The average system out there is quite old – nine years.

The market is focused, of course, on clinicals. Once the bubble begins to burst on clinicals, something's gonna have to give on revenue cycle.

Another statistic for year end is that the number of hospitals per integrated delivery system took a big jump last year from 6.4 to 7.1. Which tells us that the acquisition spree has not slowed down.

It did a little bit in 2009, and that's because access to capital was so constrained from the recession. But integrated delivery networks are continuing to buy hospitals. And they're going to consolidate.

There's a difference between an integrated delivery system and a holding company. And I think it;s the responsibility of the IDSs, as they look at acquisitions, one of the acquisition costs is the cost of consolidating systems. And, frankly, it's probably driving some things that are changing in the market now.

For example PACS. If you're a PACS guy you made a pile of money between, say, 1997 and 2005. And then the market cooled off. It was saturated.

Now, we saw last year, a little uptick. It's replacements, due to mergers and acquisitions.

That's another bit of fuel being added to the fire. That and the fact that the revenue cycle systems are old. And bundled payments, and the whole payment reform, is driving all this.

But it's not happening yet. So all we're doing is saying we're predicting.

It's just ever so slight. If you look at the heat map there are changes, small changes, but it's not a groundswell.