EMR in Europe

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T A B L E O F C O N T E N T S

CHAPTER ONE: EXECUTIVE SUMMARY ..........................................................1

Industry at a Glance ............................................................................................................ 1
Scope and Methodology ...................................................................................................... 2
Size and Growth of the Market .......................................................................................... 3
Key Issues and Trends Affecting the Market ................................................................... 6
Leading Market Participants ............................................................................................. 7
Conclusions .......................................................................................................................... 9

CHAPTER TWO: INDUSTRY OVERVIEW ........................................................11

Introduction ....................................................................................................................... 11
The Medical Record .......................................................................................................... 12
The Electronic Medical Record ........................................................................................ 14
Industry Terminology ....................................................................................................... 15
Industry Structure ............................................................................................................. 19
Advantages ......................................................................................................................... 20
Increased Access and Efficiency ..................................................................................... 20
Improved Documentation................................................................................................ 20
Quality of Care ................................................................................................................ 20
Increased Resources ........................................................................................................ 21
Quality Assurance ........................................................................................................... 21
Eliminates Costs .............................................................................................................. 21
Disadvantages .................................................................................................................... 21
Reliability ........................................................................................................................ 22
Accountability ................................................................................................................. 22
Patient Privacy ................................................................................................................ 22
EMR Software ................................................................................................................. 23
Hardware Requirements .................................................................................................. 27
Components of an EMR .................................................................................................. 29
Administrative System Components ............................................................................... 30
Laboratory System Components ..................................................................................... 30
Radiology System Components ...................................................................................... 31
Pharmacy System Components ....................................................................................... 31
Computerized Physician Order Entry ............................................................................. 31
Clinical Documentation................................................................................................... 32
Flow of Patient Data across Various Components .......................................................... 33
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European EMR Adoption Model .................................................................................... 34
US EMR Adoption Model............................................................................................... 36
Key Differences in US vs. EU EMR Adoption Model .................................. 38

CHAPTER THREE: EUROPEAN COUNTRY DEMOGRAPHICS .................41

Austria ................................................................................................................................ 42
Denmark ............................................................................................................................. 43
Finland ................................................................................................................................ 45
France ................................................................................................................................. 46
Germany ............................................................................................................................. 47
Italy ..................................................................................................................................... 48
Netherlands ........................................................................................................................ 49
Spain ................................................................................................................................... 50
Sweden ................................................................................................................................ 51
United Kingdom ................................................................................................................ 52

CHAPTER FOUR: EMERGING TRENDS ...........................................................55

Virtualization Technology ................................................................................................ 55
Cloud Computing .............................................................................................................. 56
Dashboard modules ........................................................................................................... 58
Discreet Recordable Transcription .................................................................................. 59
Tablet Adoption ................................................................................................................. 59
Interoperability .................................................................................................................. 60
Dimensions of Interoperability........................................................................................ 60
Benefits ........................................................................................................................... 61
Smart Cards Technology .................................................................................................. 62
Wireless Technologies ....................................................................................................... 64
Open Source EMR Applications ...................................................................................... 66
Benefits of Open Source EMR Applications .................................................................. 66
Usability And Adoption .................................................................................................... 67
Privacy Issues ..................................................................................................................... 68
Technology Limitations..................................................................................................... 68
Social and Organizational Barriers ................................................................................. 69
International Markets and Trends .................................................................................. 69
Asia and Other EMR Markets ......................................................................................... 69
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CHAPTER FIVE: LEADING MARKET PARTICIPANTS ................................71

Agfa Healthcare Corporation ........................................................................................... 71
Company Overview ...................................................................................... 72
Performance Review ..................................................................................... 72
Products and Services ................................................................................... 73
Growth Strategy ............................................................................................ 74
Locations ........................................................................................................ 74
ALERT Life Sciences Computing S.A ............................................................................. 75
Company Overview ...................................................................................... 75
Products and Services ................................................................................... 75
Locations ........................................................................................................ 76
Allscripts Healthcare Solutions, Inc................................................................................. 76
Company Overview ...................................................................................... 77
Performance Review ..................................................................................... 77
Products and Services ................................................................................... 78
Growth Strategy ............................................................................................ 79
Locations ........................................................................................................ 79
Ascribe plc. ......................................................................................................................... 79
Company Overview ...................................................................................... 79
Performance Review ..................................................................................... 80
Products and Services ................................................................................... 80
Growth Strategy ............................................................................................ 81
Locations ........................................................................................................ 81
Cambio Healthcare Systems ............................................................................................. 82
Company Overview ...................................................................................... 82
Performance Review ..................................................................................... 82
Products and Services ................................................................................... 83
Growth Strategy ............................................................................................ 84
Locations ........................................................................................................ 84
Cerner Corporation........................................................................................................... 85
Company Overview ...................................................................................... 85
Performance Review ..................................................................................... 86
Key Acquisitions, Alliances, and Partnerships........................................... 86
Products and Services ................................................................................... 87
Growth Strategy ............................................................................................ 88
Locations ........................................................................................................ 88
CompuGroup Medical AG ............................................................................................... 89
Company Overview ...................................................................................... 89
Performance Review ..................................................................................... 89
Key Acquisitions, Alliances, and Partnerships........................................... 90
Products and Service .................................................................................... 90
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Growth Strategy ............................................................................................ 92

