Is Europe Ready for Operational Workflow and Analytics in Radiology?

Published 07/03/2019

A change of perspective for imaging IT vendors was clear at the conference this year. Tools improving the individual radiologist workflow, solutions aimed at streamlining and optimising operations and dashboard analytics for business intelligence across the entire enterprise were all prominent. Imaging IT vendors are clearly becoming more concerned with how radiology fits into the wider healthcare enterprise. Using decades of experience in imaging technology, imaging IT vendors are now trying to help healthcare providers better manage their radiology operations in the context of the large and complex healthcare enterprises that exist today.

Below we highlight some of the new trends from ECR in radiology. We have grouped these into three core groups, radiologist workflow tools, operational tools and analytics, discussing their presence and potential viability in the European healthcare market.

Radiology Workflow Tools to Augment Radiologists

The first group of tools on show were a selection of radiology workflow tools aimed at making the daily life of the radiologist more streamlined with less distractions, and ultimately enabling them to do more cases in less time.

Examples include anatomically adaptive hanging protocols and other viewing related features to improve the workflow of the reading radiologist, along with solutions for easy peer-review and collaborative tools with image sharing functionalities across the healthcare provider networks. Another hot topic is auto-triage tools where machine learning algorithms are pre-diagnosing the exam and feeding the result into the worklist for automated prioritisation. This means that urgent cases can be analysed first, leading to faster turnaround time for cases likely to be of disease phenotype. Although installation of such algorithms directly on the modalities is being discussed and tested, there is also an argument for installation on imaging IT instead of modalities. Broader imaging IT platforms would have access to a broader set of inputs from across the imaging department, as opposed to AI software being installed on a single scanner. On a central IT platform, data could be pulled and analysed from all modalities in the hospital, independent of brand or age. Given that many larger networks operate a fleet of imaging equipment, the status of advanced software updates and capability on each individual modality would not be a limiting factor.

The aim of these tools is to increase the workflow efficiency of the individual radiologist by automating steps and minimising distractions from their primary functions. Since many of these tools are deeply associated with the viewing and analysis process, they are most likely to be integrated into the PACS or viewing platform and essentially become integrated features in the existing systems. However, there remains some way to go for many vendors in seamlessly integrating these tools into their core imaging IT platforms, especially in the case of artificial intelligence.

Operational Tools for Daily Management

Another group of products entering the market are operational tools that can support running the radiology department, rather than assisting the individual radiologist. These tools can be roughly divided into tools that support fleet management and tools that support administrative, staffing, legal and resource management.

Software for modality fleet management typically manages scheduling, performance and maintenance activities in the radiology department. Reducing downtime, improving utilization and better predicting maintenance needs all also ultimately help the hospital CFO or department head to increase the cost efficiency of the department. Modality vendors are leading the charge in this area; however, there is a clear need for some degree of vendor neutrality, as many hospitals will have different brand modalities and optimally would like to manage them all through the same system. This creates opportunity for third party vendors to enter this space, although it will be difficult to compete with the dominance of the large modality vendors, especially as many vendors are increasingly offering long-term managed service offerings; therefore, third party offerings will need to offer an exceptional value proposition for the provider.

Typical subjects to be covered under the second group of operational tools would be staffing, certification, clinical audit, finance, legal or regulatory compliance related tools to ensure correct documentation and staffing and assist with due diligence. The operational tools could also include automatic case load balancing for radiologists within the healthcare enterprise, whereby time savings could be obtained at larger high-volume multi-speciality hospitals. While this area is commonly overlooked and underserved in terms of digitalisation, the costs associated with many of these activities are significant. Moreover, for imaging IT vendors, operational budgets offer a new revenue stream compared to typical clinical software and modality procurement.

Business Intelligence Solutions Helping to Optimise Healthcare Business

Business Intelligence tools were also on show from multiple imaging IT vendors. The purpose of these tools is generally to learn from and improving the processes and operations to optimise the business or radiology department. As opposed to the general business intelligence software from vendors such as SalesForce and Microsoft, these tools are more targeted at the specific needs of a hospital or radiology department. Typical subjects to be covered would include both financial and clinical outcome measures; for example, follow up tracking to predict and limit missed appointments, or patterns in radiology technician performance for quality control and training. The typical format for these solutions is a customisable dashboard with data export functionalities that mines data from the core imaging IT platform.

