This document provides a summary of the US market for electronic medical record (EMR) technologies. It discusses key definitions, the need for EMRs, functional requirements, advantages, the market size and adoption trends, major vendors, regulations, and President Bush's vision for increased EMR usage. The presentation concludes with Cognizant's vision to become a top global health IT services provider by building EMR expertise, partnering with vendors and academic institutions, and potentially developing their own EHR capabilities.

1. © 2006, Cognizant Technology Solutions. All Rights Reserved.
The information contained herein is subject to change without notice.
Establishing
Cognizant in
EMR Market
Space
Gopalakrishnan.R (121258)
The U.S. Market for EMR Technologies
18 June 2007
Disclaimer : Information presented in this presentation are meant to
be informative and not a final authority

2. © 2006, Cognizant Technology
Table of Contents
1. EMR
1. EMR vs EHR: Definition
2. Terminologies Used In Industry
3. Why EMR? The Need and Demand For
4. Functional Requirements of an EMR
5. Advantages of EMR
1. Clinical Benefits
2. Financial Benefits
6. EMR Environment
2. Market Overview
1. Market Size
2. EMR Adoption Model
3. Adoption Scenario
4. Projected Benefits of EMR Adoption

3. © 2006, Cognizant Technology
Table of Contents (cont.)
5. Drivers and Inhibitors
6. Implementation Costs and ROI
1. Hospitals (Case Study)
5. EMR Adoption - Summary
3. Competitive Landscape
1. Major Vendors
2. Vendor Rating
3. Key Regulations and Certifications
1. HIPAA
2. Code of Federal Regulations (CFR) - Part 11
3. Key Certifications - CCHIT
3. Conclusions & Outlook
4. US President Bush Vision
5. Vision & Roadmap for Cognizant

4. © 2006, Cognizant Technology Solutions. All Rights Reserved.
The information contained herein is subject to change without notice.
EMR
The U.S. Market for EMR Technologies
18 June 2007
Disclaimer : Information presented in this presentation are meant to
be informative and not a final authority

5. © 2006, Cognizant Technology
EMR vs EHR: Definition
© 2006 HIMSS AnalyticsTM
http://www.himssanalytics.org/docs/WP_EMR_EHR.pdf

6. © 2006, Cognizant Technology
Terminologies used in the Industry
 CDO – Care Delivery Organization
 CDR – Clinical Data Repository
 CMV – Controlled Medical Vocabulary
 CDSS – Clinical Decision Support System
 CPOE – Computerized Provider Order Entry
 CHI - Consolidated Health Informatics initiative
 CFR - Code of Federal Regulations
 CMS - Centers for Medicare and Medicaid Services
 CCHIT - Certification Commission for Healthcare Information
Technology
 DICOM – Digital Imaging and Communication in Medicine
 EHR – Electronic Health Record
 eMAR – Electronic Medical Administration Record
 EMPI - Enterprise Master Person Index
 eRex - Electronic Prescribing
 FHA - Federal Health Architecture
 HIPPA - Health Insurance Portability and Accountability Act of 1996
 HHS - Department of Health and Human Services
 HIT - Health Information Technology

7. © 2006, Cognizant Technology
Terminologies used in the Industry
(Cont.)
 HIMSS - The Healthcare Information and Management Systems
Society
 HL7 - Health Level Seven
 IOM - Institute of Medicine
 LIS - Laboratory Information Systems
 NHIN - National Health Information Network
 NHII - National Health Information Infrastructure
 NIH - National Institutes of Health
 PACS – Picture Archiving and Communication Systems
 ONCHIT - Office of the National Coordinator for
 PIS - Pharmacy Information Systems
 PHR - Personal Health Record
 RHIO - Regional Health Information Organization
 VA - Department of Veterans Affairs
 VHA - Veterans Health Administration
 VHA’s EHR - Veterans Health Administration’s Electronic Healthcare
Record
 VistA - Veterans Health Information Systems and Technology
 Architecture

8. © 2006, Cognizant Technology
Why an EMR? The need and Demand
for:
 Timely, accurate health data
 Rapid sorting of available information
» Patient-specific data
» Knowledge bases, decision support tools
 Information at the point of care
 Managing patient services
 Tracking costs and value
 Assessing provider performance
 Information for research, public health
 Communicating across distances
 Monitoring patient conditions remotely
http://www.emr.msu.edu/Documents/ppt/Why%20Use%20an%20EMR_files/frame.htm

9. © 2006, Cognizant Technology
Functional Requirements
 A detailed list of EMR Requirements are
captured in the following link for
reference.
http://www.vch.ca/professionals/docs/phcn/clinical_emr_requirements.pdf

