto a single platform
that can communicate seamlessly using industry stand-
ards to other clinical systems using DICOM, HL7, XDS-I
and HTTPS. Direct access is delivered by having a unifed
viewer for viewing all the images on the archive whether at
the bedside or on the go.
Planning future requirements and upgrades, it is always
quite tricky to try and forecast how many terabytes a
healthcare organisation will need the next year, but usually
straightforward to forecast how many studies are expect-
ed. With an OpEx-based pay-per-study model, healthcare
organisations dont have to pay a fortune in advance for
terabytes of storage. We make it easy to work out next
years storage budget and only pay for what you use.
What happens if there are problems on the network
connecting the cloud and the hospital?
There are multiple locations where the data is stored be-
cause redundancy is critical to the operation of the solu-
tion to safeguard the patient data. The overall solution has
several redundancies built into it with a local cache that is
confgurable depending on the customer requirement and
utilisation. The solution has multiple redundancies and
keeps several copies within its archives to guard against
any data loss.
Implementing technology in a clinical setting can be
tricky, is that why Dell is one of the few IT companies to
have a chief medical offcer?
For Dell its more than the technology, it is how technol-
ogy works in a clinical setting. We are not just looking at
selling a product to our customers but making sure that
the technology and end-to-end solutions we deliver are in-
strumental to patient care and help doctors focus on care
delivery rather than technology. We are thinking of the pa-
tient care pathway and how fast images can be accessed
at the point of care.
Having a chief medical ofcer makes sure that there is
continuous clinical focus and that we deliver solutions
that make a diference while implementing them in a way
that works for the hospitals. Dell has a deep understand-
ing and experience of implementing technology in a clini-
cal setting as clinicians make up 15% of our consultants.
This ensures we constantly deliver in the context of patient
care and clinical workfow. As a clinician I am quite excited
to work for Dell with its focus on Healthcare and transfor-
mation to end-to-end solutions that make a diference in
patient care.
Dr Hussein, thank you very much for the interview.
(HTW)
In healthcare, security technology is usually perceived
as something that hampers workfows and makes
access to relevant patient data more diffcult. Is this
really the case?
It is not! On the contrary, setting up an intelligent iden-
tity and access management solution can be hugely
benefcial for a hospital. It increases security, enhanc-
es compliance with relevant regulations in the respec-
tive country and, if done correctly, it actually speeds up
workfows considerably and reduces the workload for
the medical staf.
How can this be achieved?

What is needed is a coherent infrastructure for single
sign-on and authentication. Most doctors do not work on
a specifc workstation all day, but change computers
regularly, some of them 50 or more times a day. This
means that they have to log on the same information sys-
tems again and again. But this is completely unnecessary.
With a single sign-on solution, the doctor or nurse can log
onto any computer in a hospital with the help of a proxim-
ity badge, a fngerprint reader or other identifcation tech-
nologies. And they can continue to work on exactly the
same screen as before.
We have calculated that on average a doctor saves about
25 to 30 minutes per day when the hospital introduces a
single sign-on solution from Imprivata time that can be
used to improve patient care. It also increases the compli-
ance with security and privacy requirements and is thus in
the interest of the hospitals information governance com-
mittee and the board.
How should a hospital without experience in
this feld approach the issue of single sign-on and
authentication?
How can the adoption of electronic medical records in hospitals be accelerated? By
streamlining authentication and access procedures, argues Mark Clark, Vice President
of International Sales at the UK-based company Imprivata. HealthTech Wire has talked
to the IT and security specialist in the run-up to Medica.
Speed up EMR adoption by streamlining security
Mark Clark, Vice President of International Sales, Imprivata
It is important to specify exactly what the customer wants
before a system is installed. What we then recommend
is a phased approach: specify which departments have
the highest priority and then start with these before rolling
out the system to other departments. Many hospitals start
with the emergency room because of the number of doc-
tors and caregivers that work there and all use the same
computers.
What kind of hardware do you recommend for the single
sign-on and authentication procedure?
This very much depends on what the customer prefers,
the environment and the existing infrastructure. We ofer
various modalities: fngerprint readers, proximity badges,
facial recognition and others. Facial recognition in particu-
lar can be very efcient for what we call a secure walk-
away. The user leaves a workstation and a camera, with
the help of the software, is able to recognise the user has
left, prompting an action such as darkening or locking the
screen. When the same user returns, they are recognised
by the computer and the screen unlocks without any ac-
tion from the user.
There are many companies that offer solutions for iden-
tity and access management. Why is Imprivata a good
choice?
We specialise in healthcare and have built up contacts
with major software providers over a number of years
HIS, EMR, radiology and many more. We have a special-
ised service team that analyses workfows together with
the customer to plan thoroughly before implementation.
We ofer tight integration with key HIS systems such as
Agfa, iSOFT/CSC, Siemens, Epic and many other special-
ists all over Europe.

These are certainly advantages as our expertise in under-
standing thousands of healthcare workfows by working
closely with many customers means that once a contract
is signed, we are very quick to get a system into use. As
a result, we are the most widely deployed in Europe, with
many satisfed clinical users in the UK, but also in Austria,
Switzerland, France and other European countries. We un-
derstand the many diferent healthcare markets in Europe
as well as their diferent needs.
Why do you choose Medica to show your security
software?
