Medical Imaging

Summary

Table of Contents

U.S. Market for PACS and EMR

Publication date: September 2009

In 2008, the market for PACS was valued at almost $1.3 billion, representing an increase of 6.7% over 2007. This market encompasses large hospitals (500+ beds), medium hospitals (201-499 beds), community hospitals (200 beds and under) and imaging centers (non-affiliated). This growth will be fuelled by the sales of PACS, mostly to the community and imaging center markets. Replacement–driven sales will fuel the market for the medium and large ho...

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TABLE OF CONTENTS ............................................I

LIST OF FIGURES ................................................ VII

LIST OF CHARTS .....................................................X

EXECUTIVE SUMMARY ........................................ 1

1.1 OVERVIEW OF PACS AND EMR ........................ 1
1.2 PICTURE ARCHIVING COMMUNICATION SYSTEM (PACS) ........................................... 2
1.3 ELECTRONIC MEDICAL RECORD (EMR) ........... 4
1.4 DIGITAL IMAGING AND COMMUNICATIONS IN MEDICINE (DICOM) PRINTERS .......... 6
1.5 COMPETITIVE ANALYSIS ................................... 8

RESEARCH METHODOLOGY .............................. 9

2.1 RESEARCH SCOPE .............................................. 9
2.2 IDATA’S 9-STEP METHODOLOGY ...................... 9
Step 1: Project Initiation & Team Selection .... 10
Step 2: Prepare Data Systems and Perform Secondary Research.............................. 11
Step 3: Preparation for Interviews & Questionnaire Design ..................................... 12
Step 4: Performing Primary Research ............. 13
Step 5: Research Analysis: Establishing Baseline Estimates ..................................... 15
Step 6: Market Forecast and Analysis ............. 15
Step 7: Identify Strategic Opportunities .......... 17
Step 8: Final Review and Market Release ....... 18
Step 9: Customer Feedback and Market Monitoring.................................................. 19

U.S. MARKET FOR PACS, EMR & DICOM PRINTERS ............................................ 20

3.1 INTRODUCTION ................................................ 20
3.1.1 Introduction to PACS ................................. 20
3.1.2 Introduction to EMR .................................. 21
3.1.3 Introduction to DICOM Printers ............... 22
3.1.4 PACS, EMR and DICOM Printer Market Relationships...................................... 22
3.2 MARKET OVERVIEW ........................................ 24
3.2.1 PACS, EMR and DICOM Printer Markets 24
3.2.2 Effect of Economic Crisis .......................... 27
3.3 MARKET ANALYSIS AND FORECAST ............... 28
3.3.1 PACS Market ............................................. 28
3.3.2 PACS Hardware ........................................ 30
3.3.3 PACS Software ........................................... 30
3.3.4 PACS Financing Options ........................... 30
3.3.5 EMR Market ............................................... 33
3.3.6 EMR Hardware .......................................... 35
3.3.7 EMR Software ............................................ 35
3.3.8 EMR Financing Options ............................ 36
3.3.9 DICOM Printer Market ............................. 36
3.3.10 DICOM Printer Selection ........................ 39
3.4 TOTAL MARKET DRIVERS AND LIMITERS ....... 40
3.4.1 Market Drivers for PACS .......................... 40
3.4.2 Market Limiters for PACS ......................... 41
3.4.3 Market Drivers for EMR Adoption ............ 42
3.4.4 Market Limiters for EMR Adoption ........... 44
3.4.5 Market Drivers for DICOM Printers ......... 46
3.4.6 Market Limiters for DICOM Printers ........ 46
3.5 LEGISLATION ................................................... 48
3.5.1 PACS Legislation ....................................... 48
3.5.2 EMR Legislation ........................................ 48
3.5.3 EMR Certification ...................................... 51
3.6 COMPETITIVE ANALYSIS ................................. 54
3.6.1 Overall Market Competitive Analysis ........ 54
3.6.2 PACS Market Shares ................................. 58
3.6.3 EMR Market Shares ................................... 58
3.6.4 DICOM Printer Market Shares ................. 58
3.7 MERGERS AND ACQUISITIONS ......................... 59
3.7.1 PACS .......................................................... 59
3.7.2 EMR 59

