In primary care, the use of ICT has rapidly grown among the general practitioners. In 1999, 64 percent of European GPs had a PC in their practice, compared to 37 percent in 1996. Figures show a 90 percent PC penetration for primary care in the northern countries, ranging to only 20 percent in the southern ones. The statistics are very similar for GP Internet access. One can observe a serious increase in connectivity between the GPs and the hospitals, the laboratories, and the public health network as part of the "managed care" concept, which also includes the electronic patient record (EPR). The 105.000 pharmacies in Europe are considered to be a replacement market. Between 90 and 100 percent are equipped with a PC.
Mrs. Lessens sees the home care segment as a growing market, since more and more patient groups prefer to remain at home during their illness, like elderly, disabled, and chronically ill people. Through shorter hospital stays, they are able to improve their quality of life. As a result, both economic and social reasons will force the governments to develop alternative medical care programmes. Here, a new market opens for patient-friendly tele-monitoring devices, that will evolve simultaneously with the growing use of telemedicine applications. The HIST study distinguishes 5 types of telemedicine services, which are tele-pathology, tele-radiology, distant medical education and tele-consultation, tele-emergency services, and tele-surgery.
Between 1997-2004, the report estimates an annual coverage growth rate of 25.2 percent for telemedicine. According to Mrs. Lessens, this market has a financial potential of 902 million euro. In the United States, telemedicine is expected to reach a turnover of 3 billion euro by 2002. Yet, still a few difficult hurdles remain to be taken with regard to issues such as a legal and ethical framework, EPR standardisation, expensive technical equipment, adaptation to changes in the method of care delivery, and reimbursement. In contrast with this, the integrated Hospital Information System (HIS) forms one of the largest ICT segments in the health care industry sector.
There exists an almost 100 percent market share for patient administration systems, although the integrated clinical patient record is still far from being implemented. In turn, the Laboratory Information Systems (LIS) represent a replacement market but Mrs. Lessens foresees a powerful revival because of the upcoming need for storage and reproduction of multimedia medical data. The market share for Radiology Information Systems (RIS) is typically high, rating 70 percent, but an exponential growth is clearly showing in the PACS and medical imaging sector. In addition, Management Information Systems that have to serve as knowledge resource systems for data warehousing and data mining are gaining popularity among hospital staff. The HIST study also indicates the emergence of Internet and Intranet technologies like electronic data exchange (EDI) as well as health networks.
Mrs. Lessens stressed the increasing role of the Internet as a provider of on-line health services for the citizen in terms of medical information delivery, an interactive tool for communication with care providers, and for e-health shopping. In 1999, there were already 10.000 health sites on the Web and some 43 percent of the U.S. patient-consumers are consulting the Internet for answers to their health care problems. Health is a top 3 topic of interest in the citizen's search for on-line information. Fast emerging trends are e-commerce and e-pharmacies. The U.S. on-line health market will account for 2.4 billion euro by 2003 with prescription pharmaceuticals representing a total of 40 percent.
Internet use among health professionals is also growing with 36 percent of the doctors and 30 percent of the nurses searching on-line for information on care and health issues. The future holds in store a more active role for the Web as a location for database services, specialised sites, education and training, as well as decision-making tools to assist physicians. At present, the most popular URLs for doctors are non-commercial sites, or hospital and pharmaceutical sites. From a clinical point of view, health professionals are using the Internet mainly for information retrieval, such as patient data and examination results.
Figures from 1998 demonstrate that hospitals use the Internet principally for internal applications, such as e-mail, rating 84.8 percent, and research, 78.8 percent, as well as for customer marketing, which scored 47 percent in 1998 but is expected to grow with another 34.8 percent. Yet, applications such as electronic software distribution, remote user traffic and supply chain tools show spectacular growth figures of respectively 27.3, 43.9, and no less than 57.6 percent, as well as customer transactions with are expected to increase with 33.3 percent. The Deloitte & Touche report is now available under the title Market Analysis on the emerging European Health Telematics Industry at the EHTEL Web site.