conhit 2014 Overview to conhit and the German Health IT market Michael Heinlein

conhit 2014 Overview to conhit and the German Health IT market Michael Heinlein

Market Report Content table 1. General introduction Healthcare in Germany / Hospital organization 2. Global overview of the IT infrastructure in hospitals 3. Pricing and decision making on the German market 4. Market communication channels 5. Quality management, data privacy and certification issues 6. General recommendations for the German market 7. Experiences and summary 2

Market organization Krankenhaus Hospital Gemeinschaftspraxis Group practice MVZ Medical care centers Krankenkasse health insurance Rehabilitationsklinik rehabilitation center Stationäre Pflege inpatient care Ambulante Pflege outpatient care 3

Health Care in Germany (organization and infrastructure) Hospitals (approx. 2.017) Private practices (approx. 130.000) Medical care centers - Medizinische Versorgungszentren MVZ (approx. 1.700) Rehabilitation Center (approx. 1.300) 4

Hospitals and the pro rata amount of hospital beds in Germany Most ofbedsin 2011 werein Public hospitals Amount of hospitals according to hospital chains Amount of beds in hospitals according to hospital chains (Public hospitals) (Private hospitals) 2.045 hospitals 502.029 beds (Non-profit organized hospitals) 5

Hospital organization in Germany University hospitals (tertiary care) 36 in Germany Private hospitals around 10 % market share in regard to institutions around 30 % market share in regard to beds Hospitals belonging to private chains (also hospitals supported by the church secondary and tertiary care). The biggest chains are: Helios Kliniken (54 hospitals, 20 rehabilitation centers, 30 MCC) www.helios-kliniken.de Rhön (59 hospitals, 48 MCC) www.rhoen-klinikum-ag.com (now part of Helios) Sana Kliniken (43 hospitals) www. sana.de Asklepios (46 hospitals, 25 rehabilitation centers) www.asklepios.com Schön Kliniken (14 hospitals) www.schoen-kliniken.de General hospitals (state or county hospitals secondary and tertiary care from 80 beds until 1.000)) 6

The role of health insurances (compulsory health insurance system) 156 health insurance companies in the GKV (compulsory health insurance CHI) organization are listed (end of 2011 number is decreasing) Health institutions are billing to Kassenärztliche Vereinigung CHI physician association and the health insurance companies are refunding money over this organization to the health institutions The services the CHI is providing to their insurants are relatively low In addition to the normal service there are IGeL-Leistungen available (voluntary service, paid by the insurant himself to the health institution or covered by private insurance companies Basically the German healthcare system is privately financed 7

Growth rate of systems in the German Health Care market 8

Hospital Information Systems (overview) Agfa Healthcare (Orbis) approx. 600 customers Full service approach, tries to cover nearly every niche product with own solutions Siemens Healthcare (medico/s and ishmed) approx. 600 customers Broad range of software modules, open for cooperation CSC - formerly know as isoft Health (clinic center) approx. 60 HIS customers In addition approx. 250 RIS and LIS customers Basically open for cooperation brightone - formerly know as Tieto (imedone, imedweb) approx. 200 HIS customers In addition approx. 500 customers with their kitchen and hygiene management systems Meierhofer (MCC, cooperation with RZV) approx. 150 customers Strong in special modules in addition to 9 normal HIS GTMHC solution Strong cooperation with SAP

Hospital Information Systems (overview) Compugroup medical (systema, fd klinika) approx. 250 customers Growing weaker, currently losing market share Bought MCS parametrix 30% market share in Switzerland) Systema marekt leader in Austria Nexus (KIS) approx. 160 customers Rising star won most of HIS projects in Germany Especially strong in medical documentation (bought little specialized companies recently) AMC (clinixx) smaller HIS providers with a very little market share but the only webbased solution on the German market PCS - Patidok (market leader in Austria) 10

Missing system modules in German HealthCare market EMR solutions are missing on the market the reasons: Private policy Who should pay for an EMR solution? Telemedicine solutions the market is starting Combination telemedicine and AAL Big demand for mobile solutions (IOS, Android, MS): usability concepts (!) for existing or new software solutions are still missing 11

General statement regarding pricing on the German market License fee The normal pricing is approximately minus 35-40% in relation to the Danish price level Installation fee For man-days the companies are invoicing between 900,00 to 1.250,00 each day (for travel expenses a flat fee is required) Support (1 st and 2 nd level) Price range between 1,0 and 1,5% of license fee, monthly (workday 9am to 5pm support) Attention: in most cases the customer likes update and upgrade services included in this price 12

General statement regarding time schedule for decision making Tender (approx. 2 years) Preparation > 1 year (preparation group, fixing the hospital needs etc.) Tender itself plus 6 months Decision plus 3 months Installation plus 3 months later Direct award (approx. 1,5 years) Investment planning in one year Decision and installation the year after 13