PICTURE ARCHIVING COMMUNICATION SYSTEM MARKET .......................... 60

4.1 INTRODUCTION ................................................ 60
4.1.1 Definition of PACS ..................................... 61
4.1.2 DICOM Standards for PACS ..................... 61
4.1.3 HL-7 Standards .......................................... 62
4.1.4 Integrating the Healthcare Enterprise (IHE)........................................................ 62
4.1.5 PACS Workflow ......................................... 62
4.1.6 PACS Image Backup .................................. 63
4.1.7 Hospital Information Systems and Integration ..................................................... 63
4.2 MARKET OVERVIEW ........................................ 65
4.2.1 Total PACS Market .................................... 65
4.2.2 Market Breakdown ..................................... 67
4.2.3 PACS Hardware ........................................ 68
4.2.4 PACS Software ........................................... 68
4.2.5 PACS Financing Options ........................... 69
4.3 MARKET ANALYSIS AND FORECAST ............... 71
4.3.1 Number of Facilities .................................. 71
4.3.2 Total PACS System Sales ........................... 73
4.3.2.1 PACS Market from New Unit Sales ......75
4.3.2.2 PACS System Upgrades Market ...........78
4.3.3 PACS Service and Maintenance Market .... 80
4.4 INSTALLED BASE AND PENETRATION OF PACS......................................................... 82
4.4.1 PACS Penetration ...................................... 82
4.4.2 PACS Installed Base .................................. 85
4.5 PACS MARKET BY HOSPITAL TYPE ................ 88
4.5.1 Large Hospital PACS Market .................... 88
4.5.2 Medium Hospital PACS Market ................. 90
4.5.3 Community Hospitals PACS Market .......... 92
4.5.4 Non-Affiliated Imaging Center PACS Market ...................................................... 94
4.6 PACS MARKET BY SPECIALTY ........................ 97
4.6.1 Department PACS Systems by Market Share and Unit Share .............................. 97
4.6.2 Radiology PACS by Hospital Type ............ 99
4.6.3 Cardiology PACS by Hospital Type ........ 101
4.6.4 Orthopedic PACS by Hospital Type ........ 103
4.7 DRIVERS AND LIMITERS ................................ 105
4.7.1 Market Drivers ......................................... 105
4.7.2 Market Limiters ........................................ 107
4.8 LEGISLATION ................................................. 109
4.8.1 Health Insurance Portability and Accountability Act (HIPAA).......................... 109
4.8.2 Integrating the Healthcare Enterprise Standard (IHE)...................................... 109
4.9 COMPETITIVE ANALYSIS ............................... 110
4.9.1 Leading Competitors in the PACS Market by Market Share .............................. 110
4.9.2 Leading Competitors in the PACS Market by Installed Base Share................... 114
4.9.3 Competitor Concentration ....................... 117
4.10 MERGERS AND ACQUISITIONS ..................... 119

ELECTRONIC MEDICAL RECORD MARKET......................................................... 120

5.1 INTRODUCTION .............................................. 120
5.1.1 EMR vs. EHR ........................................... 120
5.1.2 Significance of EMR Adoption ................. 121
5.1.3 Implementation of Computerized Physician Order-Entry (CPOE) .................... 121
5.1.4 HIMSS Analytics EMR Adoption Model .. 122
5.2 MARKET OVERVIEW ...................................... 123
5.2.1 Total Ambulatory EMR Market ............... 123
5.2.2 Acute vs. Ambulatory EMR ...................... 125
5.2.3 EMR Hardware ........................................ 125
5.2.4 EMR Software .......................................... 126
5.2.5 EMR Financing Options .......................... 127
5.3 MARKET ANALYSIS AND FORECAST ............. 128
5.3.1 Total Revenue from Sales and Annual Support .................................................. 128
5.3.2 Total Number of Ambulatory Practices ... 130
5.3.3 Installed Base and Penetration of EMR ... 132
5.3.3.1 EMR Installed Base ............................132
5.3.4 EMR Penetration ..................................... 135
5.3.5 EMR Units Sold ....................................... 137
5.3.6 EMR Average Selling Price of Per-Practice Model ........................................... 139
5.3.7 EMR Average Selling Price of Subscription Model............................................ 141
5.4 QUANTITATIVE BENEFITS AFTER EMR IMPLEMENTATION...................................... 143
5.4.1 Reductions in Chart Pulls, Transcription Costs, Number of Patient Encounters and
Malpractice Premiums ...................................... 143
5.4.2 Reduction in Storage Space and Management of Archives ................................ 145
5.4.3 Total Cost Savings after Year One of EMR Implementation .............................. 147
5.4.4 Time Frame: Point of Purchase to EMR Installation ......................................... 149
5.5 INFORMATION TECHNOLOGY AND EMR FUNCTIONALITIES .................................... 150
5.5.1 Physician Preference for Mode of IT Support .................................................... 150
5.5.2 Physician Preference for EMR Model and Operating System............................ 152
5.5.3 Preferred Functionalities by Physician Practices for EMR Package................. 155
5.6 MARKET DRIVERS AND LIMITERS ................. 157
5.6.1 Market Drivers ......................................... 157
5.6.2 Market Limiters ........................................ 159
5.7 EMR LEGISLATION AND CERTIFICATION ...... 164
5.7.1 EMR Legislation ...................................... 164
5.7.2 EMR Certification .................................... 166
5.8 EMR COMPETITIVE ANALYSIS ...................... 169
5.8.1 Leading Competitors in the EMR Market by Market Share ............................... 169
5.8.2 Competitor Concentration ....................... 172
5.9 MERGERS AND ACQUISITIONS ....................... 174

