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Signify Premium Insight: Imaging IT and AI Predictions for 2022

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Co-written by Amy Thompson, Dr Sanjay Parekh & Steve Holloway

A new year has arrived. Despite the numerous new releases and innovations throughout 2021, and vendors laying foundations for longer-term technological shifts, vendors enter 2022 under similar circumstances to 2021. A new variant of Covid-19 is sweeping the world, causing disruption to both healthcare services as well as the wider economy. Providers are looking for efficiencies and must find ways to address the enormous and ever-present backlog of patients, while vendors must raise their eyes and continue to deliver on longer term strategies, without neglecting providers’ needs of the moment. Despite this uncertainty, however, there are several key trends and developments we can expect to see in the coming year.

Vendor focus will intensify on structured data aggregation 

Vendors and providers alike are increasingly understanding the potential that clinical data offers healthcare. This is true not only in a singular department such as radiology, where the use of data has, in the past, primarily focused, but throughout the wider clinical workflow, including in preclinical and clinical research, companion diagnostics and precision medicine.

To realise this potential there must first be progress in several other areas. One of the most pressing challenges will be getting standardised and machine-readable data from the radiologist reports and automating the population of the findings into the clinical workflow in the first place. Structured reporting tools will help facilitate this inclusion of standardised diagnostic data into the clinical workflow. Over the course of the coming year, vendors will continue to develop structured reporting technology, either in house, or through partnerships that help lay the foundation for a greater role of data in diagnosis. Further, data management platforms will continue to technically evolve, focusing not only on image management, but broader structured “holistic” data management of images, annotations, reports and clinical documentation.

Federated learning also looks set to be increasingly adopted by vendors. This will enable AI developers to create generalisable AI solutions without the need to host third-party data. As such, federated learning will enable AI developers to leverage healthcare providers’ local data to train their algorithms without that data leaving hospital infrastructure. This means that algorithms can be trained on larger and more diverse datasets that are more representative of local case mix, ensuring that the algorithms have a high sensitivity and specificity.

Thirdly, a host of new partnerships will be made between imaging vendors, healthcare providers and the pre-clinical sector (clinical trials, CRO’s, pharma). Demand for Real World Evidence (RWE) to support a new era of drug-development and companion diagnostics will present new commercial opportunities to leverage the vast datasets held by imaging vendors and providers alike.

 Pathology will play a greater role in medical imaging IT

The longer-term direction of medical imaging IT systems to fully fledged enterprise imaging solutions is well understood, but so far, the number of solutions that have expanded beyond radiology and into other departments is minimal; the combination of radiology and cardiology has been the primary example from vendors when displaying multi-ology functionality. This will begin to change in 2022, with digital pathology becoming a focus area for many vendors and where significant progress will be made.

Digital Pathology is being adopted in three ways: primary diagnosis, supporting pathologists’ primary reading and reporting; secondary use, including clinical consult, tumour boards and medical education; and preclinical use, in research, clinical trials and drug development. Adoption has been ramping up significantly in preclinical use. However, the limited deployment of primary use systems pre-Covid limited the scope for secondary adoption and integration into enterprise imaging.

The advent of the global Covid-19 pandemic has dramatically shifted provider focus. There has been much greater investment in diagnostics and the digitalisation of pathology with the inefficiencies of lab processes highlighted during the pandemic. Furthermore, loosening regulation for primary use in the USA has opened-up the largest market globally, while VC/PE investment in digital pathology reached record levels in 2021.

For imaging vendors, digital pathology will increasingly become a key topic and differentiator in enterprise imaging deals in 2022. For the majority, offering primary use applications will only be tenable via partnership, so we expect to see more deals announced between imaging IT vendors and specialist digital pathology vendors in 2022, following in the wake of announcements such as that of Fujifilm and Inspirata.

Furthermore, we expect to see more focus on bespoke workflow tools that support the use of pathology data and reports in radiology, as well as broader multidisciplinary workflows (e.g., tumour boards and alike). Fundamentally, most healthcare providers in mature markets are still early in terms of primary and secondary use adoption of digital pathology. However, most are looking to leverage existing and future investment in enterprise imaging where possible to deploy an integrated offering that can support access to digital pathology and integrate a primary diagnostic offering. Therefore, vendors must be prepared with a clear roadmap for how to address this need for enterprise imaging capability to support secondary use, while also supporting primary use system integration. With many prominent EI deals due for renewal or tendering in 2022, competency around digital pathology could be a dealmaker or a deal-breaker.

