Health Insight Driven Health. Doctors Survey: England Country Profile. Healthcare IT is on the Rise in England

Health Insight Driven Health Doctors Survey: England Country Profile Healthcare IT is on the Rise in England

Overview Accenture conducted an online survey of 3700 doctors across eight countries: Australia, Canada, England, France, Germany, Singapore, Spain and the United States. Approximately 500 doctors per country (200 for Singapore) participated in the survey, which assessed doctors attitudes and perceptions on the benefits of health information and communications technology. The survey was conducted between 16 November 2012 and 27 December 2012. The analysis provided comparisons by country, sector, age and use. The margin of error for the eight study countries in total is +/- 1.5% and the margin of error for England is +/- 4%. Copyright 2013 Accenture All rights reserved. 2

Method: Data Collection Summary Number of Completed Interviews (3700 total)* Australia Canada England France Germany Singapore Spain US 500 500 500 500 500 200 500 500 Field Start Date 20 Nov. 19 Nov. 19 Nov. 16 Nov. 16 Nov. 19 Nov. 16 Nov. 16 Nov. Field End Date 15 Dec. 16 Dec. 17 Dec. 23 Dec. 15 Dec. 27 Dec. 17 Dec. 17 Dec. Average Interview Length (in minutes) Language 16 14 15 15 14 15 15 14 English English French English French German English Spanish English *In each country half the completed interviews were among primary care physicians and half were among specialists. **First amount is for primary care physicians, second amount is for specialists. Copyright 2013 Accenture All rights reserved. 3

Method With whom did Accenture work to conduct the quantitative survey? Accenture worked with Harris Interactive, which was responsible for the entire project including recruitment and screening of physicians from the M3 Global Research online panel of more than 1.3 million verified, worldwide healthcare professionals. What kinds of doctors/physicians were surveyed? Primary and secondary/specialist care doctors in Australia, Canada, England, France, Germany, Singapore, Spain and the US who have registered to take part in market research. All work on a full time basis, in a mix of private and public practice settings. Most spend almost 80% of their working time in direct patient care and have been practising medicine for almost 18 years (on average). How did Accenture recruit physicians for the study? Physicians were contacted through a web mail-out, whereby they were able to follow a unique link to the survey and complete it anonymously. To maximise participation, up to two email reminders were sent. Are we confident in the quality of the respondents and that they meet the study criteria? All physicians details are double-verified when they join the panel and were rescreened for this study to ensure participant quality. Was the questionnaire translated into the appropriate native language? Yes, the survey was translated into: French (France); German (Germany), and Spanish (Spain). The English was localised for Australia, England and Singapore. Copyright 2013 Accenture All rights reserved. 4

Terminology Healthcare IT is an umbrella term for the exchange of health information in an electronic environment, including health information exchange, electronic medical records and electronic health records. Health information exchange (HIE) is the mobilisation of healthcare information electronically across organisations within a region, community or hospital system. An electronic medical record (EMR) is a computerised medical record created in an organisation that delivers care, such as a hospital or doctor's surgery, usually part of a local standalone health information system that allows storage, retrieval and modification of records. Copyright 2013 Accenture All rights reserved. 5

Research Results Highlights of England and 8-Country Findings

Key England Findings - Summary Key study findings for physicians in England revealed that over the last two years, doctors use of healthcare IT and HIE has risen slightly. Doctors in England are embracing the use of these technologies to some extent, despite the fact that many agree that the use of HIE, specifically, does not reduce organisational cost as anticipated. Doctors in England experienced a decrease in their electronic communication with clinicians in other organisations. Nevertheless, doctors state that they have gained important HIE benefits such as improved decision-making and the reduction of medical errors. Additionally, doctors in England are embracing the Internet as they are among the most likely to read online forums and view online videos. Moreover, doctors across all eight countries uniformly agree on two key issues: 1) Cost is the main barrier to electronic medical record (EMR) adoption, and 2) Patients should have at least some access to and be able to update elements of their EMR. Copyright 2013 Accenture All rights reserved. 7