Integrators and consultants Some important integrators on the market: März Internetwork DFC Systems Computacenter Comparex T-Systems (subsidiary from Telekom) Some important consultants: Synagon AG, Dr. Dujat Qcmed GmbH, Dr. Knips Ingenieurbüro Dünkel. M. Dünkel IFK Braunschweig, Prof. Riedel Vosseler Consulting, Mrs. Vosseler ProKlinik, Dr. Armin Wurth Unity, Meik Eusterholz 14

The role of distributors, integrators and consultants Distributors Little number of distributors for IT solutions for hospitals, most of them a regionally oriented (i.e. GesBeCo) Distributors are playing a big role regarding the service for GPs Integrators The backround from integrators (except T-Systems) is hardware oriented Software solutions are mostly interesting regarding the need of a deeper hardware consultancy or increasing sales for hardware Consultants Most of the consultants are only involved in tender handling Only seldom consultants are involved to push new and innovative projects (more in public funded projects) But: consultants sometimes are the key to get in a tender process! 15

The importance of a reference site Without a German reference site it is nearly impossible to enter the market! How to get a reference site? Most of the first reference sites are a kind of present with a nice extra wrapping (support, updates and upgrades free of charge etc.) Identification of the key persons in the market (more IT- or more medical-oriented?) 16

The language question Is not only a question of language The IT system itself must be in German Country-specific needs, especially in diagnosis and procedure coding, have to be integrated (ICD, OPS, EBM, ) The German market loves using standards for everything, but an existing standard is normally not suitable for daily work, adjustments with German experts in the special areas are indispensable Normally everybody is expecting a country subsidiary from a company, but in the German market this is not absolutely necessary Installation services must be in German First level support in German and should be based in Germany Second level support is required in German but needs not to be in Germany (German time zone is required) 17

Stake holders Decision making for IT solutions in hospitals MD/nurse The MD and the nurses used to be able to take their own decisions Now they are often only supporting decisions Medical technicians IT The role of the medical technicians is changing In most cases they will be part of the MIT department in the future Decision makers and often preparers of the ideas for new IT solutions In the future the IT-department leader will be the leader of a new organizational department MIT (medical technique and IT) 18

Stake holders Decision making for IT solutions in hospitals Where are decisions taken? Hospital chains tendency to centralize to decision making process (especially Asklepios, Sana, Helios or Rhön) but so often as a supplier you get one question: Where do you have an installation in one of our hospitals? To prepare a decision it is necessary to have one hospital who will be a good partner to get in touch with centralized decision responsible persons And to try to get in parallel a good contact to central responsible There is a change in buying strategy from autonomous decision making to central buying center organization So for the moment: often in German we are saying "the cat bites its own tail" 19

Quality management, data privacy and certification issues Data privacy discussion: Information flow from one system to another Information security within the system Medical device directive: Software as a medical device? ISO 80001, ISO 9001 (for partnerships with bigger companies) DICOM conformance statement (English version sufficient) HL7 conformance statement 20

Past Experience with Danish IT solutions on the German Healthcare Market Go To Market Camp 2012 conhit participation 2012 (3 companies) and 2013 (6 companies) conhit 2014 Denmark Partner country!! Danish Roadshow 2013 in Berlin Entscheiderfabrik 2013 (Daintel) First reference sites First partnerships between German distributors and Danish Solution Providers The German Market is interested in the Danish approach, which is in some cases different to the German way and partially more innovative (based on the different needs on the Danish Healthcare sector) 21

Important events Medica, November 20 th to 22 nd 2013, not real relevant for IT system providers with focus on German market ConhIT connecting Healthcare IT, May 06 th to 08 th, 2014 the one Healthcare IT exhibition in Germany Schliersee Konferenz (http://www.ehealthopen.com), little circle of industry and hospital representatives (every January) KH-IT (http://www.kh-it.de/tagungen.html), two times a year, founded by heads of IT-departments in hospitals (next conference April 9 th ) DG Telemed Association (http://dgtelemed.de/de/veranstaltungen/?lang=de) Telemed congress (http://www.telemed-berlin.de/) 22

Others Organizations KH-IT Leiter organization (association of heads of ITdepartments from hospitals Bvitg (association of IT solution providers for hospitals and GP`s) Entscheiderfabrik (association of consultants focus hospitals) DG Telemed (association for telemedicine projects, companies and user) BVMI (association of IT professionals in healthcare) To use organizations within a marketing strategy successfully it is necessary to be an active member in a organization! 23

Summary German market challenge The German market is the biggest market in Europe regarding the lump sum of investments in IT in hospitals and GP`s The market is also one of the biggest markets regarding the number of hospitals and GP`s License prices are lower than elsewhere in Europe (western Europe) A lot of companies are active on the German market (from all over the world) => strong competition! For the first project won normally a time schedule from 1,5 up to 2 years has to be calculated 24

Summary German market challenge Customers are strongly regulation-oriented (data privacy, software as a medical device, ISO 80001) Germans extremely love well-defined products (description and use cases especially regarding innovative system approaches) Personal advice: start together with a regional partner on the German market Personal advice: Find a well defined strategy for your product lines and your company <= Be well prepared for the German market! 25