Two weeks ago, AI analytics platform developer CLEW launched its ICU Conversion and Accelerator programme in the US. The Israeli company says the programme offers customers a ‘first-of-a-kind’ FDA-approved AI algorithm-powered Virtual ICU, an ICU workflow platform, as well as support for healthcare providers to migrate from their legacy Philips eICU systems.
The Signify View
Referencing Philips in the media announcement reflects more the multinational’s almost total dominance of US teleICU than CLEW’s current aspirations to dethrone it. While Philips will inevitably see its 80% market share challenged as health systems upgrade their teleICU systems, the more intriguing battle will unfold among the vendors below it.
With the first FDA-510(k)-cleared Virtual ICU (which uses AI algorithms to predict patient deterioration on hospital wards), along with a new financing approach, CLEW has the tools to disrupt the status quo.
However, its ability to do so ultimately boils down to whether the various elements of the ICU Conversion and Accelerator programme address healthcare providers’ evolving teleICU demands. Our assessment is that the platform can do so.
Healthcare providers explain that any new teleICU solution must integrate seamlessly with existing hospital IT. It must be able to pull information from EHRs, labs, imaging etc. and curate it in so clinicians can view everything they need in one place. Interoperability between different hospital departments and clinical settings is key to this, and will become more important as hospital telehealth deployments move beyond the ICU.
Healthcare providers also say solutions must go further than just monitoring, and build in functionality around predictive analytics so clinicians are better alerted to patients with escalating acuity levels. They also say platforms should be more modular, so that providers can tailor solutions that suit their planned deployments, for example in different countries, and in non-ICU settings.
Addressing the challenge of integration, CLEW says the ICU Conversion and Accelerator programme includes a pre-built ‘integration hub’ that, it claims, significantly reduces the IT resources required to install and maintain the EMR and patient bedside monitoring interfaces. CLEW’s integration hub is already deployed at hospitals using Epic and Cerner EMRs.
Addressing demand for functionality around predictive analytics, CLEW says its FDA-cleared Virtual ICU leverages AI algorithms to predict patient deterioration on hospital wards. The company adds that the platform streamlines workflow to improve communications, decision-making, and care delivery, potentially improving clinical outcomes and lowering cost.
The last point above is important. Faced with unprecedented financial challenges, hospitals and health systems are more cost-sensitive than ever. Any flexible finance model that can reduce operating and implementation costs is attractive, and makes teleICU accessible to smaller hospitals.
Vendors are responding to this, helping customers move from traditional capital expenditure (CapEx) models (usually based on number of beds at deployment) towards operating expense (OpEx) models (where the vendor bears some financial burden for a time after the system is implemented). CLEW says it offers customers ‘minimal upfront capital and operating outlays during the first year’. Other vendors should follow suit.
Philips might be by far the dominant teleICU vendor in the US, and has enjoyed a relatively long period with little competition. However, recent years have seen the number of vendors addressing the market increase. Philips will experience a tougher competitive environment as existing, long-term customers evaluate their next generation requirements, and as new greenfield providers evaluate the broader range of solutions on offer.
The key battleground will, however, be among the relatively short but growing tail of vendors behind Philips. These include iMDsoft, GE Healthcare, Hillrom, Ambient Clinical Analysis, MIC, Epic, Ceiba, Cloud Solutions, Teladoc Health and Amwell. These vendors will feel most compelled to respond to the competitive threat that CLEW’s ICU Conversion and Accelerator Programme provides.
That said, teleICU is evolving. While CLEW can reasonably expect revenue uplift, and some market share gain, from its new programme, new opportunities are opening to all vendors in this space. As such, vendors may adopt a less defensive stance to CLEW’s threat, and instead concentrate on how to capitalise on these new opportunities.
Until now, teleICU has been almost exclusively centred around the ICU (as the name implies). A key demand driver for teleICU solutions was Covid, when inundated hospitals benefitted from remote ‘command centres’ of intensivists and critical care nurses delivering real time information to frontline staff.
But there is now an opportunity for telehealth to move into other hospital settings. These include general wards (where teleICU can be used in conjunction with analytics tools to monitor high risk patients and prioritise treatment for those with escalating conditions to avoid them entering the ICU), EDs, step-down wards and neonatal ICU etc. GE Healthcare, for example, is exploring use cases beyond the ICU, generating interest from hospitals for its Mural platform in labour & delivery, although its number of deployments remains relatively small.
This trend will underpin demand for solutions which rely on predictive AI, but as we have described earlier these solutions must offer much more flexibility and functionality. Providers, departments and even individuals must be able to adapt platform views, and devices and departments will need to be more connected and interoperable than ever. CLEW’s Virtual ICU is one of few products currently on the market that address this.
There is another potential route to market for CLEW. Some teleICU providers just offering monitoring services buy IT from Philips (and other vendors) and then sell monitoring services to hospitals. This is particularly attractive to smaller hospitals that may not be in a position, financially or technically, to deploy their own solution. HiCuity, Equum, Telemedora, Remote ICU, INteleICU and eNext ICU follow this model, and CLEW has already teamed up with Equum to an extent on this. It will be important for CLEW to develop more such relationships to gain share over its rivals.
Brake on Growth?
While its ICU Conversion and Accelerator programme gives CLEW a strong platform, the company is still a small vendor with limited ability to truly scale and disrupt. It will need more funding to serve the migration of more customers from Philips, and also realise its European ambitions. In March 2021 it registered its AI-powered ICU clinical management and support solution for CE approval, ahead of a planned European expansion (its board has historical links to target customers in France, Germany, Italy and Spain). Key to success here will be developing a more modular, bespoke teleICU solution for each country, which will require investment.
CLEW speaks confidently of luring health systems away from Philips’ legacy to its own teleICU platforms. This is easier said than done, with or without additional funding.
CLEW must demonstrate that the ICU Conversion and Accelerator Programme not only delivers new efficiencies and cost savings once deployed, but also that migration causes minimal disruption to existing hospital ICU operations. CLEW’s claims to offer ‘risk free’ migration in just 12 weeks will be put to the test.
The company’s moves in the market are not enough to trouble Philips right now, but are certainly enough to shake up the competitive landscape of US teleICU vendors below it, particularly as they eye the 80% of ICU beds in the US that are not yet monitored with teleICU solutions. While strong revenue growth and market share gains appear to be within CLEW’s grasp, it might not be at the expense of other teleICU vendors, who have their sights set on opportunities beyond the ICU. If CLEW wants to join them, it will need to find a way to scale quickly.