Transcript 1999 CHIM EXHIBITOR MARKETPLACE

Greater China eHealth Forum
Hong Kong
Evolution of Global HIT
Where Does China Stand on
the Global HIT Continuum?
October 8, 2011
Presentation Agenda
•
Page

About the Dorenfest Group

Evolution of Global HIT
10

Current Status and Future Direction of HIT in China
18

Where Does China Stand on the Global HIT Continuum?
28

Q&A
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DORENFEST CHINA HEALTHCARE GROUP
The Dorenfest Group

40 years experience in HIT

Offer healthcare improvement services through a variety of businesses.

–
Software
–
Hospital operations improvement
–
Consultation with technology and software vendors in health
–
Information and data analytics
Focusing now on improving patient care and operational efficiency through
better change management
–
Work process improvement
–
Management systems improvement
–
Improvement in services for patients
–
Improvement in quality of patient care
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DORENFEST CHINA HEALTHCARE GROUP
Some Dorenfest Hospital Projects in Other
Countries
Abington Memorial Hospital
Addison Gilbert Hospital
Adventist Health System/Sunbelt
Adventist Health System/West
Akron General Hospital
Albemarle Hospital
Baptist Healthcare System
Baxter County Regional Hospital
Baylor Health Care System
Benedictine Health System
Boulder Community Hospital
Brackenridge Hospital
Bristol Bay Regional Health System
Burlington Medical Center
Caritas Health Services
Carondelet Health System
Central DuPage Health System
Central Washington Hospital
Centura Health
Charleston Area Medical Center
Children’s Health Care
Cleveland Home Health Agency
Community Memorial Hospital
Conway Regional Medical Center
Cortland Memorial Hospital
Cox Medical Centers and Health Services
DCH Healthcare Authority
Delnor Community Hospital
Dreyer Medical Clinic
Duluth Clinic
East Alabama Medical Center
Edward Health Services Corporation
Flagler Hospital
Florida Hospital
Freeman Health Services
Freeport Memorial Hospital
Glenoaks Medical Center
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The Good Samaritan Hospital
Grady Health System
Greenwich Health Authority
Hamot Medical Center
Hazleton-St. Joseph Medical Center
Hinsdale Hospital
Holy Redeemer Hospital and Medical Center
Horizon Health Care Group
Howard Young Medical Center
Humility of Mary Health Care
Illinois Medical Billing Service
Integris Health System
Jackson County Memorial Hospital
Johnston Memorial Hospital
Kennebec Health System
Lakeland Regional Health System
Little Sisters of the Poor Health Services
Los Angeles County Department of
Health Services
Marion General Hospital
Medical Center of Southern Indiana
Memorial Health Alliance of Burlington
Memorial Health Services – Long Beach
Memorial Hospital – Belleville
Memorial Health System – South Bend
Mid-Maine Medical Center
Michigan HealthLink
Miller-Dwan Health System
Mount Clemens General Hospital
Muskogee Regional Medical Center
Nebraska Methodist Health System
Presbyterian Health Care Services
Progressive Health System
Providence Medical Center
Pungo District Hospital
Rapides Regional Medical Center
Ravenswood Hospital
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Resurrection Health Care Corporation
River District Hospital
Riverside County Health Services Agency
Robert Wood Johnson University Hospital
Rush North Shore Medical Center
Salinas Valley Memorial Hospital
San Antonio Community Hospital
Scripps Clinic
Shadyside Hospital
Sharp HealthCare
Sisters of Charity of Nazareth Healthcare
System
South Jersey Hospital System
Southeastern Ohio Regional Medical Center
Southern Illinois Health Corporation
St. Agnes Hospital
St. Clare’s Hospital
St. Elizabeth Hospital
St. Francis Medical Center
St. Joseph Health System – Orange, CA
St. Joseph Hospital – Cheektowaga, NY
St. Joseph’s Hospital – Marshfield, WI
St. Joseph’s Medical Center – Brainerd, MN
St. Luke’s Hospital – Duluth
St. Mary’s Hospital – Amsterdam, NY
St. Mary’s Hospital – West Palm Beach
St. Mary’s Medical Center – Duluth
St. Vincent Infirmary Medical Center
Stillwater Medical Center
SwedishAmerican Health System
Texoma Medical Center
Tulane University Hospital and Clinic
University of Tennessee Bowld Hospital
Valley Hospital
Washington County Health System
William Beaumont Hospital Corporation
Willis-Knighton Medical Center
Yuma Regional Medical Center
DORENFEST CHINA HEALTHCARE GROUP
Some Dorenfest Healthcare Supplier Projects in
Other Countries
3COM Corporation
3M Corporation
Abbott Laboratories
ALLTEL
American Business Computers
American Hospital Supply Corporation
American Medical International
Amicare
Anacomp, Inc.
Anixter, Inc.
Apple Computer, Inc.
Arthur D. Little, Inc.
Arthur Young & Company
AT&T Information Systems
AT&T Technologies
Automated Information Systems, Inc.
AVNET
Bacon, Whipple and Company
Bain and Associates, Inc.
Basic American Medical Inc.
Baxter Diagnostic, Inc.
Baxter Travenol Laboratories
BayNetworks
Becton Dickinson
Bell Atlantic
Bell Laboratories
Biovation, Inc.
Bristol-Myers Squibb
Brunswick Corporation
Cerner
Community Health Computing
COMPAQ Computer
Compucare
Computer Sciences Corporation
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Crowntek, Inc.
Datacare, Inc.
Dell Computer Corporation
Digital Equipment Corporation
E.I. du Pont de Nemours & Company
Eclipsys/TDS
Eli Lilly
Emtek
General Electric Company
Habush & Habush, Inc.
Hambrecht & Quist, Inc.
HBO & Company
Health Data Network
Health Systems International, Inc.
Health-Comp. Inc.
Hewlett-Packard
Hill-Rom
Honeywell
Hospital Corporation of America
Humana, Inc.
IBM Corporation
IDX Corporation
IMS America, Ltd.
Information Strategies, Inc.
Intel Corporation
Intellimed
Johnson & Johnson
Kimberly Clark
Lawson Software
LORAL/Martin
Lotus Development
McDonnell-Douglas Health Information Systems
McGraw Hill
McMullen & Associates (Canada)
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MedAmerica Health Systems
Medicus Systems
Mediflex Systems
Meta Software
Microsoft Corporation
Moore Business Systems, Inc.
Motorola, Inc.
National Medical Enterprises
NCR Corporation
NetFRAME
Nuvatec, Inc.
Ohio Nuclear
Pathlab
PeopleSoft
Physio Control
Praxis International
Prime Health, Inc.
PROMIS Health Technologies
Ransburg Corporation
Retrieval Systems
SAIC
Sentry Data, Inc.
Shared Medical Systems
Spacelabs, Inc.
Standard Register
Sun Information Systems
Sunquest Corporation
TETRAD (England)
Total Business Systems
Trinity Computing Systems
Universal Health Services
VoiceLinks Medical
Wisconsin Blue Cross
Xerox Computer
DORENFEST CHINA HEALTHCARE GROUP
Dorenfest’s Investigation of China Healthcare
in 2005-2006
1.
Visited 17 cities in China
2.
Met 100’s of healthcare industry leaders in China
3.
Visited over 100 hospitals to review hospital operations and define
opportunities for improvement
4.
Met provincial and city health bureau leaders in cities visited
5.
Met with many companies selling products and services to the healthcare
industry in China
6.
Evaluated a group of hospital ownership and management opportunities and
assessed viability of the Dorenfest “model hospital” in China
7.
Developed a strategy for bringing Dorenfest skill and experience to China
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DORENFEST CHINA HEALTHCARE GROUP
China Healthcare Leaders Want to Leapfrog the
World in IT Use