Medica is the largest event of its kind and attracts interna-
tional visitors from all technical and clinical areas of health-
care. This makes it an important event in terms of dissem-
inating knowledge about electronic medical records. A
key issue in the feld of hospital information systems is to
increase their adoption. Many hospitals and regional care
networks have HIS systems in place, but often they are
not used sufciently. A single sign-on and authentication
solution is a way to accelerate HIS adoption and we would
very much like to spread this message to all who would be
involved in adopting and using an EMR.
Mr Clark, thank you very much for the interview.
(HTW)
Imprivata
+44 (0) 1923 226759
sales@imprivata.com
www.imprivata.com
V
is
it
Im
p
riv
a
ta
in
h
a
ll 1
5
,
b
o
o
th
B
1
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.
65
In healthcare, security technology is usually perceived
as something that hampers workfows and makes
access to relevant patient data more diffcult. Is this
really the case?
It is not! On the contrary, setting up an intelligent iden-
tity and access management solution can be hugely
benefcial for a hospital. It increases security, enhanc-
es compliance with relevant regulations in the respec-
tive country and, if done correctly, it actually speeds up
workfows considerably and reduces the workload for
the medical staf.
How can this be achieved?

What is needed is a coherent infrastructure for single
sign-on and authentication. Most doctors do not work on
a specifc workstation all day, but change computers
regularly, some of them 50 or more times a day. This
means that they have to log on the same information sys-
tems again and again. But this is completely unnecessary.
With a single sign-on solution, the doctor or nurse can log
onto any computer in a hospital with the help of a proxim-
ity badge, a fngerprint reader or other identifcation tech-
nologies. And they can continue to work on exactly the
same screen as before.
We have calculated that on average a doctor saves about
25 to 30 minutes per day when the hospital introduces a
single sign-on solution from Imprivata time that can be
used to improve patient care. It also increases the compli-
ance with security and privacy requirements and is thus in
the interest of the hospitals information governance com-
mittee and the board.
How should a hospital without experience in
this feld approach the issue of single sign-on and
authentication?
How can the adoption of electronic medical records in hospitals be accelerated? By
streamlining authentication and access procedures, argues Mark Clark, Vice President
of International Sales at the UK-based company Imprivata. HealthTech Wire has talked
to the IT and security specialist in the run-up to Medica.
Speed up EMR adoption by streamlining security
Mark Clark, Vice President of International Sales, Imprivata
It is important to specify exactly what the customer wants
before a system is installed. What we then recommend
is a phased approach: specify which departments have
the highest priority and then start with these before rolling
out the system to other departments. Many hospitals start
with the emergency room because of the number of doc-
tors and caregivers that work there and all use the same
computers.
What kind of hardware do you recommend for the single
sign-on and authentication procedure?
This very much depends on what the customer prefers,
the environment and the existing infrastructure. We ofer
various modalities: fngerprint readers, proximity badges,
facial recognition and others. Facial recognition in particu-
lar can be very efcient for what we call a secure walk-
away. The user leaves a workstation and a camera, with
the help of the software, is able to recognise the user has
left, prompting an action such as darkening or locking the
screen. When the same user returns, they are recognised
by the computer and the screen unlocks without any ac-
tion from the user.
There are many companies that offer solutions for iden-
tity and access management. Why is Imprivata a good
choice?
We specialise in healthcare and have built up contacts
with major software providers over a number of years
HIS, EMR, radiology and many more. We have a special-
ised service team that analyses workfows together with
the customer to plan thoroughly before implementation.
We ofer tight integration with key HIS systems such as
Agfa, iSOFT/CSC, Siemens, Epic and many other special-
ists all over Europe.

These are certainly advantages as our expertise in under-
standing thousands of healthcare workfows by working
closely with many customers means that once a contract
is signed, we are very quick to get a system into use. As
a result, we are the most widely deployed in Europe, with
many satisfed clinical users in the UK, but also in Austria,
Switzerland, France and other European countries. We un-
derstand the many diferent healthcare markets in Europe
as well as their diferent needs.
Why do you choose Medica to show your security
software?
Medica is the largest event of its kind and attracts interna-
tional visitors from all technical and clinical areas of health-
care. This makes it an important event in terms of dissem-
inating knowledge about electronic medical records. A
key issue in the feld of hospital information systems is to
increase their adoption. Many hospitals and regional care
networks have HIS systems in place, but often they are
not used sufciently. A single sign-on and authentication
solution is a way to accelerate HIS adoption and we would
very much like to spread this message to all who would be
involved in adopting and using an EMR.
Mr Clark, thank you very much for the interview.
(HTW)
Imprivata
+44 (0) 1923 226759
sales@imprivata.com
www.imprivata.com
V
is
it
Im
p
riv
a
ta
in
h
a
ll 1
5
,
b
o
o
th
B
1
6
a
t
M
e
d
ic
a
.
Healthcare professionals and IT management at Savonlin-
na Central Hospital have been working since 2002 to de-
velop a patient data system that has always been charac-
terised by the keywords of compatibility, process support
and user-centeredness.
The groups achievement has recently been acknowledged
by the Healthcare Information and Management Systems
Society (HIMSS), which in May awarded Savonlinna a
prestigious prize for best practice in healthcare IT at the
World of Health IT (WoHIT) event in Copenhagen.
