Carsten, generally speaking, how can we use digital data management solutions such as FORUM to shape markets?

At ZEISS, we can promote and establish the standard that raw data from eye exams is stored centrally and that “digitalization” does not simply mean storing PDF reports of exams in the electronic health record (EHR/EMR¹) system. The benefit for customers is that progression analysis is performed dynamically, and as soon as ZEISS has new and improved algorithms available customers are able to use them and include the patient's historical data. We have an excellent foundation to work with for this because we led the way with the ZEISS FORUM software, which is now well-established in many markets. With approximately 8,000 installations in roughly 100 countries, we have the largest install base in this market. But the competition has is catching up: Topcon now offers a full cloud-based data management solution called Topcon Harmony in parallel to their server-based product, ImageNet which is reflected in Topcon's software sales figures. Providers of electronic health record systems (EHR/EMR) have also expanded their offerings — many of them are using the DICOM standard (Digital Imaging and Communications in Medicine) and offer extensive device integrations. At ZEISS, we have the opportunity to take advantage of our broad portfolio range. When it comes to monitoring chronic eye disease’s (glaucoma and AMD) and digitally connecting diagnostics to surgery (cataract and corneal surgery), ZEISS is the only device manufacturer in ophthalmology able to offer digitalization solutions for the respective clinical workflows. With this we are able to convince customers with our solution.

What kinds of regional differences are there in the area of digital solutions? What has your experience been?

Potential regional differences depend on how entrenched digitalization already is in the healthcare system and how the healthcare system is structured. Let's compare the United States to China and the European markets. The U.S. is a market with a very high degree of specialization and focus on optimizing the efficiency of everyone involved and the entire value creation chain. This makes collaboration and networking between the partners extremely important. Therefore, it is critical to not lose the efficiency gained at the interfaces. The U.S. also started moving in the direction of digitalization early on, so they see value in software solutions that provide added efficiency. For example, if a software solution can save one minute per patient visit and thus allow one extra patient to be seen by the physician per day, then there is corresponding willingness to invest money in this software solution.

On the other hand, this also results in very high customer expectations — if software takes longer to load than consumer product software it will not be accepted or tolerated. By contrast, in China there is very little willingness to pay for software "only". Therefore, our colleagues in China have decided to heavily market our FORUM Office PC solution (server PC with pre-installed FORUM software). They are finding a lot of success with this approach. The Chinese team has generated the highest quantities for the FORUM Office solution and has developed a strong FORUM business as a result. The situation in Europe is very heterogeneous, and it depends very much on the local market. The U.K. and Scandinavian markets, for example, are heavily shaped by the optometry segment, while Spain and the Netherlands have a very strong clinical and hospital sector, and Germany — despite all of the consolidation taking place — still has a very large number of single practices.

Will future cloud solutions make us less dependent on regional differences?

That is too sweeping of a statement. Our cloud solution offers customers added value because the only thing they need to do is connect to the public Internet. The rest — like operating the server infrastructure and running the software— is handled by us. The cloud solution provides other benefits as well. It enables data to be easily exchanged between healthcare professionals for the treatment of patients, for example, or it can be used to request the opinion of a specialist. It also allows data to be accessed any time and from nearly any location. Cloud solutions also offer the future potential of linking and using algorithms from various providers to compare your own data with third-party data (anonymously).
But cloud operations are also subject to data security, access authorization and privacy requirements. Many of these requirements are governed by local legal provisions which can vary greatly. And even in harmonized regions like the European Union, individual member states have made additional provisions which we need to meet as a company. In Europe, for example, France is the country with the highest requirements when it comes to data protection. This could make it necessary for us to run a server for the cloud in France. We also have to take into account the provisions and laws regarding the handling of healthcare data in each country. These too can differ greatly from region to region. For example, the mere storage of medical exam data is not considered a medical product in the U.S., but in other countries it might be.

Carsten, thank you very much for the informative talk.