US Hospital Information Systems Overview and Outlook, Managing Information in an Era of Reform

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1 US Hospital Information Systems Overview and Outlook, Managing Information in an Era of Reform December 2014

2 Contents Section Slide Number Executive Summary 11 Market Background 19 The EHR Landscape 39 Overview of US Hospitals 53 Trends in National Health Expenditures 70 Total Hospital Information Systems Market Drivers, Restraints and Trends 76 Forecast and Trends 86 Forecast and Trends Market Segments 93 Demand Analysis 101 Competitive Environment 104 The Last Word 111 Appendix 114 2

3 List of Exhibits Exhibit Slide Number US Hospital Information Systems: Frost & Sullivan Research Methodology, Hospital Information Systems: Market Engineering Measurements, US, Hospital Information Systems: First Level Market Segmentation, US, Hospital Information Systems: Percent Revenue Breakdown, Clinical Versus Non-Clinical, US, Hospital Information Systems: Percent Revenue Breakdown, Software Versus Hardware, US, Hospital Information Systems: Second Level Market Segmentation, US, Hospital Information Systems: Percent Revenue Breakdown Among Clinical, Financial, and Administrative Information Systems, US, 2013 Hospital Information Systems: Percent Revenue Breakdown Among Clinical, Financial, and Administrative Information Systems, US, 2013 Hospital Information Systems: Top Five Clinical Applications as a Percentage of Segment and Total Market Spend, US, 2013 Hospital Information Systems: Clinical Applications with the Strongest Projected Growth in Hospital Spend, US, Hospital Information Systems: 25th Annual HIMSS Leadership Survey Primary Clinical IT Focus, US, 2014 Hospital Information Systems: Percent Revenue Breakdown Among Clinical, Financial, and Administrative Information Systems, US,

4 List of Exhibits (continued) Exhibit Hospital Information Systems: Top Five Financial Applications as a Percentage of Segment and Total Market Spend, US, 2013 Hospital Information Systems: Financial Applications with the Strongest Projected Growth in Hospital Spend, US, Hospital Information System: 25th Annual HIMSS Leadership Survey Primary Financial IT Focus, US, 2014 Hospital Information Systems: Percent Revenue Breakdown Among Clinical, Financial, and Administrative Information Systems, US, 2013 Hospital Information Systems: Top Five Administrative Applications as a Percentage of Segment and Total Market Spend, US, 2013 Hospital Information Systems: Administrative Applications with the Strongest Projected Growth in Hospital Spend, US, Hospital Information Systems: Healthcare Reform-Driven IT and Data Needs by HIS Market Segment, US, 2014 Slide Number Hospital Information Systems: Functionalities Required for Comprehensive EHRs, US, Hospital Information Systems: The 25 th Annual HIMSS Leadership Survey Top IT Priority for the Next Two Years, US, 2014 Hospital Information Systems: Percentage of Office-Based Physicians with Adoption of a Basic EHR and Possession of a Certified EHR*, US,

5 List of Exhibits (continued) Exhibit Hospital Information Systems: Percentage of Non-Federal Acute Care Hospitals with Adoption of a Basic EHR and Possession of a Certified EHR, US, Slide Number Hospital Information System: EHR Vendor Market Share, US, Hospital Information Systems: Top Ten Inpatient EHR Products Ranked by Number of Meaningful Use Attestations, US, Hospital Information Systems: Number and Percentage of Hospital EHR Adoption by Status, US, Hospital Information Systems: Key US Hospital Demographics, US, Hospital Information Systems: Percentage Distribution of Community Hospitals by Bed Size, US, Hospital Information Systems: Numbers of Community Hospitals by Bed Size, US, Hospital Information Systems: Percentage Breakout of Urban Versus Rural Hospitals, US, Hospital Information Systems: Number of Hospitals by Geographic Region, US, Hospital Information Systems: Top Ten For Profit Hospital Systems by Number of Hospitals, US, Hospital Information Systems: Top Ten Non Profit Hospital Systems by Number of Hospitals, US, Hospital Information Systems: Total Number of Community Hospitals, US, Hospital Information Systems: Inpatient Admissions per 1,000 in Community Hospitals, US,