The frst hospital in its nation to receive such recognition,
the hospitals IT system was judged to have reached a
very high 6 on the HIMSS EMR Adoption curve, indicating
among other achievements that a functioning clinical deci-
sion support system is in place to provide guidance for all
clinician activities related to protocols and outcomes in the
form of variance and compliance alerts.
East Savo Hospital District provides secondary health care
services to 46,000 people in six local communities in east-
ern Finland. The districts central hospital is in Savonlinna.
According to Ari Ptsi, CIO of East Savo Hospital District,
his goal has been that every IT purchase supports high
quality patient care. In turn, a key representative of the
clinical side, Tuija Kallio, Head Physician, Emergency Med-
icine, Information Management, adds that, Here in Savon-
linna, the importance of collaboration between information
management and those involved in clinical work has been
understood from the start. Patient care processes rely on
jointly agreed models of operation and electronic data
transfer.
According to Tuija Kallio healthcare professionals need to
actively take part in the development of the hospital in-
formation system - and that IT, in turn, needs to under-
stand its fundamental role as an important support service.
Development ideas have to come from the users.
Healthcare IT underpinning the work of a Finnish Central Hospital have been held to be truly user-centred
a distinction that has just helped the body win a major international award for IT excellence.
High-quality IT delivering quality care
at Finlands Savonlinna Central Hospital
Ari Ptsi, CIO of East Savo Hospital District
In Savonlinna, cooperation between information manage-
ment and users has always been smooth, Kallio says.
Ptsi agrees - and also says it is productive that the clinical
staf is demanding in terms of the kind of functionality
it wants, technology-wise, from IT. It motivates us in IT
management, too, to always demand the most user-friend-
ly solution. And when weighing up diferent solutions, the
ability to judge what best serves the organisation as a
whole is key.
Key design principles central to project success
The work in the Central Hospital has been guided
by a number of key principles, says the team. These are:
data stored in the system should be used actively - not
just in high-quality patient care, but also in managing
and further developing the hospital operations
applications get introduced one at a time, anticipating
changes in the operating environment
development of the hospital information system entity
is a continuous process, founded on active, real-time
observation of the organisation in practice.
Data is fed into the system just once. Thereafter it is at
the immediate disposal of all parties, points out Ptsi.
That means that electronic medical records, referrals and
regulations, structural recording, imaging and laboratory,
medication tools, a common database for primary health-
care and secondary healthcare, electronic prescriptions
and decision support - a raft of key healthcare applications
- have all been successfully linked to a core database.
Patient details always available
What has been the single biggest game-changer out of
all this hard work? According to Kallio, that has to be the
merging of the primary healthcare and secondary health-
care databases.
I can see a patients complete history in one go. The fact
that any data entered into the system is immediately at the
disposal of other care professionals involved in the patients
treatment is a signifcant asset. For example, up-to-date
medication data makes the work of the joint emergency
service much more efcient, she says.
Meanwhile, for the joint emergency service, it is absolutely
vital from a patient care perspective that up-to-date infor-
mation passes smoothly between diferent sub-systems.
At Savonlinna, single sign-on to applications is also in use.
That means that, If Im asked to consult on a patients
treatment, Im able to go over his or her care history im-
mediately and enter instructions for the care profession-
als involved in treating the patient. Irrespective of whether
the patient is a primary or secondary healthcare customer,
details of medication, laboratory answers and X-rays are
always at my disposal.
In addition, without an all-embracing patient data system
a new regional telephone helpline serving patients would
also still just be a dream. Now that they have patient data
centrally available, nurses are able to provide hundreds of
patients a day with quality care via the helpline, says Kallio.

The hospitals prime technology partner is Tieto, the lead-
ing healthcare and welfare IT solution provider in the Nor-
dic countries with a strong position in Germany and the
Netherlands.
Tieto Healthcare & Welfare
Petri Turtiainen
petri.turtiainen@tieto.com
+35 820 726 7201
Tuija Kallio, Head Physician, Emergency Medicine,
Information Management, Savonlinna Central Hospital
Healthcare professionals and IT management at Savonlin-
na Central Hospital have been working since 2002 to de-
velop a patient data system that has always been charac-
terised by the keywords of compatibility, process support
and user-centeredness.
The groups achievement has recently been acknowledged
by the Healthcare Information and Management Systems
Society (HIMSS), which in May awarded Savonlinna a
prestigious prize for best practice in healthcare IT at the
World of Health IT (WoHIT) event in Copenhagen.
The frst hospital in its nation to receive such recognition,
the hospitals IT system was judged to have reached a
very high 6 on the HIMSS EMR Adoption curve, indicating
among other achievements that a functioning clinical deci-
sion support system is in place to provide guidance for all
clinician activities related to protocols and outcomes in the
form of variance and compliance alerts.
East Savo Hospital District provides secondary health care
services to 46,000 people in six local communities in east-
ern Finland. The districts central hospital is in Savonlinna.
According to Ari Ptsi, CIO of East Savo Hospital District,
his goal has been that every IT purchase supports high
quality patient care. In turn, a key representative of the
clinical side, Tuija Kallio, Head Physician, Emergency Med-
icine, Information Management, adds that, Here in Savon-
linna, the importance of collaboration between information
management and those involved in clinical work has been
understood from the start. Patient care processes rely on
jointly agreed models of operation and electronic data
transfer.