Chinese hospitals and health bureaus are carefully considering how to be
more successful in taking next steps forward in IT use

There is a recognition that for China to accomplish its objectives in HIT
requires the following:
–
Learning quickly from the global experience
–
Overcoming resistance to change
–
Knowing how to manage change
–
Doing more of what the rest of the world did right and less of what they
did wrong to avoid mistakes other countries have made and China is
still making
–
Developing more expertise in these areas of need quickly
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DORENFEST CHINA HEALTHCARE GROUP
The Dorenfest Group Is Bringing Needed New
Skills to China
1.
Hospital Operations Improvement and Change Management
2.
IT Program Improvement, Problem-solving, Strategy, and Planning
3.
New Approaches to Buying IT Systems in a Stronger Partnership with Users
4.
New Ways to implement IT Systems
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DORENFEST CHINA HEALTHCARE GROUP
Examples of Dorenfest Projects in China



Some health bureau clients for RHN and digital hospital planning
–
Shenzhen
–
Chongqing
Some hospital clients
–
Peking University Third Hospital
–
Shanghai Changning Maternity & Infant Health Institute
–
Rizhao City People’s Hospital
–
Foshan City First People’s Hospital
Help clients from other locations bring their skills to Mainland China
–
Hong Kong Hospital Authority
–
Microsoft
–
Philips
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DORENFEST CHINA HEALTHCARE GROUP
Greater China eHealth Forum
Evolution of Global HIT
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DORENFEST CHINA HEALTHCARE GROUP
The U.S. Hospitals Have Sought an EMR/EHR Since
the 1960s through Four Generations of IT Systems