Several enterprise imaging vendors are now developing dashboards; today, they are mostly suitable for most mid- and large-size hospitals that have limited capability to measure and assess their own performance. However, it will be a challenge to make them relevant for very large hospitals who often have their own BI solutions and departments responsible for care quality and financial intelligence across multiple departments and sites. Some vendors therefore try to work more as a data provider as opposed to a full-service provider, enabling access to the required information from their systems for the hospitals own analytics and dashboarding. Others are taking a best-of-breed approach, offering richer and radiology-specific intelligence that far exceeds more broader multi-department analytics.

When developing business intelligence dashboards that pull data from different systems within the enterprise, and obvious challenge that industry and healthcare providers are already very familiar with is interoperability. For this reason, many dashboards from enterprise imaging vendors today are compatible only with their own systems and a small subset of partners and are unable to pull information for example from competitor PACS. However, this is changing, with more vendor neutral solutions coming to market. At the same time, consolidation in clinical IT is becoming more evident; many providers are choosing to consolidate more applications and departments with a single enterprise imaging solution, assuming that by using a single solution, more data will be available for analytics and dashboarding due to easier access to data and fewer customised interoperability solutions required.

Initially this market was dominated by standalone solutions from specialist vendors; however recent acquisitions in the industry means that now practically all solutions are owned by enterprise imaging vendors. For the enterprise imaging vendors, these capabilities offer a competitive advantage and the possibility of tapping into new revenue streams at the senior executive level of hospital leadership. Offering products and professional services to help manage and optimise imaging from an operational and a business management perspective is expected to drive future growth opportunities for the currently stagnant imaging IT market.

Operations and Analytics in a European Context

So, what are the prospects of these solutions entering the European healthcare market? At ECR, it was clear that vendors were adapting their marketing messages to address the unique characteristics of the European market.

Whereas in the US hospital consolidation has been driven by mergers and acquisitions, consolidation has taken place in some parts Europe through the formation of large regional networks, often with large tenders and a single imaging IT vendor within a network following the “one throat to choke” principle. This means that the operational and analytics piece becomes an integrated part of the current offering from the enterprise imaging vendor, and it would be unlikely for a provider network to use a third-party vendor for such solution. As most healthcare systems in Europe are under significant pressure to minimize costs of operation, workflow optimisation and analytics aspect will become an essential part of the value proposition, which means the platform vendors will be required to have this as part of their offering. However, the single-payer nature of many markets in Europe also changes the priority of focus. Care quality measures are a bigger driver in Europe than in the US, which has tended to focus more on financial operational costs so far.

An enterprise imaging setup is often a necessity for being able to offer many of the operational and business intelligence tools discussed above, so we can expect demand to be closely tied to the enterprise imaging maturation in each country. Overall, enterprise imaging is less mature in Europe compared to the US; however, countries with high maturation include Sweden, Denmark, Netherlands and Spain. Other countries with strong hospital consolidation but not currently a high level of enterprise imaging such as Norway and United Kingdom are also expected to see some demand in near future.

EHR is also less widespread in Europe, so dashboards and analytics from EHR vendors will compete less with specialist imaging IT analytics products on the market. This means imaging IT vendors have the opportunity to better shape the market around imaging operations, before developing broader enterprise business intelligence platforms with additional professional services and customisation offerings.

Based on feedback at ECR, we are already starting to see early uptake of these products in Europe. However, with return on investment (ROI) being absolutely essential for such products, vendors with early products in the field will require extensive ROI research to succeed and establish future market demand. That said, a strong presence in local markets with advanced enterprise imaging maturation will be equally important.

About Signify Research

Signify Research is an independent supplier of market intelligence and consultancy to the global healthcare technology industry. Our major coverage areas are Healthcare IT, Medical Imaging and Digital Health. Our clients include technology vendors, healthcare providers and payers, management consultants and investors. Signify Research is headquartered in Cranfield, UK.

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