According to Tuija Kallio healthcare professionals need to
actively take part in the development of the hospital in-
formation system - and that IT, in turn, needs to under-
stand its fundamental role as an important support service.
Development ideas have to come from the users.
Healthcare IT underpinning the work of a Finnish Central Hospital have been held to be truly user-centred
a distinction that has just helped the body win a major international award for IT excellence.
High-quality IT delivering quality care
at Finlands Savonlinna Central Hospital
Ari Ptsi, CIO of East Savo Hospital District
In Savonlinna, cooperation between information manage-
ment and users has always been smooth, Kallio says.
Ptsi agrees - and also says it is productive that the clinical
staf is demanding in terms of the kind of functionality
it wants, technology-wise, from IT. It motivates us in IT
management, too, to always demand the most user-friend-
ly solution. And when weighing up diferent solutions, the
ability to judge what best serves the organisation as a
whole is key.
Key design principles central to project success
The work in the Central Hospital has been guided
by a number of key principles, says the team. These are:
data stored in the system should be used actively - not
just in high-quality patient care, but also in managing
and further developing the hospital operations
applications get introduced one at a time, anticipating
changes in the operating environment
development of the hospital information system entity
is a continuous process, founded on active, real-time
observation of the organisation in practice.
Data is fed into the system just once. Thereafter it is at
the immediate disposal of all parties, points out Ptsi.
That means that electronic medical records, referrals and
regulations, structural recording, imaging and laboratory,
medication tools, a common database for primary health-
care and secondary healthcare, electronic prescriptions
and decision support - a raft of key healthcare applications
- have all been successfully linked to a core database.
Patient details always available
What has been the single biggest game-changer out of
all this hard work? According to Kallio, that has to be the
merging of the primary healthcare and secondary health-
care databases.
I can see a patients complete history in one go. The fact
that any data entered into the system is immediately at the
disposal of other care professionals involved in the patients
treatment is a signifcant asset. For example, up-to-date
medication data makes the work of the joint emergency
service much more efcient, she says.
Meanwhile, for the joint emergency service, it is absolutely
vital from a patient care perspective that up-to-date infor-
mation passes smoothly between diferent sub-systems.
At Savonlinna, single sign-on to applications is also in use.
That means that, If Im asked to consult on a patients
treatment, Im able to go over his or her care history im-
mediately and enter instructions for the care profession-
als involved in treating the patient. Irrespective of whether
the patient is a primary or secondary healthcare customer,
details of medication, laboratory answers and X-rays are
always at my disposal.
In addition, without an all-embracing patient data system
a new regional telephone helpline serving patients would
also still just be a dream. Now that they have patient data
centrally available, nurses are able to provide hundreds of
patients a day with quality care via the helpline, says Kallio.

The hospitals prime technology partner is Tieto, the lead-
ing healthcare and welfare IT solution provider in the Nor-
dic countries with a strong position in Germany and the
Netherlands.
Tieto Healthcare & Welfare
Petri Turtiainen
petri.turtiainen@tieto.com
+35 820 726 7201
Tuija Kallio, Head Physician, Emergency Medicine,
Information Management, Savonlinna Central Hospital
Where do we stand in terms of wireless technologies in
medicine, compared with other felds?
I think we are still at a very early stage. Healthcare is only
starting to embrace wireless technologies. This is not a
problem of technology, but rather a problem of proper
workfows. We are convinced that the more consumers
get used to wireless devices in their daily routine, the more
they will expect to use these devices for their own health-
care as well.
Where do you see the most important benefts of wire-
less medical devices?
There are many studies that demonstrate a variety of both
clinical and fnancial benefts that mHealth provides. The
biggest beneft in my view is that, with wireless technologies,
patients get better access to medical care, whenever
and wherever they need it. The second big advantage
of mHealth is that wireless medical devices can provide
medical data that doctors or nurses previously did not
have. We are talking about near real-time physiologic
data that can be analysed and will lead to better care in
the future.
In which felds of medicine do you think mHealth will
have the biggest impact?
Mobile health is predominantly being used for managing
chronic disease, in diferent scenarios. One important sce-
nario is the long-term management of patients with dia-
betes, obesity, hypertension, chronic heart failure, COPD
and other chronic conditions in a home based environ-
ment. Mobile solutions are also increasingly being used
Wireless technologies have revolutionised many areas of life in recent years. And the same will apply to medi-
cine. Qualcomm, the company responsible for wirelessly-enabling the frst version of Amazons Kindle e-reader,
is now entering the European healthcare market with its 2net Platform, provided by its subsidiary Qualcomm
Life. The Platform is part of a mobile ecosystem that helps unlock biometric data from medical devices and
make the data available through the entire continuum of care. Rick Valencia, Vice President of Qualcomm and
General Manager of Qualcomm Life, reveals why he is looking forward to coming to Europe.
Qualcomm Life is Mobilising Healthcare
Rick Valencia, Vice President of Qualcomm
and General Manager of Qualcomm Life
Qualcomm Life
Jamie Eisinger
jeisinge@qti.qualcomm.com
+1 858-845-1033
www.qualcommlife.eu
for monitoring patients who have been discharged from
the hospital in order to avoid costly re-admissions.
