U.S. MARKET OVERVIEW



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U.S. MARKET OVERVIEW Hospital Document/ Electronic Forms Management Applications 2010 Year End Report This historical report of the U.S. hospital market is brought to you as an online resource from the Dorenfest Institute.

Document/Electronic Forms Management Summary of Installation (2009/2010) Document Management Electronic Forms Management 41% 49% 59% 65% Nearly two-thirds of US hospitals used a document management solution in 2010. Nearly half of US hospitals used an electronic forms management solution. The adoption of both solutions increased compared to 2009. 2009 (N=5,235) 2010 (N=5,281)

Document/Electronic Forms Management Summary of Plans (in Not Automated Hospitals) Document Management Electronic Forms Management 1,801 2,655 1.43% 2.55% Plans for first time purchases are minimal for document management and electronic forms management applications. About three percent of hospitals that don t current use these solutions plan to purchase document management software for the first time. Numbers in white represent the number of not automated hospitals. Percent of "Not Automated" Hospitals Planning to Purchase Software

Document/Electronic Forms Management Summary of Plans (Replacing Current Software) Document Management 3,445 0.44% Replacement activity will be minimal in this market. Activity may be slightly greater for document management applications by volume and percent. Electronic Forms Management 0.19% (2578) Numbers in white and in parenthesis represents number of hospitals with installed or contracted systems Percent of Hospitals with Installed or Contracted Systems Planning to Purchase Software

Document/Electronic Forms Management Summary of Plans Document Management (n=61) Electronic Forms Management (n=43) 12% 25% 88% 75% The majority of the hospitals that plan to purchase document and electronic forms management applications will purchase the technology for the first time. Percent of Hospitals with Installed Software Percent of Hospitals Planning to Purchase Software for the First Time

Summary of Installation Only 2,321 of the 5,281 US hospitals in this report (44 percent) have installed software for both document management and electronic forms management. Of these hospitals, 921 facilities (40 percent) use the same technology vendor for both electronic forms and document management. An additional 1,381 hospitals (26 percent) have installed software or contract to install one of the two applications. The majority of these hospitals 81 percent (1,124) are using document management. The remaining 1,579 hospitals (30 percent) do not use software for either of these two applications areas.

Document Management Top 10 Installed and Contracted Systems MCKESSON 537 15.98% MEDITECH 393 11.70% CERNER CORPORATION 306 9.11% PERCEPTIVE SOFTWARE, INC. 265 7.89% HYLAND SOFTWARE, INC. 243 7.23% SIEMENS HEALTHCARE 204 6.07% CPSI 199 5.92% EMC CORP. 110 3.27% HEALTHLAND 103 3.07% CGI 102 3.04% 100 Vendors share the remaining 31.37% of the market. * The total percentage may exceed 100 percent due to rounding or some organizations may have more than one vendor installed. N = 3,360

Document Management Top 10 Installed/Contracted Systems Hospitals Under 100 Beds PERCEPTIVE SOFTWARE, INC. 181 12.71% CPSI 174 12.22% MEDITECH 162 11.38% MCKESSON 145 10.18% HEALTHLAND 100 7.02% CERNER CORPORATION 98 6.88% EMC CORP. 75 5.27% HEALTHCARE MANAGEMENT SYSTEMS, INC. 73 5.13% HYLAND SOFTWARE, INC. 62 4.35% SIEMENS HEALTHCARE 56 3.93% 71 Vendors share the remaining 24.02% of the market. * The total percentage may exceed 100 percent due to rounding or some organizations may have more than one vendor installed. N = 1,424

Document Management Top 10 Installed/Contracted Systems Hospitals 100-199 Beds MCKESSON 138 19.57% MEDITECH 110 15.60% CERNER CORPORATION 78 11.06% HYLAND SOFTWARE, INC. 60 8.51% SIEMENS HEALTHCARE 54 7.66% PERCEPTIVE SOFTWARE, INC. 43 6.10% CGI 22 3.12% CPSI 21 2.98% EMC CORP. 19 2.70% SELF-DEVELOPED 18 2.55% OPEN TEXT CORPORATION 18 2.55% 46 Vendors share the remaining 23.26% of the market. * The total percentage may exceed 100 percent due to rounding or some organizations may have more than one vendor installed. N = 705

