U.S. MARKET OVERVIEW Hospital Radiology PACS (RPACS) Applications 2009 Year End Report This historical report of the U.S. hospital market is brought to you as an online resource from the Dorenfest Institute.

 2010 HIMSS Analytics

RPACS Applications Summary of Installation (2008/2009) 76% 81% 74% 80% 74% 79% 72% 76% 67% 71% 66% 71% 65% 69% 60% 63%

Computed Tomography Computed Radiography Ultrasound Magnetic Resonance Imaging Digital Radiography Nuclear Medicine Digital Fluorscopy Angiography Digital Mammography Orthopedic

All applications within RPACS show an increase in installation over the past year. Digital mammography and orthopedic radiology installation increased by nine percent from the previous year.

34% 43% 29% 38% 2008 (n=5166) 2009 (n=5235)

Source: HIMSS AnalyticsTM Database (U.S. Edition)

 2010 HIMSS Analytics

RPACS Installation Summary By Number of Beds 74% 91% 94% 98% 98% 100%

RPACS contracted or installed

No RPACS/plans to purchase

1% 1% 1% 1% 0% 0% 24%

No RPACS/no plans

8% 5% 1% 2% 0%

Source: HIMSS AnalyticsTM Database (U.S. Edition)

Under 100 Beds (N=2,634) 100 to 199 Beds (N=1,009) 200 to 299 Beds (N=630) 300 to 399 Beds (N=400) 400 to 499 Beds (N=234) 500 or More Beds (N=328)

Almost all hospitals with over 300 beds have RPACS installed or contracted to install. The under 100 bed market has the largest growth potential for first time adopters of RPACS.

 2010 HIMSS Analytics

RPACS Installation Summary By Number of Imaging Procedures 72% 93% 96% 99%

RPACS contracted or installed

No RPACS/plans to purchase

Under 25,000 (N=1,052)

1% 2% 1% 0%

25,000 to 49,999 (N=399) 50,000 to 99,999 (N=547) 100,000 or More (N=550)

27%

No RPACS/no plans

5% 3% 1%

Source: HIMSS AnalyticsTM Database (U.S. Edition)

Hospitals that perform more procedures are more likely to have an installed RPACS system or contract to intsall RPACS. Virtually all hospitals that perform 25,000 or more procedures annually have installed an RPACS system.  2010 HIMSS Analytics

Number of Modalities Installed One

1.20%

Two

3.19%

Three

3.08%

Four

3.55%

Five

4.23%

Six

5.00%

Seven

5.73%

Eight

Among hospitals that have installed RPACS technology, the majority of the hospitals have installed between eight to ten modalities. This suggests that organizations are implementing a full compliment of modality applications with their RPACS acquisition strategy.

20.00%

Nine

26.68%

Ten

27.34%

N = 4,419 Source: HIMSS AnalyticsTM Database (U.S. Edition)

 2010 HIMSS Analytics

Number of Modalities Installed By Number of Beds 25%

None

9% 6% 2% 2% 0%

Under 100 Beds (N=2,622) 100 to 199 Beds (N=1,007) 200 to 299 Beds (N=630) 300 to 399 Beds (N=400) 400 to 499 Beds (N=234) 500or More Beds (N=328) 29%

10%

One to Six

3% 4% 3% 2%

Hospitals with 200 or more beds are more likely than hospitals with less than 200 beds to have a full range of RPACS modalities installed.

46% 82%

Seven to Ten

Source: HIMSS AnalyticsTM Database (U.S. Edition)

91% 94% 95% 98%

 2010 HIMSS Analytics

Number of Modalities Installed By Number of Imaging Procedures 28%

None

Most hospitals that perform 50,000 or more imaging procedures have seven to ten RPACS modalities installed.

