In late August, Vienna became my home for the upcoming year. From this base, in the heart of central Europe, I will immerse myself into the Euro-culture (and the amazing Kaffee Kulture of Vienna – I may never step into a Starbucks again) and in the process hope to gain a deeper understanding of how Europe looks at the adoption and use of IT to improve care delivery.

Shortly after arriving in Vienna I headed to the famed Vienna Academic Medical Center (famed for it was here that teaching medicine at the bedside of the patient originated). While the medical center has some state of the art technology (Gamma Knife), its IT leaves much to be desired. Every person I spoke to had little positive to say about their antiquated, slow, roll your own HIS and shelves of nilla folders full of patient records are everywhere. When inquiring as to why nothing has been done to update this system, there is a general resignation that this is just the way it is done.

This week I had a much bigger opportunity to get a broader perspective of the Euro-HIT market by attending Health2.0 in London. A far more intimate affair of roughly 500 people from across Europe and Middle East, the event provided some brief glimpses across this diverse landscape.

Some Quick Insights:

• The UK wants to become the innovation hub for HIT in Europe and is leveraging the massive NHS procurement budget to encourage innovation (see their report outlining their investment strategy).
• Barcelona is already laying claim to this title due to all the conferences held there – but little in the way of true innovation from Barcelona was to be seen at Health2.0.
• In Germany it appears that they are pushing ahead with their FFS model claiming that German efficiency will lead it to be more effective than America’s experience. Payers are the market to sell into in Germany as hospitals and ambulatory practices are not spending.
• Many attending Health2.0 told me to look to Estonia as the beacon of HIT in Europe as they completely modernized their IT infrastructure shortly after gaining independence from Russia. Estonia is also reported to have the fastest Internet speeds in Europe.
• In Central/Eastern Europe, physicians are paid low wages making them attractive advisors/consultants to healthcare start-ups.
• Denmark has gone far to standardize healthcare across the country, eliminate waste, etc. but like just about everywhere else, struggles with interoperability. One region’s HIS infrastructure cannot connect to another’s, which is surprising for such a small country of 5M inhabitants.
• The EU has done little to establish any sort of consistency across member nations. To their credit, epSOS has been able to launch a 15 country standard for eRx. In 2014 the EU also earmarked 574M euros for eHealth initiatives as  part of the massive Horizon 2020 initiative. Rumor has it that the process to tap that money is so convoluted that it is not much different than trying to tap federal funds in the US. Thus, the lion’s share of this EU initiative will likely go to Europe’s own version of EU beltway bandits and academic institutions that are masters at responding to RFPs.
• Europe’s private investment climate for HIT start-ups is abysmal. I about fell out of my chair as I listened to a panel of EU investors talking about rounds of 100,000. – 2M euro as being adequate. That may be fine for a single small European country but woefully lacking to build scale. It was little wonder that virtually all of the start-ups I spoke to are looking to move to the US to be closer to what they see as a bigger, more lucrative market and potentially far more financial resources than that found at home.

Loads of Demos, Same Old, Same Old, and a Few Diamonds
One thing Health2.0 does well is give exposure to tons of start-ups. With rapid-fire, three minute demos, one will be exposed to a lot of demos in two short days. Yes, three minutes with no Q&A is really nothing but a tease, but thankfully, it blows through a ton of Apps quickly that have little new to deliver and gives one a primer of those that truly have something of interest.

Most of the demos from the start-ups were no different than what I’ve seen in the US, yawn. You have wearables, you have wellness, you have PHRs, you have EHRs, etc. etc. And you have extremely few viable business models. But in and amongst all this there were some diamonds, which are listed below:

Mint Labs, Portugal: Wow, some pretty incredible work here on combining visualization (neuro-imaging) and analytics. Under development for eight years (PhD thesis). Only recently been taken to market. They have a few betas in Europe and a couple in US (Emory and UCSD if I recall correctly). If you are a neurologist, neuro-surgeon, etc, you are going to go ga-ga over this one.

Infermedica, Poland: Clinical decision support (CDS) at point of care. Think iTriage on steroids (mega-steroids) and you get some idea as to what they have developed. Again, heavy attention to UI and visualization with extremely strong analytics underpinnings. Challenge, CDS has always been a hard sell, just ask Isabela Health.

mySugr, Austria: Yes, yet another diabetes app but this one has gained some significant traction in Europe, approved in several countries for diabetes management and their take on gamification is apparently working based on early adherence numbers.

NurseBuddy, Finland: Announced the release of V3.0 that has open APIs and a developers’ sandbox to allow others to build on this care management platform. What I particularly liked about this solution is that it is very inclusive of the entire care team including patient and care giver (family members, friends etc.), something that few care management platforms address today.

Each of the above has a unique value proposition that warrants a closer look. Since the investment climate in Europe for start-ups pales in comparison to their US brethren, US investors would be wise to spend a bit more time overseas as virtually all of these companies are seeking opportunities in the US.