Qualcomm Life is introducing its wireless 2net Plat-
form in Europe, having already launched it in the US in
December 2011. What challenges will the mobile health
industry need to overcome in order to reach healthcare
systems in Europe?
We think that Europe is actually ahead of the US in terms
of leveraging mobile health. The telehealth industry is sub-
stantially more advanced in Europe than it is in the US. If
we did not have a majority of our employees in the US,
we might have launched our healthcare platform in Europe
frst. A recent mHealth report by the GSMA, a global or-
ganisation of mobile operators, mentions 44 mHealth pro-
jects in Europe of a substantial size that have either gone
live already or are being piloted. The biggest one is the
3millionlives project in the UK, where the Department of
Health intends to provide mHealth solutions to three mil-
lion people. These are very interesting projects both from
a medical and from a business point of view.
What is the 2net Platform that you are introducing in
Europe?
The 2net ecosystem consists of a number of gateways or
methods to connect that capture and send wireless data
securely and privately to the cloud-based 2net Platform. It
is an enabler for wireless technologies in medicine. When
our Platform is in place, patients can simply plug into the
system, and their medical device will immediately start
capturing and sending data to the secure backend.
Which customers are you primarily targeting?
Our mission is to mobilise healthcare. This means that
we are addressing whoever is interested in setting up a
wireless care network in healthcare. Our experience in the
US with over 100 customers now suggests that there are
predominantly two sorts of customers: we have device
manufacturers that use our Platform to mobilise specifc
medical devices, and we have disease management com-
panies that use our Platform as an aggregator of wireless
data in their specifc care settings.
Why is Qualcomm a good partner for healthcare compa-
nies that want to go wireless?
We are really good at managing devices in an operators
network, this is certainly one reason. We have done this
for over 25 years now, and our engineers, who are re-
sponsible for the core wireless technologies, are among
the best in the world. For example, Qualcomm was the
enabler of Amazons Kindle when it was frst launched.
We provided the Kindle wireless platform that was so ad-
mired at that time. As an expert provider of wireless net-
works, we certainly know how to secure such networks.
We handle nearly 16 million messages per day across
4 continents and over 40 countries. For its healthcare
platform, Qualcomm Life uses a highly secured data
link from the device to the platform. And at platform lev-
el, the data reside in a secured backend. For our Euro-
pean customers, we will have a data centre in Europe to
make sure that all patient data remain within Europe. That
is another good argument for choosing Qualcomm. We
launched Qualcomm Life Europe on the 12th of November
at the The International Telecare & Telehealth Confer-
ence in the UK and you can fnd out more about us at
www.qualcommlife.eu.
Mr Valencia, thank you very much for the interview.
(HTW)
69
Where do we stand in terms of wireless technologies in
medicine, compared with other felds?
I think we are still at a very early stage. Healthcare is only
starting to embrace wireless technologies. This is not a
problem of technology, but rather a problem of proper
workfows. We are convinced that the more consumers
get used to wireless devices in their daily routine, the more
they will expect to use these devices for their own health-
care as well.
Where do you see the most important benefts of wire-
less medical devices?
There are many studies that demonstrate a variety of both
clinical and fnancial benefts that mHealth provides. The
biggest beneft in my view is that, with wireless technologies,
patients get better access to medical care, whenever
and wherever they need it. The second big advantage
of mHealth is that wireless medical devices can provide
medical data that doctors or nurses previously did not
have. We are talking about near real-time physiologic
data that can be analysed and will lead to better care in
the future.
In which felds of medicine do you think mHealth will
have the biggest impact?
Mobile health is predominantly being used for managing
chronic disease, in diferent scenarios. One important sce-
nario is the long-term management of patients with dia-
betes, obesity, hypertension, chronic heart failure, COPD
and other chronic conditions in a home based environ-
ment. Mobile solutions are also increasingly being used
Wireless technologies have revolutionised many areas of life in recent years. And the same will apply to medi-
cine. Qualcomm, the company responsible for wirelessly-enabling the frst version of Amazons Kindle e-reader,
is now entering the European healthcare market with its 2net Platform, provided by its subsidiary Qualcomm
Life. The Platform is part of a mobile ecosystem that helps unlock biometric data from medical devices and
make the data available through the entire continuum of care. Rick Valencia, Vice President of Qualcomm and
General Manager of Qualcomm Life, reveals why he is looking forward to coming to Europe.
Qualcomm Life is Mobilising Healthcare
Rick Valencia, Vice President of Qualcomm
and General Manager of Qualcomm Life
Qualcomm Life
Jamie Eisinger
jeisinge@qti.qualcomm.com
+1 858-845-1033
www.qualcommlife.eu
for monitoring patients who have been discharged from
the hospital in order to avoid costly re-admissions.
Qualcomm Life is introducing its wireless 2net Plat-
form in Europe, having already launched it in the US in
December 2011. What challenges will the mobile health
industry need to overcome in order to reach healthcare
systems in Europe?