Document Management Top 10 Installed/Contracted Systems Hospitals 200-299 Beds MCKESSON 83 18.08% MEDITECH 71 15.47% CERNER CORPORATION 48 10.46% HYLAND SOFTWARE, INC. 47 10.24% SIEMENS HEALTHCARE 28 6.10% OPEN TEXT CORPORATION 21 4.58% CGI 17 3.70% MEDPLUS, a Quest Diagnostics Company 16 3.49% 3M HEALTH INFORMATION SYSTEMS 15 3.27% SELF-DEVELOPED 14 3.05% 46 Vendors share the remaining 27.67% of the market. * The total percentage may exceed 100 percent due to rounding or some organizations may have more than one vendor installed. N = 459

Document Management Top 10 Installed/Contracted Systems Hospitals 300-399 Beds MCKESSON 67 21.27% CERNER CORPORATION 28 8.89% MEDITECH 28 8.89% HYLAND SOFTWARE, INC. 27 8.57% SIEMENS HEALTHCARE 22 6.98% MEDPLUS, a Quest Diagnostics Company 18 5.71% PERCEPTIVE SOFTWARE, INC. 13 4.13% STREAMLINE HEALTH SOLUTIONS, INC. 11 3.49% QUADRAMED 9 2.86% 4 VENDORS TIED WITH THE SAME NUMBER OF INSTALLTION AND MARKET SHARE 42 Vendors share the remaining 23.17% of the market. N = 315 32 10.16% * The total percentage may exceed 100 percent due to rounding or some organizations may have more than one vendor installed.

Document Management Top 10 Installed/Contracted Systems Hospitals 400-499 Beds MCKESSON 48 26.37% CERNER CORPORATION 27 14.84% SIEMENS HEALTHCARE 24 13.19% HYLAND SOFTWARE, INC. 12 6.59% MEDITECH 10 5.49% MEDPLUS, a Quest Diagnostics Company 9 4.95% SELF-DEVELOPED 8 4.40% PERCEPTIVE SOFTWARE, INC. 8 4.40% CGI 8 4.40% 2 VENDORS TIED WITH THE SAME NUMBER OF INSTALLTION AND MARKET SHARE 22 Vendors share the remaining 17.58% of the market. N = 182 10 5.49% * The total percentage may exceed 100 percent due to rounding or some organizations may have more than one vendor installed.

Document Management Top 10 Installed/Contracted Systems Hospitals 500+ Beds MCKESSON 56 20.36% HYLAND SOFTWARE, INC. 35 12.73% CERNER CORPORATION 27 9.82% SIEMENS HEALTHCARE 20 7.27% STREAMLINE HEALTH SOLUTIONS, INC. 19 6.91% 3M HEALTH INFORMATION SYSTEMS 18 6.55% CGI 15 5.45% MEDITECH 12 4.36% EMC CORP. 9 3.27% MEDPLUS, a Quest Diagnostics Company 9 3.27% 26 Vendors share the remaining 26.18% of the market. * The total percentage may exceed 100 percent due to rounding or some organizations may have more than one vendor installed. N = 275

Electronic Forms Top 10 Installed and Contracted Systems FORMFAST, INC. 508 20.70% SELF-DEVELOPED 226 9.21% CERNER CORPORATION 207 8.44% STANDARD REGISTER 196 7.99% CPSI 194 7.91% BOTTOMLINE TECHNOLOGIES, INC. 186 7.58% MCKESSON 162 6.60% ACCESS 93 3.79% HEALTHLAND 83 3.38% HEALTHCARE MANAGEMENT SYSTEMS, INC. 77 3.14% 47 Vendors share the remaining 23.68% of the market. * The total percentage may exceed 100 percent due to rounding or some organizations may have more than one vendor installed. N = 2,454

Electronic Forms Top 10 Installed/Contracted Systems Hospitals Under 100 Beds FORMFAST, INC. 187 18.17% CPSI 175 17.01% SELF-DEVELOPED 108 10.50% HEALTHLAND 81 7.87% CERNER CORPORATION 76 7.39% HEALTHCARE MANAGEMENT SYSTEMS, INC. 68 6.61% BOTTOMLINE TECHNOLOGIES, INC. 52 5.05% MCKESSON 43 4.18% STANDARD REGISTER 41 3.98% ACCESS 32 3.11% 36 Vendors share the remaining 17.88% of the market. * The total percentage may exceed 100 percent due to rounding or some organizations may have more than one vendor installed. N = 1,029

