New From Kalorama Information: EMR 2012: The Market for Electronic Medical Record Systems KLI Current Physician Usage of EMR

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1 New From Kalorama Information: EMR 2012: The Market for Electronic Medical Record Systems KLI Paperless medicine is a key goal of healthcare systems. Kalorama Information has continued to track the market for electronic medical records (EMR) and electronic health records (EHR). U.S. Federal government incentives are established, and physicians are routinely receiving incentive payments. What impact has those payments shown, and how have vendors reacted? And what will happen in this market in the years to come? This report, EMR 2012, Kalorama's most recent look at the market and trends impacting electronic medical record software and related services, seeks to answer these questions and provide crucial data for business planning. A market summary provides a total market analysis. Also included is a competitive analysis of leading EMR system providers. The report covers: Current Physician Usage of EMR 2011 Market for EMR and Forecast Hospital and Physician EMR Adoption Statistics Pricing of Select EMR Systems Cost of Installations for Physicians and Hospitals Profiles of Major Vendors Current Vendors with CCHIT Qualification Analyst Conclusions Regarding the EMR Market Opportunities for Entrants: Is the Window on Market Leadership Closed 2011 Market Share for EMR for Hospital Market 2011 Market Share for EMR in Physician/Web-based Market The information for this report was gathered using both primary and secondary research including comprehensive research of secondary sources such as company literature, databases, investment reports, and medical and business journals. Telephone interviews and correspondence were the primary method of gathering information. All market data pertains to the world market at the manufacturers level. The base year for data was Historical data was provided for the years 2010 and 2011, with forecast data provided for 2012 through For the purpose of this study, Kalorama Information conducted interviews with more than 22 key industry officials, consultants, health care providers, and government personnel. These sources were the primary basis in gathering information specifically relating to revenue and market share data presented in this report. Additional interviews were completed with relevant company representatives including marketing directors, division managers, and product representatives. As part of its coverage, the following companies are profiled in this report: Allscripts Healthcare Solutions Cerner Corporation eclinicalworks Epic Systems, Inc. GE Healthcare Medical Information Technology, Inc. (MEDITECH, Inc.) MedPlus, Inc. McKesson Corporation NextGen Healthcare Information Systems/QSI Practice Fusion Siemens Medical Solutions Other select EMR companies are profiled in brief...

2 C H A P T E R O N E Executive Summary INDUSTRY AT A GLANCE Paperless medicine is a key concern of the U.S. healthcare system today, for both internal business and regulatory reasons. The healthcare industry is facing significant challenges to improve quality of care and patient satisfaction while controlling rising costs. The federal government has stepped in to try to prompt a smarter, more efficient and less costly healthcare system that advocates better connections, better data and faster, more detailed analysis. Smarter healthcare is interconnected so that doctors, nurses, patients and insurers all share up-to-date information seamlessly and efficiently. Electronic Medical Record (EMR) is at the heart of the health information technology market, and it affects most healthcare IT purchases. Government initiatives and cost concerns are key drivers of EMR and will remain so in the near future. Healthcare information technology companies seeking to understand the market for health information technology will need to build products that address the need for EMR, or work around or interface with existing systems. An understanding of EMR products in the marketplace is critical. The healthcare industry includes establishments ranging from small private practices of physicians with only one medical assistant to large city hospitals that employ thousands of professionals. Healthcare is a large market, and one that has been slow to adopt the technology. This means opportunities for technology companies. Many consider this arena the new frontier for IT. The financial opportunities created by the government stimulus create unprecedented opportunities

