ehealth across Canada 2008 European ICT Mission January 28-February 5 (Stockholm, Helsinki, Oslo, Copenhagen, Brussels, Nuremberg, Amsterdam)

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2 ehealth across Canada 2008 European ICT Mission January 28-February 5 (Stockholm, Helsinki, Oslo, Copenhagen, Brussels, Nuremberg, Amsterdam) Branham Group Inc.

3 Introduction Agenda Branham ehealth 2007 Study ehealth Vendor Landscape Looking Ahead What does the future Holds?

4 Introduction Branham Group BRANHAM GROUP Global Marketing Consultancy and Industry Analyst firm focused on the Information Technology Sector Established in1990 Based in Ottawa, Canada Services Delivered Over 50 Countries

5 Branham Edition 15 th Anniversary Issue Premier Annual Listing of the Top Public and Private ICT Firms in Canada Ranked by Gross Revenue Print Version Published by Backbone Magazine Published by Branham at

6 Branham Edition

7 Outsourcing Directory Branham is launching a major directory initiative to build brand and market Canada s outsourcing industry Over 250 Domestic and Multinational Companies with Outsourcing capabilities in Canada to be highlighted All Outsourcing Capabilities including ehealth vendors Marketing and Distribution Plan:

8 Annual ehealth in Canada report 3rd Printing 600 Pages of Data and Analysis Comprehensive National and Provincial Coverage Cover Hospital/Acute, Primary and Continuing Care markets Data obtained through personal interviews, extensive literature search and ongoing market monitoring with 116 Key decision-makers across Canada Market Size and Trends Analysis Current Inventory and Buyers Intentions data Vendor Market Share data New Opportunity Analysis The source for vendors currently selling or planning to sell into the Canadian market Custom Consulting engagements Database Reseller HIMSS, Other Partner with ehealth in Canada

9 ehealth 2007 Study

10 QUÉBEC Population: 7.54M Hospitals: 127 Beds: 20,829 Health Authorities:18 Budget: $314M NEWFOUNDLAND & LABRADOR Population: 0.52M Hospitals: 14 Beds: 1,498 Health Authorities:4 Budget: $28M NL Centre for Health Information (NLCHI) PEI Population: 0.14M Hospitals: 7 Beds: 474 Health Authorities:0 Budget: $11M BRITISH COLUMBIA Population: 4.2M Hospitals: 89 Beds: 8,431 Health Authorities:6 Budget: $250M healthnetbc ALBERTA Population: 3.2M Hospitals: 101 Beds: 7,234 Health Authorities:9 Budget: $225M Alberta Wellnet SASKATCHEWAN Population: 1.0M Hospitals: 64 Beds: 3,130 Health Authorities:13 Budget: $53M - Health Information Solutions Centre (HISC) - Saskatchewan Health Information Network (SHIN) MANITOBA Population: 1.2M Hospitals: 68 Beds: 4,269 Health Authorities:11 Budget: $37M - e-health Services Manitoba (pending) - Diagnostic Services Manitoba ONTARIO Population: 12.4M Hospitals: 144 Beds: 26,572 Health Authorities:14 Budget: $500M - e-health Council - Smart Systems for Health Agency (SSHA) NEW BRUNSWICK Population: 0.75M Hospitals: 26 Beds: 2,662 Health Authorities:8 Budget: $35M Office of ehealth (OeH) NOVA SCOTIA Population: 0.94M Hospitals: 35 Beds: 3,108 Health Authorities:9 Budget: $40M

11 Canadian Market Size Canadian Institute for Health Information (CIHI) forecasts that public spending on healthcare will rise 6.9% to $113B for the 2007/2008 fiscal year Estim ated Population IT Budget ehealth Prov. spending IT Budget will consume (Thousands) per Person (Millions) approximately NL $26 2.1% or 517 $2.3B $50.3 of this NS $ $63.9 public sector spending. This represents PE $ $84.8 NB $ $53.3 about the same level of ehealth spending QC $544 7,543 $72.1 in 2006/2007 ON $865 12,393 $69.8 MB $78 1,170 $66.7 SK $ $68.3 AB $345 3,202 $107.7 BC $300 4,196 $71.5 TOTAL $2,338 31,842 $73.4

12 Canada Health Infoway has received $400M in Budget 2007 in addition to the Canadian Market Size Cont.. Canada Health Infoway (CHI)is a notfor-profit corporation, created in 2001, whose members are the Federal, Provincial and Territorial Deputy Ministers of Health CHI role is to foster and accelerate the development and adoption of electronic health information systems with compatible standards and communications technologies on a pan- Canadian basis, with tangible benefits to Canadians.