Finance Systems (1960s and 1970s)

Limited Clinical Systems (1970s and 1980s)

More Advanced Clinical Systems (Late 1980s and 1990s)

Electronic Health Records (2000s)
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DORENFEST CHINA HEALTHCARE GROUP
But Poorly Implemented Change Layered Redundant
Work on Top of Original Inefficiency
Growth in
Redundancy
4x
3x
2x
Before IT=1x
Total Hospital Work Process
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DORENFEST CHINA HEALTHCARE GROUP
At the Beginning
1.
Large vision
2.
Hardware technology limited and expensive
 Large computers
 Inefficient software development methodologies
3.
Self development was the only software approach and remained the preferred
approach for a period of time
4.
Packaged software emerged first as a customizable starter set and later
became products requiring less customization from user to user
5.
As time passed, packaged software products became preferred
 Less expensive
 Faster to implement
 But many problems in implementation
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The Late 1970s and 1980s
1.
Several generations of technology, software vendors, software approaches, and
products came and went
2.
Software buying and implementation methods improved
 Users and management became more involved
 Functional requirements to define needs and compare vendors became
more complete and useful
 User site visits, user customer references, and user discussions with
counterparts at other hospitals became part of an improved buying
approach
3.
Integration became a large problem as the number of software vendors used by
a hospital increased
 Started out all manual with duplicate entry into multiple systems
 Moved to “hard coding” of interfaces between systems
 Caused a focus on the development of standards for software products of
different vendors to communicate with each other
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DORENFEST CHINA HEALTHCARE GROUP
The 1990s and 2000s
1.
Management of the buying and implementation of IT software continued to
improve
2.
A new generation of software systems emerged, with better features and
functions built on superior technological platforms
3.
Integration problems kept growing, causing the movement from hard coded
interfaces to standards such as HL7, and interface engines which facilitated the
transfer of data in a more efficient way between software systems
4.
Clinical data repositories, data analytics tools, and clinical decision support
systems emerged
5.
The pressure for physicians to enter orders through CPOE grew in the late
1990s and early 2000s.
6.
In the 2000’s, the long sought after vision of an EHR began to emerge in
inpatient and ambulatory settings. The U.S. 2009 healthcare stimulus will
further expand EHR use
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DORENFEST CHINA HEALTHCARE GROUP
HIT Evolution in the Rest of the World

Canada started in the late 1970s

Europe and Australia began in the early 1980s

Asia began in the 1990s

Canada, France, Germany, England, and Australia all started later than the
U.S., Invested less, and have made more progress

Hong Kong started even later, invested less, and now is the state of the art in
HIT use in the world

China HIT is now at an earlier stage of development. China has the goals and
desire to “leapfrog” the rest of the world in HIT use in the next few years
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DORENFEST CHINA HEALTHCARE GROUP
Successful Later Adopters Learned from the Experience
of Earlier Adopters to Make Progress Faster

By playing close attention to what worked and did not work in earlier adopter
countries, later adopters were able to avoid many of the difficulties experienced
by earlier adopters and accomplish better results

China is now at a key point with more rapid progress in IT use being a key
factor to support the successful implementation of healthcare reform in China
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DORENFEST CHINA HEALTHCARE GROUP
Greater China eHealth Forum
Current Status and Future Direction
of HIT in China
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DORENFEST CHINA HEALTHCARE GROUP
The Development of HIT in China
1.
Chinese hospitals began to computerize in the early 1990s
2.
The initial focus of computer efforts was on financial systems
3.
In the early 2000s, Chinese hospitals began to implement IT for clinical
systems
4.
Many software solutions are now available, with several hundred smaller
software companies now operating in the HIT market
5.
Between 2005 and 2010, China hospital spending on IT grew from $600 million
(USD) in 2005, nearing $3 billion USD in 2010
6.
This rapid growth in spending will continue at an even more rapid pace over
the next several years
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DORENFEST CHINA HEALTHCARE GROUP
Factors Contributing to Future Spending Growth
in China HIT
1.
China hospital work processes were redundant, expensive, and error-prone, which led
to the initiation and development of HIT in China
2.
In 2003, the ministry of health (MOH) issued guidelines for health IT development which
called for all cities in China to implement RHN and digital hospital programs by 2010
3.

