The European Union regards eHealth as one of the six most promising economic sectors over the next ten years. The market includes clinical information systems for medical providers as well as non-clinical web-based health information systems for the general public, telemedicine and e-care such as remote patient counseling and monitoring and paperless transmission of x-rays, and basic electronic infrastructure such as electronic patient record systems and networks connecting hospitals, doctors and insurance companies.
Representing approximately 30% of Europe’s market for eHealth solutions and products, Germany has a 6.3billion Euro (almost US$10 billion) eHealth market that is growing – as is the rest of the European Union’s - at 11% per year. The German eHealth market is expected to almost double by 2014 to reach over 11 billion Euros (US$16.5 billion) by 2014. After 2014, growth in the telemedicine segment of the market is expected to accelerate and reach 19%. There are no statistics for U.S. or import market share.
Rising interest in healthcare, technological developments and an aging population will drive healthcare’s share of GDP in Germany from 12% to 16% by 2020. Germany needs eHealth solutions to keep down the cost of medical care as the population ages and as an important tool to achieve a principal goal of the German government to emphasize speed of diagnosis rather than simply finding ways to shorten hospital stays. The ambitious German national eHealth project established by law in 2003 is one of the world’s largest information technology projects and plans to use electronic health cards to link 70 million patients with 2,000 hospitals, 200,000 general practitioners, 20,000 pharmacies and 200 public health insurance companies. Electronic transmission of drug prescriptions and electronic health insurance cards are top priorities.
However, implementation of eHealth initiatives such as electronic health insurance cards for all German residents is at least two years behind schedule, as the cost of the solutions and the benefits to doctors and medical institutions of the technology currently in the market has been questioned. Insufficient financing,fragmented markets, lack of interoperability, insecurity about legal changes and high fragmentation in demand and sourcing are impeding growth. Also, currently only 19% of German hospitals are equipped with modern clinical information systems.
Best prospects for American companies wishing to enter the German eHealth market are mostly in the technical development area such as central information storage systems and clinical information systems, and new telemedicine and e-care applications. U.S. companies with cost-effective, easy-to-use and fully localized German-language eHealth solutions and fully-tested, reliable and market-ready products should therefore have excellent opportunities to compete with present suppliers to the German market. U.S. companies seeking to become eHealth suppliers in Germany should also become familiar with the decentralized procurement process of much of the eHealth technology, the public procurement process for the technology for the electronic health insurance cards and supporting systems, and the applicable German regulations. Having an agent or distributor in Germany is also key to entering the market.
To take advantage of these opportunities, and to find representation in the German and European eHealth markets, U.S. eHealth technology suppliers should consider exhibiting at the world’s largest medical technology trade show MEDICA 2010 in November 2010, either with a full company booth/stand, or in the U.S. Commercial Service’s lower-cost Corporate Executive Office incubator program. For further information on Germany’s eHealth market opportunities or to exhibit at MEDICA 2010, U.S. companies should contact theauthor of this report, Anette Salama, whose contact details follow at the end of this report.
German Government Strategies to Implement eHealth
Germany needs eHealth solutions to keep down the cost of medical care as the population ages and as an important tool to achieve a principal goal of the German government to emphasize speed of diagnosis rather than simply finding ways to shorten hospital stays.
In the 2003 Law for the Modernization of Statutory Health Insurance, the German Federal Ministry of Health – which sets health policy in Germany along with the Ministries of Health in each German Land (state) – provided for the introduction of an electronic health card (“Gesundheitskarte”) for all German residents. The German government’s 2005 strategy for modernization is to establish an eHealth infrastructure starting with mandatory systems for the online verification of insurance status and patient copayment share, electronic transmission of drug prescriptions and drug interaction and contraindication checks, and patient information on an “Electronic European Health Insurance Card” to improve patient access to medical treatment in other EU member states. This will be followed by step-by-step implementation of a personal electronic patient record on an electronic chip card, if the German citizen gives informed consent. Germany has also changed its main goal from shortening the length of hospital stays to increasing the speed of diagnosis.
According to this report, the strategy for achieving these modernization targets is based on two pillars:
- An ICT infrastructure financed by one or more high-volume, ubiquitous application so that other applications can build on the infrastructure without also having to bear those basic costs, including online verification of insurance status (mandatory for citizens) including availability of all data for an electronic European Health Insurance Card (eEHIC); electronic transmission of drug prescriptions (mandatory); and drug interaction and contraindication checks (voluntary for the insured).
- The implementation of a private electronic patient record (ePR) and other, step by step, voluntary applications that use the already-established infrastructure. Electronic transmission of drug prescriptions and electronic health insurance cards are top priorities.
The ambitious German national eHealth project established by the 2003 law is one of the world’s largest information technology projects. The plan is to use electronic health cards to link 70 million patients with 2,000 hospitals, 200,000 general practitioners, 20,000 pharmacies and 200 public health insurance companies. The plan is to build connected Virtual Private Networks and specialized centralized infrastructure services. Doctors’ offices, pharmacies and hospitals will use card terminals with secure connections to the network for both patient and health professional electronic cards.
While the government ministries set policy and devise strategies for implementation, the implementation itself is highly decentralized, in the hands of doctors, dentists, insurance companies, hospitals, pharmacies and others, which make individual procurement decisions. As a result, the Federal Government has put into action a number of public relations programs to encourage investment in eHealth to carry out the objectives of the 2003 law. One such program is the dedicated website for the electronic health card. A 2005 law also established a specialized company named gematik (“Company for Telematik Applications”) located in Berlin and owned by eight national professional associations in the health services field. Gematik’s role is to coordinate the technical implementation of the government’s eHealth strategy, including the testing and certification procedures for hardware and software products or components. It is controlled by the Ministry of Health and has been described as being functionally a government agency.
These government mandates have created a demand for supply of eHealth solutions in four categories.
According to the European Commission’s 2007 eHealth task force report Accelerating the Development of the eHealth Market in Europe, eHealth comprises:
1. Clinical Information Systems:
a. Specialized tools for health professionals within care institutions (e.g., hospitals). Examples are radiology information systems, medical imaging, surgery training, and planning systems.
b. Tools for primary care and for outside-care institutions such as general practitioner and pharmacy information systems.
2. Tele-medicine and e-care, personalized health systems and services, such as disease management services, remote patient monitoring (e.g., at home); teleconsultation; telecare; telemedicine; and teleradiology.
3. Integrated regional/national health information networks and distributed electronic health record systems and associated services such as e-prescriptions or e-referrals.
4. Secondary level non-clinical systems:
a. Systems for health education and health promotion of patients/citizens such as health portals or online health information services.
b. Specialized systems for researchers and public health data collection and analysis such as biostatistical programs for infectious diseases, drug development, and outcome analysis.
c. Support systems such as supply chain management, scheduling systems, billing systems, administrative and management systems, which support clinical processes but are not used directlyby patients or healthcare professionals.
By Anette Salama