Electronic Forms Top 10 Installed/Contracted Systems Hospitals 100-199 Beds FORMFAST, INC. 135 25.76% MCKESSON 52 9.92% CERNER CORPORATION 48 9.16% BOTTOMLINE TECHNOLOGIES, INC. 45 8.59% SELF-DEVELOPED 41 7.82% STANDARD REGISTER 40 7.63% ACCESS 30 5.73% SIEMENS HEALTHCARE 18 3.44% CGI 16 3.05% IATRIC SYSTEMS, INC. 15 2.86% 29 Vendors share the remaining 19.85% of the market. * The total percentage may exceed 100 percent due to rounding or some organizations may have more than one vendor installed. N = 524

Electronic Forms Top 10 Installed/Contracted Systems Hospitals 200-299 Beds FORMFAST, INC. 77 23.33% STANDARD REGISTER 37 11.21% BOTTOMLINE TECHNOLOGIES, INC. 35 10.61% SELF-DEVELOPED 35 10.61% CERNER CORPORATION 34 10.30% MCKESSON 19 5.76% ACCESS 11 3.33% 3M HEALTH INFORMATION SYSTEMS 11 3.33% EPIC 9 2.73% IATRIC SYSTEMS, INC. 8 2.42% 24 Vendors share the remaining 19.39% of the market. * The total percentage may exceed 100 percent due to rounding or some organizations may have more than one vendor installed. N = 330

Electronic Forms Top 10 Installed/Contracted Systems Hospitals 300-399 Beds FORMFAST, INC. 52 22.51% STANDARD REGISTER 26 11.26% BOTTOMLINE TECHNOLOGIES, INC. 25 10.82% MCKESSON 18 7.79% ACCESS 14 6.06% SELF-DEVELOPED 14 6.06% CERNER CORPORATION 11 4.76% EPIC 11 4.76% SIEMENS HEALTHCARE 6 2.60% MEDPLUS, a Quest Diagnostics Company 5 2.16% 23 Vendors share the remaining 22.51% of the market. * The total percentage may exceed 100 percent due to rounding or some organizations may have more than one vendor installed. N = 231

Electronic Forms Top 10 Installed/Contracted Systems Hospitals 400-499 Beds FORMFAST, INC. 29 20.71% STANDARD REGISTER 21 15.00% CERNER CORPORATION 19 13.57% MCKESSON 18 12.86% BOTTOMLINE TECHNOLOGIES, INC. 14 10.00% SELF-DEVELOPED 10 7.14% SIEMENS HEALTHCARE 9 6.43% EPIC 6 4.29% CPSI 3 2.14% ACCESS 3 2.14% 11 Vendors share the remaining 9.29% of the market. * The total percentage may exceed 100 percent due to rounding or some organization may have more than one vendor installed. N = 140

Electronic Forms Top 10 Installed/Contracted Systems Hospitals 500+ Beds STANDARD REGISTER 31 15.50% FORMFAST, INC. 28 14.00% CERNER CORPORATION 19 9.50% SELF-DEVELOPED 18 9.00% BOTTOMLINE TECHNOLOGIES, INC. 15 7.50% MCKESSON 12 6.00% 3M HEALTH INFORMATION SYSTEMS 11 5.50% EPIC 11 5.50% QUADRAMED 7 3.50% HYLAND SOFTWARE, INC. 7 3.50% 20 Vendors share the remaining 22.00% of the market. * The total percentage may exceed 100 percent due to rounding or some organization may have more than one vendor installed. N = 200

Document Management Vendors Being Considered for a Planned Purchase HEALTHLAND # of Times Considered HEALTHLAND 7 MEDITECH 7 CPSI 6 MCKESSON 6 HYLAND SOFTWARE, INC. 6 CERNER CORPORATION 6 HEALTHCARE MANAGEMENT SYSTEMS, INC. 3 PERCEPTIVE SOFTWARE, INC. 2 QUADRAMED 2 8 ADDITIONAL VENDORS UNDER CONSIDERATION 8

Electronic Forms Vendors Being Considered for a Planned Purchase Vendor # of Times Considered HEALTHLAND 6 CPSI 6 MCKESSON 4 HEALTHCARE MANAGEMENT SYSTEMS, INC. 2 10 ADDITIONAL VENDORS UNDER CONSIDERATION 10

Document/Electronic Forms Management Temporal Summary of Installation Document Management (n=1188) Electronic Forms Management (n=742) 31% 37% 59% 54% The majority of contracts for all document and electronic forms management solutions have been signed after 1999; half have been signed since 2005. Prior to 1985 1985 to 1989 1990 to 1994 1995 to 1999 2000 to 2004 2005 to 2010

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