England Physician Demographics Gender Age 8- Country Total England (n = 3700) (n = 500) Male 73% 7 Female 2 23% Under 30 2% 2% 30-39 24% 31% 40-49 34% 39% 50-59 30% 23% 60+ 10% 6% Physician Type Primary Care/General PracHce/Family Physician 50% 50% Secondary Care/Specialist 50% 50% Average # of Years PracHsing Medicine 18.3 18.7 Average Time Spent Face- to- Face with PaHents 79% 70% LocaHon of Primary Work Place Urban/City 66% 70% Suburban/Next to a city 20% 20% Small town/rural 14% 9% OrganisaHon Status 8- Country Total England (n = 3700) (n = 500) Public 54% 93% Private not- for- profit/charitable 1% Private for profit 39% 6% Average # of Physicians in OrganisaHon 172.1 273.6 Primary Work Se]ng Mostly surgery- or clinic- based 62% 52% Exclusively hospital- or lab- based 15% 28% Mostly hospital- or lab- based 13% 13% Equally hospital- based and surgery/clinic- based 8% 5% Mostly long- term care facility- based 1% 0% Mostly hospice- based 1% 1% Other 1% 0% PracHce Size (among those who work in surgery/clinic) (n = 2604) (n = 287) Solo prachce 28% 4% Single- speciality partnership or group (2 or more physicians) MulH- speciality partnership or group (2 or more physicians) 44% 4 28% 48% Note: Unweighted Data Base: All Qualified Respondents Copyright 2013 Accenture All rights reserved. 8

Doctors in England and abroad increasingly use electronic means to enter patient notes and access clinical data about patients seen by different health organisations. However, the use of electronic tools such as e-billing and e-scheduling to reduce the administrative burden has not been as robust as in the previous year. Furthermore, doctors are less likely this year to communicate electronically with clinicians in other organisations. 8- Country Total England Total Healthcare IT 2011 2012 % change 2011 2012 % change I enter pahent notes electronically either during or afer consultahons 58% 66%* 14% 54% 64%* 19% My organisahon uses electronic tools to reduce the administrahve burden for delivering health care (e.g., e- scheduling or e- billing) I receive electronic alerts/reminders while I am seeing my pahents (e.g., prompts regarding contraindicahons or preventahve care) I use computerised clinical decision support systems to help make diagnoshc and treatment decisions while I am seeing my pahents (e.g., real- Hme access to evidence- based prachce guidelines) 54%* 4-13% 36%* 29% - 19% 31% 36%* 16% 45% 46% 2% 20% 22%* 10% 21% 24% 14% HIE I have electronic access to clinical data about a pahent who has been seen by a different health organisahon (e.g., hospital, laboratory) I am nohfied electronically of my pahents interachons with other health organisahons (e.g., admissions to hospital) 33% 4* 42% 41% 54%* 32% 18% 20%* 11% 25% 29% 16% I send prescriphons to pharmacies electronically (e- Prescribing) 18% 21% 1 12% 12% 0% I send order requests (e.g., for lab, radiology or diagnoshc tests) to laboratories electronically I send or receive referrals electronically to/from health professionals in other organisahons (e.g., for specialist appointments) 36% 34% - 6% 44% 46% 5% 25% 2* 8% 35% 33% - 6% I communicate electronically with clinicians in other organisahons (e.g., via secure email) I receive clinical results electronically that populate my pahents electronic medical records 30%* 22% - 2 39%* 31% - 21% 53% 54% 2% 64% 60% - 6% *Significant difference between 2011 and 2012; p<.05 Copyright 2013 Accenture All rights reserved. 9

In 2011, doctors in Spain had the highest adoption rate for Healthcare IT and HIE. This trend continued in 2012. England experienced a slight increase in adoption of Healthcare IT and HIE from 2011 to 2012. Connected Health Maturity Index: Total Doctors, 2011-2012 Y Axis 60 2011 2012 England 2011 England 2012 Health information exchange (% routine users) 50 40 30 20 Canada Singapore Canada England England Singapore US Spain France Australia Germany Germany Australia France Spain US 10 10 20 30 40 50 60 Note: Unweighted Data Base: All Qualified Respondents Q705. How frequently do you use/perform the following functions/activities? EMR adoption and use (% routine users) X Axis Copyright 2013 Accenture All rights reserved. 10