7% 4% 1% 36%

One to Six

11% 6% 3% 36%

Seven to Ten

Under 25,000 (N=1,052) 25,000 to 49,999 (N=399) 50,000 to 99,999 (N=547) 100,000 or More (N=550) 83% 90% 96%

Source: HIMSS AnalyticsTM Database (U.S. Edition)

 2010 HIMSS Analytics

RPACS Applications Summary of Plans (in “Not Automated” Hospitals) Computed Tomography

2,881

973

4.3%

Computed Radiography

3.2% (1,051)

Magnetic Resonance Imaging

3.2% (1,230)

Ultrasound

3.0% (1,067)

Digital Radiography

574

2.2%

(1,490)

Nuclear Medicine

1.8%

(1,496)

Digital Mammography

1.8%

(2,971)

1.6%

(1,583)

3,102

Digital Fluoroscopy Angiography

1,695

Orthopedic

1.2% 0.7%

(1,921) (3,236)

There is low activity for purchasing RPACS applications for the first time. By percent, Computed Tomography, which is one of more frequently installed RPACS applications, was most frequently identified as a solution to be purchased for the first time. Number in white and in parentheses represents number of “not automated” hospitals.

Percent of "Not Automated" Hospitals Planning to Purchase Software

Source: HIMSS AnalyticsTM Database (U.S. Edition)

 2010 HIMSS Analytics

RPACS Applications Summary of Plans (Replacing Current Software) Orthopedic

1,967

Angiography

0.76% 0.42% (3,299)

Computerized Tomography

0.38%

(4,248)

Magnetic Resonance Imaging

0.38%

(3,990)

Nuclear Medicine

0.38%

(3,724)

Ultrasound

0.36%

(4,153)

Computed Radiography

0.36%

(4,169)

Digital Fluoroscopy

0.36%

(3,637)

Digital Mammography

0.36%

(2,249)

Digital Radiography

0.35%

(3,730)

Very few hospitals indicate plans to replace their current RPACS software. By percent, replacement of orthopedics is most frequently mentioned. By volume, angiography will see the highest level of replacements. Number in white and parentheses represents number of hospitals with installed or contracted systems

Percent of Hospitals with Installed or Contracted Systems Planning to Purchase Software

Source: HIMSS AnalyticsTM Database (U.S. Edition)

 2010 HIMSS Analytics

RPACS Applications Summary of Plans Angiography (n=37)

38%

62%

Computed Radiography (n=49)

31%

69%

Computerized Tomography (n=58)

28%

72%

Digital Fluoroscopy (n=39)

33%

Digital Mammography (n=61) 13%

87%

Digital Radiography (n=45)

29%

Magnetic Resonance Imaging (n=54)

28%

Nuclear Medicine (n=41) Orthopedic (n=38) Ultrasound (n=47)

67%

34% 39% 32%

71% 72% 66% 61% 68%

The majority of the planned purchases are first time purchases across all RPACS applications. In particular, most of the purchase plans for digital mammography will be among hospitals that are planning to purchase this solution for the first time.

Percent of Hospitals with Installed Software - Replacing Percent of Hospitals Planning to Purchase Software for the First Time

Source: HIMSS AnalyticsTM Database (U.S. Edition)

 2010 HIMSS Analytics

Summary of Installation • 1,208 of the 5,235 hospitals in 2009 (23 percent) have installed software or signed a contract for software for all 10 modalities in radiology PACS. – Excluding orthopedics, 1,833 hospitals (35 percent) have installed all software or signed a contract for all nine modalities. – 1,685 (32 percent) have installed software or signed a contract for all the modalities with the exception of digital mammography.

• There are 800 hospitals (15 percent) have not implemented or have not signed a contract to implement any of the 10 radiology PACS modalities. • The remaining 3,227 hospitals (62 percent) have installed or planning to install at least one RPACS application. Source: HIMSS AnalyticsTM Database (U.S. Edition)

 2010 HIMSS Analytics

Hospital Radiology PACS Top 10 Installed and Contracted Systems Vendor

# of Installations

% of Market*

GE HEALTHCARE

996

22.84%

MCKESSON PROVIDER TECHNOLOGIES

691

15.85%

FUJIFILM MEDICAL SYSTEMS USA, INC.

444

10.18%

PHILIPS HEALTHCARE

439

10.07%

AGFA HEALTHCARE

307

7.04%

AMICAS

277

6.35%

SIEMENS HEALTHCARE

201

4.61%

NOVARAD CORPORATION

177

4.06%

CARESTREAM HEALTH, INC

139

3.19%

DR SYSTEMS, INC.

