Case studies

EHR Case Studies

Uppsala County, Sweden

Uppsala County EHR operates across the two county hospitals and publicly funded primary care providers, namely GPs. Additionally, 17 private GP practices now use the system voluntarily. The system is intended to be used by all healthcare professionals. The guiding principle behind investing in an EHR was for aiding staff and improving performance and that this improvement would automatically improve service provision for patients. The reason for investing in a EHR which would operate across primary and secondary care was to ensure a more efficient system of referrals.
The decision was made to invest in a user focused system and so a reference group of 50 potential users was set up and referred to throughout the procurement process. The reference group created the requirements which were used for the call for proposals and a scoreboard by which to evaluate the vendors. The reference group then tested and provided feedback on test systems created by the remaining vendors. The vendor, Cambio, was selected based on the reference groups feedback. Users were also very much involved once implementation began and shaped the development of the system.
In order to aid the smooth running of the project, and to ensure that lessons were taken on board, a dedicated organisational team of four people was created who worked on the project, generally in full time roles. They were people with very different backgrounds and expertise. At least half the team had experience in running similar projects, although not on such a large scale.

 Read more: Uppsala Case Study Report [PDF 566KB]


TreC, Trento, Italy

The name TreC, Italian for three Cs, stands for Cartella Clinica del Cittadino (Citizen's Medical Record). The emphasis in TreC is on the citizen. The system being implemented is a personal health record (PHR) which differs from typical Electronic Health Records (EHR) that focus on meeting organisational needs. With PHR the systems are "personal" and designed with citizens in mind. Empowering citizens through giving them responsibility for the management of their own health is a strategic aim for TreC.
The project is funded by the Autonomous Province of Trento (Provincia Autonoma di Trento- PAT), managed jointly by the Bruno Kessler Foundation (Fondazione Bruno Kessler-FBK) and the Province and overseen by a project steering board. The FBK also researched and created a low level prototype of the system which tendering parties were asked to build upon.
As the budget for the development of the web component of TreC system is under 190,000 euro a full public procurement process was not legally required. Instead, a set of requirements were drawn up and then five companies were selected from the province database of local companies and invited to present their solutions (technical and economic offer). The company which won the tender, GPI, have worked in collaboration with FBK to build the system based on the FBK prototype.
The system is currently being rolled out across the province. There are already 10,000 users.

 Read more: TreC Case Study Report [PDF 2.29MB]


Estonian EHR

The Estonian Electronic Health Record (EHR) is part of the Estonian National Health Information System (ENHIS). The ENHIS began in 2000 with the aim of improving and extending health services for patients and citizens. The ENHIS comprises four main eHealth projects: EHR, Digital Registration, Digital Imaging and Digital Prescription. In order to effectively manage the development of these eHealth projects the Ministry of Social Affairs initiated the establishment of a separate administrative body, the Estonian eHealth Foundation (EeHF), in 2005.
The EHR is part of the Health Information Exchange (HIE) platform. It utilises already existing state infrastructure such as electronic ID cards and X-Road security and communications. The Health Information Act 2008 specified the content of information stored centrally. Electronic documents use the standard HL7 CDA to format documents that are stored in a central database and archived electronically. Legal regulations specify the security requirement for the EHR and its access. All healthcare providers must send agreed data to the EHR.
An open procedure for procurement was employed by EeHF for the procurement of Health Information Exchange(HIE) infrastructure. Invitations were sent to suppliers who could comply with the EeHF's standards for hardware and software. Compliance with the standards set by the EeFH is the main specification for the procurement of EHR.
 Read more: Estonian EHR Case Study [PDF 1.49MB]


Catlonia PACS

The decision to invest in a PACS solution for local health centres and the provision of a central backup system for sharing digital images is part of a wider strategic plan to make the autonomous community of Catalonia an innovative eHealth region.
In order to implement this health centres were required to conduct image digitalization projects. A total of twelve projects were conducted, which represented the remaining 70% of health centres which weren't already using PACS. The projects were partially funded by and supported by Public Health Department in Catalonia . Once connected to the central imaging archive system (RCIM), health centers have to follow the procedures for sharing their digital images held on the local PACS.

The procurement process was based on three pillars:

The first step was the purchase of all necessary equipment for digitalization. Second, a collaborative agreement for the use of the Hospital of Sabadell's Image Diagnosis Centre (UDIAT) self-developed PACS was made. This was a structural element for the Medical Image Digitalization Plan exchange, in order to guarantee the maintenance and evolution of the product. The result of that is that all healthcare centres in the public infrastructure do not need to pay license costs. The last action of the process consists of the agreement of healthcare centres to assume the remaining investments.

 Read more: Catalonia EHR Case Study [PDF 540KB]

Solimed EHR, Solingen, Germany

In 2004, the Solimed Medical Quality Network Association was founded by 28 practice-based physicians. It now has 146 members. Plans for investment in an EHR developed and in 2007 Solimed-Health Company Ltd (Solimed - Unternehmen Gesundheit GmbH & Co. KG) was founded with 75 members of the Solimed Medical Quality Network Association.
The EHR connects outpatient doctors' practices in the city of Solingen, Germany with the 3 Solingen hospitals using a network and exchange automated software. The Solimed EHR is unique within North Rhein-Westfalia as it is applied to the entire treatment process. To manage this care pathways were established.
The Medical Quality Network Association Solingen agreed on requirements and investigated the solutions available on the market. Four potential solutions were identified. Following a trial period of six months two out of the four tested solutions were assessed as meeting the needs and requirements of the association. Representatives from these companies then presented their solution and ran system demonstrations. Negotiations for a framework contract then began. Bids were assessed against the network's requirements and the successful solution, MCS / medatiXX, was selected. Solimed GmbH has invested 700,00 euro in the EHR.

