CHAPTER THREE: EMERGING TRENDS Meaningful Use Economic Stimulus Package

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1 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 Scope and Methodology CHAPTER TWO: INDUSTRY OVERVIEW Introduction The Medical Record The Electronic Medical Record Industry Terminology Industry Structure Advantages Increased Access and Efficiency Improved Documentation Quality of Care Increased Resources Quality Assurance Eliminates Costs Disadvantages Reliability Accountability Patient Privacy EMR Software ardware Requirements omponents of an EMR Administrative System Components Laboratory System Components Radiology System Components Pharmacy System Components Computerized Physician Order Entry Clinical Documentation Flow of Patient Data across Various Components Pricing of EMRs US EMR Adoption Model EMR Adoption Rates CHAPTER THREE: EMERGING TRENDS Meaningful Use Economic Stimulus Package

2 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 Exchange Update Regional Extension Centers Personnel Issues Security Breaches/Portable Devices Tablet Adoption New Network for Doctors National Physician Education Program ICD-10 controversy Physician Position and Usability Accountable Care Organizations The Personal Health Record System Doctor s Surveys AAFP, ACP, Medscape Interoperability Dimensions of Interoperability Benefits Smart Cards Technology Wireless Technologies Open Source EMR Applications Benefits of Open Source EMR Applications Adoption Issues Usability And Adoption Physician Group Practices And the Recession Quality of Care/Malpractice/Security Cost-Benefit Analysis ROI for a Typical Physician Practice EHR Incentive Program Implementation Costs and ROI for Hospitals Summary Privacy Issues Technology Limitations Social and Organizational Barriers E-Prescribing CCHIT NHIN Results of Wal-Mart and DELL Launches Direct PPC Offerings Healthcare Spending US and International

3 Europe Asia, and Other EMR Markets The US Market CHAPTER FOUR: LEADING MARKET PARTICIPANTS Allscripts Healthcare Solutions Aprima Medical Software, Inc Cerner Corporation Computer Programs and Systems, Inc. eclinicalworks Epic Systems, Inc. GE Healthcare Medical Information Technology, Inc. (MEDITECH, Inc.) MedPlus, Inc. McKesson Corporation NextGen Healthcare Information Systems/QSI Practice fusion Quadramed Corporation Siemens Medical Solutions CHAPTER FIVE: COMPANIES IN BRIEF Abraxas Medical Solutions ADP AdvancedMD Amazing Charts Athenahealth BizMatics ChartLogic CureMD e-mds Dr First/Rcop Greenway Medical Technologies Healthland Health Management Systems Henry Schein Keane LLS Data Systems Medsphere Systems MeridianEMR, Inc Nightingale Infomatix Sequel Systems, Inc SoapWare, Inc StreamLine MD SuiteMed Vitera Healthcare Solutions Waiting Room Solutions Web PT

4 CHAPTER SIX: MARKET ANALYSIS Market Overview Market by Segment Hospital EMR Market Physician EMR Market Competitive Analysis Hospital Market Leaders Physician Office EMR Market Leaders CHAPTER SEVEN: CONCLUSIONS Overview One: Physician Practices Still High Growth Area Two: Meaningful Use Confusion Still A Factor For industry Three: No Clear Leader Still, Opportunity For New Players Four: Expect More Mergers and Acquisitions Five: Interoperability A Major Hurdle (And Eight Other Important Conclusions About the Market...) APPENDIX I: DEFINITION OF INDUSTRY PRODUCTS APPENDIX II: LIST OF SELECT MAJOR COMPANIES LIST OF EXHIBITS CHAPTER ONE: EXECUTIVE SUMMARY Figure 1-1: Percentage EMR Usage by Physicians, Figure 1-2: Growth Rate of EMR Usage Figure 1-3: Fully Functional Physician Use of EMR vs. Basic Use, Figure 1-4: Hosptiials at Stage 3 or higher Table 1-1: EMR Market Analysis, Table 1-2: Forecasted EMR Market Analysis: Figure 1-5: EMR Market Analysis: Figure 1-6: Market Share of EMR Providers, percent 2011 CHAPTER TWO: INTRODUCTION Table 2-1: EMR Terminology Table 2-2: Physician Adoption of EMRs (Basic System and Fully Functional System) Figure 2-1: Overall Physician Adoption of EMRs Table 2-3: Percentage of Office-based Physicians Using Select EMR Features (US, 2007)

5 Table 2-4: Percentage Installation of Various Clinical Applications in Hospitals (US, 2009) Figure 2-5: EMR/EHR Adoption for Acute Care Hospitals Table 2-6: Average Total Cost for a Three-physician Practice for EMR/PMS Installations (2011) Table 2-7: Total Cost Range for EMR/PMS Installations (2011) Table 2-8: Two-year Total Cost for EMR/PMS Installations/Subscriptions Selected Products (not including team costs) Table 2-9: US EMR Hospital Adoption Model Table 2-10: Ownership vs Non-ownership Adoption Rates 2010 Table 2-11: Doctors Office Adoption Rates 2011 CHAPTER THREE: EMERGING TRENDS Table 3-1: HITECH Act Subsidy Plan Table 3-2: Mergers and Acquisitions Table 3-3 AAFP Most Commonly Cited EMR Companies Results 2011 Table 3-4 ACP /American EHR Partners Cited Companies List Table 3-5: Cost Break-up for a Typical One-Physician Practice (5-year period) Figure 3-1: Distribution of Cumulative Savings Table 3-6: EHR Incentive Program Payments 2011 Table 3-7: Vendor Product Certifications 2006 Table 3-8: CCHIT 2007 Vendor Certifications Table 3-9: CCHIT 2008 Vendor Certifications Table 3-10: EMR/EHR Certifications 2010 Table 3-11: Modular System Certifications 2010 Table 3-12: System Certification in Figure 3-2: By Sector Contribution to the US GDP (2009) Figure 3-3: The US Healthcare Spending ( ) CHAPTER FOUR: LEADING MARKET PARTICIPANTS Table 4-1: Mergers and Acquisitions Figure 4-2: Allscripts Healthcare Solutions Revenues ($million) Figure 4-3: Cerner Revenues ($millions) Figure 4-4: CPSI Revenues ($millions) Figure 4-5: eclinicalworks Revenues, ($millions) Figure 4-6: Epic (estimated) Revenues ($millions) Figure 4-7: GE Healthcare Applications Revenues ($millions) Figure 4-8: MEDITECH Revenues ($ millions) Figure 4-9: MedPlus Revenues ($millions) Figure 4-10: McKesson Revenues, ($millions) Figure 4-11: NextGen Revenues, ($millions) Figure 4-12: Siemens Medical Solutions Revenues, ($millions) CHAPTER SIX: MARKET ANALYSIS

6 Table 6-1: EMR Market Analysis, Table 6-2: Forecasted EMR Market Analysis: Figure 6-1: EMR Market Analysis: Table 6-3: Hospital EMR Market Analysis Table 6-4: Forecasted Hospital EMR Market Analysis: Figure 6-2: Hospital EMR Market Analysis: Table 6-5: Physician/Web-based EMR Market Analysis Table 6-6: Forecasted Physician/Web-based EMR Market Analysis: Figure 6-3: Physician/Web-based EMR Market Analysis: Figure 6-4: EMR Market Breakdown, Physician/Web vs. Hospital 2011 Figure 6-5: EMR Market Breakdown, Physician/Web vs. Hospital 2016 Table 6-7 Notable Companies