Objectives and scope of the study
The sector covers the business activities specified in NACE Rev. 1.1 Division 85.11 and focuses on acute care hospitals. In 2005, the number of acute care hospitals in the European Union Member States was around 13,000. They are typically large or medium-sized units in terms of employment and serve patients mainly from the city or region they are located in. Around 50% are public, 40% private for-profit and 10% private non-profit.
e-Business in hospitals: findings from the e-Business Survey 2006
The e-Business Survey 2006 shows that the hospital activities sector is one of the sectors with the highest ICT and e-business use. This is however partly due to the fact that hospitals tend to be larger organisations with more than 250 employees:
- Sector differences: In comparison with the other nine sectors considered in the e-Business Survey 2006, hospitals are quite advanced in ICT and e-business use. For example, as regards ICT networks, hospitals were found to be above the all-sectors average in internet access, broadband access and remote access to the hospital’s computer network. Hospitals also reported higher levels for internal and external e-collaboration as well as e-procurement. However, hospitals were found to be well behind other sectors in e-business solutions facing patients, notably online booking of services and e-marketing. This indicates opportunities for improvement in this respect.
- Size class differences: According to the survey results, small hospitals generally lag behind medium-sized and large ones in ICT and e-business use. This applies, for example, for internet, broadband and remote network access as well as for internal and external e-collaboration. However, small hospitals reported higher shares of employees that have internet access and internet telephony use as well as for online service booking.
- Drivers and barriers of e-business: Expectations from health insurance funds were mentioned as the most important driver among the items asked. “Gaining competitive advantage” and the fact that “competitors do it” was also reported to be important, which confirmed that there is considerable competition among hospitals. Security concerns and expensive technology were mentioned as the most important barriers. The other barriers asked in the survey followed well behind: “hospital is too small”, “legal issues”, “lack of reliable ICT providers”, and “systems not compatible”.
- Standards and interoperability: Currently there is a large number of ICT standards for the health sector in use. Commitment to European and international standards is generally weak, and there is a tendency for Member States to create national ICT standards for the health sector. Only 26% of the hospitals of the survey said they use the health-specific HL7 standard. In four of seven categories asked in the survey, the share of hospitals reporting difficulties due to a lack of interoperability was larger than the all-sectors average: invoicing, payments, technical aspects, and regulatory aspects.
- Data security: Hospitals face a dilemma: on the one hand patient data need to be readily available; on the other hand, information needs to be protected from unauthorised use and against loss or modification. Hospitals were found to respond to this challenge: The reported levels of use of secure server technology and digital signature or public key infrastructure in the hospital sector were twice as high as in all sectors. The level of use of a firewall was also reported to be much higher in the other sectors studied by e-Business [email protected] in 2006 .
Implementation and integration of separate information systems
Hospital Information Systems (HIS) are the core means of e-business in hospitals. Two types of systems are of particular importance: firstly, e-prescribing and medication management systems as prescriptions are a core means of treatment, and, secondly, imaging systems because imaging is a core means of diagnosis. Integration of separate systems is a further important issue:
- HIS benefits and implementation. HIS can help to cope with the huge amount of data a hospital has to deal with, they can enhance communication among professionals and bring useful knowledge to them, and they can make processes more efficient. Almost all European hospitals have at least an electronic system for patient data and financial administration. However, only a minority uses more sophisticated systems for computerised pharmacy services, imaging and medication.
- e-Prescribing and medication management. When supporting medical decisions, e-prescribing and electronic medication management systems can reduce medical errors and, ultimately, save lives. However, less than 20% of hospitals surveyed this year by e-Business [email protected]tch reported practicing some form of e-prescribing, and only around 2% said that they use “knowledgeable” systems. This makes the introduction of systems for Computerised Physician Order Entry (CPOE) a political and economic issue. However, CPOE systems may not be appropriate in medical units with frequent need of emergency medication because CPOE may delay therapy and diagnostic testing.
- Radiology Information Systems. Electronic imaging offers improved visualising, archiving and communication methods. It can thus improve diagnosis and quality of care as well as reduce administration costs. However, the survey found that only around a quarter of the hospitals apply such systems.
- HIS integration. As hospital services may require the interaction of different departments, separate HIS need to be integrated to open up all potential benefits. However, often this is not the case inside the same hospital. Findings suggest that there are three principal reasons: firstly, a lack of ICT planning which may be caused by a complex hospital organisation; secondly, difficulties with ICT suppliers, and, thirdly, a lack of commonly used industry standards.