 AI product categories will blur as Imaging IT vendors increasingly control channel

AI is still a very young market within medical imaging. As such, the technology itself as well as its application and use are evolving quickly. Leading AI tools have already progressed from being single point solutions which assess a medical image to identify a single radiological finding, into more complete and more mature solutions which offer greater value to providers. At present these more sophisticated solutions may be categorised into one of three categories, which exist alongside advanced point solutions, such as FFRCT:

– Comprehensive solutions that can identify many findings on an image and make a more meaningful difference to a radiologist’s workflow than single point solutions, whose clinical value is often limited. Additionally, they may pick up secondary or incidental findings that the radiologist may not even be actively looking for, avoiding missed diagnoses.

– End-to-end solutions, which offer care coordination and solve problems along the length of the clinical workflow, adding value beyond the diagnostic slice, for a given clinical condition such as stroke care.

– AI body area suites or workflow packages, typically provided by imaging IT vendors, which curate multiple native and third-party AI tools and other capabilities

These are currently well-defined categories, but over 2022, the distinctions between these groups will become less clear. Comprehensive solutions will begin addressing providers’ requirements outside of the diagnostic portion and expand into care coordination and clinical decision making. Third party platforms and marketplaces will combine more specialist tools from vendors into suites that are able to address many different aspects of a high value use case, by combining several single-use solutions. Workflow packages will expand beyond single use cases, creating greater value solutions for radiologist.

Beyond this evolution of the solutions themselves, however, 2022 will also see imaging IT vendors taking a more central role in the deployment of AI and enabling its broader use. This will see these vendors expand comprehensive solutions to take on an end-to-end approach. In addition to image analysis capabilities, imaging IT vendors could also leverage worklist triage, structured reporting, advanced visualisation and other workflow components in more cohesive packages creating further value for the radiologist.

 AI tools will not be sold on the basis of their technology

Until recently, medical imaging AI solutions have advertised themselves based on their use of machine learning technology and accuracy. However, in a transition that will accelerate and become more prevalent in 2022, the focus will be instead on the clinical advantages of the products. AI developers will, instead of selling a technology, highlight their solution’s ability to solve problems for providers.

Providers are becoming more knowledgeable about AI, and the number of vendors offering AI solutions has increased dramatically over recent years, so highlighting a solution’s machine learning credentials alone is no longer enough to differentiate a product in the market. Instead, vendors are having to highlight the overall value they can bring to a provider. This is a challenging task in many cases, especially as many providers currently do a poor job of measuring clinical and diagnostic outcomes accurately.

This has been seen already in stroke care, for example, where some vendors have moved away from touting the technical performance of their stroke detection algorithm, and instead positioned themselves as stroke care vendors by creating a care coordination platform, emphasising their capability across the entire stroke care pathway. Crucially, the importance of the technical specifics of these stroke care vendors’ algorithms have been displaced by a metric that providers are much more interested in; a solution’s ability to deliver the best outcomes for patients.

This trend will gather pace over 2022 and will be prevalent across acute (e.g., pulmonary embolism) and chronic (e.g., oncology) use cases. While algorithm developers will be keen to show that they are able to integrate into medical imaging departments with more thorough solutions, other companies such as marketplace and platform providers will also look to better meet providers’ needs. This need to offer solutions that solve vendors’ problems mean that partnerships continue to proliferate as AI vendors are too small or too specialist to offer the broader clinical capability to providers look to partner to bolster their value proposition.

Operational workflow’s importance will only grow and increasingly influence business models

There were several releases of operational workflow tools in 2021 as imaging IT vendors sought solutions that could improve the efficiency of their customers. These vendors have focused on developing solutions which grant providers better oversight of the operation of their medical imaging departments, their radiologists, and their fleets of medical imaging equipment. The continuing development of these solutions will allow these providers to attend to more patients and more precisely manage their patient’s care pathways.

The development and inclusion of these tools are, in the longer term, also set to give providers better oversight of their departments and generate data about their operation, which will lead to better planning capability, and improve their ability to strategise. This will become particularly important as acute providers utilise teleradiology or outpatient imaging centres for additional reading, or as provider networks grow through M&A activity and visibility over multiple sites is required.

To make the most of this demand for operational tools from providers, vendors will focus on ensuring their solutions are, for the most part at least, vendor agnostic. This will enable these vendors to sell their solutions into any provider, regardless of which other imaging IT systems they use, and grant the vendor an entry point into providers served by competitors. However, the incumbent imaging IT vendor is still best placed to offer providers the richest feature set, making it the most likely to be chosen by providers.

The importance of such solutions will be highlighted in 2022, but different vendors will take different approaches. Vendors which specialise in imaging IT and are targeting the development of enterprise imaging systems will focus on worklists, triage and departmental or operational analytics, while the vendors which also offer hardware will ensure that the use of their modalities, particularly those that are more time consuming such as MR and CT, can be optimised and departments can maximise the use of their resources. These vendors will look to hone functionality such as virtual image acquisition, automatic patient position and protocol efficiency.