Gave momentum to hospitals to purchase clinical systems

Very little progress towards stated goals during the policy period
Improved use of IT is one of eight pillars of the new China healthcare reform plan, giving
a new momentum to HIT in China healthcare. Focuses include:

Improved hospital IT systems

Electronic health records (EMR and EHR)

Data sharing through RHNs and integration with community clinics

IT systems to support expanded health insurance
4.
Chinese hospital leaders want to take a big leap forward in improving work processes
and in digitizing Chinese hospitals
5.
While money has always been a problem in Chinese hospitals, today there is much
more money available from many sources, and it is now being spent more freely
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DORENFEST CHINA HEALTHCARE GROUP
Evolution of RHNs in China
1.
The Ministry of Health (MOH) guidelines for Health IT Development called for
regional health networks and digital hospitals to be implemented throughout
China between 2003 and 2010
2.
This provided much momentum for RHNs a few years ago, as many health
bureaus undertook regional health network and digital hospital investment
3.
In the last few years data sharing has begun to emerge in China as some
RHNs share limited data such as test/diagnostic results and some patient
information
4.
Healthcare reform calls for e-health records and RHN development and has
provided substantial additional funding in a variety of ways, so it is expected
that substantial additional progress will be made in the next few years
5.
Much more activity and funding in many cities and provinces with even U.S.
funding for one or two major planning projects, including the Sichuan Provincial
Health Bureau EHR and Regional Health Network Project
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DORENFEST CHINA HEALTHCARE GROUP
The Competitive Environment
1.
There are hundreds of small software vendors active in China HIT
2.
The market segments with the most vendors are HIS, PACS, RIS, LIS, and
EMR
3.
All HIT vendors in the market started in a city and most are still operating in
that city or a small region around the city. Many of these smaller local vendors
have a dominant market share in the area they service. Some HIT vendors are
becoming more national in scope
4.
Many vendors in the hospital computer systems market offer heavily
customized solutions rather than products. These heavily customizable
solutions create greater dependency on the software vendor and are more
difficult/expensive to keep current when vendors release new software updates
periodically
5.
Chinese hospital leaders would like to see a new generation of HIT software
developed for the country to assist in helping them accomplish their “leapfrog”
objectives
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DORENFEST CHINA HEALTHCARE GROUP
The Current Computing Environment in a Typical
Large Complex Chinese Hospital Today
Sample Current Systems (High Level View)
Core Vendor
(Vendor 1)
Major Financial
Systems
Major Clinic
Major Ancillary
Systems
Financial
(Vendor 2)
R.I.S./PACS
(Vendor 4)
Order
Management
Inpatient ADT
and Billing
Cashiering
(Vendor 2)
MD Workstation
(Vendor 2)
L.I.S.
(Vendor 3)
Inpatient Physician
Workstation
Outpatient and
ER Registration
General Accounting
(Vendor 2)
Pharmacy
(Vendor 2)
Blood Bank
(Vendor 3)
Outpatient Physician
Workstation
Outpatient Pricing
and Charging
L.I.S.
(Vendor 3)
Bar Code
(Vendor 3)
Inpatient
Pharmacy
Material Supply
OR/Anesthesia
(Vendor 5)
Outpatient
Pharmacy
Smart Card
Ultrasound
(Vendor 6)
Lab Price System
Patient Consultation
Survey
Stomatology
(Vendor 7)
Inpatient
Insurance Interface
RF Card Producing
Sub-System
Many Other Niche and
Specialty Systems
Inpatient EMR
(Vendor 8)
Instrument and
Equipment
Management
Major
Admin Systems
Medical Ins
(Vendor 9)
Office
Automation
Systems
Performance
Assessment System
(Vendor 13)
Policy Exchange
Platform
(Vendor 13)
Webport System
(Vendor 13)
Hospital Website
(Vendor 13)
Medical Ins
(Vendor 10)
Medical Records
(Vendor 11)
Human Resources
(Vendor 12)
Note: Chart taken from a couple of real hospital situations with each vendor or product family shown in a different color
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DORENFEST CHINA HEALTHCARE GROUP
What Are The Key Factors Impeding Success In
China HIT?
1.
Chinese hospitals have not invested a lot of resources in IT systems and
infrastructure to get to the present level of accomplishment
2.
Because of weak change management, the implementation of new IT systems
in China has often added work instead of reducing work, and has created
unnecessarily redundant work processes and unhappy users
3.
The poor results in HIT in China have been caused primarily by the way
Chinese hospitals buy and implement software products
4.
The inexperience in the buying of HIT software products in China has followed