6 List of Exhibits (continued) Exhibit Slide Number Hospital Information Systems: Inpatient Days per 1,000 in Community Hospitals, US, Hospital Information Systems: Hospital Revenue, US, 1997 through Hospital Information Systems: Hospital Revenue per Employee, US, 1997 through Hospital Information Systems: Distribution of Inpatient Versus Outpatient Revenues as a Percentage of Total Hospital Revenue, US, 1992 through Hospital Information Systems: Number of Hospital Mergers and Acquisition Deals, US, Hospital Information System: 25th Annual HIMSS Leadership Survey Business Issues with Most Impact on Healthcare, US, Hospital Information Systems: Projections for NHE as a Percentage of GDP, US, 2008 through Hospital Information Systems: Projections for NHE, US, 2008 through Hospital Information Systems: Projected Growth for Expenditures for Health Services and Supplies by Select Categories, US, 2013 and 2019 Hospital Information Systems: Growth of National Health Expenditures by Type of Health Insurance, US, 2013 and 2019 Hospital Information Systems: Aggregate Hospital Payment-to-Cost Ratios for Private Payers, Medicare and Medicaid, US, Components of a New Value-Driven Healthcare Ecosystem 79 6

7 List of Exhibits (continued) Exhibit Slide Number Total Hospital Information Systems Market: Market Engineering Measurements, US, Total Hospital Information Systems Market: Revenue Forecast, US, Total Hospital Information Systems Market: Percent Revenue by Segment, US, Total Hospital Information Systems Market: Revenue Forecast by Segment, US, Clinical Information Systems Segment: Market Engineering Measurements, US, Clinical Information Systems Segment: Revenue Forecast, US, Financial Information Systems: Market Engineering Measurements, US, Financial Information Systems: Revenue Forecast, US, Administrative Information Systems: Market Engineering Measurements, US, Administrative Information Systems: Revenue Forecast, US, Hospital Information Systems: Penetration Analysis for Clinical Segment, US, Hospital Information Systems: Penetration Analysis for Non-Clinical Segment, US, Hospital Information Systems: Competitive Market Structure, US,

8 List of Exhibits (continued) Exhibit Slide Number Hospital Information Systems: Select Key Market Participants by Tiers of Competition, US, Hospital Information Systems: Recent Industry Deals, US, Hospital Information Systems: Definitions for Select Clinical Information Systems, US, Hospital Information Systems: Definitions for Select Financial Information Systems, US, Hospital Information Systems: Definitions for Select Administrative Information Systems, US, Decision Support Database: Number of Hospital Staffed Beds, Total Discharges, Patient Days and Gross Patient Revenue by State, US, 2012 Decision Support Database: National Health Expenditures and Annual Growth by Category, US, 2008 through 2023 Decision Support Database: National Health Expenditures, Share of Gross Domestic Product, and Average Annual Growth by Category, US, 2008 through

9 Methodology The objective of the research service is to present a comprehensive analysis of the US Hospital Information Systems (HIS) market with respect to market potential and key market dynamics at play over the next 5 to 7 years. The regional scope of the analysis is focused on the United States. The study also covers factors driving overall market growth, challenges impacting the hospital industry, and opportunities within the total market and key market segments as estimated for the forecast period. The study period covered by this service for the HIS market is from 2013 to 2020, with the base year as 2013 and forecast period from 2014 to Source: Frost & Sullivan 9

10 Methodology (continued) US Hospital Information Systems: Frost & Sullivan Research Methodology, 2014 Research Goals, Objectives and Scope Secondary Research Research Approach Primary Research Data presented in this research was gathered through the following processes: In-depth interviews conducted with healthcare information technology (IT) vendors; hospital IT management and staff, and key opinion leaders (KOLs) Secondary research conducted using Frost & Sullivan proprietary content as well as publicly available sources of information such as government websites, academic and trade journals, and online media. Market size and forecasts were developed using Frost & Sullivan proprietary forecasting tools. A discussion of forecast assumptions is provided. Analysis and Forecasting Writing Quality Check and Strategic Review Release Source: Frost & Sullivan 10

