A Paperless Hospital Information System for less than 1Million? What we can learn from Spain

Earlier this week I was in Barcelona, Spain, presenting at a Microsoft customer event called the Health Industry Leaders Innovation Forum.  Healthcare executives from across the EMEA region came together to share information on how they are using information technology in healthcare and to exchange ideas on how to drive even greater innovation in the industry.  We listened to presentations on progress being made in the provision of e-health services at the National Health Service in the UK including some exciting portal work in Wales.  Members from our UK team discussed progress to date on the NHS Common-User-Interface initiative.   A physician leader from Spain talked about healthcare industry trends and opportunities for venture-funded projects in his country, and IT executives from Egypt shared ideas on clinical transformation opportunities there.  A complete review of the Forum proceedings is beyond the scope of my Blog, but I did want to share information on one of the presentations that particularly caught my attention.  It caught my attention because it illustrates so well something I've been writing about on this Blog and elsewhere; how commodity software is being used to build very robust healthcare industry solutions quickly and inexpensively.

The customer in this case is a new hospital in the Valencia region of Spain. 
Torrevieja Salud is a 250 bed, privately managed, public facility that recently began serving patients.  It has 11 operating theaters, 22 surgical beds and a full service ER with a 50 bed observation unit.  From the very beginning, project designers planned for a facility that would be completely paperless when it opened its doors.  The commodity building blocks they used included SQL Server 2005, Exchange, Terminal Server, Windows Server, MS Dynamics NAV, BizTalk 2006-HL7 Adapter, SharePoint, and the .Net Framework.   Over a 2-year period, a development team of just 22 people built a fully functional healthcare information solution they call Florence.  It handles all clinical and administrative functions for the entire facility.  It even provides a rich balanced scorecard view of key performance indicators.  Partners included Microsoft, HP, Drager Medical, Palex, B Braun, and Servicom 2000.  I asked how much money they thought they had spent developing their HIS?  The answer was approximately €600,000 (around $800,000).  Compare that to the tens, or hundreds of millions of dollars being spent for equivalent functionality in an American hospital of equal size and you're left scratching your head.  In fact, even in those American hospitals spending that kind of money I've rarely seen a true "paperless" environment.

To be honest, I didn't have an opportunity to visit Torrevieja Salud and see it with my own eyes.  But even if their HIS built on commodity software did half of what is being claimed or cost 10 times as much, it would still be a bargain.  I'm sure the folks at Torrevieja would be delighted to show off their new facility to anyone who might be interested.  American Hospitals take note.  I think there is a lesson here!


Bill Crounse, MD   Healthcare Industry Director     Microsoft

Comments (13)
  1. ClickRich says:

    Hugely exciting.

    I doubt the figures a touch (I wish I could employ developers for less than $18,000 pa), but don’t doubt that the sentiment is absolutely right.  Health care IT buyers such as myself won’t be buying monolithic systems from a vendor in 5 years (or in some cases now).  We will use standard building blocks to create health care platforms in collaboration with many organisations.

    Tell us more!


  2. Mark says:

    I’m not entireley surprised, although costs of developers in the UK would be higher. We’re all still waiting to hear what our billions have bought with the NPfIT.

  3. It’s fantastic for me as a health IT professional in a developing country. You talk about millions dollars and how to reduce the costs to just hundreds-thousand dollars, but in a developing country, we have just few thousands dollars per month (I mean less than 10’000$/month)  to manage entire hospital! There is not enough money to prepare drug, even regular serum or needle, but you exactly feel that the hospital need an HIS.

    There is no money, so there is no HIS, so you loose your resources (including your little budget), so you have no money. The worse cycle you can even imagine!

  4. Bill Crounse, MD says:

    In the developed or developing world, providing expediant, safe and effective care to our patients is always the first order of business.  I am well aware that information technology is still beyond the reach of many facilities around the world.  What I wanted to point out is an encouraging trend; how the use of commodity software is lowering the total cost of development of solutions for the industry.  While a million dollars is still a lot of money no matter where you live, it is a far cry from needeing to spend tens or hundreds of millions of dollars on IT systems and solutions to run a modern hospital.  And every dollar saved on IT, is a dollar that can be spent taking care of patients.  May that trend continue!

    Bill Crounse, MD    Healthcare Industry Director     Microsoft  

  5. Dr. Crounse,

    I agree with your last statement. Obviously providing health care to patients is the number one priority but this example you put forth shows how existing, proven technologies may be leveraged in the health care space at a low TCO.