Impacts of ICT use in hospitals on the wider health system
ICT investment in hospitals impacts not only on the hospitals themselves but also on the wider health care system. Related issues include, firstly, the continuity of care across hospital borders and, secondly, the question whether the role of hospitals is changing with regard to relationships towards patients and the division of labour with different hospitals and other health care providers.
- ICT supporting continuity of care. Since healthcare is increasingly specialised and tasks are distributed across a large number of health professionals, there is a need for ensuring continuity of care across departmental and extra-mural interfaces. ICT can support structured communication among clinicians to achieve appropriate health care provision. Electronic patient records and web services are two means of improving continuity of care which are currently on the deployment agenda of many European hospitals. However, there is hardly any evidence of actual implementation of comprehensive electronic health records.
- Changing role of hospitals. The role of acute care hospitals is to provide in-house, comprehensive, specific and round-the-clock care. Some hospitals also have the role of professional and student education and academic research. In the course of increasing investment in ICT, the role of hospitals may change. The analysis for this report suggests that ICT impacts mainly on the relationship towards patients and the need for in-patient care. Most importantly, electronic communication between hospitals and general practitioners or the patients themselves may make a patient’s visit at the hospital unnecessary. The hospitals’ boundaries potentially become more permeable; the role of hospitals may slowly shift from an in-house care provider to an outbound communicator.
The analysis of the e-Business Survey 2006 as well as of main topics of e-business in hospitals showed that ICT and e-business has enormous impact on hospitals. The core impacts are in workflows and business process efficiency. Workflows are likely to become more streamlined and efficient because patient data are available much quicker when they are accessible from any workstation in the hospital at any time.
Although the majority of European hospitals are public, there is considerable competition in the sector – among the hospitals and between hospitals and primary care providers. ICT influences this competition. For example, more than half of the hospitals in the e-Business Survey 2006 stated that competition in the sector increased due to ICT. 40% said that the fact that “competitors do it” is a driver of ICT use. In many European countries it may be politically desirable that the number of beds per inhabitant, the number of employees and wards per hospital or even the number of hospitals diminishes in order to contain costs while improving the quality of care.
The following policy implications are directed primarily to e-business and health policy makers. Health policy makers may have direct or indirect influence on investment decisions in hospitals, and public hospitals in particular. Therefore some of the implications directly affect hospital management.
- Fostering interoperability. In order to facilitate the integration of separate information systems in hospitals, health policy makers should increase awareness about interoperability issues in e-health. They should actively promote and facilitate interoperability by appropriate investments in the work of standardisation organisations and their standardisation efforts. Voluntary use of standards by hospitals and other health service providers could contribute significantly to interoperability.
- Enhancing ICT investment. Improvements in ICT applications in hospitals can come about only if the hospitals invest adequately in these technologies. Hospitals should carefully plan ICT spending within the near future and also develop a long-term strategic ICT plan. They should not necessarily expect quick returns of ICT investment. Many hospitals lack the investment capabilities as well as human resources for a “great thrust” towards implementation of comprehensive ICT applications. A step-by-step investment approach however appears to be appropriate.
- Improving education and training in health ICT. Effective use of ICT in hospitals requires adequate education of the users, e.g. physicians, nurses, and pharmacists as well as administrative staff. In particular, there appears to be a need for training of hospital Chief Information Officers and Chief Executive Officers, as the e-Business Survey 2006 found that ICT is expected to heavily impact on hospital management in the future. Thus, policy makers should strive for providing adequate education and training opportunities for hospital managers.
- Ensuring data security. Hospitals need to be aware that security issues cannot be solved by purely technical means but that a broad approach needs to be applied, including a security policy and provisions such as security training.
- Monitoring role changes. Health policy makers should thoroughly monitor the changing role of hospitals in order to drive wanted developments and to react to unwanted developments if need be. Relevant indicators to be monitored include, e.g., shifts in size classes, in different locations, and public or private ownership. The relationships of hospitals towards patients, other hospitals, and primary health service providers should also be monitored.
- Inform the public about ICT in hospitals. Research for this report has not revealed any signs that patients and citizens are requiring more ICT use in hospitals. Thus, a potentially important driver of ICT use in hospital appears to be missing. Therefore, patients and citizens in Europe should be better informed about the benefits of ICT use in hospitals. Such information could be provided by public authorities in the field of health and ICT on European, national and regional levels.
Reference to earlier sector studies
The sector was covered as part of the "Health
and social services industry" in sector studies of 2002-2004
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