2. Source: Forrester 2008

3. configurability multi- tenant efficiency, scalability

4. Level 0 Outsourcing is not SaaS. In outsourcing, a service provider operates a major application or a unique application landscape for a large enterprise customer. As the outsourcing company can't leverage this application for a second customer, outsourcing does not qualify as SaaS. Level 1 Manual ASP business models target midsize companies. At level 1, a hosting provider runs packaged applications like SAP's ERP 6.0, which require significant IT skills, for multiple midsize enterprises. Usually, each client has a dedicated server running its instance of the application and is able to customize the installation in the same way as self-hosted applications. Level 2 Level 2: Industrial ASPs cut the operating costs of packaged applications to a minimum. At level 2, an ASP uses sophisticated IT management software to provide identical software packages with customer-specific configurations to many SMB customers. However, the software package is still the same software that was originally created for self-hosted deployment.

5. Level 3 Level 3: Single-app SaaS is an alternative to traditional packaged applications. At level 3, software vendors create new generations of business applications that have SaaS capabilities built in. Web-based user interface (UI) concepts and the ability to serve a huge number of tenants with one, scaleable infrastructure are typical characteristics. Customization is restricted to configuration. Single-app SaaS adoption thus focuses on SMBs. Salesforce.com's CRM application initially entered the market at this level. Level 4 Business-domain SaaS provides all the applications for an entire business domain. At level 4, an advanced SaaS vendor provides not only a well-defined business application but also a platform for additional business logic. This complements the original single application of the previous level with third- party packaged SaaS solutions and even custom extensions. The model even satisfies the requirements of large enterprises, which can migrate a complete business domain like "customer care" toward SaaS. Level 5 Dynamic Business Apps-as-a-service is the visionary target. Forrester's Dynamic Business Application imperative embraces a new paradigm of application development: "design for people, build for change." At level 5, advanced SaaS vendors coming from level 4 will provide a comprehensive application and integration platform on demand, which they will prepopulate with business applications or business services. They can compose tenant-specific and even user-specific business applications on various levels. The resulting process agility will attract everyone, including large enterprise customers.

6. SaaS Architecture Features Single Instance Multi Tenancy Product Management Suite Billing and Metering Application Lifecyle Management Subscription Management Provisioning User and Role Systems End User Self Service Interface Service Catalog Peer-To-Peer Message Bus Contextual Logging

7.  Efficiency gains — Virtualization allows to deliver efficiencies much closer to multi tenancy by allowing for rapid and even automated creation of complete and identical new Virtual environments, full backups/snapshots of environments, easy upgrades across multiple environments, automated load balancing, etc.  Avoiding downsides, achieving delivery advantages —  clients have a need for system changes to match key cycles — like their pay for performance cycles. As a result, there is a demand for more tightly controlled, client-unique system changes.  concerns over: ▪ (a) security and inappropriate data access, ▪ (b) impact of other clients on their system performance, ▪ (c) inability to establish and pay for their own, higher service levels (common among large companies), ▪ (d) being forced into an upgrade, ▪ (e) inability to support the level of client specific configurations and even customizations as necessary, ▪ (f) inability to obtain client level user acceptance testing, ▪ (g) inability to determine the precise production/go live dates for the system.

8. Cloud Services IaaSPaaSSaaS

9. TCO Components TraditionalSaaS Cost of Application  Cost of Database  Cost of Server  Cost of PCs  Cost of Peripherals  Cost of Implementation  Cost of AMC  Cost of subscription 

10. THE DISRUPTIVE APPROACH

11.  HIS Suite  FO  BO  Patient Portal  Kiosk  Mobile Health Enables Multi- Channel Delivery

12.  HIS (FO & BO)  SRL  ePACS  ePharm  Mobile Health  eMail Servers  eHRMS (e.g. mPower/ Adrenalin)  IaaS (Infrastructure as a Service)  Content Management  Service Desk Management