Third Edition. Essentials of the U.S. Hospital IT Market

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1 Third Edition Essentials of the U.S. Hospital IT Market

2 ii Introduction Essentials of the U.S. Hospital IT Market Introduction... iii Objectives of the Report... iii Research Methodologies... iii The HIMSS Analytics TM Database... iii Executive Overview... iv Market Overview... vi Key Vendors... vi Healthcare Consulting Companies... viii Five-Year CAGR Market Spend Forecast The Forecasting Model Ambulatory Clinic Applications Hospital-Owned Ancillary Clinical / Departmental Systems Cardiology PACS Radiology PACS Document Management Electronic Medical Records Nursing Patient Safety The EMR Adoption Model Operating Room IT Environment Bar Code Applications Financial Decision Support Financial Management Health Information Management Human Resources Revenue Cycle Management The Next-Generation Revenue Cycle Management Index Industry Signposts

3 Introduction Essentials of the U.S. Hospital IT Market iii Introduction Objectives of the Report IMSS Analytics TM is a respected and trusted source of information and knowledge for the healthcare information technology (IT) industry. The HIMSS Analytics Database TM (derived from the Dorenfest IHDS+ Database TM ) captures information on more than 5,000 hospitals and 30,000 medical facilities in the United States. With this data, HIMSS Analytics can analyze and assess industry trends related to legacy IT systems, emerging IT systems, current technologies and emerging technologies. Our analysis of this data will accomplish the following objectives: Present a forecast of market spending for key application environments, as well as the overall market. Present the market status for major financial and clinical applications. Present vendor market-share positions relative to major financial and clinical applications. Present predicted growth rates for key healthcare applications. Research Methodologies HIMSS Analytics collects data on a continuous basis to create its database of hospitals and associated organizational entities. Data gathered by HIMSS Analytics is first captured with structured frameworks. The data is then scrubbed in a quality assurance procedure to ensure the data is accurate and reliable. Data used for research and analysis is subjected to analysis for emerging market shifts and trends as well as changing market drivers and technology adoption. The resulting research analysis is then peer-reviewed by the HIMSS Analytics researchers with a final review provided by HIMSS Analytics executives. HIMSS Analytics Database (derived from the Dorenfest IHDS+ Database TM ) The HIMSS Analytics Database provides a comprehensive overview of the IT environments of more than 5,000 hospitals and 30,000 healthcare facilities that are associated with these hospitals. The HIMSS Analytics database includes information on more than 100 applications, server, desktop, wireless, network, security and specific departmental technologies in use

4 iv Introduction Essentials of the U.S. Hospital IT Market by these facilities. The database also includes demographic information regarding hospital ownership positions in integrated delivery networks, the key management contacts for the IDS and hospitals, and the relationship with owned or affiliated ambulatory or subacute facilities. Hospitals that participate in the annual study receive 48 free benchmark reports that compare hospitals to 10 of their peers relative to staffing, budgeting and operating support metrics, which include HIMSS Analytics EMR Adoption Model SM comparisons that provide insights into IT sophistication and intensity. Executive Overview The year 2007 was one in which there was continued clamoring by the current administration about the need for electronic healthcare records (EHRs) without a funding mechanism to help deliver on the rhetoric. Many hospitals feel that an unfunded mandate is being driven by the government to force higher adoption of EHRs, but with no clear indication or direction on how healthcare organizations are to fund this adoption. Critical access hospitals are one example where a change in reimbursement has ignited a segment of the market to evaluate and select more sophisticated IT solutions. Payers are experimenting with pay-for-performance models that require hospitals to enable themselves to report on improved patient outcomes, and this model may help drive adoption of more sophisticated levels of EHR capabilities. Capital spending for IT applications in 2008 is projected to be 47 percent to 52 percent of hospitals total capital budgets. This percentage of IT application spending relative to total capital spending is projected to remain relatively constant through The year 2007 saw continued clamoring about the need for electronic health records but no funding to deliver on the rhetoric. Several market drivers will continue to increase hospital IT spending. HIPAA claims attachment regulations will drive hospitals to more effectively integrate their financial and clinical IT solutions. Regulations ranging from recovery audit contractors, severityadjusted DRGs, and ICD-10-CM conversions will force hospitals to critically assess their revenue cycle management and health information management IT applications for compliance capabilities. Ongoing pressures from the government and from employers will continue to drive hospitals to evaluate their quality and outcomes measures and their reporting and management. New regulations impacting the revenue cycle management (RCM) environment, and the need to improve outcomes and quality management in care delivery environments, will force extreme budgeting competition between financial and clinical applications over the next five years. The prioritization of hospitals IT budgets will be polarizing events for many healthcare organizations and their cultures.