 Read more: Solimed EHR Case Study Report [PDF 714KB]

Northern Norway EHR

The Northern Norway Regional Health Authority (Helse Nord RHF) is responsible for public hospitals in northern Norway and has purchased a joint EHR system for the Northern Health region to be used by all hospitals in the region. The procurement process was conducted in the period 2009 to 2011.
The intended procurement was widely publicised so that all interested parties could apply to participate in the competition. The applications were assessed and candidates selected. Candidates received tender documents and could prepare their offers. A evaluation and negotiation phase then ensued which reduced the number of candidates. The project groups recommendations were then presented to the steering committee for approval.
Helse Nord emphasized that the EHR should not only maintain documentation required by clinicians, but also support clinical processes. The region is keen to capture the clinical work processes so that clinicians, as far as possible, relate to digital information instead of paper. It is Helse Nord's strategy to ensure electronic interaction between the five health trusts in the region. The goal is better coordination and standardised procedures which will improve quality and patient experience.

 Read more: Northern Norway EHR Case Study Report [PDF 1.8MB]

Telemonitoring Case Studies

Whole System Demonstrator Pilot Programme, England

The Whole System Demonstrator (WSD) Pilot Programme is a national initiative for telecare, telehealth and telemonitoring as part of healthcare and social care provision in England. It aims to improve the understanding of the clinical impact of telecare, telehealth and integrated health and social care and identify ways that technology can help people manage their own health while maintaining their independence. WSD has three pilot sites at Cornwall, Kent and Newham, and a WSD Action Network (WSDAN) of twelve sites. It is probably the largest randomised control trial of telecare and telehealth in the world to date.
The sites used the National Framework Agreement (NFA) for preventative technology as a procurement model. The NFA is a contractual vehicle which enables purchasers to order goods or services under the framework agreement’s terms and conditions. The evaluation criteria used by the NFA ensure that the contracts are awarded to suppliers submitting the most economically advantageous tenders, taking into account attributes including price, quality and capacity.

 Read more: Whole System Demonstrator Case Study Report [PDF 587KB]

Remote Telemonitoring Service Northern Ireland

The Remote Telemonitoring Northern Ireland (RTNI) managed service, now rebranded as Telemonitorig NI, is an "end to end service" which seeks to assist in the delivery of better integrated care through reforming the support available for patients with long term conditions. Through RTNI patients will be enabled to have greater control, learn more about their condition and live more independent lives. The service also aims to assist in reducing inpatient admissions and optimising staff resources.
RTNI is an exceptional initiative in terms of its scale, covering the whole of Northern Ireland. The service processes patient referrals; delivers, installs, maintains and repairs patient equipment; provides training; collects monitoring data; and provides a triage service which validates monitoring data, delivers patient advice and escalates cases to the local response team where needed.
The service was designed, procured and implemented through a process which involved representatives from five local Health and Social Care Trusts (HSCT) within the Northern Ireland region. The procurement was led by the European Centre for Connected Health (ECCH), renamed Centre for Connected Health and Social Care (CCHSC) with support from both legal and procurement specialists. The procurement process was comprehensive and transparent and relied on a thorough evaluation methodology. Bids were evaluated through stages including: a pre-qualification questionnaire (PQQ) and two invitations to participate in dialogue (ITP) before a competitive dialogue phase ensued. From the competitive dialogue the remaining vendors were invited to present a trial and ultimate best and final offers (BAFO). The winning vendor is TF3, a consortium of Tunstall Healthcare, Fold Telecare and S3 Group.

 Read more: Remote Telemonitoring Northern Ireland (RTNI) Managed Service [PDF 1,23MB]


eTrikala, Greece

The Municipality of Trikala has spearheaded eService development in Greece. The Municipality's interest in ICT enabled services began in 2000. In 2004, in order to manage the Municipalities ICT services and develop infrastructure, the Municipality recruited employees to form the "eTrikala" office. In order to streamline bureaucracy the office became a private company, 99% owned by the municipality, in 2008.
The eTrikala office developed the first telehealth project for the municipality in 2006. Following this a telemonitoring service for citizens with Chronic Heart Failure, Chronic Asthma or COPD, Arrhythmias and Hypertension was established. The emphasis in Trikala has been very much on integrating health and social care. eTrikala has developed its telemonitoring and telecare services further through involvement in European projects such as ISISEMD, Intelligent System for independent living and self-care of seniors with cognitive problems or mild dementia; INDEPENDENT, ICT Enabled Service Integration for Independent Living; and RENEWING HEALTH, REgioNs of Europe WorkINg toGether for HEALTH.
Procurement for telehealth services follows the standard European model in line with Directive 2004/18/EC . Transparency and fairness are the key qualities of the procurement process employed in Trikala.
Lessons learnt include the importance of user acceptance, preparation of the user's support network and environment and the hiring of multi-disciplinary staff.

 Read more: Trikala Case Study Report [PDF 1.29MB]


HerzAs: remote monitoring of heart failure patients, Germany

The project uses telemonitoring technology to improve heart failure care. Patients at high risk of hospital admission are monitored through a balance which transmits body weight remotely. This data is supplemented by results from a daily administered health status questionnaire, integrated into the balance. The data is collected and monitored in a special care centre, staffed with heart failure nurses and other medical personnel. Coaching via telephone and regularly scheduled calls with the patients also take place. The patients continue to see their local GP or cardiologist. This service was procured by a large German health insurance company, following a very careful requirements analysis, in a negotiated tendering procedure. It yields important insights into possible approaches for social health insurance companies when buying complex telemonitoring services.
 Read more: HerzAs Case Study Report EN [PDF 650KB]
 Read more: HerzAs Case Study Report DE [PDF 650KB]