Locations ........................................................................................................ 92
CSC/iSoft ............................................................................................................................ 93
Company Overview ...................................................................................... 93
Performance Review ..................................................................................... 96
Key Acquisitions, Alliances, and Partnerships........................................... 96
Products and Service .................................................................................... 98
Growth Strategy .......................................................................................... 100
Locations ...................................................................................................... 100
Egton Medical Information Systems Limited ............................................................... 101
Company Overview .................................................................................... 101
Performance Review ................................................................................... 102
Key Acquisitions, Alliances, and Partnerships......................................... 102
Products and Service .................................................................................. 103
Growth Strategy .......................................................................................... 104
Locations ...................................................................................................... 104
Epic Systems, Inc. ............................................................................................................ 105
Company Overview .................................................................................... 105
Performance Review ................................................................................... 106
Key Acquisitions, Alliances, and Partnerships......................................... 106
Products and Services ................................................................................. 107
Growth Strategy .......................................................................................... 108
Locations ...................................................................................................... 108
GE Healthcare ................................................................................................................. 109
Company Overview .................................................................................... 109
Performance Review ................................................................................... 109
Key Acquisitions, Alliances, and Partnerships......................................... 110
Products and Services ................................................................................. 111
Growth Strategy .......................................................................................... 112
Locations ...................................................................................................... 112
IMS MAXIMS ................................................................................................................. 113
Company Overview .................................................................................... 113
Key Acquisitions, Alliances, and Partnerships......................................... 113
Locations ...................................................................................................... 114
Indra Sistemas ................................................................................................................. 115
Company Overview .................................................................................... 115
Performance Review ................................................................................... 115
Key Acquisitions, Alliances, and Partnerships......................................... 116
Products and Services ................................................................................. 117
Growth Strategy .......................................................................................... 117
Locations ...................................................................................................... 118
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InterSystems..................................................................................................................... 119
Company Overview .................................................................................... 119
Products and Services ................................................................................. 119
Key Acquisitions, Alliances, and Partnerships......................................... 120
Locations ...................................................................................................... 120
McKesson Corporation ................................................................................................... 121
Company Overview .................................................................................... 121
Performance Review ................................................................................... 122
Key Acquisitions, Alliances, and Partnerships......................................... 122
Products and Service .................................................................................. 123
Growth Strategy .......................................................................................... 124
Locations ...................................................................................................... 124
Medical Information Technology, Inc. (MEDITECH, Inc.) ........................................ 125
Company Overview .................................................................................... 125
Performance Review ................................................................................... 125
Key Acquisitions, Alliances, and Partnerships......................................... 126
Products and Services ................................................................................. 127
Growth Strategy .......................................................................................... 128
Locations ...................................................................................................... 128
Microtest........................................................................................................................... 129
Company Overview .................................................................................... 129
Products and Services ................................................................................. 129
Locations ...................................................................................................... 130
NoemaLife ........................................................................................................................ 131
Company Overview .................................................................................... 131
Performance Review ................................................................................... 131
Key Acquisitions, Alliances, and Partnerships......................................... 132
Products and Services ................................................................................. 132
Growth Strategy .......................................................................................... 133
Locations ...................................................................................................... 134
SAP AG ........................................................................................................................... 134
Company Overview .................................................................................... 134
Performance Review ................................................................................... 134
Key Acquisitions, Alliances, and Partnerships......................................... 135
Products and Services ................................................................................. 135
Growth Strategy .......................................................................................... 136
Locations ...................................................................................................... 136
Siemens AG ...................................................................................................................... 137
Company Overview .................................................................................... 137
Performance Review ................................................................................... 138
Key Acquisitions, Alliances, and Partnerships......................................... 139
Products and Service .................................................................................. 139
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Growth Strategy .......................................................................................... 140

Locations ...................................................................................................... 140
Tieto .................................................................................................................................. 141
Company Overview .................................................................................... 141
Performance Review ................................................................................... 141
Products and Services ................................................................................. 142
Growth Strategy .......................................................................................... 143
Locations ...................................................................................................... 143