13 Top ehealth Trends Top ehealth Trends Increasing consolidation of vendors in the acute care market Bigger wins but fewer winners Regional Health Authorities and other buyers working together in group purchases for economies of scale. Majority of Provinces are moving beyond planning to implementation for components of their Provincial EHR Branham expects the EMR market in primary care to expand beyond current 10-20% market penetration with net new provincial certification/buying programs coming online in 2008 In general, buyers interested in a number of applications

14 ICT Technology Vendors in Canada ehealth Vendors Landscape

15 Branham ehealth Vendor DB 469 ehealth Firms Tracked

16 18% ICT Technology Vendors in Canada 21% Vendors Selling in Canada Canadian owned Canadian subsidiary Foreign owned 61% 469 Vendors 61% Canadian Owned» CLINICARE» MediSolution» XWAVE» TELUS/Emergis 18% Canadian Subsidiary» Cerner Canada» Agfa Canada» McKesson Canada 21% Foreign Owned» Meditech» Initiate Systems

17 ICT Technology Vendors in Canada Primary Business Focus Applications Infrastructure Services 27% Primary Business Focus # of Vendors % of Total Vendors Applications % 54% 19% Infrastructure 91 19% Applications Infrastructure Services Services % TOTAL %

18 ICT Technology Vendors in Canada Ownership % Public Ownership % Private Ownership 29% 86% 68% 71% 14% 32% Canadian owned Canadian subsidiary Foreign owned

19 ICT Technology Vendors in Canada Province # of Vendors AB 26 BC 33 Canadian Owned Vendors by Province MB 7 NB 3 NL 3 NS 11 ON 135 PE 2 QC 63 SK 3 AB BC MB NB NL NS ON PE QC SK PE 1% QC 22% ON 47% SK 1% AB 9% BC 12% MB 2% NB 1% NS 4% NL 1% TOTAL 286

20 ICT Technology Vendors in Canada Top 5 ehealth Vendors - Core Clinical Applications Laboratory Sample Size = 623 hospitals (84%), 73,080 beds (85%) Pharmacy Sample Size = 613 hospitals (83%), 73,061 beds (86%) RIS Sample Size = 632 hospitals (84%), 74,382 beds (86%) PACS Sample Size = 603 hospitals (81%), 72,546 beds (85%) Category Vendors Market Share (% hospitals) Meditech 40% Cerner 9% GE Healthcare 8% MediSolution 7% Meditech 39% Cerner 11% GE Healthcare 8% CGSI 7% Eclipsys, MediSolution, IBS 3% Meditech 39% Agfa 15% Cerner 10% Artefact 7% MediSolution 7% Agfa 38% GE Healthcare 13% Philips 6% McKesson 5% Fuji 4%

21 ICT Technology Vendors in Canada Top 5 ehealth Vendors - Core Clinical Applications Database Sample Size = 388 hospitals (52%), 57,868 beds (68%) Integration Engine Sample Size = 427 hospitals (57%), 50,121 beds (58%) Servers Sample Size = 47 hospitals (60%), 58,394 beds (69%) Category Sample Size = 540 hospitals (72%), 66,296 Beds (77%) Electronic Messaging Vendors Market Share (% hospitals) Microsoft 61% Meditech 51% Oracle 44% Sybase 12% MySQL 2% Microsoft 73% Meditech 18% IBM 16% Novell 7% Netscape 3% Quovadx 32% Microsoft 17% SUN 11% Cerner 7% Summit 6% HP 66% IBM 48% SUN 31% Dell 17% Stratus 7%

22 Top 10 Healthcare Companies Top 10 IT Healthcare Companies

23 Top 10 Healthcare Companies Total revenues for the Top 10 companies in 2007 were $6.7 billion. The current group of companies generated $6.1 billion in Year-over-year growth rate of %9.44. Rank Ranking Company 1 4 Telus (wireless and data) 2 22 xwave 3 31 Emergis 4 45 SXC Health Solutions (formerly Systems Xcellence) 5 80 MediSolution TECSYS Klick Communications Nightingale Informatix CLINICARE QHR Technologies

24 Top 10 Healthcare Companies Revenue Comparison ($000) Top 10 healthcare companies - revenue comparison % 9.44% 6,800,000 6,700,000 6,600,000 6,500,000 6,400,000 6,300,000 6,200,000 6,100,000 6,000,000 5,900,000 5,800,000 6,122,876 6,700,937 6,127,076 6,705, Top 10 healthcare All healthcare

25 ICT Technology Vendors in Canada Province Branham 300* Population** Canadian Owned Vendors AB 10.22% 10.50% 9.09% BC 14.86% 13.20% 11.54% MB 0.62% 3.60% 2.45% NB 0.62% 2.30% 1.05% NS 1.55% 2.80% 3.85% NL 0.00% 1.50% 1.05% ON 56.66% 38.80% 47.20% PE 0.62% 0.40% 0.70% QC 14.24% 23.40% 22.03% SK 0.31% 0.30% 1.05%