10. © 2006, Cognizant Technology
Advantages of EMR
Clinical Benefits
 Improved Clinical Decision Making
» Decision Support Features
» Adverse Drug Event Avoidance
» Health Maintenance Reminders
» Access to a More Complete Patient Record
 Enhanced Documentation
» Improved Accuracy
» Improved Legibility
» Improved Completeness
» Improved Security

11. © 2006, Cognizant Technology
Advantages of EMR (cont.)
» Tailored Patient Education
» Advanced Reporting Capabilities
 Better Patient Care
» Greatest Benefits
» Web Consultation
Financial Benefits
» Increased productivity
» Increased revenue
» Avoidance of costs
» Increased profit
http://www.emrexperts.com/emr-ebook/

12. © 2006, Cognizant Technology
EMR Environment
© 2006 HIMSS AnalyticsTM
http://www.himssanalytics.org/docs/WP_EMR_EHR.pdf

13. © 2006, Cognizant Technology
EMR Environment (contd)
 CDR - A real-time transaction-
processing database of clinical patient
information.
 CMV - Normalizes data from a relational
and definitional hierarchy, enabling
other components of the EMR to
operate optimally.
© 2006 HIMSS AnalyticsTM
http://www.himssanalytics.org/docs/WP_EMR_EHR.pdf

14. © 2006, Cognizant Technology Solutions. All Rights Reserved.
The information contained herein is subject to change without notice.
Market
Overview
The U.S. Market for EMR Technologies
18 June 2007
Disclaimer : Information presented in this presentation are meant to
be informative and not a final authority

15. © 2006, Cognizant Technology
Market Size
 Market Size :
» “The 1.2 billion-dollar market for EMR is expected to grow
nearly 400% in the next eight years^”
» “… electronic health records in the United States is poised to
grow at a rate of 13.5 percent over the next four years, and
by 2015 it will top $4.85 billion… *”
^ - http://www.kaloramainformation.com/EMR-Technologies-1365762/
* - http://www.healthcareitnews.com/printStory.cms?id=6332

16. © 2006, Cognizant Technology
Market Adoption - EMR Adoption
Model
© 2006 HIMSS AnalyticsTM
http://www.himssanalytics.org/docs/WP_EMR_EHR.pdf

17. © 2006, Cognizant Technology
Market Adoption - Adoption Scenario
© 2006 HIMSS AnalyticsTM
http://www.himssanalytics.org/docs/WP_EMR_EHR.pdf
 Profiles of Progress – State Health IT Initiatives
:http://www.nascio.org/publications/documents/NASCIO-ProfilesOfProgress.pdf

18. © 2006, Cognizant Technology
Market Adoption : Projected
Benefits of EMR Adoption

19. © 2006, Cognizant Technology
Market Adoption : Projected Benefits
of EMR Adoption (contd)

20. © 2006, Cognizant Technology
Drivers and Inhibitors
Drivers
 Clinical Benefits
» Practices want improved clinical procedures
» Higher quality documentation
» Patient education
» Reminders and protocols
» Management of medications
» Signing of charts
» Callbacks and telephone tri-age
 Financial Drivers
» All practices look for cost reduction
» Reduced transcription costs
http://findarticles.com/p/articles/mi_m0DUD/is_5_22/ai_74571489

21. © 2006, Cognizant Technology
Drivers and Inhibitors (Contd.)
 Administrative Gains
» Decreased chart pulls and less filing
» Fewer lost charts
» Improved communication
» Chart requests and audits
Inhibitors
 Cost
 Security and Privacy Issues
 Acceptance and Testing
 Infrastructure and development
 Technical Issues
http:www.fastercures.org/pdf/emr_whitepaper.pdf

22. © 2006, Cognizant Technology
Implementation Costs & ROI
 Adoption costs for hospitals : “…the cumulative cost for 90
percent of hospitals to adopt an EMR system is $98 billion if
20 percent of hospitals now have such a system. Average
yearly costs for the fifteen-year adoption period are $6.5
billion—about one-fifth of our earlier-described estimate of
potential efficiency savings in hospitals.”
 Adoption costs for physicians : “….the cumulative costs to
reach 90 percent adoption are $17.2 billion, almost equally
split between one-time costs and maintenance costs. The
average yearly cost during the adoption period is about $1.1
billion.”
http://content.healthaffairs.org/cgi/content/full/24/5/1103#SEC8

23. © 2006, Cognizant Technology
Implementation Costs & ROI (Contd)
 Hospitals
» Case Study :
• Capital Region Healthcare: Cost and Quality
Benefits - The following link for reference.
• www.providersedge.com/ehdocs/ehr_articles/Capital_Region_Healthcare-
Cost_and_Quality_Benefits.pdf

24. © 2006, Cognizant Technology
EMR Adoption - Summary
 The adoption of interoperable EMR systems could
produce efficiency and safety savings of $142–$371
billion.
http://content.healthaffairs.org/cgi/content/full/24/5/1103#SEC8