We think that Europe is actually ahead of the US in terms
of leveraging mobile health. The telehealth industry is sub-
stantially more advanced in Europe than it is in the US. If
we did not have a majority of our employees in the US,
we might have launched our healthcare platform in Europe
frst. A recent mHealth report by the GSMA, a global or-
ganisation of mobile operators, mentions 44 mHealth pro-
jects in Europe of a substantial size that have either gone
live already or are being piloted. The biggest one is the
3millionlives project in the UK, where the Department of
Health intends to provide mHealth solutions to three mil-
lion people. These are very interesting projects both from
a medical and from a business point of view.
What is the 2net Platform that you are introducing in
Europe?
The 2net ecosystem consists of a number of gateways or
methods to connect that capture and send wireless data
securely and privately to the cloud-based 2net Platform. It
is an enabler for wireless technologies in medicine. When
our Platform is in place, patients can simply plug into the
system, and their medical device will immediately start
capturing and sending data to the secure backend.
Which customers are you primarily targeting?
Our mission is to mobilise healthcare. This means that
we are addressing whoever is interested in setting up a
wireless care network in healthcare. Our experience in the
US with over 100 customers now suggests that there are
predominantly two sorts of customers: we have device
manufacturers that use our Platform to mobilise specifc
medical devices, and we have disease management com-
panies that use our Platform as an aggregator of wireless
data in their specifc care settings.
Why is Qualcomm a good partner for healthcare compa-
nies that want to go wireless?
We are really good at managing devices in an operators
network, this is certainly one reason. We have done this
for over 25 years now, and our engineers, who are re-
sponsible for the core wireless technologies, are among
the best in the world. For example, Qualcomm was the
enabler of Amazons Kindle when it was frst launched.
We provided the Kindle wireless platform that was so ad-
mired at that time. As an expert provider of wireless net-
works, we certainly know how to secure such networks.
We handle nearly 16 million messages per day across
4 continents and over 40 countries. For its healthcare
platform, Qualcomm Life uses a highly secured data
link from the device to the platform. And at platform lev-
el, the data reside in a secured backend. For our Euro-
pean customers, we will have a data centre in Europe to
make sure that all patient data remain within Europe. That
is another good argument for choosing Qualcomm. We
launched Qualcomm Life Europe on the 12th of November
at the The International Telecare & Telehealth Confer-
ence in the UK and you can fnd out more about us at
www.qualcommlife.eu.
Mr Valencia, thank you very much for the interview.
(HTW)
Could you tell us about the
regional electronic health-
care record project at
Osakidetza?
Through Osabide Global,
Osakidetzas new electronic
healthcare record project,
we aim to improve the way
medical staf work in three
strategic ways. To improve
efciency for medical pro-
fessionals. To improve clin-
ical security, through the
incorporation of elements
of control at specifc points
in the clinical process and
minimising the risk of errors in recording information. And f-
nally, to provide patient guidance, with information systems
playing an active role by keeping doctors up to date with
any relevant news concerning their patients.
How was speech recognition introduced and how was it in-
tegrated into the rest of Osakidetzas computer systems?
The introduction process began at the beginning of 2007,
when it was incorporated into the radiology service at Cru-
ces Hospital, where it was a success. Very quickly, all radi-
ologists were using voice recognition. It was frst introduced
using InfoRX, the corporate reporting system for radiology
services. The applications success led to its integration into
the corporate reporting system for Osakidetzas complete
network. This meant that all the doctors in the centre who
asked for the tool could make their reports using voice rec-
ognition.
What are the benefts of speech recognition?
In radiology services the accuracy is very high, approxi-
mately 98%, as there is a very extensive specifc vocabu-
lary. With regard to the rest of the services, for the moment,
the percentage is slightly lower, as there are no specifc dic-
tionaries for each individual service. Therefore it depends
on the implication of the specialists themselves to improve
the vocabulary for each service in order to make the system
more accurate.
Speech recognition also meant more than a reduction in
costs. The introduction has released administrative person-
nel from the task of transcribing reports. Now these staf
members can dedicate their time to other tasks, which con-
tributes to an improvement in patient care.
It is logical that reports are completed sooner as it is the
doctor who begins and fnishes the report, which is auto-
matically available on the network via the EHR. In addition,
these reports are saved in the same system with the same
standard, which means that problems of comprehension
and loss are avoided.
Has the use of speech recognition contributed to the pro-
ject, Osabide Global?
Voice recognition has helped us in the deployment of Osaki-
detzas new corporate reporting tool, SIB. Our aim is to in-
corporate new technologies (mobiles, touchscreens, and
voice recognition) in our day-to-day work so that doctors can
work more comfortably without leaving their environment.

What has the users reaction been?
Medical staf and doctors are professionals who know what
they want and you cannot impose anything on them. It is
the doctors themselves who are asking for it, which means
they consider it as a tool that can help them a lot in their
daily work.
What are the expectations for the future?
Osakidetza is expanding voice recognition to all its services.
Currently rollout has started in the following areas: oncology,
dermatology, pathology, UCI, cardiology, psychiatry.
Mr Begoa, thank you very much for the interview.
(HTW)
Martn Begoa is a computer science graduate from the University of Deusto in Bilbao. His work is focused on
developing computer applications. He is currently deputy manager of Computer and Information Systems at
Osakidetza, the Basque health service.
NUANCE HEALTHCARE
Anne Durand-Badel
anne.durand-badel@nuance.com
+43 160 119 1048
Speech recognition: More than a reduction in costs
This has been quite a year for TPP, with your frst hospital
deployment and the launch of the SystmOne Social Care
module. What have been the highlights for you?