In England (as well as in the other seven countries), routine use of HIE is on the rise. At the same time, the perception that HIE reduces costs is going down. In 2012 doctors were less likely to report that HIE reduces costs to their organisation or service compared to 2011. HIE Use and Physician Perceived Cost Reduction 60% 50% 52% 50% 48% 40% 41% 30% 20% 29% 19% 31% 21% Routine HIE Users* (8 country total) Reduces Organizational Cost (8 country total) Routine HIE Users* (England) Reduces organizational Cost (England) 10% 0% 2011 2012 *Reduced Base: Excludes doctors not interested in using Healthcare IT or HIE. Copyright 2013 Accenture All rights reserved. 11

Although doctors in England report many benefits of HIE, such as improved decision-making ability and reduced medical errors since 2011, it appears many hoped-for economic benefits have dropped off in the past year. Slightly fewer doctors report reduced service costs, reduced patient waiting times, number of patients that can be seen per day, and reduced risk of litigation. Moreover, improvements in the ability to achieve a better work-life balance have not been realised; in fact, they have significantly declined. 8- Country Total England 2011 2012 % Change 2011 2012 % Change Improved diagnoshc decisions 68% 74%* 9% 70% 79%* 13% Improved quality of treatment decisions 69% 74% 71% 79%* 11% ReducHon in medical errors 73% 76% 4% 74% 79% Reduced costs for my own organisahon/ service 60% 4-22% 58% 56% - 3% Reduced waihng lists/waihng Hmes 48%* 38% - 21% 45% 44% - 2% Increased numbers of pahents that can be seen per day 46%* 34% - 26% 41% 3-10% Reduced risk of lihgahon 5* 44% - 23% 58% 52% - 10% Improved work- life balance 4* 34% - 28% 45%* 35% - 22% *Significant difference between 2011 and 2012; p<.05 Copyright 2013 Accenture All rights reserved. 12

For the second year, doctors globally indicate the main barrier to electronic medical records (EMR) and HIE adoption is cost. Although issues regarding privacy and security of patient information have remained a concern to doctors internationally, 2012 saw a decrease among doctors in England who ranked this issue as a concern. In England, there is growing concern about cost, loss of productivity, difficulty of using EMR systems, lack of technical expertise, lack of easy access to a computer and lack of staff training. Barriers to EMR/HIE Adoption 8- Country Total England Total 2011 2011 2012 2012 2011 2011 2012 2012 Ranked 1st Most Important Rank Ranked 1st Most Important Rank Ranked 1st Most Important Rank Ranked 1st Most Important Rank Cost to my organisaaon 14% 1 24% 1 14% 3 25% 1 Concerns about privacy and security of pahent data Concern about loss of produchvity/too Hme consuming to input data 13% 2 11% 2 1 2 11% 3 10% 4 10% 3 5% 5 4 The system is too difficult to use 5% 6 8% 4 5% 5 4 IT systems that can't 'talk' to each other 11% 3 8% 4 18% 1 13% 2 Lack of technical experhse to manage implementahon 4% 7 6% 5 4% 6 4 Lack of easy access to a computer 2% 9 5% 6 1% 9 5% 5 Low IT literacy/lack of training among clinicians and staff 5% 6 5% 6 2% 8 4% 6 More important (moved up in rank) in 2012. Less important (moved down in rank) in 2012. Copyright 2013 Accenture All rights reserved. 13