25. © 2006, Cognizant Technology Solutions. All Rights Reserved.
The information contained herein is subject to change without notice.
Competitive
Landscape
The U.S. Market for EMR Technologies
18 June 2007
Disclaimer : Information presented in this presentation are meant to
be informative and not a final authority

26. © 2006, Cognizant Technology
Major Vendors
 Cerner
 COMPUTER PROGRAMS AND SYSTEMS, INC.
 Eclipsys Corporation
 Epic Systems Corporation
 GE Healthcare
 McKesson Corporation
 Medical Information Technology, Inc. (MEDITECH)
 MedPlus
 Quadramed Corporation
 Siemens Medical Solutions
http://www.kaloramainformation.com/prod-toc/EMR-Technologies-1365762/

27. © 2006, Cognizant Technology
Vendor Rating
 The following link provides an “Extensive Evaluation
Ranking Top Electronic Medical Record Applications”
http://www.providersedge.com/ehdocs/ehr_articles/2004_EMR_Survey_Summary_Report.pdf

28. © 2006, Cognizant Technology Solutions. All Rights Reserved.
The information contained herein is subject to change without notice.
Key Regulations and
Certifications
The U.S. Market for EMR Technologies
18 June 2007
Disclaimer : Information presented in this presentation are meant to
be informative and not a final authority

29. © 2006, Cognizant Technology
Key Regulations and Certifications
 HIPAA
 Code of Federal Regulations (CFR) - Part 11
 Key Certifications
» The Certification Commission for Healthcare
Information Technology
http://www.kaloramainformation.com/prod-toc/EMR-Technologies-1365762/

30. © 2006, Cognizant Technology Solutions. All Rights Reserved.
The information contained herein is subject to change without notice.
Conclusions &
Outlook
The U.S. Market for EMR Technologies
18 June 2007
Disclaimer : Information presented in this presentation are meant to
be informative and not a final authority

31. © 2006, Cognizant Technology
Conclusions & Outlook
 EMRs Why their Time has come
http://www.providersedge.com/ehdocs/ehr_articles/EMRs-Why_Their_Time_Has_Come.pdf
 EMR is necessity
 US is market leader
 Office-Based Physicians are in Growth Area
 EMR costs will be reduced
 EMR software is defined by Applications
 There is large market for vendors
 EMR is a budget priority for Healthcare Companies
 HIPPA to drive EMR growth
http://www.kaloramainformation.com/prod-toc/EMR-Technologies-1365762/

32. © 2006, Cognizant Technology Solutions. All Rights Reserved.
The information contained herein is subject to change without notice.
US President
Bush Vision
The U.S. Market for EMR Technologies
18 June 2007
Disclaimer : Information presented in this presentation are meant to
be informative and not a final authority

33. © 2006, Cognizant Technology
US President Bush Vision
 "We will make wider use of electronic records and other
health information technology to help control costs and
reduce dangerous medical errors."
-- President Bush, January 31, 2006
http://www.whitehouse.gov/stateoftheunion/2006/

34. © 2006, Cognizant Technology Solutions. All Rights Reserved.
The information contained herein is subject to change without notice.
Vision &
Roadmap for
Cognizant
The U.S. Market for EMR Technologies
18 June 2007
Disclaimer : Information presented in this presentation are meant to
be informative and not a final authority

35. © 2006, Cognizant Technology
Vision & Roadmap for Cognizant
 Market Pulse
» Build Strong Analyst Relationship
 Branding
» Sponsoring Major Healthcare Conferences like HIMSS /
AHIP / NMHCC / RSNA
 Building DCG
» Partner with Medical Academic Research Institutions
» Incubate COM (Cognizant Institute of Medicine) building
niche Domain / Technical Competencies
 Increasing Value Propositions : Six Sigma
 Striking Deals
» Partner with Lead EMR Vendors : Off shoring / Outsourcing
Product Development & Maintenance

36. © 2006, Cognizant Technology
Vision & Roadmap for Cognizant
 Evolving as an mature EMR ISV ? (2-3 yrs)
» Achieving Delivery Excellence through Innovation and
competitiveness
» Presenting / Publishing Technical, Solutions Paper in
Summits
 Building EHR Competences to spearhead in HIT Space?
(3-4 yrs)
 Reaching Top 10 Global HIT Services Company? (5-6
yrs)
“As we look ahead, there will be no shortage of challenges. In
spite of few barriers, it is high time for Cognizant, to reach
further milestones by exhaustively understanding EMR market
and taking complete advantage of the opportunity market is
offering”

37. © 2006, Cognizant Technology
“The more intensely we feel about an idea or a
goal, the more assuredly the idea, buried deep
in our subconscious, will direct us along the
path to its fulfillment.”
Earl Nightingale
(US motivational writer and author, 1921-1989)
Passion

38. © 2006, Cognizant Technology
Thank you