DIGITAL IMAGING & COMMUNICATIONS IN MEDICINE PRINTERS ........... 175

6.1 INTRODUCTION .............................................. 175
6.2 MARKET ANALYSIS AND FORECAST ............. 177
6.2.1 DICOM Printer Market ........................... 177
6.2.2 DICOM Printer Units Sold ...................... 179
6.2.3 DICOM Printer Selection ........................ 181
6.3 DRIVERS AND LIMITERS ................................ 181
6.3.1 Market Drivers ......................................... 181
6.3.2 Market Limiters ........................................ 182
6.4 COMPETITIVE ANALYSIS ............................... 183
6.4.1 Market Share ............................................ 183
6.4.2 Installed Base Share ................................ 187
6.4.3 Competitor Concentration ....................... 189
ABBREVIATIONS ................................................. 192

LIST OF FIGURES

EXECUTIVE SUMMARY ......................... 1
RESEARCH METHODOLOGY ................. 9
U.S. MARKET FOR PACS, EMR & DICOM PRINTERS.................................... 20
Figure 3-1: Total PACS, EMR and DICOM Printer Markets, U.S., 2005 – 2015... 25
Figure 3-2: Total PACS Market, U.S., 2005 – 2015............................................. 28
Figure 3-3: Total Ambulatory EMR Market, U.S., 2008 ...................................... 33
Figure 3-4: Total Market for DICOM Printers, U.S., 2005 – 2015 ....................... 37
Figure 3-5: PACS, EMR and DICOM Printer Markets Drivers and Limiters, U.S.,
2008 ................................................... 47
Figure 3-6: Leading Competitors for PACS, EMR and DICOM Printer Market
Shares, U.S., 2008 .............................. 56
PICTURE ARCHIVING COMMUNICATION SYSTEM MARKET..................... 60
Figure 4-1: Total PACS Market, U.S., 2005 – 2015............................................. 65
Figure 4-2: Number of Facilities, U.S., 2005 – 2015 ........................................... 72
Figure 4-3: Percentage of Revenue from PACS Sales, U.S., 2005 – 2015............. 73
Figure 4-4: PACS Market from New Unit Sales, U.S., 2005 – 2015 ..................... 76
Figure 4-5: Percentage of Revenue from System Upgrades, U.S., 2005 – 2015..... 78
Figure 4-6: Percentage of Revenue from Service and Maintenance, U.S., 2005 –
2015 ................................................... 80
Figure 4-7: Penetration of PACS, U.S., 2005 – 2015 ........................................... 82
Figure 4-8: Number of Facilities with PACS, U.S., 2008 ..................................... 84
Figure 4-9: Installed Base for PACS, U.S., 2005 – 2015...................................... 86
Figure 4-10: PACS Units Sold in the Large Hospital Market, U.S., 2005 – 2015 .. 88
Figure 4-11: PACS Units Sold in the Medium Hospital Market, U.S., 2005 – 201590
Figure 4-12: PACS Units Sold in the Community Hospital Market, U.S.,
2005 – 2015 ........................................ 92
Figure 4-13: PACS Units Sold in the Non-Affiliated Imaging Center Market,
U.S., 2005 – 2015 .................... 95
Figure 4-14: PACS Market Drivers and Limiters, U.S., 2008............................. 108
Figure 4-15: Leading Competitors in the PACS Market for Market Share, U.S.,
2008 ................................................. 112
Figure 4-16: Leading Competitors in the PACS Market for Installed Base Share,
U.S., 2008 ........................................ 115
Figure 4-17: Competitor Concentration in the PACS Market, U.S., 2005 – 2015 117
ELECTRONIC MEDICAL RECORD MARKET................................................ 120
Figure 5-1: Total Ambulatory EMR Market, U.S., 2008 .................................... 123
Figure 5-2: Total Revenue from Sales and Annual Support in Ambulatory Care,
U.S., 2005 – 2015 ............................. 128
Figure 5-3: Total Number of Ambulatory Practices, U.S., 2008 ......................... 130
Figure 5-4: Ambulatory EMR Installed Base for EMR, U.S., 2005 – 2015 ........ 132
Figure 5-5: EMR Penetration in Ambulatory Care, U.S., 2005 – 2015................ 135
Figure 5-6: Total Units Sold in Ambulatory Care, U.S., 2005 – 2015................. 137
Figure 5-7: ASP of Per-Practice Ambulatory EMR Installation, U.S., 2005 – 2015139
Figure 5-8: ASP of Ambulatory EMR Subscription Model, U.S., 2005 – 2015 ... 141
Figure 5-9: Quantitative Benefits after EMR Implementation, U.S., 2008 .......... 144
Figure 5-10: Quantitative Benefit in Reduction of Storage Space and Management
of the Archive, U.S., 2008 ................ 145
Figure 5-11: Total Cost Savings after Year One of Ambulatory EMR
Implementation, U.S., 2008 ............... 147
Figure 5-12: Time from Point of Purchase to EMR Installation for Ambulatory
Practices and Acute Care Setting, U.S., 2008................................................ 149
Figure 5-13: Physician Preference for EMR Model and Operating System Types,
U.S., 2008 ........................................ 152
Figure 5-14: EMR Market Drivers and Limiters, U.S., 2008 .............................. 163
Figure 5-15: Leading Competitors in the EMR Market, U.S., 2008 .................... 170
Figure 5-16: Competitor Concentration in the EMR Market, U.S., 2005 – 2015 . 172
DIGITAL IMAGING & COMMUNICATIONS IN MEDICINE PRINTERS ....... 175
Figure 6-1: Total Market for DICOM Printers, U.S., 2005 – 2015 ..................... 177
Figure 6-2: Units Sold in the Total DICOM Market, U.S., 2005 – 2015 ............. 179
Figure 6-3: Drivers and Limiters for the DICOM Printer Market, U.S., 2008 ..... 182
Figure 6-4: Leading Competitors for the DICOM Printer Market by Market Share,
U.S., 2008 ........................................ 185
Figure 6-5: Competitor Concentration in the DICOM Printer Market, U.S., 2005 –
2015 ................................................. 190
ABBREVIATIONS ............................... 192