3 for both hospital-based and ambulatory providers to implement EMR technology. However, there are many issues to be addressed. There is a variety of factors affecting the adoption of this technology both positive and negative including: Increase in access and efficiency Increase in documentation Increase in quality of care Increase in resources Increase in quality assurance Concern over liability Concern over accountability Patient privacy Costs Vendors are a vital part of shaping this industry. Having the competitive intelligence is just one part of advancing this industry. Participants need to be ever vigilant of the economic pulse, needs of the industry and the government s role in healthcare to properly meet the challenges facing the industry today and in the future. SCOPE AND METHODOLOGY This report, EMR 2012 is a look at the market and trends impacting electronic medical record software and related services. Included in the report are statistics influencing the industry, demographics; life expectancy, and company strategies. Information is presented as a U.S. market, with a section on key international markets. A market summary includes a total market analysis. Also included is a competitive analysis of leading EMR system providers. The information for this report was gathered using both primary and secondary research including comprehensive research of secondary sources such as

4 company literature, databases, investment reports, and medical and business journals. Telephone interviews and correspondence were the primary method of gathering information. For the purpose of this study, Kalorama Information conducted interviews with more than 21 key industry officials, consultants, health care providers, and government personnel. These sources were the primary basis in gathering information specifically relating to revenue and market share data presented in this report. Additional interviews were completed with relevant company representatives including marketing directors, division managers, and product representatives. All market data pertains to the world market at the manufacturers level. The base year for data was Historical data was provided for the years 2009 and 2010, with forecast data provided for 2012 through Compound annual growth rates (CAGRs) are provided for the and periods for each region and/or segment covered. Competitive analysis is provided for the year The forecasted market analysis for was largely based on demographic trends, new developments, company performance trends, merger and acquisitions, and national expansion. PHYSICIAN USE OF EMR Continued gains have been made in physician adoption in EMR systems since we last reported on this topic in early CMS s recent survey, also corresponds with numbers from an Accenture study on the same topic that shows nearly 50% of physicians in the US have used EMR. This is a significant improvement over 2006 when Kalorama Information first began studying EMR and represents the success of the stimulus incentives in the ARRA stimulus law of As part of the ARRA legislation passed in February, the federal government set aside nearly $20 billion in incentives for hospitals and physician practices adopting electronic medical records. The first incentives were paid in 2011 based on 2010 performance. More than $1.3 billion in Medicare EHR Incentive Program payments have been made between May 2011 and the end of December 2011 and more than $1.1 billion in Medicaide EHR Incentive Program payments have been made between January 2011 and the end of

5 December Medicare and Medicaid could penalize providers who are not using certified EHRs by In the US, EMR has made significant gains in hospital and health systems. Demographic studies from 2007 indicate there is wide variance among in different regions (Physicians in the Western US more likely than Eastern US) and age (physicians under 44 more likely) Statistics from the National Ambulatory Medical Care Survey (NAMCS) indicate that 56.9 percent of the office-based physicians used partial or full EMR systems in 2011, an increase from the percent reported in About 33.9 percent of physicians reported that they now have systems that met the criteria of a basic system and about 12 percent reported having systems that met the criteria for a fully functional system. Physicians increasingly are adopting electronic medical records systems, even before government economic incentives for doing so have kicked in. But a survey by the Centers for Disease Control and Prevention also found those doctors weren't yet doing a whole lot with the technology.

6 A DEEPER LOOK AT PHYSICIAN USAGE STATISTICS The numbers above indicate a progressive percentage of adoption, and there can be little doubt that the ARRA stimulus law incentives for EMR use has had an impact. But these numbers can be examined further to illustrate where the state of paperless medicine, especially in physician offices is currently. The following chart depicts the rate of increase each year in the NAMCS survey of physicians. The largest increases were in 2007 and 2008, prior to the incentive programs. It may be argued that growth may slow incrementally as the low hanging fruit of potential adopters, those that may have been more open to an electronic system, begin to use an EMR system, and that the remaining physicians will require more convincing. We do see however, smaller increase in the survey results between 2009 and 2010, but adoption rates in 2011 have almost matched those in We believe to some degree this implies confusion with meaningful use standards and the qualification and interoperability of systems.