a similar path to other countries around the world in their early stages of
evolution. Most countries have learned from bad experience in their early
investments a better way to make HIT buying decisions
5.
Fueled by healthcare reform, substantial investment in new IT systems will be
made by Chinese hospitals. But the reasons for the poor results accomplished
from past investments in HIT are not well understood by Chinese hospitals and
are not being corrected fast enough
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DORENFEST CHINA HEALTHCARE GROUP
What Are The Key Factors Impeding Success In
China HIT? (Continued)
6.
The current state of the art in HIT software products, hardware platforms, and
integration tools to facilitate the accomplishment of China’s HIT goals is in
need of improvement
7.
More importantly, the implementation and change management skill required to
take this big leap forward in IT use in China is not yet available at the level
required for China to accomplish its goals
8.
Many times, hospital leadership, not knowing what it does not know, is
continuing to use poor buying and implementation approaches, because they
do not know better ways are possible, and there is still strong momentum to
continue with these poor approaches
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DORENFEST CHINA HEALTHCARE GROUP
Major Areas of Future Development and Opportunity
in the China HIT Market
1.
Application software will become more productized with greater tools to support
the growing use of IT in hospitals
2.
New application software to serve the not yet automated areas of clinical work
processes are emerging very quickly
3.
Integration tools to facilitate the development of an improved IT environment
will emerge
4.
Data analytics products and support tools to facilitate better data analysis,
reporting, and decision making will emerge as Chinese Hospital Managers
grow in sophistication
5.
Service and implementation tools will improve
 General contracting for entire efforts with some company software and
some partner software
 Planning and implementation services to support making better buying
decisions and creating more successful implementation of software
 Other problem-solving services
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DORENFEST CHINA HEALTHCARE GROUP
Today Chinese Hospital HIT Investment Is Spent
Differently Than the Rest of the World
2005 GLOBAL H.I.T. INVESTMENT STRUCTURE
100%
13.0%
90%
80%
70%
58.9%
51.5%
22.3%
66.6%
60%
Service
Software
50%
Hardware
40%
20.7%
12.2%
30%
64.7%
13.2%
20%
28.9%
10%
27.8%
20.2%
0%
Global
U.S.
Europe
China
SOURCE: CCW Research
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DORENFEST CHINA HEALTHCARE GROUP
Greater China eHealth Forum
Where Does China Stand on the
Global HIT Continuum?
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DORENFEST CHINA HEALTHCARE GROUP
Broad Comparison of U.S. and China HIT Situations
Key Element
U.S.
China
$7,500+
$100+
6+
1 to 2
Very high
Very low
Number of Software Vendors in a Hospital
80+
20+
Integration Status
Okay
Very bad
Size of IT Staff
Very Big
Small
Dependence on Software Vendors
Medium
Very High
Implementation Approaches
Fair
Bad
Historic Data Available in Any Form
Lots
Very Limited
Considerable
Very limited
Growing
Limited to none
Per Capita Healthcare Spending
Employees per bed
HIT Spending
.
Historic Data Available in Accessible Automated Form
Clinician Use of Data
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DORENFEST CHINA HEALTHCARE GROUP
Creating More Success in the Current China
Healthcare Environment
1.
There is much momentum for change
2.
The rapid change being fueled by healthcare reform activities requires stronger
IT systems to support it. More money will be spent, and better results are
required
3.
By recognizing what the rest of the world learned from their successes and
failures, and doing more of what the rest of the world did right and less of what
the rest of the world did wrong, China will be able to make faster and better
progress in the future
4.
We are now happy to take questions from the audience to assist in your
thought process as you move forward
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DORENFEST CHINA HEALTHCARE GROUP
THANK YOU.
FOR MORE INFORMATION CONTACT:
SHELDON I. DORENFEST OR XIAO LIU
THE DORENFEST GROUP
NBC TOWER, SUITE 2725
455 N. CITYFRONT PLAZA DRIVE
CHICAGO, IL 60611-5555
U.S. OF AMERICA
PHONE: 312-464-3000
FAX: 312-467-0541
THE DORENFEST CHINA
HEALTHCARE GROUP
HUAIHAI EAST ROAD NO. 45
HUAIHAI PLAZA
SUITE 908
SHANGHAI, CHINA
PHONE: 021-51001821
WEB SITE ADDRESS: www.Dorenfest.com
E-MAIL ADDRESS: [email protected]
SHELDON’S E-MAIL ADDRESS: [email protected]
XIAO’S E-MAIL ADDRESS : [email protected]
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DORENFEST CHINA HEALTHCARE GROUP