11 Key Findings Hospital Information System (HIS) are computer systems designed to improve the management of all of a hospital s medical (e.g., clinical), financial, and administrative tasks with the core goals of improving the quality of healthcare services while delivering maximum operational and financial efficiencies. The US HIS market is fairly mature, with penetration rates as high as % in administrative and financial systems and around % for clinical systems. However, there are many opportunities for new growth as hospitals increasingly turn to IT solutions to navigate a plethora of challenges arising from healthcare reform, the growing adoption of IT throughout society, and changing cultural norms. Among the most pressing issues impacting the HIS market over the next 5 to 7 years are - The Volume of Digital Data The Reemergence of Rising Hospitals Seek New Grows with the Rise of Healthcare Expenditures Business Models in the EHRs, Creating Demand for Drives the Need for Robust Face of Unprecedented Additional IT Solutions Cost Containment Change EHR adoption has accelerated dramatically due to the CMS EHR Incentive Program, creating a network effect for even more IT adoption. Today, legacy non-clinical systems need to integrate with clinical data and perform new functions, especially analytics. *Electronic Health Records The majority of US healthcare expenditures are now paid for by federal and state government sources. The need to control costs continues to grow in importance as the percentage of US GDP devoted to healthcare expands. The Patient Protection and Affordable Care Act will require hospitals to adopt new business models to meet demands of newly insured patients. Changing reimbursement models will create greater financial risks for all healthcare stakeholders. Source: Frost & Sullivan 12

12 Key Findings (continued) The US Hospital Information Systems market was valued at $ billion in The market is expected to grow at a CAGR of % between 2014 and 2020 to reach an estimated market value of $ billion by 2020, representing a % increase in revenue. Administrative information systems will be the fastest growing market segment with a CAGR of % over the forecast period. Financial information systems will be the second fastest growing market segment with a CAGR of % over the forecast period. Clinical information systems will grow by slowly than the other segments with a CAGR of % over the period. The key drivers and restraints for the market include - Market Drivers Market Restraints 1 Healthcare Reform and Changes in Reimbursement Require Focus on Improving Quality and Efficiency 1 Financial Challenges Resulting from Changes in Reimbursement 2 Provider Consolidation Drives IT Replacement Opportunities 2 Provider Consolidation Puts Downward Pressure on Pricing 3 Increasing Demand for Healthcare Services Drive Need for New IT 3 Uncertainty About the Direction of Meaningful Use Slows IT Replacement Cycle Source: Frost & Sullivan 13

13 Scope and Segmentation Geographic Coverage United States (US) Study Period Base Year 2013 Forecast Period Monetary Unit US Dollars The Hospital Information Systems (HIS) market covers a very wide variety of systems and solutions that pertain to the management of a hospital s clinical, financial, and administrative information-related tasks. For the purpose of this report, the HIS market consists of software applications and related maintenance and implementation services sold in conjunction with such applications but does not include information technology (IT) hardware (computers, mobile devices, medical devices, etc.) or telecommunications infrastructure solutions. Examples of typical hospital information systems include clinical solutions like electronic health records (EHRs), computerized physician order entry (CPOE), clinical decision support (CDS), nursing systems, and more; financial solutions like revenue cycle management (RCM), contract management, business intelligence, and more; and administrative systems like asset tracking, customer relationship management (CRM), single sign on, human resources, payroll, and more. This report only pertains to information systems used by non-federal US community hospitals for inpatient care settings (acute care). The scope of this study does not include information systems used by ambulatory providers (outpatient care) such as physician offices; post-acute care settings; long term care settings; nursing homes; and other care settings. Source: Frost & Sullivan 14

14 Key Questions This Study Will Answer What type of information systems are used by hospitals in the provision of patient care, the oversight of core financial processes including patient billing, and daily operations management of personnel, supplies, and facilities? What are the market-shifting macro trends impacting healthcare in the US, particularly in the provision of hospital care, and how are these trends shaping the demand for information technology? What are the specific drivers and restraints impacting the Hospital Information Systems market over the next 7 years? What are the competitive characteristics of the US Hospital Information Systems market and who are some of the key IT vendors serving the market? What is the 7-year outlook for the key IT applications that comprise the US Hospital Information Systems (HIS) market across the clinical and non-clinical market segments? Source: Frost & Sullivan 15

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