5 Introduction Essentials of the U.S. Hospital IT Market v Key healthcare IT vendors and consulting companies will continue to consolidate the market over the next five years. Key acquisitions over the last year include: Eastman Kodak s PACS division by Onex VasTech by Lawson Software Extended Care Information Network by Allscripts Emergin by Philips Global Care Solutions by Microsoft Misys CPR by QuadraMed Quovadx by HEALTHvision JJWild by Perot Systems LYNX Medical Systems by Picis Sunquest by Vista Equity Partners Smart Document Solutions by Companion Technologies MD-X Solutions by MedAssets VISICU by Philips Patient Care Technologies by MEDITECH CareScience by Premier Practice Partner by McKesson Over the next five years the pace of consolidations will be most rapid in the ambulatory market. A recent example of this trend was the acquisition of Allscripts by Misys in Applications with a projected compounded annual growth rate (CAGR) of 5 percent or greater in the 2008 to 2013 time frame are dictation with speech recognition; eligibility; encoder (driven by new regulations); outcomes/quality management; cardiology information systems; data warehousing/financial; Radio Frequency Identification (RFID) patient tracking; and RFID supply tracking. An evaluation of the EMR Adoption Model SM scores over the 2006 to 2007 period shows that hospitals are continuing to advance the care-delivery capabilities of their EMR environments (see Figure 1). But will this advance comprise budget shortfalls or boost competition with other IT applications over the next five years? Stay tuned.

6 vi Introduction Essentials of the U.S. Hospital IT Market N=4,048/5,073 Stage 7 Stage 6 EMR Adoption Model Trends SM Medical record fully electronic; HCO able to contribute CCD dataset as a byproduct of EMR; Data warehousing in use Physician documentation (structured templates), full Clinical Decision Support System (variance & compliance), full RPACS 2006 Final 0.0% 0.1% 2007 Final 0.0% 0.8% Stage 5 Closed loop medication administration 0.5% 1.4% Stage 4 CPOE, CDSS (clinical protocols) 3.0% 2.2% Stage 3 Clinical Documentation (flow sheets), CDSS (error checking), PACS available outside Radiology 18.0% 25.1% Stage 2 Stage 1 Clinical Data Repository, Controlled Medical Vocabulary, CDSS inference engine, may have Document Imaging Ancillaries Lab, Radiology, Pharmacy All Installed 38.8% 37.2% 18.9% 14.0% Stage 0 All Three Ancillaries Not Installed 20.7% 19.3% Data from HIMSS Analytics database (derived from the Dorenfest IHDS+ Database ) 2008 HIMSS Analytics Figure 1 Market Overview Key Vendors The key vendors in the hospital IT market are multinational companies with large portfolios of IT solutions that cover most operating environments for healthcare delivery systems. These corporations are referred to as enterprise vendors. Their portfolios of solutions range from financial solutions and EMR environments to solutions that are used in ancillary departments. An emerging strategy for large enterprise vendors that also provide medical devices used in healthcare delivery is to tightly couple IT applications with their medical devices. What follows are representative examples of where vendors are deploying this strategy: GE Healthcare: integration of cardiology applications with cardiology devices; the integration of operating-room management applications with medical devices used in the operating-room environment; and the integration of its PACS environment with its radiology information system.

