Understanding the US Healthcare IT Market from a Wall Street Perspective

1. 从华尔街的角度看美国医疗卫生信息化（HCIT）从华尔街的角度看美国医疗卫生信息化（HCIT） 俞毅 博士IBM大中华区业务咨询服务部 医疗卫生行业 总监yuy@cn.ibm.com

2. 美国HCIT市场总览 • Niche market • Revenue: $28 billion, $14 billion of which is spent by hospitals • Largest company (Cerner) represented 4% of HCIT spending • 2006 HIMSS conference had 863 exhibitors • Historical 8%-12% growth • Has been cyclical, recently becoming secular • Improvements in IT and health care create secularities • Prior cyclicality driven by IT (Y2K, HIPAA) and health care profitability trends

3. HCIT 投入 Y2K Rebound to Steady, Near 10% Growth ____________________ Source: Sheldon I. Dorenfest and Associates, Ltd.

4. HCIT 投入 Non-Hospital Spending Likely to Grow Fastest ____________________ Source: Healthcare Information Systems report, BBC Research.

5. HCIT 股价表现 Cain Brothers’ HCIT index has slightly under performed the Dow Jones and Russell 2000 over the last twelve months ____________________ Source: Capital IQ. Note: As of September 20, 2006.

6. 实际的医院信息环境非常分散 • Dozens of significant applications • Millions in capital investment • Average task requires info from 5-7 disparate applications • Further fragmentation related to in-house customization

7. 信息化的推动和阻碍因素（医疗和银行业的比较）信息化的推动和阻碍因素（医疗和银行业的比较） The U.S. Banking System: Enablers of Electronic Evolution • Industry-wide standards • Single regulatory body (Federal Reserve) • Modest consumer movement between banks • Unique consumer identifier (account #) • Limited relevant (objective) data • All inclusive data repository • Widespread access to data repositories • Data security standards (PIN #)

8. 信息化的推动和阻碍因素（医疗和银行业的比较）信息化的推动和阻碍因素（医疗和银行业的比较） The U.S. Health Care System: Obstacles to Electronic Evolution • Minimal standards • Several regulatory bodies • Constant consumer movement between providers and plans • No unique patient identifier • Extensive relevant (subjective) information • Incomplete data repository • Limited access to data repositories • Minimal data security standards

9. 信息化的推动和阻碍因素（医疗和银行业的比较）信息化的推动和阻碍因素（医疗和银行业的比较） The U.S. Health Care System: Addressing the Obstacles • HL7, HIPAA, XML • NHIN – type projects • Consumer-centric data • Mapping systems / local storage and secure identifiers • Detailed clinical standards (e.g. SNOMED) • Linkage across health networks – RHIOs • Improved interoperability • Multi-layer / user-defined security

10. Wireless Security Personal Health Records Pay for Performance Disease Management EMR / Decision Support E-Prescribing HCIT发展的主要趋势 Disaster Preparedness • Greater patient-level data • IT Standardization/ • interoperability • Standards-based medicine RHIOs ____________________ Source: Healthcare Informatics, February 2006.

11. HCIT的未来增长点 • Clinical information systems: CPOE leads to EMR / data warehousing • Department-specific apps (PACs, ICU, ER, OR, Cardiology) - “Best of Breed” is back (was it ever gone?) • Consumer interaction (scheduling, education, PMR) • Standards-based medicine – IT-based workflow management • Interoperability/Connectivity – e.g. RHIOs and beyond • Workflow driven data integration / access • Wireless, web-driven leverage • Revenue cycle management: recapturing lost value (25% of total health care) • Many points in the cycle to be addressed

12. HCIT的未来增长点 • Payor information systems & services • Operations throughput / contract management • Defined contribution / HSA • Standardized-based medicine • Pay for performance administration • Consumer-Driven Business models • Personal health management • Data / information access

13. HCIT的融资市场 The financing market for HCIT transactions is showing signs of strength • From 2001-2005, there were approximately 6 true HCIT IPOs • There could be 6-8 HCIT IPOs over the next 9-12 months • Companies meaningfully more seasoned than prior IPO “wave” ____________________ Source: IPO Monitor, as September 20 2006. * company previously listed on TSX, but completed NASDAQ IPO on June 22, 2006.

14. HCIT的风险投资市场 HCIT VC investment activity rising on both absolute and relative basis ____________________ Source: Venture Source as of January 1, 2006.

15. HCIT的风险投资市场 Over the last year approximately 23 venture capital deals done in HCIT, raising nearly $455 million ____________________ Source: Venture Source as of September 20, 2006.

16. HCIT的风险投资市场 Over the last year approximately 23 venture capital deals done in HCIT, raising nearly $455 million ____________________ Source: Venture Source as of September 20, 2006.

17. HCIT的公司并购（M&A）交易 • M&A activity rose significantly in 2005 and 2006 thus far • 34 notable transactions announced in 2005 vs. 26 transactions in 2004 • Approximately 30 transactions announced YTD 2006 • Notable transactions completed in the last 12 months: • Sage Software / Emdeon Practice Services • WebMD / Medsite.com • McKesson / RelayHealth • Allscripts Healthcare Solution / A4 Health Systems • GE Healthcare / IDX Systems ____________________ Source: Capital IQ and company filings and press releases.

18. HCIT市场还是会继续非常分散863 Companies Presented at 2006 HIMSS Diversified Companies Integrators “Best of Breed” Applications

19. 结论 • Opportunity for greater application of IT in health care remains • Macro drivers firmly in place and unlikely to waver • Evolving payment and delivery models offer many new HCIT opportunities • IT and HCIT advances to promote interoperability suggest opportunities for companies of all sizes • HCIT remains a niche industry ____________________ Source: Capital IQ and company filings and press releases.