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Survey: Infrastructure, Interoperability Key Barriers to Global HIT Development

February 16, 2018
by Heather Landi
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A new survey report from Black Book Research on global healthcare IT adoption and records systems connectivity finds nations in various phases of regional electronic health record (EHR) adoption. The survey results also reveal rapidly advancing opportunities for U.S.-based and local technology vendors.

Black Book, a New York City-based research firm, surveyed 7,469 physicians, health administrators, technology managers and clinical leaders in ambulatory and inpatient settings across 23 foreign countries to identify gaps, challenges and successes in healthcare IT adoption. In addition, 2,388 providers and regional healthcare delivery organizations also responded to questions on planned health IT acquisitions, budgets, timetables and vendor awareness.

The report, “State of the Global EHR Industry, 2018” projects that global healthcare spending on EMR/EHR technology to top $25.1 billion USD in 2017 and continue growing to over $30.2 billion by 2020.

According to the survey, 90 percent of international respondents indicated there is an enduring confusion on the definition of a highly interoperable EHR system outside the United States. The majority of respondents (72 percent) stated in 2017 that their regional preferable strategy for EHRs is to link disparate systems through messaging, APIs, web services and clinical portals. Only seven percent of all international EHR survey respondents described their regional HIT system as having "meaningfully connectivity" with other providers.

The survey results indicate a pending shift from siloed EHR systems for regions of healthcare delivery organizations in Europe, the Middle East and South Asia where nearly 57 percent of respondents anticipate a move to comprehensive healthcare IT systems with data exchange and care coordination capabilities similar to the global offerings of current U.S.-based vendors by 2023.

Over half of the total survey participants were sourced from 10 highly advancing HIT regions. Of those, five foreign countries—Norway, Netherlands, United Kingdom, New Zealand and Australia—are near 100 percent EHR adoption rates and evidence of extensive use of enterprise technology tools. And, the other five countries—Germany, France, Canada, Switzerland and Singapore—with over 75 percent provider adoption rates.

Countries were scored on ICT infrastructure, secure health networking, data storage and exchange capabilities, national health technology policy, available funding and protection of privacy. Among those regions with progressive EHR adoption initiatives but significantly lacking in a major component of readiness in Q1 2018 are Japan, China, Qatar, Brazil, Taiwan, India and Russia. All these regions received a majority (51 percent-plus) of provider feedback scores that indicated current infrastructure situations prohibit EHR adoption.

New Zealand and Denmark lead the list of countries deemed to have the highest potential for progressing EHR interoperability and expanded HIT functionalities beyond their local regions, according to the survey. The report ranks those countries in order: New Zealand, Denmark, Israel, Singapore, Netherlands, Germany, Hong Kong, Norway, Australia, Canada, Sweden, Finland, United Kingdom, Switzerland and France.

“A number of countries have launched national initiatives to develop ICT-based health solutions including EHR systems and have progressed well, despite several hurdles,” Doug Brown, managing partner of Black Book Research, said in a statement. “As the obstacles are clearing with technological and non-technological interventions, approved standards and regulatory frameworks, funding and health-tech guidelines, the growth opportunities for U.S.-based global EHR vendors magnify as well.”

Vendors were ranked on 18 key performance indicators with evaluation criteria concentrated on ambulatory EHR, inpatient EHR, interoperability and health data exchange, population health, care coordination and cybersecurity and privacy capabilities. According to the survey, 83 percent of current EHR users in Europe (outside of the United Kingdom) expressed significant frustration with country-specific and local vendors that typically serve only one country with limited components, such as coding, scheduling and results reporting. 

Of those current clients, 72 percent of respondents revealed those system limitations will lead to the replacement of their local and/or country-specific EHR with a global player to support their wider needs by 2023. 

"With several U.S. EHR-based vendors continuing to focus considerable resources toward global development technology efforts in advancing healthcare economies, it is critical that foreign governments and medical-delivery organizations match their specific needs, financial situation and timetables with vendors' product roadmaps as to not be swept away by a vendor's promises to selfishly gain global market share,” Brown said.

This investment on ICT infrastructure for healthcare technology is expected to propel double-digit growth of the electronic health records market spend in these specific regions through 2026.

The report also includes surveys of system users aimed to rate the performance of healthcare technology vendors on client experience and customer satisfaction in those respective locations. The report identifies the top-ranked vendors for 2018 by region. Allscripts was rated the top vendor within the regions of South Asia (Singapore, Philippines, Malaysia, Thailand, India) and the United Kingdom.

Cerner was rated the top vendors for the following regions: Oceania (Australia, New Zealand, South Pacific Islands); Middle East (Israel, UAE, Saudi Arabia, Kuwait, Qatar); Middle East (Israel, UAE, Saudi Arabia, Kuwait, Qatar).

System users in Nordic Europe countries rated InterSystems as the top vendor; while system users in Western Europe gave ChipSoft top ranking.

Orion Health was ranked as the top vendor in Canada, everis NTT Data as the top-rated vendor in Latin America (Brazil, South and Central America, Mexico); and in Greater China (China, Hong Kong, Taiwan), system users rated Neusoft as the top vendor.

“The global healthcare sector is undergoing a wave of transformation, with digitization being the core focus area of service providers,” said Brown. “Healthcare IT products, services and systems are in high demand in nations significantly upgrading their healthcare infrastructures such as Singapore, Israel, Japan and Italy, as well as infrastructure-generating nations of India, China, Brazil, Qatar and Indo

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