A high point was seeing the contract for Airedale being
signed. It will transform care in the area and improve ef-
ciency for clinicians. There will be clear sharing of vital data
between healthcare professionals, allowing for quicker and
more accurate diagnosis and more efective treatment path-
ways and better communication. I really think that were at
the point where integrated care is becoming a reality.
How is this implementation likely to change the life of the
hospital clinician, the patient and the GP?
It will make the life of the hospital clinician more straightfor-
ward and safer. Care pathways will become clearer, more data
will be available and both the patient and the clinician will feel
more informed. As a GP, I look forward to better communica-
tion and the development of new ways of working that put the
patient at the centre. I will be informed of admissions elec-
tronically, which will mean we can jointly work towards the
earliest supported discharge and can ensure post-discharge
care is implemented as soon as my patient leaves the hospital.
Do you think it will change the way the patient interacts
with healthcare professionals?
Through implementations of SystmOne on smaller scales,
weve already seen vast improvements in communication
on a patientclinician level and a clinicianclinician level.
Patients want to feel that clinicians know and understand
their condition, and their medical history. SystmOne gives
clinicians the tools to do this, and new developments will al-
low patients to view their own electronic record, and submit
questions online.
What has been the reaction to the new Social Care mod-
ule in primary, secondary and social care?
When it comes to sharing data people are wary of the re-
strictions placed upon them and the repercussions if things
go wrong. Integrating the three sectors requires a large cul-
tural shift away from the historic ownership of the patient
record to empowering the patient. We expect our data to be
shared (albeit safely and securely and with our permission)
because we, as patients, know that will be the best route for
giving us the best care.
What can we expect from the company in the next few
years?
I can safely say Ive never seen the company move at this
speed before. Every week, there are exciting new devel-
opments, new organisations join us and we hire new staf.
Were at a crucial point in our history. I really think that we
could be on the edge of transforming healthcare in England
for the better. I expect our knowledge and our experience
will see us staying ahead of the curve with many exciting
new developments.
Dr Parry, thank you very much for the interview.
(HTW)
With the launch of its new social care module, SystmOne Social Care, earlier this year TPP can offer clinicians and their
patients a fully integrated patient record, covering primary, secondary and social care. Dr John Parry, TPPs clinical director
describes to HealthTech Wire how the technology is changing the way patients and healthcare professionals interact.
TPP
Sarah Grifn
+44 113 20 500 83
sarah.grifn@tpp-uk.com
www.tpp-uk.com
One patient, one record is now becoming a reality
Dr John Parry, Clinical Director, TPP
71
Could you tell us about the
regional electronic health-
care record project at
Osakidetza?
Through Osabide Global,
Osakidetzas new electronic
healthcare record project,
we aim to improve the way
medical staf work in three
strategic ways. To improve
efciency for medical pro-
fessionals. To improve clin-
ical security, through the
incorporation of elements
of control at specifc points
in the clinical process and
minimising the risk of errors in recording information. And f-
nally, to provide patient guidance, with information systems
playing an active role by keeping doctors up to date with
any relevant news concerning their patients.
How was speech recognition introduced and how was it in-
tegrated into the rest of Osakidetzas computer systems?
The introduction process began at the beginning of 2007,
when it was incorporated into the radiology service at Cru-
ces Hospital, where it was a success. Very quickly, all radi-
ologists were using voice recognition. It was frst introduced
using InfoRX, the corporate reporting system for radiology
services. The applications success led to its integration into
the corporate reporting system for Osakidetzas complete
network. This meant that all the doctors in the centre who
asked for the tool could make their reports using voice rec-
ognition.
What are the benefts of speech recognition?
In radiology services the accuracy is very high, approxi-
mately 98%, as there is a very extensive specifc vocabu-
lary. With regard to the rest of the services, for the moment,
the percentage is slightly lower, as there are no specifc dic-
tionaries for each individual service. Therefore it depends
on the implication of the specialists themselves to improve
the vocabulary for each service in order to make the system
more accurate.
Speech recognition also meant more than a reduction in
costs. The introduction has released administrative person-
nel from the task of transcribing reports. Now these staf
members can dedicate their time to other tasks, which con-
tributes to an improvement in patient care.
It is logical that reports are completed sooner as it is the
doctor who begins and fnishes the report, which is auto-
matically available on the network via the EHR. In addition,
these reports are saved in the same system with the same
standard, which means that problems of comprehension
and loss are avoided.
Has the use of speech recognition contributed to the pro-
ject, Osabide Global?
Voice recognition has helped us in the deployment of Osaki-
detzas new corporate reporting tool, SIB. Our aim is to in-
corporate new technologies (mobiles, touchscreens, and
voice recognition) in our day-to-day work so that doctors can
work more comfortably without leaving their environment.

What has the users reaction been?
Medical staf and doctors are professionals who know what
they want and you cannot impose anything on them. It is
the doctors themselves who are asking for it, which means
they consider it as a tool that can help them a lot in their
daily work.
What are the expectations for the future?
Osakidetza is expanding voice recognition to all its services.
Currently rollout has started in the following areas: oncology,
dermatology, pathology, UCI, cardiology, psychiatry.
Mr Begoa, thank you very much for the interview.