Many doctors in England state that patients should be able to update information in their EMR such as demographics and family medical history. Doctors in England, as well as those in the other study countries, however, are less enthusiastic about patients updating lab test results. Patient Allowed Access to Electronic Medical Record Patient Updateable Information in Electronic Medical Record 8-Country Total No Access 14% Lab test results 45% 8-Country Total 25% 29% England Total 61% 1 22% Limited Access 62% Full Access 24% Change in symptoms New symptoms New medications 23% 23% 21% 34% 32% 28% 44% 46% 50% 28% 29% 34% 32% 30% 25% 40% 41% 41% Personal medical history 20% 33% 4 28% 35% 3 Limited access 60% England Total No access 6% Full access 34% Medication side effects Self-measured metrics Allergic episodes Family medical history Demographic information 19% 33% 48% 18% 3 45% 1 28% 55% 15% 29% 55% 11% 24% 65% 21% 31% 48% 22% 3 41% 23% 25% 52% 16% 3 4 12% 25% 62% Patient should not update Some information All information Copyright 2013 Accenture All rights reserved. 14

Research Results Highlights of Comparative Country Findings

Globally, as well as in England, most physicians use EMR (91% and 82% respectively). Whereas globally six out of ten physicians use it in their own practice, in England physicians are more likely to use it in their hospital or clinic than in their own practice. Location of EMR Use Use in my own practice Use in my hospital or clinic Yes (NET): 95% 93% 93% 92% 91% 8 83% 82% 76% 73% 68% 65% 6 63% 59% 60% 58% 51% 46% 4 43% 39% 34% 3 3 2 2 Spain Germany US France Global Total Singapore Australia England Canada (n = 500) (n = 500) (n = 500) (n = 500) (n = 3700) (n = 200) (n = 500) (n = 500) (n = 500) Note: Weighted Data Base: AUS, CAN, FRANCE, GERMANY, SINGAPORE, SPAIN, England Or US And Currently Practising Medicine Q615. Do you use electronic patient medical records in your practice (excluding billing systems)? Copyright 2013 Accenture All rights reserved. 16

Globally, the number of physicians entering patient notes electronically and routinely has increased since last year (up 14%). England increased its routine use by 19%. I enter patient notes electronically either during or after consultations % Use Routinely Change from 34% 4% 1% 1% 14% 14% 19% 2 22% 2011-2012 Use Routinely 58% 78% 74% 7 72% 73% 6 68% 58% 6% 8% 19% 8% 6% 9% 10% 4% 6% 19% 4% 36% 5% 6% 10% 9% 10% 10% 18% 29% 4% 5% 23% 8% 11% 9% 5% 26% 5% 11% 19% 18% 2% 6% 3% 5% 13% 9% 12% 12% 1 15% 9% 5% 9% 3% 9% 16% 15% 9% 9% 4% 5% 4% 5% 8% 9% 4% 10% 12% 8% 5% 2011 2012 2011 2012 2011 2012 2011 2012 2011 2012 2011 2012 2011 2012 2011 2012 2011 2012 US Germany Spain France Global Total 66% 56% 64% 54% 64% 41% 52% 36% 44% Australia England Singapore Canada Use Sometimes Use Rarely Interested in Using Not Interested in Using (n = 500) (n = 500) (n = 500) (n = 500) (n = 3700) (n = 500) (n = 500) (n = 200) (n = 500) Note: Unweighted Data Base: All Qualified Respondents Q705. How frequently do you use/perform the following functions/activities? Copyright 2013 Accenture All rights reserved. 17

Globally, the number of physicians who routinely access clinical data about patients seen by different health organisations has increased by 42%. England increased its routine use by 32%. I have electronic access to clinical data about a patient who has been seen by a different health organisation (e.g. hospital, laboratory) % Use Routinely Change from 41% 32% 53% 42% 32% 42% 62% 7 1 2011-2012 22% 26% 32% 33% 34% 31% 29% 34% 41% 49% 49% 4 45% 44% 42% 39% 54% 12% 69% 15% 13% 15% 8% 19% 15% 14% 18% 6% 10% 1 1 5% 1 10% 15% 5% 19% 15% 15% 5% 15% 6% 6% 6% 43% 6% 1 8% 43% 3 28% 6% 34% 38% 3 13% 35% 29% 24% 26% 28% 24% 5% 24% 24% 22% 22% 10% 15% 16% 6% 8% 11% 14% 3% 3% 5% 8% 8% 9% 4% 10% 10% 2011 2012 2011 2012 2011 2012 2011 2012 2011 2012 2011 2012 2011 2012 2011 2012 2011 2012 Spain England Singapore Global Total US Canada Australia Germany France Use Routinely Use Sometimes Use Rarely Interested in Using Not Interested in Using (n = 500) (n = 500) (n = 200) (n = 3700) (n = 500) (n = 500) (n = 500) (n = 500) (n = 500) Note: Unweighted Data Base: All Qualified Respondents Q705. How frequently do you use/perform the following functions/activities? Copyright 2013 Accenture All rights reserved. 18