7 Figure 1-4 Hosptials at Stage 3 or higher SIZE AND GROWTH OF THE MARKET Healthcare Information Technology (HIT) is primarily divided into two categories clinical and administrative IT solutions. HIT is used in the business and administrative environment of hospitals, primary care centers, diagnostic centers, and physician practices. EMR is a clinical IT solution, which broadly encompasses five areas Pharmacy Information Systems (PISs), Radiology Information Systems (RISs), Laboratory Information Systems (LISs), other information systems for clinical functions, wireless-enabled systems and surgical management systems. Tools, such as Computerized Practitioner Order Entry (CPOE) systems and decision support systems, are used across all these information systems. There are certain tools, such as Picture Archiving and Communication Systems (PACS), which are used only for data stored in the RIS. Documentation, point of care, and medication administration

8 are some of the tools used in the information systems for clinical solutions. Administrative solutions would include patient administration, billing, electronic booking systems, finance, supply chain management, and HR/payroll. Revenues are inclusive of all software, services and consulting. The market for EMR was $17.9 billion in 2011 as indicated in Table 1-1. It is expected to rise to $35.4 billion by 2016, as indicated in Table 1-2. Kalorama includes revenues for EMR/EHR systems, CPOE systems, and also directly related services such as installation, training, servicing, consulting which are key profit areas for companies. It does not include PACS or hardware. (Kalorama has a report on the subject The US Market for PACS at While growth was a little slower in 2011 than anticipated (still over 13%), with some hesitation on the part of physicians and confusion about meaningful use guidelines, physician adoption has improved and incentive checks have been issued. Kalorama Information believes adoption and upgrading activities will be brisk in As new systems are sold, companies will still earn revenues from existing clients in servicing and consulting services. The forecast assumes the trend of adoption will continue to improve, hospital EMR adoption will supercede doctors and current EMR stage 3 will move up in stages, that current EMR owners will upgrade and train on systems, and that the threat of penalties will force doctors and hospitals to make upgrade decisions.

9 Figure 1-5 EMR Market Analysis: Revenues (in millions) $ Year Source: Kalorama Information

10 KEY ISSUES AND TRENDS AFFECTING THE MARKET There are several primary issues and trends affecting the electronic medical records (EMR) industry. Demographics, increasing life expectancy, and technology innovation will continue to fuel growth in the future. New developments will also positively influence growth. Issues and trends explored in this study include: Meaningful Use Economic Stimulus Package Stimulus Guarantee Challenges to Healthcare Reform Virtualization Technology Storage Area Networks Cloud Computing Dashboard Modules Mergers and Acquisitions Stark Law Discreet Recordable Transcription Health Information Exchanges Regional Extension Centers Personnel Issues Security Breaches/Portable Devices Tablet Adoption New Network for Doctors National Physician Education Program ICD-10 Controversy

11 Physician Position Accountable Care Organizations Personal Health Record Doctor s Surveys Interoperability Smart Card Technology Wireless Technology Open Source EMR Applications Adoption Issues Usability and Adoption Quality of Care/Malpractice Cost Benefit Analysis Privacy Issues Technology Limitations CCHIT NHIN Results of WalMart and Dell Offerings Direct PPC Offerings International Markets and Trends LEADING MARKET PARTICIPANTS The electronic medical records market in the United States is competitive, with over 400 providers. Companies remain competitive by offering high-quality solution packages to private practices and hospitals. As Figure 1-1 indicates McKesson has the largest share of the EMR market; however, there is still ample opportunity for other companies and new entrants. The main drawback for smaller companies is the cost to enter the market with a certified product.

12 Several leading market participants are discussed in this report along with unique niche players including: Allscripts Healthcare Solutions Cerner Computer Programs & Systems eclinicalworks Epic GE Healthcare McKesson MEDITECH MedPlus NextGen QuadraMed Corporation Siemens Other companies

CHAPTER THREE: EMERGING TRENDS Meaningful Use Economic Stimulus Package

CHAPTER THREE: EMERGING TRENDS Meaningful Use Economic Stimulus Package CHAPTER ONE: EXECUTIVE SUMMARY Industry at a Glance Physician Use of EMR Hospital Use of EMR Size and Growth of the Market Key Issues and Trends Affecting the Market Leading Market Participants Conclusions

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