LIST OF CHART S

EXECUTIVE SUMMARY ......................... 1
Chart 1-1: Total PACS and EMR Market, U.S., 2005 – 2015 ................................. 1
Chart 1-2: Total PACS Market Value, U.S., 2005 – 2015 ...................................... 2
Chart 1-3: Total PACS Market from New Unit Sales, U.S., 2005 – 2015 ............. 3
Chart 1-4: Total Ambulatory EMR Market, U.S., 2005 – 2015............................... 4
Chart 1-5: Total Ambulatory EMR Units Sold, U.S., 2005 – 2015 ......................... 5
Chart 1-6: Total Market Value for DICOM Printers, U.S., 2005 – 2015 ................ 6
Chart 1-7: Total DICOM Printer Units Sold, U.S., 2005 – 2015............................ 7
Chart 1-8: Leading Competitors, PACS, EMR and DICOM printers, U.S., 2008.... 8
RESEARCH METHODOLOGY ................. 9
U.S. MARKET FOR PACS, EMR & DICOM PRINTERS.................................... 20
Chart 3-1: Total PACS, EMR and DICOM Printer Markets, U.S., 2005 – 2015 ... 26
Chart 3-2: Total PACS Market, U.S., 2005 – 2015 .............................................. 29
Chart 3-3: Total Ambulatory EMR Market, U.S., 2008 ....................................... 34
Chart 3-4: DICOM Printer Market, U.S., 2005 – 2015 ........................................ 38
Chart 3-5: Leading Competitors for U.S. PACS, EMR and DICOM Printer
Market Shares, 2008 ........................... 57
PICTURE ARCHIVING COMMUNICATION SYSTEM MARKET..................... 60
Chart 4-1: Total PACS Market, U.S., 2005 – 2015 .............................................. 66
Chart 4-2: PACS Revenue Segmentation, U.S., 2008........................................... 67
Chart 4-3: Percentage of Revenue from PACS Sales, U.S., 2005 – 2015 ............. 74
Chart 4-4: Total PACS Market from New Unit Sales, U.S., 2005 – 2015.............. 77
Chart 4-5: Percentage of Revenue from System Upgrades, U.S., 2005 – 2015 ...... 79
Chart 4-6: Percentage of Revenue from Service and Maintenance, U.S., 2005 –
2015 .................................................. 81
Chart 4-7: Penetration of PACS, U.S., 2005 – 2015 ............................................ 83
Chart 4-8: Installed Base for PACS, U.S., 2008 ................................................. 87
Chart 4-9: PACS Units Sold in the Large Hospital Market, U.S., 2005 – 2015 .... 89
Chart 4-10: PACS Units Sold in the Medium Hospital Market, U.S., 2005 – 2015 91
Chart 4-11: PACS Units Sold in the Community Hospital Market, U.S., 2005 –
2015 ................................................... 93
Chart 4-12: PACS Units Sold in the Non-Affiliated Imaging Center Market, U.S.,
2005 – 2015 ....................................... 96
Chart 4-13: Leading Segments by Market Value, U.S., 2008 ............................... 97
Chart 4-14: Leading Segments by Unit Share, U.S., 2008 ................................... 98
Chart 4-15: Radiology PACS Units by Hospital Type, U.S., 2008 ..................... 100