Globally, around two out of ten physicians routinely e-prescribe. Routine e-prescribing usage in England remained at the same level (12%) from 2011 to 2012. I send prescriptions to pharmacies electronically (e-prescribing) % Use Routinely Change from 2011-2012 33% 36% 32% 1 0% 0% -36% 20% -43% 49% 13% 21% 65% 11% 5% 12% 10% 36% 1 8% 14% 25% 49% 16% 8% 20% 25% 6% 10% 33% 6% 43% 39% 43% 43% 52% 55% 16% 15% 18% 21% 12% 12% 8% 10% 8% 8% 8% 9% 11% 8% 8% 5% 6% 4% 11% 5% 5% 5% 6% 5% 5% 9% 9% 8% 10% 9% 10% 11% 11% 12% 5 59% 42% 43% 5 58% 21% 20% 1 1 20% 18% 25% 30% 24% 24% 44% 4 33% 36% 2011 2012 2011 2012 2011 2012 2011 2012 2011 2012 2011 2012 2011 2012 2011 2012 2011 2012 US Singapore Spain Global Total England Canada France Australia Germany Use Routinely Use Sometimes Use Rarely Interested in Using Not Interested in Using (n = 500) (n = 200) (n = 500) (n = 3700) (n = 500) (n = 500) (n = 500) (n = 500) (n = 500) Note: Unweighted Data Base: All Qualified Respondents Q705. How frequently do you use/perform the following functions/activities? Copyright 2013 Accenture All rights reserved. 19

For the second consecutive year, physicians in England are most likely to report that they routinely receive electronic alerts/reminders while seeing patients. I receive electronic alerts/reminders while I am seeing my patients (e.g., prompts regarding contraindications or preventative care) % Use Routinely Change from 2011-2012 2% 32% 10% 3% 16% 13% 52% -4% 12% 45% 46% 9% 11% 5% 34% 14% 6% 29% 24% 31% 10% 14% 15% 45% 16% 8% 22% 9% 40% 44% 3 38% 13% 13% 8% 2 22% 31% 23% 33% 13% 13% 16% 20% 13% 9% 11% 8% 31% 36% 31% 35% 21% 9% 15% 2 14% 13% 20% 9% 10% 20% 19% 20% 14% 20% 11% 15% 14% 33% 32% 20% 9% 2 2 26% 13% 13% 9% 11% 35% 30% 1 19% 11% 11% 8% 4 45% 1 12% 16% 20% 18% 1 2011 2012 2011 2012 2011 2012 2011 2012 2011 2012 2011 2012 2011 2012 2011 2012 2011 2012 England US Australia Spain Global Total Singapore Germany France Canada Use Routinely Use Sometimes Use Rarely Interested in Using Not Interested in Using (n = 500) (n = 500) (n = 500) (n = 500) (n = 3700) (n = 200) (n = 500) (n = 500) (n = 500) Note: Unweighted Data Base: All Qualified Respondents Q705. How frequently do you use/perform the following functions/activities? Copyright 2013 Accenture All rights reserved. 20

Among all countries, physicians in England are the most likely to believe that patients should have full access to their electronic personal health records (34%). Access Patient Should Have to Electronic Personal Health Record 34% 31% 30% 29% 24% 22% 21% 18% 12% Full access 54% 60% 65% 63% 5 61% 65% 68% 65% Limited access 34% 14% 14% 13% 16% 6% 4% 11% England US Singapore Canada Global Total Spain France Australia Germany No access (n = 500) (n = 500) (n = 200) (n = 500) (n = 3700) (n = 500) (n = 500) (n = 500) (n = 500) Note: Weighted Data Base: All Qualified Respondents Q710. What level of access should a patient have to his or her electronic personal health record? Copyright 2013 Accenture All rights reserved. 21