CHAPTER SIX: MARKET ANALYSIS ...............................................................145

Market Overview ............................................................................................................. 145
Market by Country.......................................................................................................... 148

CHAPTER SEVEN: CONCLUSIONS ..................................................................169

Conclusion One: .............................................................................................................. 169
Conclusion Two: ............................................................................................................. 169
Conclusion Three: ........................................................................................................... 170
Conclusion Four: ........................................................................................................... 170
Conclusion Five: .............................................................................................................. 170
Conclusion Six: .............................................................................................................. 171
Conclusion Seven:............................................................................................................ 171

APPENDIXA: DEFINITION OF INDUSTRY PRODUCTS ..............................173

APPENDIXB: LIST OF SELECT MAJOR COMPANIES ................................177

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LIST OF EXHI BI TS

CHAPTER ONE: EXECUTIVE SUMMARY

Table 1-1: European EMR Market Analysis, 2010-2012 ................................................. 4
Table 1-2: Forecasted European EMR Market Analysis: 2013-2017 ............................. 5
Figure 1-1: European EMR Market Analysis: 2010-2017 ............................................... 6

CHAPTER TWO: INDUSTRY OVERVIEW 

Table 2-1: Terminology Comparison Matrix .................................................................. 19

CHAPTER THREE: EUROPEAN COUNTRY DEMOGRAPHICS

AND EMR TRENDS 
Figure 3-1: EMR Adoption Stage in Austria 2010-2011 by Percent of Institutions .... 43
Figure 3-2: EMR Adoption Stage in Denmark 2010-2011 by Percent of Institutions 45
Figure 3-3: EMR Adoption Stage in France 2010-2011 by Percent of Institutions ..... 47
Figure 3-4: EMR Adoption Stage in Germany 2010-2011 by Percent of Institutions 48
Figure 3-5: EMR Adoption Stage in Italy 2010-2011 by Percent of Institutions ......... 49
Figure 3-6: EMR Adoption Stage in Netherlands 2010-2011 by Percent of................. 50
Figure 3-7: EMR Adoption Stage in Spain 2010-2011 by Percent of Institutions ....... 51
Figure 3-8: EMR Adoption Stage in Sweden 2010-2011 by Percent of Institutions .... 52
Figure 3-9: EMR Adoption Stage in UK 2010-2011 by Percent of Institutions ........... 53

CHAPTER FIVE: LEADING MARKET PARTICIPANTS 

Figure 5-1: Agfa Revenues 2010-2012 ($ millions) ......................................................... 73
Figure 5-2: Allscripts Revenues 2010-2012 ($ millions) ................................................. 78
Figure 5-3: Cambio Revenues 2010-2012 ($ millions) .................................................... 83
Figure 5-4: Cerner Revenues 2010-2012 ($ millions) ..................................................... 86
Figure 5-5: CompuGroup Revenues 2010-2012 ($ millions).......................................... 90
Figure 5-6: CSC/ iSoft Revenues 2010-2012 ($ millions) ............................................... 96
Figure 5-7: EMIS Group Revenues 2010-2012 ($ millions) ......................................... 102
Figure 5-8: Epic Revenues 2010-2012 ($ millions) ........................................................ 106
Figure 5-9: Agfa Revenues 2010-2012 ($ millions) ....................................................... 110
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Figure 5-10: Indra Revenues 2010-2012 ($ millions) .................................................... 116
Figure 5-11: McKesson Revenues 2010-2012 ($ billions) ............................................. 122
Figure 5-12: Meditech Revenues 2010-2012 ($ millions).............................................. 126
Figure 5-13: NoemaLife Revenues 2010-2012 ($ millions) ........................................... 132
Figure 5-14: SAP Revenues 2010-2012 ($ millions) ...................................................... 135
Figure 5-15: Siemens Revenues 2010-2012 ($ millions)................................................ 138
Figure 5-16: Revenues 2010-2012 ($ millions) .............................................................. 142