26 ICT Technology Vendors in Canada ehealth Vendors vs. Branham 300 vs. Population 60.00% 50.00% 40.00% 30.00% Branham 300* Population** Canadian Owned Vendors 20.00% 10.00% 0.00% AB BC MB NB NS NL ON PE QC SK

27 ICT Technology Vendors in Canada Canadian ehealth Vendors - Profiles

28 Canadian ehealth Vendors - XWAVE Canadian organization operating globally Established in 1999 $355 M + in revenues and over 1500 employees Head office in St. John, Newfoundland and Labrador XWAVE plans, designs, builds and operates complete ICT solutions Three service lines: Systems Integration and Software Engineering Infrastructure Services Product Fulfillment Solution Focus: Client and Provider Registries iehrs Telehealth Electronic Medical Records Healthcare Portals Strategic Healthcare Consulting Wait Time and ereferral One of the largest healthcare consulting practices

29 Canadian ehealth Vendors - XWAVE New Brunswick xwave has been chosen to integrate and maintain components of the provincial One Patient One Record (OPOR) system British Columbia xwave has been involved in two of the seven provincial ehealth projects xwave custom designed a Change, Implementation and Adoption (CIA) Strategy for the recent awarded contract of the BC Provincial Laboratory Information Solution (PLIS) xwave is one of six successful proponents arising from a Request for Proposals from the Ministry of Health to deliver an application service provider (ASP)-based clinical management system (CMS) to BC physicians

30 Canadian ehealth Vendors - CLINICARE Canadian organization operating in North America Established in 1984 Privately owned Head office in Calgary, Alberta CLINICARE develops, markets and supports computer software solutions for medical group practices Solution Focus: Electronic Medical Record (EMR) Practice Management Applications (PMA) Productivity Software Enhancement and Support Services

31 Canadian ehealth Vendors - CLINICARE 2007 Canadian Health Informatics 'Healthcare Transformation of the t Year' for the implementation of our EMR/EHR solution at the 55 physician Winnipeg Clinic CLINICARE Corporation has been recently chosen by BC Ministry of Health as part of their Electronic Medical Records (EMR) certification cation program making CLINICARE an EMR vendor certified in 3 out of 4 national certification programs With the help of CLINICARE's EMR, Saskatchewan physicians improve e the management of chronic disease and increasingly involve consumers in self-management CLINICARE has received the US-based Best in KLAS Award three years in a row for being North America s s highest rated Ambulatory EMR for groups of physicians

32 Canadian ehealth Vendors - TELUS Canadian telecommunication company operating in Western Canada established in 1990 $ 9.0 B in annual revenue and over 29,000 employees head office in Burnaby, British Columbia In the midst of acquiring Emergis, a Canadian IT leader in Healthcare Emergis develops and manages solutions that automate transactions and the secure exchange of information to increase the process efficiency and quality of service of its customers Emergis Subsidiary Solution Focus: Electronic Health Records Health Claims Management Clinical Care Applications Solutions for Pharmacies Practice Management Network Solutions Security Services Health Professional Services Telus acquisition of Emergis creates leading electronic health care solution provider

33 Canadian ehealth Vendors - TELUS Federal Emergis brings health expertise to the implementation of a dental electronic health record (EHR) at 21 Canadian Forces clinics across Canada Alberta Alberta Health & Wellness has selected Emergis to provide advisory and consulting services on moving Alberta Netcare to a paperless electronic health record (EHR) environment British Columbia TELUS leads managed operations services in the recent BC Provincial ial Laboratory Information System (PLIS) project. TELUS will also be responsible for secured hosting of patient laboratory data Ontario TELUS has been chosen by Saint Elizabeth Health Care, a non-profit home and community health care organization, as the IP provider in a five-year deal worth $6.5 million

34 Summary on CDN vendors Dominated by a great number of players # % ehealth vendors are privately held Majority focused on niche markets/single markets ehealth Vendors Location:» Ontario 47.3%» Quebec 22%» British Columbia 11.5%» Alberta 9% Primary Business Focus:» Services» Applications Telus future acquisition of Emergis will influence how the Canadian ehealth market will evolve Innovative health technology solutions

35 Looking Ahead Emerging Technologies in Canada

36 Looking Ahead Canada s healthcare system: Transforming and modernizing Voice Recognition, Biometrics Remote healthcare services delivery Wireless Technologies Internet Based Solutions VoIP Telephony Portals Technologies Consumer Portals Physician Portals Automation of Business Processes (Financial, HR, Admin..) Paper Charts -> EHR/EMR Software across the continuum of care Chronic Disease Management

37 Contact J. Wayne Gudbranson President & CEO Tel: (613) ext

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