Nine out of ten physicians, globally and in England, are in favour of patients being able to update at least some demographic information in their personal health record. Demographic Information All/Some Information (Net) 95% 90% 89% 88% 88% 8 86% 86% 80% 41% 55% 65% 62% 63% 60% 5 73% 79% 39% 33% 24% 25% 24% 26% 29% 18% 16% 20% 10% 11% 12% 12% 13% 14% 14% 5% US Canada Global Total Singapore England Australia France Spain Germany All informahon Some informahon PaHent should not update (n = 476) (n = 430) (n = 3200) (n = 184) (n = 473) (n = 429) (n = 444) (n = 439) (n = 325) Note: Weighted Data Base: All Qualified Respondents Q712. How much information should a patient be able to update in his or her electronic personal health record? Copyright 2013 Accenture All rights reserved. 22

More than half of physicians globally (55%) and just under half of physicians in England (4) are in favour of allowing patients to update all information about their family medical history in their health record. Family Medical History All/Some Information (Net) 91% 91% 88% 85% 84% 84% 81% 78% 72% 65% 54% 6 55% 54% 4 3 49% 43% All informahon 44% 3 29% 3 29% 31% 26% 21% 9% 9% 12% 15% 16% 16% 19% 22% 29% 28% Some informahon PaHent should not update France Singapore US Global Total Canada England Germany Australia Spain (n = 444) (n = 184) (n = 476) (n = 3200) (n = 430) (n = 473) (n = 325) (n = 429) (n = 439) Note: Weighted Data Base: All Qualified Respondents Q712. How much information should a patient be able to update in his or her electronic personal health record? Copyright 2013 Accenture All rights reserved. 23

More than half of physicians, both globally and in England, feel that patients should be able to update all information about allergic episodes in their health record (55% and 52% respectively). Allergic Episodes All/Some Information (Net) 90% 85% 83% 83% 81% 80% 79% 7 74% 70% 5 55% 62% 44% 54% 49% 52% 48% All informahon 20% 10% 3 2 30% 25% 28% 28% 26% 20% 15% 1 1 19% 20% 21% 23% 26% Some informahon PaHent should not update France US Global Total Spain Germany Singapore Canada England Australia (n = 444) (n = 476) (n = 3200) (n = 439) (n = 325) (n = 184) (n = 430) (n = 473) (n = 429) Note: Weighted Data Base: All Qualified Respondents Q712. How much information should a patient be able to update in his or her electronic personal health record? Copyright 2013 Accenture All rights reserved. 24

Globally, over three quarters of physicians are in favour of allowing patients to update at least some information about changes in symptoms in their health record. In England, seven out of ten physicians feel that patients should be able to update at least some of this information. Change in Symptoms All/Some Information (Net) 86% 81% 81% 7 75% 72% 72% 71% 71% 43% 4 50% 44% 33% 39% 40% 36% 45% All informahon 43% 34% 31% 34% 42% 33% 32% 35% 26% Some informahon PaHent should not update 14% 19% 19% 23% 25% 28% 28% 29% 29% Singapore France US Global Total Germany Australia England Canada Spain (n = 184) (n = 444) (n = 476) (n = 3200) (n = 325) (n = 429) (n = 473) (n = 430) (n = 439) Note: Weighted Data Base: All Qualified Respondents Q712. How much information should a patient be able to update in his or her electronic personal health record? Copyright 2013 Accenture All rights reserved. 25

Both globally and in England, eight out of ten physicians are in favour of allowing patients to update at least some information about medication side effects in their health record. Medication Side Effects All/Some Information (Net) 84% 82% 82% 81% 80% 79% 78% 78% 72% 53% 4 50% 48% 53% 48% 41% 39% 40% All informahon 31% 35% 32% 33% 2 31% 3 39% 32% Some informahon PaHent should not update 16% 18% 18% 19% 20% 21% 22% 22% 28% France Singapore US Global Total Spain England Canada Germany Australia (n = 444) (n = 184) (n = 476) (n = 3200) (n = 439) (n = 473) (n = 430) (n = 325) (n = 429) Note: Weighted Data Base: All Qualified Respondents Q712. How much information should a patient be able to update in his or her electronic personal health record? Copyright 2013 Accenture All rights reserved. 26