    This is exactly what we should be striving towards in the developed world, while looking forward to a time when we can effectively provide these same solutions to developing nations as well. We can go through the growing pains and deliver even more effective, cheap solutions in the near future. This is an excellent case study to be sure.

  6. hlthblog says:


    Thanks for weighing in.  There’s been so much interest in this topic that it will be the focus of the next installment of my monthly audio-cast "House Calls for Healthcare Professionals".  The CEO, CIO and two clinicians from Torrevieja Hospital will join me on the program.  Be watching for it here:


    The program will be posted sometime towards the end of February.

    Bill Crounse, MD    Healthcare Industry Director     Microsoft

  7. Tibor Duliskovich MD says:

    Just my two forints… I worked in medical IT for the last 15 years and was still surprised to learn, how inexpensive software development can be these days. I am not a developer and not a business person, so I repeat what I hear from others in industry.

    One area where IT is strong in medicine is radiology. PACS or Picture Archiving and Communication Systems are driving imaging workflow. They used to cost dozens of millions of USD to develop just 6-8 years ago. With tools available today the life-cycle is much more intense and PACS could be developed for few millions in a year or two (I am talking about "basic" PACS covering 95% of everyday activities, not specialty workstations). That is ten times reduction in cost and two fold reduction in development time.

    On my recent trip to Russia I learned that same can be achieved with local Russian companies for one third the price tag of a US-based company. And India supposedly is even cheaper… No wonder there are 250-300 hundred PACS variants on the global market. We are looking toward serious market consolidation in coming years.

    On top of this, home-grown products are not only cheaper, but also fit exactly right for the facility, do not have unnecessary functionality or restrictions or unnecessary code for licensing. Plus the support is in house.

    Have a nice day,


  8. Bill Crounse, MD says:


    Thanks for your comments.  There’s a growing appreciation for, and interest in, applying lower-cost commodity software solutions in healthcare.  I’m seeing evidence of this in both the developing and developed world.  In my next Blog post I’ll review some great work that’s going on in a US-based hospital that is achieving a signficant return on investment by using commodity software to automate paper-based work-flow processes.  The results are truly astounding.

    Bill Crounse, MD      Healthcare Industry Director    Microsoft    

  9. HealthBlog says:

    Hospital de São Sebastião Earlier this year, I shared the amazing story of Torrevieja Salud Hospital

  10. hlthblog says:

    I wanted to share this comment from a HealthBlog reader regarding his experience at Torrevieja Salud Hospital.

    E. Martin writes;


    I am ex IT and I am a patient of the salud. I am amazed at the interaction of their system, Every patient is processed by card [SIP] and given a summary of their treatment when they leave after any procedure or process. In that sense it is not paperless, but all info re patient is available to all system users as far as I can ascertain. I had an operation there on Oct 5th and the facility and staff were first class. It feels like a private hospital and a friend of mine who accompanied said it was better than her private hospital in UK in terms of cleanliness and appearance. They do tend to operate a fine hospital. it seems to be open longer hours than UK. The only point I would make is possibly starting with a blank screen may have helped them develop a better IT system rather than trying to accommodate outdated hospitals and thinking. Any other questions please feel free to email. Cheers Edward, resident of Torrevieja.


    Thanks Mr. Martin.  And, congratulations again to the team at Torrevieja Salud.

    Bill Crounse, MD   Worldwide Health Director   Microsoft

  11. hesham says:

    is good idea but is very expincive

  12. Hal Hassan says:


    I have just been reading all your comments with my 11yr old daughter, she is doing a report on Torrevieja Hospital. Stats, all previous research prior to build, plans and opinions. Thanks for so much insight about the paperless environment, the hospital inhabits. It has given my daughter much to think on and is an extra point for her environmental swing for the hospitals existance, let alone our own personal excellant experiences at the unit itself.

  13. Sami says:

    In Lebabon the cost of programmers is no less that $30,000

    when you consider salary and benefits. I believe in Spain, being part of the EU it cannot be lower.

    So in 2 years a programmer cost $60,000, and 22 programmers cost 60,000×22=$1,320,000. This just for programmers added an extra 25% for overhead (Project leades, supervisors, medical expertise etc) and the cost would be 1.5 million.

    Add on top of this the cost of servers, licenses for databases, exchange etc, the cost of PCs and you are probably up to 2 million. Add a PACS with specch recognitions and that takes you up anothe 1-1.5 million. I can go on and on….. the .8 million is not realistic.

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