By Siddharth Saha Healthcare – Industry Analyst, Frost & Sullivan

The European healthcare industry has seen many early initiatives to develop the infrastructure to make patient health records available to the various stakeholders and decision makers. While individual physician practices / clinics and hospitals have been acquiring electronic medical records (EMR) systems at a slow pace, the industry has witnessed the implementation of projects involving the use of telemedicine technologies, regional healthcare networks and solutions like the electronic healthcard system. However, no solution has found universal acceptance. One of the main reasons for this is the regional variations in the healthcare systems.

Early Initiatives With the Patient Record
While manual patient records continue to be used by providers, primitive systems consisted of telemedicine links which transmitted text, images and voice across geographic expanses to clinicians for diagnosis or second opinion. Though the information largely constituted investigations and therapy results, it was in no way considered a complete medical record. Other initiatives included networking of physician clinics, hospitals, homecare providers and laboratories, radiology centers and in some cases pharmacies. These networks only enabled the transmission of patient related data. Some of the prominent initiatives include the MEDCOM project in Denmark that linked stakeholders, HEALTHNET and UUMA regional e-health service in Finland, SJUNET and Carelink national projects in Sweden and the Northern Norwegian Health Network in Norway. One of the overriding factors for these initiatives is the fact that over 90 percent of provider organizations fall within the public sector and that most of these projects are funded by governments and state health authorities. Prominent projects in other countries include the EVISAND and DIRAYA electronic health record projects in Spain, electronic health records implementation in the Lombardia region in Italy and the FLOW project in Belgium which connected hospitals and general practitioners to the IRIS network in Brussels. While these publicly funded projects are commendable for having set the ball rolling, they still lacked true support for clinical decision making due to the absence of clinical knowledge databases, a feature which is supported by current commercial electronic medical records (EMR) systems. Another disadvantage was the regional localization of such projects. The industry as such faced several restraints that hindered active growth.

Market Restraints in Europe
While the healthcare industry across Europe continues to face constrained budgetary conditions, the lack of incentives provided by payers or healthcare authorities to healthcare organizations that use information technology systems has curbed the pace of adoption. In the recent couple of years, documented evidence of the benefits of electronic medical records systems or rather the cost both financial and human of not using IT systems that promote patient safety has spurred systems adoption both in North America and Europe. On the brighter side, the medical fraternity acknowledges the benefits of such a system, even as localized resistance to change in workflows and processes may be encountered during implementation. Successfully dealing with cultural and organizational resistance is an issue both users and software integrators have to incorporate into the migration plan. Other restraining factors include a confusing array of available sub-systems and platforms that need integration with existing legacy hospital information systems that cash strapped owners are not willing to forego in the immediate future. The European market is currently seen to be extremely fragmented with a number of small market participants either specializing in a niche product range or a local market. There is no Pan-European player dominating the market. This fragmentation brings with it problems like slow development and acceptance of universal standards for systems architecture, data exchange and clinical terminology all critical for a national electronic medical record.

Current Scenario
The United Kingdom leads the market having taken initiatives by outlining and awarding contracts to upgrade information technology infrastructure in the National Health Service (NHS) in England. While a large proportion of the funds will be utilized to upgrade overall clinical information systems portfolio, it is expected that the EMR industry will receive the much needed push.  By awarding large contracts to a select list of carefully evaluated vendors, the British authorities have made it clear they would like to perceive accountability in the project. While it would do a great deal of good to have standardized products and systems in use throughout the country, the market may experience, a price war triggered by the need to maintain market share, and several alliances as the market consolidates. This is exactly what the German and French industries, two other major markets, need to achieve true adoption of standardized systems. It is predicted that the European electronic medical records market will grow at a compound annual growth rate of 18.7 percent between 2003 and 2010.  The Scandinavian nations quick to adopt IT will be among the first to reach saturation in this market.

The Future of the Industry
It is expected that the multinational IT and modality companies will use all their resources to capitalize on the business potential that the EMR industry offers in the European market. While some bring with them experience of successful implementation in the North American markets, others are still testing out their systems that have been customized to the different European industry.  Another Global modality company, Philips, has recently announced an agreement with leading North American healthcare information systems vendor Epic, to develop and market solutions that combine the power of information systems that derive data from patient monitoring devices. With several vendors partnering and supporting standards initiatives like Prorec in many European countries, it is expected that the challenge of achieving universal standards will be overcome.  The European EMR industry is also expected to witness a number of acquisitions as existing clinical information systems vendors are valued for their relatively strong installed base, a condition sought after by the global players.