7 Introduction Essentials of the U.S. Hospital IT Market vii Siemens Medical Systems: integration of its PACS environment with the radiology information system. McKesson: integration of its robotic and medication-dispensing cabinets with its patient safety software computerized practitioner order entry (CPOE), pharmacy and the electronic medication administration record (emar) and integration of its PACS environment with its radiology information system. Overall, the top enterprise healthcare IT vendors with respect to IT application market share for the U.S. hospital market are: McKesson Information Solutions (MCK: NYSE): Siemens Medical Systems (SI: NYSE): GE Healthcare (GE: NYSE): acquired IDX Systems Cerner Corporation (CERN: Nasdaq): Medical Information Technology, Inc. (MEDITECH - Private): Eclipsys Corporation (ECLP: Nasdaq): Epic Systems Corporation (private): QuadraMed Corporation (QD: AMEX): Computer Programs and Systems, Inc. (CPSI: Nasdaq): Keane Healthcare Services (NYSE: KEA): Dairyland Healthcare Solutions (private): Healthcare Management Systems (private): Niche vendors that specialize in applications for ancillary departments or departmental systems continue to play major roles in some application segments. Representative niche vendors within specialty environments include: Soft Computing Corporation: laboratory, radiology, pharmacy; Unibased System Architecture: enterprise scheduling;

8 viii Introduction Essentials of the U.S. Hospital IT Market Surgical Information Systems: operating room management; Picis/MSM: operating-room management; ICU applications; Mediware: pharmacy, blood bank; ADP: payroll services; Kronos: time and attendance systems; Healthcare Consulting Companies Over the last few years, the IT consulting market to U.S. hospitals has been significantly disrupted with acquisitions (e.g., Accenture/Cap Gemini Healthcare, ACS/Superior, IBM/Healthlink, CSC/First Consulting Group) that will redefine market dynamics for outsourcing services or standard consulting engagements (e.g., strategic planning, vendor selection, implementation). Obviously, a consolidation of solely focused healthcare consulting companies by larger consulting entities is taking place, and that will result in broader and more integrated healthcare service offerings by the acquiring companies. The challenge of the acquiring companies is to keep the talent and cultures intact in the acquired organizations; some are struggling in this effort. These acquisitions will drive the emergence of new consulting companies from people who depart the acquired companies or who depart the consulting companies being cleaned up for sale. Emerging competition will come from other large consulting companies that want to play in this market (e.g., Navigant). They will hire experienced consultants who have departed acquired companies to build their offerings. Alternatively, some consultants will create boutique firms that specialize in niche consulting models, and that if successful, will be acquired yet again in the continuous cycle of healthcare consulting. Top firms providing standard consulting service engagements to hospital are: Accenture Deloitte CSC/First Consulting Group Perot Systems Corporation Siemens Medical Solutions IBM/Healthlink Cerner Corporation ACS McKesson

9 Introduction Essentials of the U.S. Hospital IT Market ix PriceWaterhouseCoopers (PwC) BearingPoint Navigant Consulting Top firms providing outsourcing services to hospitals are: CSC/First Consulting Group Perot Systems Corporation Siemens Medical Solutions McKesson Eclipsys Corporation ACS CareTech Solutions, Inc. IBM Siemens Medical Solutions, McKesson and Cerner Corporation are representative of enterprise vendors that have expanded the scope of their service offerings for consulting and outsourcing solutions. These services units are becoming significant revenue streams for their companies. This focus by multi-industry consulting firms on other healthcare segments (e.g., pharmaceutical/biotech, payers) has provided opportunities for several small and regional consulting companies (boutique firms) to increase their consulting service market share.

10 2008 HIMSS Analytics Requests for permission to reproduce or photocopy any part of this report should be sent to: 230 East Ohio Street Suite 600 Chicago, IL

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