CHAPER SIX: MARKET ANALYSIS 

Table 6-1: European EMR Market Analysis, 2010-2012 ............................................. 146
Table 6-2: Forecasted European EMR Market Analysis: 2013-2017 ......................... 147
Figure 6-1: European EMR Market Analysis: 2010-2017 ........................................... 148
Table 6-3: UK EMR Market Analysis 2010-2012 ......................................................... 150
Table 6-4: Forecasted UK EMR Market Analysis: 2013-2017 .................................... 151
Figure 6-2: UK EMR Market Analysis: 2010-2017 ...................................................... 152
Table 6-5: Germany EMR Market Analysis 2010-2017............................................... 153
Table 6-6: Forecasted Germany EMR Market Analysis: 2013-2017 .......................... 154
Figure 6-3: Germany EMR Market Analysis: 2010-2017 ............................................ 155
Table 6-6: France EMR Market Analysis 2010-2012 ................................................... 157
Table 6-7: Forecasted France EMR Market Analysis: 2013-2017 .............................. 158
Figure 6-4: France EMR Market Analysis: 2010-2017 ................................................ 159
Table 6-8: Other European Countries EMR Market Analysis 2010-2012 ................. 161
Table 6-9: Forecasted Other European Countries EMR Market
Analysis: 2013-2017 ......................................................................................................... 162
Figure 6-5: Other European Countries EMR Market Analysis: 2010-2017 .............. 163
Table 6-10: European Countries EMR Market Breakdown, 2012 ............................. 164
Table 6-11: European Countries EMR Market Breakdown, 2017 ............................. 165
Table 6-12: Selected EMR Vendors Country Presence................................................ 167
Table 6-13: Estimated Number of Contracted Hospitals in Europe by Vendor ........ 168



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Two: Introduction
33

Chart deficiency tracking

Flow of Patient Data across Various Components

The products developed by different vendors may use different clinical
standards for medical vocabularies. Further, the standards required for other activities
such as user identification and patient tracking, are not used by vendors in a uniform
way that permits efficient data entry and retrieval. This implies that a user would have
to open a chain of applications pertaining to the contributing component to view the
entire patient record. Moreover, the user would also be required to log- in and out
every time he or she switches from one application to other.
In a practical situation at an inpatient setting, the electronic data from the
various components is usually printed and converted into a paper record. The user
receives the data in electronic or written form and updates the patients record
accordingly. If new data from the components are available electronically, then old
data can be updated and specific alerts, such as medication allergies can be added to
the record accordingly. However, the clinician may not be notified about such updates
unless he or she enters into the ancillary system. Additionally, the disparate data
cannot be combined into integrated displays, such as flow sheets for clinical analysis.
If the clinician can access the patient data stored in a semantic form, he or she
will be able to obtain a list of patients diagnosed with a specific condition linked to
another list of patients diagnosed with a similar condition. This is possible due to
developments in the semantic web technologies, which can link medical conditions
that are coded as synonymous terms. This type of data may be useful for research.
An integrated architecture is created to facilitate the sharing of data across
systems. The systems can store their data locally. A system (or system user) must be
accessible to another system in order to share patient information. It can also transmit
a copy of the file to the other system. As the file is identified for sharing, it can be
integrated with other files, but it depends upon the interoperability level between the
integrating systems.
Data may be entered in the following three forms:

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Four: Issues and Trends

57

Growth of digital radiography and medical imaging in general has been

impressive. Medical imaging is one of the fastest growing components of healthcare
even during the recession. Growth in imaging has caused a corresponding growth in
image study which is taxing the capacity of existing hospital IT infrastructure and
resources. Exponential growth in the amount of data being generated at a time when
compliance, regulations, and increasing types of media-rich files is putting even more
pressure on hospital IT. As more specialties utilize PACS, data requirements will
escalate. This makes cloud solutions very appealing and cost-effective.
Cloud computing is a relatively new concept model. Cloud computing
customers do not generally own the physical infrastructure serving as host to the
software platform. Instead, they avoid capital expenditure by renting usage from a
third-party provider. They consume resources as a service and pay only for resources
that they use. Health care providers then can access the central servers using Web
browsers on personal computers or tablet PCs... Cloud computing is not network
computing. Cloud computing offers wider sharing, storage, access and manipulation
of data, which can be achieved in a cost-effective, secure, easy-to-use method. The
benefits of cloud storing are that it allows users to gain access to their applications
from anywhere, through any connected device on the network. It also allows the
facility to store large volumes of data off-site, freeing up valuable server space. The
cloud environment is currently very dynamic both in terms of development and
vendor offerings for the healthcare industry.
There are some drawbacks to cloud computing. Those are:
x Speed
x Off-site serviceability
x Security and ownership
Cloud-based EHRs are becoming more popular but there are a few issues that
have come to the forefront, namely issues regarding rights to the data. This involves
data mining. Some EHR vendors aggregate the data in the cloud from all of their
clients EHR systems for analytics.

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Six: Market Analysis

147
Table 6-2
Forecasted European EMR Market Analysis: 2013-2017
(in millions of dollars at the manufacturers level)
Year

Revenues

Percent Change

2013
2014
2015
2016
2017

Compound Annual Growth Rate

2013-2017
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