BETTER IT BETTER HOSPITAL?

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2 SEBASTIAN KROLOP, ACCENTURE RAINER HERZOG, HIMSS BETTER IT BETTER HOSPITAL? 10/7/2014 2

3 Objective of this session Examine whether there is a corelation between the level of IT implementation in hospitals and key financial and performance figures The basis for the corelation study are the HIMSS EMRAM Reports and Accenture s European Hospital Rating Reports The study s focus is Germany 3

4 HIMSS Analytics in Europe Data collection In hospitals Data Structured questionnaire Information Statistical analysis and reports Benchmarking & EMRAM Score Intelligence Conclusions Decisions Strategies & Consulting Goal Improving Healthcare through IT

5 The EMR Adoption Model (EMRAM) Paperless patient record environment for highest quality of care, data continuity & full HIE Full electronic clinical decision support, and highest medication safety Completely electronic diagnostic image management Electronic order entry with decision support and result reporting Clinical ordering and documentation especially nursing care A patient-centered electronic data repository Electronic diagnostic and pharmacy department information

6 EMRAM - value propositions for hospitals Stage 7 Paperless environment enabling data continuity to deliver and manage patient care for all hospital services and supporting data sharing with all care delivery stakeholders Optimized quality of care and patient safety Optimized clinical operational and business process efficiency value of each stage to the hospital Stage 6 Stage 5 Optimized diagnostic and care delivery efficiency by standard treatment protocols; Further reduction / elimination of medical errors improved patient safety; Reduced / eliminated paper-based documentation and dictation and transcription costs; Improved billing and coding Elimination of film, sharing images, avoiding redundant imaging Stage 4 Stage 3 Stage 2 Stage 1 Stage 0 Improved care delivery efficiency and reduced medical errors Optimized collection of nursing and clinical information; Standardized care delivery first improvements of care quality Optimized access to diagnostic results, sharing of patient-information Improved key dept. operations and access to diagnostic information Low clinical value; mainly patient administration and hospital management

7 EMR adoption in Europe EMRAM Scores, % of Hospitals, Q2/2014 (based on data from latest 24 months, no weighting etc. applied) Stage DE IT NL ES PL PT Other Europe* Europe Stage 7 0.3% 0.0% 0.0% 0.5% 0.0% 0.0% 0.0% 0.1% Stage 6 0.0% 0.6% 13.2% 4.5% 0.0% 0.0% 0.0% 2.2% Stage 5 9.9% 8.0% 36.8% 30.9% 2.4% 55.2% 66.7% 16.3% Stage 4 3.4% 1.7% 2.9% 6.8% 0.0% 6.9% 0.0% 3.2% Stage 3 6.8% 3.2% 1.5% 1.8% 0.0% 10.3% 0.0% 3.6% Stage % 31.3% 44.1% 26.4% 10.8% 0.0% 33.3% 30.0% Stage 1 0.3% 37.4% 1.5% 9.1% 16.9% 0.0% 0.0% 16.7% Stage % 17.7% 0.0% 20.0% 69.9% 27.6% 0.0% 27.9% N ,427 Mean Germany Main Gaps: Stage 0/1: Pharmacy Management System Stage 2/3: Electronic Medication Administration Record (emar) Stage 5/6: Closed Loop / Clinical Decision Support

8 Hospital IT expenditure 1/2 Based on HIT spend per capita, US hospitals spend most (87 /person). DE, IT and ES spend about ¼ per capita compared with US acute care hospitals ,122, DE IT ES NL ,754,414 US Annual Capital Expense in EUR '000s Annual IT Budget in EUR '000s IT Spend (Operating and Capital Expense) per Capita in EUR

9 Hospital IT expenditure 2/2 Based on overall Hospital Budget Dutch Hospitals spend most for IT. Germany is far behind in this respect. 4,5 4,0 3,5 3,0 2,5 2,0 1,5 1,0 0,5 0,0 1,8% ,3% 1,5% 22 3,9% ,9% 0 DE IT ES NL US Mean Annual IT Operating Expense in % of Annual Hospital Operating Expense IT Spend (Operating and Capital Expense) per Capita in EUR Average IT Spend in Europe (1.8%)

10 Number of financial statements in sample European Hospital Rating Report: The study's focus is the 2011 financial state of hospital sectors in nine European countries Sample market share based on revenues of hospitals at around $ 123 billion*** (total market $ 369 billion***) Sample as % of all hospitals in the country* 52 Portugal 33% 26 Norway** 43% 303 Italy 30% 348 France 19% 154 Spain 28% 513 Germany 30% 26 Switzerland 22% 68 Belgium 53% 32 Austria 25% *Note: Based on OECD number of hospitals per country. Actual portion can be higher if financial statement includes more than one hospital. **Note: Data based on trust level. ***Note: Excluding Italy due to lack of OECD data on hospital expenditure Source: Accenture / RWI

11 Sample Average Executive Summary - European Hospital Rating Report An industry operating in the red High Risk Class 22 % of hospitals per classification Increased Risk Class Low Risk Class > financial statements of hospitals Nine countries Every 5 th hospital is at high risk of default if not covered by funding body Every 4 th European hospital with a increased Risk Class Every 3 rd European hospital reports losses (EAT) Every 2 nd hospital will have problems obtaining loans Source: Accenture / RWI

12 Source: Accenture / RWI / 2011 ORBIS financial data Note: Sectors based on German Hospital Rating Report (German HRR). Green class 0-1%, yellow class >1-2,6%, red class > 2,6% Note: For Germany, special items (Sonderposten) are counted as equity. Therefore, the average PD is lower (PD = 0,6) compared to the German Hospital Rating Report (PD = 1,2). Adopting the calculation for the German HRR yields the same average PD (0,6). Average Hospital in Europe due to weak external financing capability (PD) close to the red zone Average probability of default per country (in %) 8,7 3,6 0,5 0,6 0,8 1,6 2,1 2,1 2,5 2,5 Switzerland Germany Belgium Italy Austria Spain Norway Sample average France Portugal

13 Source: Accenture / RWI / 2011 ORBIS financial data Note: For Germany, special items (Sonderposten) are counted as equity. Without special items the distribution of hospitals is at 73% in the green, 14% in the yellow and 12% in the red classification according to the German Hospital Rating Report 2013 (German HRR). Almost every 5th hospital in Europe at high risk of default if not covered by funding body % of hospitals per classification Germany Switzerland Belgium Sample Average Spain Italy Norway France Austria Portugal Low Risk Increased Risk High Risk

14 Source: Accenture / RWI Note: For Germany, special items (Sonderposten) are counted as equity. Wide gap between top and low risk profile (PD) in every country identified Probability of default for TOP 25% and BOTTOM 25% of hospitals (in%) 17,6 12,4 5,1 5,6 6,8 7,0 8,1 1,8 2,2 1,1 0,1 0,2 0,1 0,3 0,5 0,2 0,1 0,1 0,1 0,2 Switzerland Belgium Germany Norway Austria Sample Average TOP 25% BOTTOM 25% Italy Spain France Portugal

15 Better IT Better Hospital? Is there a corelation between level of IT implementation and financial key performance Indicators?