137

3.14%

63 Vendors share the remaining 21.67% of the market. * The total percentage may exceed 100 percent due to rounding or some organizations may have more than one vendor or RPACS applications installed.

N = 4,360 Source: HIMSS AnalyticsTM Database (U.S. Edition)

 2010 HIMSS Analytics

Hospital Radiology PACS Top 10 Installed/Contracted Systems Hospitals—Under 100 Beds Vendor

# of Installations

% of Market*

GE HEALTHCARE

332

17.40%

MCKESSON PROVIDER TECHNOLOGIES

221

11.58%

FUJIFILM MEDICAL SYSTEMS USA, INC.

184

9.64%

PHILIPS HEALTHCARE

159

8.33%

NOVARAD CORPORATION

141

7.39%

AMICAS

114

5.97%

AGFA HEALTHCARE

108

5.66%

CPSI

89

4.66%

CARESTREAM HEALTH, INC

66

3.46%

DR SYSTEMS, INC.

57

2.99%

SIEMENS HEALTHCARE

57

2.99%

57 Vendors share the remaining 26.47% of the market. N = 1,908 Source: HIMSS AnalyticsTM Database (U.S. Edition)

* The total percentage may exceed 100 percent due to rounding or some organizations may have more than one vendor or RPACS applications installed.

 2010 HIMSS Analytics

Hospital Radiology PACS Top 10 Installed/Contracted Systems Hospitals—100-199 Beds Vendor

# of Installations

% of Market*

GE HEALTHCARE

220

24.04%

MCKESSON PROVIDER TECHNOLOGIES

177

19.34%

FUJIFILM MEDICAL SYSTEMS USA, INC.

95

10.38%

PHILIPS HEALTHCARE

94

10.27%

AGFA HEALTHCARE

82

8.96%

AMICAS

48

5.25%

DR SYSTEMS, INC.

36

3.93%

SIEMENS HEALTHCARE

34

3.72%

CARESTREAM HEALTH, INC

32

3.50%

NOVARAD CORPORATION

27

2.95%

29 Vendors share the remaining 14.75% of the market. * The total percentage may exceed 100 percent due to rounding or some organizations may have more than one vendor or RPACS applications installed.

N = 915 Source: HIMSS AnalyticsTM Database (U.S. Edition)

 2010 HIMSS Analytics

Hospital Radiology PACS Top 10 Installed/Contracted Systems Hospitals—200-299 Beds Vendor

# of Installations

% of Market*

GE HEALTHCARE

181

30.57%

MCKESSON PROVIDER TECHNOLOGIES

114

19.26%

PHILIPS HEALTHCARE

69

11.66%

FUJIFILM MEDICAL SYSTEMS USA, INC.

59

9.97%

AGFA HEALTHCARE

43

7.26%

AMICAS

41

6.93%

SIEMENS HEALTHCARE

40

6.76%

HOLOGIC, INC.

21

3.55%

DR SYSTEMS, INC.

18

3.04%

CERNER CORPORATION

13

2.20%

19 Vendors share the remaining 11.99% of the market. * The total percentage may exceed 100 percent due to rounding or some organizations may have more than one vendor or RPACS applications installed.

N = 592 Source: HIMSS AnalyticsTM Database (U.S. Edition)

 2010 HIMSS Analytics

Hospital Radiology PACS Top 10 Installed/Contracted Systems Hospitals—300-399 Beds Vendor

# of Installations

% of Market*

106

27.25%

MCKESSON PROVIDER TECHNOLOGIES

80

20.57%

FUJIFILM MEDICAL SYSTEMS USA, INC.

47

12.08%

PHILIPS HEALTHCARE

45

11.57%

AMICAS

33

8.48%

AGFA HEALTHCARE

22

5.66%

HOLOGIC, INC.

21

5.40%

SIEMENS HEALTHCARE

20

5.14%

SECTRA

12

3.08%

CARESTREAM HEALTH, INC

12

3.08%

GE HEALTHCARE

15 Vendors share the remaining 9.77% of the market. * The total percentage may exceed 100 percent due to rounding or some organizations may have more than one vendor or RPACS applications installed.