Both globally and in England, eight out of ten physicians are in favour of allowing patients to update at least some self-measured metrics information in their health record. Self-Measured Metrics All/Some Information (Net) 93% 88% 83% 82% 81% 79% 78% 7 75% 54% 53% 44% 45% 45% 48% 41% 43% 36% All informahon 39% 35% 39% 3 36% 32% 3 35% 39% Some informahon PaHent should not update 12% 1 18% 19% 21% 22% 23% 25% Singapore France Germany Global Total US Spain England Canada Australia (n = 184) (n = 444) (n = 325) (n = 3200) (n = 476) (n = 439) (n = 473) (n = 430) (n = 429) Note: Weighted Data Base: All Qualified Respondents Q712. How much information should a patient be able to update in his or her electronic personal health record? Copyright 2013 Accenture All rights reserved. 27

The majority of physicians (61%) feel that the quality of patient care throughout the healthcare system has improved due to the use of EMR. Two thirds of physicians in England feel this way. Change in Quality of Patient Care 8 84% 65% 63% 63% 61% 58% 56% 53% It has improved It has stayed about the same 28% It has gotten worse 2 31% 33% 30% 36% 40% 10% 2% 9% 6% 4% 10% Singapore Spain England Canada France Global Total 6% 4% 19% Australia Germany US (n = 200) (n = 500) (n = 500) (n = 500) (n = 500) (n = 3700) (n = 500) (n = 500) (n = 500) Note: Weighted Data Base: All Qualified Respondents Q700. Compared to three years ago, how has the quality of patient care throughout the healthcare system changed because of the use of electronic medical records (EMR) (...)? Copyright 2013 Accenture All rights reserved. 28

Physicians in England are among the most likely to read online forums (7) and view online videos (58%). Internet Usage in the Past Six Months Global Total Australia Canada England France Germany Singapore Spain US (n = 3700) (n = 500) (n = 500) (n = 500) (n = 500) (n = 500) (n = 200) (n = 500) (n = 500) Read online forums 71% 70% 76% 7 51% 61% 74% 66% 82% Viewed an online video 52% 48% 53% 58% 52% 45% 50% 49% 5 Commented on and/or posted to an online article or forum Accessed news from an RSS feed 'Followed' a colleague or medical professional through Twitter or other social media platform I do not use the Internet for these activities. 29% 1 1 28% 1 45% 35% 33% 24% 19% 12% 15% 18% 25% 12% 29% 35% 1 12% 5% 8% 15% 10% 28% 24% 10% 12% 19% 13% 10% 19% 14% 11% 12% 9% Note: Weighted Data Base: All Qualified Respondents Q737. In the past six months, in what ways have you used the Internet to seek or exchange relevant health practices or industry information? Copyright 2013 Accenture All rights reserved. 29

Research Results Appendix

Representativeness and Weighting What did we do to ensure balance and a representative sample across regions, specialities, etc? Regular quota updates ensured that all subsequent mail-outs and recruitment contacts were targeted to the relevant demographic sectors in order to maintain a fair and representative split of geographies, settings and specialities. Was the data set weighted? Data for the US was weighted by years in practice, gender, region and speciality to be representative of physicians in the US. Data for all other countries was weighted by age, gender and speciality to be representative of the physician population in each country. Three trended questions** (Q705, Q805 and Q905) that were a carryover from the 2011 physicians study, however, were not weighted. **NOTE: Q705. How frequently do you use/perform the following functions/activities? Q805. To what extent is the use of electronic medical records and health information exchange (HIE) enabling the following benefits? Q905. Please select the 5 main barriers to the adoption and use of electronic medical record systems and health information exchange in your organisation. Copyright 2013 Accenture All rights reserved. 31