Chart 4-16: Cardiology PACS Units by Hospital Type, U.S., 2009 ................... 102
Chart 4-17: Orthopedic PACS Units by Hospital Type, U.S., 2008 ................... 104
Chart 4-18: Leading Competitors in the PACS Market for Market Share, U.S.,
2008 ................................................ 113
Chart 4-19: Leading Competitors in the PACS Market for Installed Base Share,
U.S., 2008 ....................................... 116
Chart 4-20: Competitor Concentration in the PACS Market, U.S., 2005 – 2015 . 118
ELECTRONIC MEDICAL RECORD MARKET................................................ 120
Chart 5-1: Total Ambulatory EMR Market, U.S., 2008 ..................................... 124
Chart 5-2: Total Market Value from Sales and Annual Support in Ambulatory
Care, U.S., 2005 – 2015 ................... 129
Chart 5-3: Total Number of Ambulatory Practices, U.S., 2008 ......................... 131
Chart 5-4: Ambulatory EMR Installed Base, U.S., 2005 – 2015 ......................... 133
Chart 5-5: Ambulatory EMR Units Sold, U.S., 2008 ......................................... 134
Chart 5-6: EMR Penetration in Ambulatory Practices, U.S., 2008 ..................... 136
Chart 5-7: Total Units Sold in Ambulatory Care, U.S., 2005 – 2015 ................. 138
Chart 5-8: ASP of Per-Practice Ambulatory EMR Installation, U.S., 2005 – 2015140
Chart 5-9: ASP of Ambulatory EMR Subscription Model, U.S., 2005 – 2015 .... 142
Chart 5-10: Quantitative Benefit in Reduction of Storage Space and Management
of the Archive, U.S., 2008 ............... 146
Chart 5-11: Total Cost Savings after Year One of Ambulatory EMR
Implementation, U.S., 2008 .............. 148
Chart 5-12: Mode of IT Support Preferred By Physician Practices, U.S., 2008 .. 151
Chart 5-13: Physician Preference for “ASP” versus Client/Server Model, U.S.,
2008 ................................................ 153
Chart 5-14: Physician Preference for Windows vs. Open Source/Linux Operating
Systems, U.S., 2008 ......................... 154
Chart 5-15: Preferred Functionalities for EMR by Physicians, U.S., 2008 ......... 156
Chart 5-16: Leading Competitors in the EMR Market, U.S., 2008...................... 171
Chart 5-17: Competitor Concentration in the EMR Market, U.S., 2005 – 2015... 173
DIGITAL IMAGING & COMMUNICATIONS IN MEDICINE PRINTERS ....... 175
Chart 6-1: Total Market for DICOM Printers, U.S., 2005 – 2015 ...................... 178
Chart 6-2: Units Sold in the Total DICOM Market, U.S., 2005 – 2015............... 180
Chart 6-3: Leading Competitors for the DICOM Printer Market by Market Share,
U.S., 2008 ....................................... 186
Chart 6-4: Leading Competitors for the DICOM Printer Market by Installed Base
Share, U.S., 2008 ............................. 188
Chart 6-5: Competitor Concentration in the DICOM Printer Market, U.S., 2005-
2015 ................................................. 191
ABBREVIATIONS ............................... 192

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