N = 389 Source: HIMSS AnalyticsTM Database (U.S. Edition)

 2010 HIMSS Analytics

Hospital Radiology PACS Top 10 Installed/Contracted Systems Hospitals—400-499 Beds Vendor

# of Installations

% of Market

GE HEALTHCARE

55

24.12%

MCKESSON PROVIDER TECHNOLOGIES

46

20.18%

PHILIPS HEALTHCARE

33

14.47%

FUJIFILM MEDICAL SYSTEMS USA, INC.

25

10.96%

SIEMENS HEALTHCARE

20

8.77%

AMICAS

20

8.77%

AGFA HEALTHCARE

14

6.14%

HOLOGIC, INC.

11

4.82%

DR SYSTEMS, INC.

11

4.82%

CARESTREAM HEALTH, INC

6

2.63%

CERNER CORPORATION

6

2.63%

10 Vendors share the remaining 7.02% of the market. N = 228 Source: HIMSS AnalyticsTM Database (U.S. Edition)

* The total percentage may exceed 100 percent due to rounding or some organizations may have more than one vendor or RPACS applications installed.

 2010 HIMSS Analytics

Hospital Radiology PACS Top 10 Installed/Contracted Systems Hospitals—500+ Beds Vendor

# of Installations

% of Market*

102

31.10%

MCKESSON PROVIDER TECHNOLOGIES

53

16.16%

PHILIPS HEALTHCARE

39

11.89%

AGFA HEALTHCARE

38

11.59%

FUJIFILM MEDICAL SYSTEMS USA, INC.

34

10.37%

SIEMENS HEALTHCARE

30

9.15%

AMICAS

21

6.40%

CARESTREAM HEALTH, INC

15

4.57%

HOLOGIC, INC.

10

3.05%

7

2.13%

GE HEALTHCARE

CERNER CORPORATION

10 Vendors share the remaining 6.71% of the market. * The total percentage may exceed 100 percent due to rounding or some organizations may have more than one vendor or RPACS applications installed.

N = 328 Source: HIMSS AnalyticsTM Database (U.S. Edition)

 2010 HIMSS Analytics

Hospital Radiology PACS Vendors Being Considered for a Planned Purchase Vendor

# of Times Considered

GE HEALTHCARE

19

PHILIPS HEALTHCARE

14

MCKESSON PROVIDER TECHNOLOGIES

12

SIEMENS HEALTHCARE

10

AGFA HEALTHCARE

9

FUJIFILM MEDICAL SYSTEMS USA, INC.

9

DR SYSTEMS, INC.

6

CERNER CORPORATION

5

AMICAS

4

CARESTREAM HEALTH, INC

3

SECTRA

3

NOVARAD CORPORATION

3

13 ADDITIONAL VENDORS BEING CONSIDERED Source: HIMSS AnalyticsTM Database (U.S. Edition)

16  2010 HIMSS Analytics

RPACS Applications Temporal Summary of Installation Angiography (n=2154)

50%

47%

Computed Radiography (n=2606)

47%

50%

Computerized Tomography (n=2676)

47%

50%

Digital Fluoroscopy (n=2316)

49%

48%

Digital Mammography (n=1054)

36%

62%

Digital Radiography (n=2311)

49%

48%

Magnetic Resonance Imaging (n=2519)

48%

49%

Nuclear Medicine (n=2405)

48%

48%

Orthopedic (n=928) Ultrasound (n=2610) Prior to 1985 2000 to 2004

1985 to 1989 2005 to 2009

Source: HIMSS AnalyticsTM Database (U.S. Edition)

45% 48%

Almost all of the RPACS applications contracts occurred after 1999. About half of the contracts for RPACS applications were between 2005 and 2009.

53% 49% 1990 to 1994

1995 to 1999

 2010 HIMSS Analytics

Contact HIMSS Analytics Phone: 877-364-2500 Fax: 312-638-9401 Email: [email protected] Web: www.himssanalytics.org

Source: HIMSS AnalyticsTM Database (U.S. Edition)

 2010 HIMSS Analytics