(HTW)
Martn Begoa is a computer science graduate from the University of Deusto in Bilbao. His work is focused on
developing computer applications. He is currently deputy manager of Computer and Information Systems at
Osakidetza, the Basque health service.
NUANCE HEALTHCARE
Anne Durand-Badel
anne.durand-badel@nuance.com
+43 160 119 1048
Speech recognition: More than a reduction in costs
This has been quite a year for TPP, with your frst hospital
deployment and the launch of the SystmOne Social Care
module. What have been the highlights for you?
A high point was seeing the contract for Airedale being
signed. It will transform care in the area and improve ef-
ciency for clinicians. There will be clear sharing of vital data
between healthcare professionals, allowing for quicker and
more accurate diagnosis and more efective treatment path-
ways and better communication. I really think that were at
the point where integrated care is becoming a reality.
How is this implementation likely to change the life of the
hospital clinician, the patient and the GP?
It will make the life of the hospital clinician more straightfor-
ward and safer. Care pathways will become clearer, more data
will be available and both the patient and the clinician will feel
more informed. As a GP, I look forward to better communica-
tion and the development of new ways of working that put the
patient at the centre. I will be informed of admissions elec-
tronically, which will mean we can jointly work towards the
earliest supported discharge and can ensure post-discharge
care is implemented as soon as my patient leaves the hospital.
Do you think it will change the way the patient interacts
with healthcare professionals?
Through implementations of SystmOne on smaller scales,
weve already seen vast improvements in communication
on a patientclinician level and a clinicianclinician level.
Patients want to feel that clinicians know and understand
their condition, and their medical history. SystmOne gives
clinicians the tools to do this, and new developments will al-
low patients to view their own electronic record, and submit
questions online.
What has been the reaction to the new Social Care mod-
ule in primary, secondary and social care?
When it comes to sharing data people are wary of the re-
strictions placed upon them and the repercussions if things
go wrong. Integrating the three sectors requires a large cul-
tural shift away from the historic ownership of the patient
record to empowering the patient. We expect our data to be
shared (albeit safely and securely and with our permission)
because we, as patients, know that will be the best route for
giving us the best care.
What can we expect from the company in the next few
years?
I can safely say Ive never seen the company move at this
speed before. Every week, there are exciting new devel-
opments, new organisations join us and we hire new staf.
Were at a crucial point in our history. I really think that we
could be on the edge of transforming healthcare in England
for the better. I expect our knowledge and our experience
will see us staying ahead of the curve with many exciting
new developments.
Dr Parry, thank you very much for the interview.
(HTW)
With the launch of its new social care module, SystmOne Social Care, earlier this year TPP can offer clinicians and their
patients a fully integrated patient record, covering primary, secondary and social care. Dr John Parry, TPPs clinical director
describes to HealthTech Wire how the technology is changing the way patients and healthcare professionals interact.
TPP
Sarah Grifn
+44 113 20 500 83
sarah.grifn@tpp-uk.com
www.tpp-uk.com
One patient, one record is now becoming a reality
Dr John Parry, Clinical Director, TPP
HIMSS INSIGHTS
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All rights reserved.
Philipp Grtzel von Grtz (Germany) specialises in
medicine, health policy and, in particular, eHealth
and information technology in healthcare. He is
one of Europes leading journalists in the eld and
author of the German book Connected Health.
Gary Flood (UK) has been writing about IT and
healthcare informatics for over 20 years, especially
the largest non-military computer project in his-
torythe UKs 12bn National Programme for IT.
Michael Lang (Germany) is a science writer who
regularly contributes to major magazines and news-
papers, including E-HEALTH-COM, the German
Cancer Research Center and Sddeutsche Zeitung.
Mary Mosquera (US) is senior editor of Government
Health IT (US). An award-winning journalist, Mary
has 20 years of experience reporting from Washing-
ton about health care, technology and business news.
Uwe Buddrus (Germany) is Managing Director of
HIMSS Analytics Europe (HAE). Uwe specialises
in benchmarking and identication of best practices
and also advises organizations, businesses and
governments on the use of IT in healthcare.
Harry Wood (UK) is the editor in chief of The British Journal
of Healthcare Computing.
Rosalia Sierra Fernandez (Spain) is a journalist at Diario Mdico.
Dr. Wolter Paans (The Netherlands) is a lecturer and researcher at the School
of Nursing at Hanze University of Applied Sciences.
Prof. Dr. Maria Mller-Staub (Switzerland) is professor in acute care and senior
researcher at ZHAW University & director of Pege PBS.
Javier Quiles del Rio (Spain) is head of the IT Project Management Service
Department at Galician Healthcare Service (SERGAS), the Government
Agency for Healthcare Service Provision in Galicia.
Jorge Prado Casal (Spain) is head of change management and deployment in the
IT Department at Galician Health Service in Santiago de Compostela.
Benigno Rosn Calvo (Spain) is general manager of the IT Department
for the Galician Health Service.
This Issues Contributors

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T H E I N F O R MAT I O N T E C H N O L O G Y J O U R N A L F O R H E A LT H C A R E L E A D E R S | V O L .

HIMSS Europe_mag_v15.indd 17 11/1/12 11:08 PM

processors, or implement it of-site with

processors, or implement it of-site with

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