849 
Kiran John
Research Analyst
Healthcare (EMEA) Frost & Sullivan
London, UK
European healthcare has witnessed an evident shift towards more technologically driven workflows. Governments and healthcare decision-making bodies have acknowledged the vital role technology will play in improving care delivery and reducing costs. Proactive measures have led to national initiatives to improve broadband connectivity, the use of international standards (HL7) for the communication of information, ePrescriptions, smartcard technology and national integration programmes for all healthcare users. Integrated healthcare remains the ultimate goal, therefore guaranteeing patient safety, effective care delivery processes, resource management, best practices, data security, multiple-point patient data access, interoperability and a sustainable healthcare platform that understands and responds to the needs of the people, healthcare providers, payer organisations, governing bodies and health professionals.
The rising costs of healthcare and restrictive hospital IT budgets have made it increasingly difficult for hospitals to replace or upgrade their hospital IT (HIT) infrastructure. This has forced the streamlining of operations and the adoption of best practices that can result in cost savings and workflow improvements. Clinical information systems (CIS) seek to achieve this by providing specific department solutions that incorporate decision support, integrated clinical and administrative processes key to the functioning of individual departments. On the administrative side, patient administration systems (PAS) seek to create an administrative platform that standardises and streamlines workflows to achieve similar results. Resource allocation plays a vital role, where demand and supply must be matched consistently. Patient eBooking seeks to achieve this by matching the needs of patients with health professionals and resources in primary and secondary care. In regions where GPs play a larger gatekeeper role, matching demand becomes increasingly important to the overall functioning of a nation’s healthcare system.
Patient eBooking systems
Patient eBooking systems enable GPs, nursing staff and administrative staff to schedule appointments to inpatients and outpatients. Some care providers use a fully functional PAS with eBooking support, while others operate using a stand-alone customised solution with limited interoperability.
Historically, scheduling of patient appointments has been a paper-dependent workflow. As the use of computers gained popularity over the last few decades, administrative workflows were the first to be computerised. Scheduling of appointments was one such workflow that was computerised, but with very limited functionality. Today, patient eBooking systems are rich in functionality and communicate using international standards with other systems in the hospital. An integrated approach to hospital IT has enabled this transformation. For example, in the UK, integrated eBooking has taken the form of a national initiative called the Choose and Book service, owned and run by Atos Origin. Across Europe this is the only nationwide patient eBooking systems initiative. Other regions prefer to install a patient eBooking system either in a single hospital or in a group of hospitals that spans many buildings, as in the case of large university hospitals. In such regions it is common to find healthcare initiatives being carried out for smaller geographic areas.
Market realities
Presently, the UK is the largest market for patient eBooking systems, followed by Germany, France, Italy, Scandinavia, Benelux and Spain. The Choose and Book service contributes largely towards the total revenue expenditure on patient eBooking solutions in Europe. Patient choice has been driving the patient eBooking market in the UK. In regions where patients have had choice, this has had a subdued effect on driving revenue expenditures.
In addition to ensuring quicker medical responses, eBooking is also used to accomplish mundane tasks that were once performed by nursing staff. This often prevents them from spending more time with patients. Since eBooking is centrally controlled, nurses are now free to make appointments or schedule resources from the patients’ bedside or from hospital management systems with ease.
Patient safety has been an increasing concern, especially when populations are growing, hospitals are reducing, healthcare professionals are limited and nursing staff is on the decline. Technology seeks to ensure patient safety under these circumstances, and resources need to be managed efficiently. The increasing role of IT has led care delivery centres to seek benefits associated with high-technology healthcare solutions. With changes in the role of clinical systems, including functions that were once administrative, these legacy systems need to be changed. Their benefits have been realised, and cost is a key influencer in preventing increased adoption of newer systems.
Outdated systems
Shorter product lifecycles are characteristic of healthcare IT. However, hospitals have not been able to keep up with this rapid change. This has forced hospitals to continue using outdated legacy systems. Hospitals, due to restrictive budgets, are unable to update constantly their systems for several reasons such as costs, time, workflow interruptions, change management and interoperability issues. At present there is a need to create unique patient identities. These unique identities will help hospitals book appointments for patients. This need has been recognised, and initiatives are already underway to create unique identities for all EU residents. In order to facilitate this change, smartcard technology is being used.
The large number of legacy systems has made upgrading these systems difficult, as most cases warrant replacement. Patient eBooking requires the cooperation of stakeholders and all users of the system for its implementation and use. It is necessary to create and maintain patient information, as it plays a vital role in running patient eBooking workflows. In order to run more sophisticated systems a functional PAS is required, as the system will need to interact with the PAS. This requires hospitals to upgrade their PAS to support eBooking. Across Europe the focus is on electronic medical records (EMR) adoption and compatibility; the necessary upgrades will eventually take place, benefiting specialty patient eBooking vendors.
Revenue expenditure – total European patient eBooking systems markets
The key to providing effective eBooking solutions is not just a matter of resource allocation. The aim is to provide an up-to-date status on current appointments and resources, accessible from all departments in the hospital. Therefore, a certain level of integration must exist before these systems can be truly implemented. In the case of nationalised eBooking, such as the Choose and Book service, locally stored information must be updated in the patient demographic service (PDS) for it to be effective. For these solutions to perform effectively, a certain level of technical sophistication must be present in supporting systems that utilise or provide information to the eBooking services.
It is noteworthy that integrated care is on the horizon. However, the role played by legacy systems is still important for healthcare delivery. It is important for vendors to be able to configure their systems to adjust to various legacy system limitations. This implies that PAS and eBooking vendors should be able to craft the solution manually, by allowing constants to be variables. Complete automation is very expensive. Therefore, PAS and eBooking vendors must be able to provide their solutions with a minimum level of dependency on existing legacy systems.
It cannot be argued that storing patient records in paper form is more effective than having them stored digitally. However, one might argue the importance of ensuring data integrity, and to ensure security is almost impossible. eBooking systems require a change of organisation and attitude. The UK is a classic example of the difficulties in breaking away from tradition. It is, however, not impossible. It is critical to inform GPs, physicians, nursing staff and residents about the benefits and limitations of the system. Creating awareness is critical.
On a smaller scale, eBooking does not require this level of awareness, but needs a voluntary change in workflow that healthcare staff and professionals must accept for the system to work. For eBooking solutions to work effectively, supporting PAS systems must provide the system with accurate and timely information, which is sourced from updated databases, which may be centrally controlled. In cases where the system is subject to several outside influences (eg, noncompliant systems), it may be easier to provide patches on the eBooking side instead.
The issuance of monetary incentives for compliance might be a wise method to utilise, but it reflects the lack of faith the users have in the system. This can be restored by emphasising the importance of the system as a mode to improve efficiency.
References
- Europa. Available at: www.europa.eu
- European Observatory on Health Systems and Policies. Available at: www.euro.who.int/observatory
- Health Protection 2007. Available at: www.healthprotectionconference.org.uk
- eUser. Available at: www.euser-eu.org/eUSER_eHealthCountryBrief.asp?MenuID=118
- National Statistics. Available at: www.statistics.gov.uk/glance
- Frost & Sullivan. Available at: www.frost.com
