HIMSS 2017: Clinical IT Show Report

After a hectic week of meetings, booth tours and press briefings, here’s The Signify View on the key takeaways from the HIMSS 2017 meet for Imaging IT and Clinical Content Management (CCM) IT stakeholders:

Emergence of Agnostic Clinical Enterprise (ACE) Platforms

While the shift has been gradual, it’s clear that the world’s largest imaging IT vendors are making a bid to “lock-in” their customer base to broader, enterprise clinical IT platforms. Siemens Healthineers announced its “Digital Ecosytem” model at the show, following similar recent announcements from Philips Healthcare (“Intellispace” platform) and GE Healthcare (“Health Cloud”). The move is hardly surprising – enterprise EHR vendors have done little to establish any real expertise in best-of-breed clinical IT or imaging IT software to date. Therefore the “the big three” are leveraging their clinical expertise and modality hardware footprint to expand the breadth of their clinical IT offerings, including analytics, dashboarding, integrated workflow and even population health and telehealth capability. These new solutions, that Signify Research has termed Agnostic Clinical Enterprise (ACE) platforms, look set to be the foundation for future cross-discipline implementations.

In adopting the ACE platform model, there are many benefits for provider and vendor alike. The single ACE platform model allows the vendor to become embedded in the providers’ core clinical workflow and care management, while also putting themselves in prime position to win long-term, managed service deals, including imaging hardware, clinical care device supply and lucrative professional services.

For providers, the ACE platform model offers a single vendor to deal with for clinical IT (“one-throat-to-choke”) and a partner to share the risk of previously capital-intensive procurement. Moreover, the ACE platform model will, over time, use the core platform vendor as a contractor. If the provider wants to bring in a new technology or software for a specific clinical function, the ACE platform vendor will have responsibility to sub-contract and integrate the new module into their platform. This will lead to greater choice for the provider in each clinical discipline.

It is still early days for the ACE platform approach as was evident from the solutions on show. The few ecosystems being touted are essentially proprietary ecosystems, available only to current customers of the vendor’s software, integrated with a few select partners. The benefit of choice for providers therefore remains very limited. Little has also been discussed on how the new clinical ecosystem will interact with the incumbent EHR platforms – any sign of encroachment into acute EHR and the focus on interoperability will soon be lost. Furthermore, the clinical IT market is awash with mid-size and small vendors each with a market role to play. For mid-size vendors with partial imaging modality business, such as AGFA Healthcare, Carestream Healthcare and Fujifilm Medical, a strategic decision will need to be made, whether to build their own ACE platform ecosystem, or specialise in a clinical area and look for platform partners. Smaller vendors, such as those with best-of-breed clinical capability will probably sub-contract into ACE platform ecosystems, or ultimately be acquired. For the smaller, more generalist vendors, they may well soon see their addressable market shrinking.

FHIR gains momentum but blockchain the missing link?

Interoperability was certainly on the agenda at HIMSS, albeit dwarfed by the big themes of cybersecurity, artificial intelligence and US health legislation uncertainty. Adoption of the new Fast Interoperability for Health (FHIR) standard was evident in some new solutions on show, but was patchy and far from mainstream – unsurprising considering FHIR is far from a well- defined and established standard today.

In contrast industry hype around blockchain was more evident and widely discussed, especially as the major EHR vendors were keen to be seen to be visibly working on interoperability. It was clear though that beneath the hype, little has happened so far. There are few working examples of blockchain in healthcare, with almost all tied into the world of financial administration and payer-provider workflow.

From a clinical IT perspective, blockchain is a long way off. It is certainly intriguing in the fact its traceability could offer a true “longitudinal” record for clinical audit, especially when applied to tracking the patient through complex, multi-provider clinical pathways. In addition, some at the show saw blockchain as a smarter way to drive interoperability and exchange of information between different health providers and vendor platforms.

That said, it is still very early days for blockchain in healthcare. Most major vendors are only starting to investigate it’s potential and scepticism remains high despite the hype. One discussion we held led to a comparison of healthcare and finance in adoption of new technology and standards – with healthcare estimated to be approximately 20 years behind finance. Blockchain in finance today is only just starting to be trialled, so for healthcare it’s reasonable to assume it’s a long way off.

Artificial Intelligence meet Workflow

There was a healthy dose of reality being eschewed from most participants with regards to artificial intelligence (AI). It seems most now understand AI will not be replacing physicians and fully diagnosing patients anytime soon so instead are focusing more on the benefits it really can provide. Interestingly, AI to date has also driven far more vendor partnerships, with major clinical IT vendors increasingly looking to work with AI specialists in targeted clinical applications.

There was also an array of AI solutions on show and almost all focused on a few key areas: workflow, efficiency, analytics, clinical audit and in some select cases, physician decision-support. Most clinical focus was on workflow analytics, with examples such as enabling customised pre-fetching of images or clinically-relevant content to add context to diagnosis. Clinical dashboard and audit was also a clear topic, with a range of solutions on show to enable providers to better monitor and predict adverse events or clinical compliance based on real-time clinical data. Automation of manual processes (quantification tools particularly) was also shown in a variety of clinical applications

However, as was evident from the findings of the recent Signify Research report on Machine Learning in Medical Imaging (published January 2017), adoption of AI for decision support and Computer Aided Diagnosis (CADx) will be a gradual process, with only a few specific clinical applications commercially available in the next five years.

Cloud Gaining Traction

Unlike many of the trends discussed above still in infancy, the adoption of cloud technology for clinical IT appears to at last be gaining traction. Vendors were reporting a far greater interest and uptake of cloud solutions, suggesting providers are overcoming concerns on data security and wanting to take advantage of the greater flexibility enabled by cloud implementations. Notably, Microsoft Azure and Amazon Web Services (AWS) were regularly discussed as making significant inroads to cloud service provision for healthcare in the last year.

That said, penetration of full third-party hosted architectures remains relatively niche and is tied closely to the scale of deployment. For small private centres and physician offices, fully hosted and Software-as-a-Service (SaaS) solutions make sense as the burden and cost of managing IT hardware, middleware, storage and maintenance are removed. For small to mid-sized hospitals, the hybrid architecture model is often more appropriate; third-party hosting is used for long-term storage, back-up and disaster recovery off-site, while primary data remains on-site. For larger hospitals and multi-provider networks, most have already invested in long-term IT infrastructure to support their networks, along with sizeable IT administration teams. Therefore, “private cloud” is most common, in which the clinical IT software is hosted on the providers’ infrastructure with a variety of in-house or third-party maintenance options.

Consequently, vendors were keen to showcase cloud and mobile-access solutions at the show, especially with regards to viewers and data management solutions (be it image archive, vendor-neutral archive or independent clinical archive solutions).

Reality Bites

Despite the broad theme of interoperability in healthcare of late, the gulf between clinical IT vendors and EHR vendors was still palpable.  Progress in some applications such as risk stratification analytics and care management (as part of population health), telehealth and clinical archiving, was on show, but mostly the worlds of clinical IT and EHR remained very much separate. Diagnostic imaging especially appeared to remain estranged from wider health IT, while it was also notable how few imaging focused symposia sessions were part of the HIMSS schedule. So, while interoperability was much hyped and the largest clinical vendors are looking to expand clinical capability, there appears to be little change yet in breaking down the barriers of clinical data interoperability in the complex mesh of vendor, provider and payer networks.

New Service from Signify Research: Clinical Content Management IT – 2017
This and other issues will be explored in full in Signify Research’s upcoming intelligence service ‘Clinical Content Management IT – World’, with first delieverable due in February 2017. For further details please click here or contact simon.harris@signifyresearch.net

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