The intensified focus on workflow will also present more opportunities for layering on professional services to operational workflow deals, placing vendor specialists within a provider organisation to support improving operational efficiency and workflow evolution. This will be the first step towards tighter vendor-provider relationships and the advent of contracting and business models based on specific performance indicators and operational targets. While a significant risk for the vendor, providers are already coming round to “performance” focused contracting, thereby ensuring a level of service and operational competency while de-risking capital investment. Therefore, providing analytics and workflow tools that identify inefficiency within radiology service-lines will no longer be enough, providers will expect their vendor partners to help solve these problems and support more efficiency care delivery.

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Signify Premium Insight: Signify Premium Insights’ 2021 Predictions – The Results

This Insight is part of your subscription to Signify Premium Insights – Medical Imaging. This content is only available to individuals with an active account for this paid-for service and is the copyright of Signify Research. Content cannot be shared or distributed to non-subscribers or other third parties without express written consent from Signify Research. To view other recent Premium Insights that are part of the service please click here.

At the very start of this year, Signify Research’s analysts assembled to pick the key threads out of the turbulence of 2020 and use them to discern the forces that would shape medical imaging in 2021. Here we revisit the predictions made about the Imaging IT, AI and Modality markets, and assess how clear the crystal ball really was.

Imaging IT and AI Markets

There will be limited releases of advanced clinical and diagnostic tools in 2021

Score: 8/10

This prediction was, with a few exceptions, very accurate. Throughout the year there were only very limited releases of imaging IT solutions that were truly new. Instead, 2021 was for most vendors a year of introspection and refinement. Several hugely impactful technological shifts are on the near horizon, with meaningful AI, cloud adoption and true enterprise-wide imaging IT, but Imaging IT vendors must first prepare their systems for such tectonic changes. While these longer-term goals were being developed in the background, the releases that saw the light of day in 2021 were those focused around workflow and operational efficiency.

There were a handful of high-profile releases, with GE Healthcare’s TruePacs, IBM Watson Health’s AI and Workflow Orchestrator platforms, Change Healthcare’s Stratus Imaging and Nuance’s Precision Imaging Network the standouts. However, in keeping with vendor’s priorities of preparing for the future, several vendors instead shared strategic plans for significant platform releases, and laid out their roadmaps towards these longer-term goals. As such most releases added additional functionality to existing systems or represented vendors catching up with their peers.

Overall, 2021 was, in essence, predominately a year of stage setting, ahead of the real show in the coming years

RSNA 2021 will herald the recovery of clinical and diagnostic innovation

Score: 6/10

This prediction painted an optimistic picture in which Covid-19’s role at the centre of medical imaging and healthcare in general would fade throughout the year. Vendors and providers alike would therefore be able to increasingly devote their resources to technological innovation, vendors would arrive at RSNA 2021 bristling with innovative leaps and providers, who had been holding off making purchases until they saw these new products, would arrive in Chicago ready to buy.

The reality was somewhat different. RSNA 2021 was smaller than previous years’ meetings with both fewer attendees and fewer exhibitors. There were some innovative new solutions on display, but, as predicted many of these had already been given soft launches earlier in the year, with the likes of Sirona Medical, Paxera Health and Change Healthcare all demonstrating products that had broken away from the traditional show-based release cycle.

At RSNA 2021, surprises, one of the clearest indicators of innovation, were few and far between. However, the foundations of innovative new products were being built, with quiet conversations taking place amongst vendors, heralding the formation of partnerships, between vendors and providers as AI developers and others look to forge ahead with pilot and clinical validation studies. The buds of innovation were quietly growing, even if the blossom was not yet on display.

Structured reporting will gain further traction in 2021

Score: 10/10

This is exactly what happened throughout 2021. While structured reporting isn’t yet universal or essential, the number of developments made in this direction are hard to ignore. From Agfa Healthcare’s release of its Precision Reporting tool, Smart Reporting’s marquee agreements with GE and Siemens to Blackford Analysis’ integration into the 3M Modal Fluency Direct reporting tool. This latter example is particularly significant as the integration of AI into a reporting solution not only exemplifies the strides structured reporting has made this year, but also places the two highly complimentary technologies together, allowing each to bolster the other and therefore help drive the adoption of both.

Structured reporting will only become more important. As AI becomes ever more significant, diagnostic data will become key, and this is what structured reporting unlocks.

This progress doesn’t mean there is no more work to be done, structured reporting isn’t yet the competitive differentiator it is set to become, and it isn’t yet a mainstay of dedicated premium offerings, as it will be. Perfecting structured reporting is difficult, doubly so when considering its clinical integration and deployment, but the corner feels like it has been turned and momentum is building. This is true both of the releases that have been made over the year, as well as the subtler anecdotal examples, with many vendors who have not yet made announcements working hard away from the limelight to bring the technology to bear.

As predicted, for many 2021 will have been the year that saw structured reporting move from longer-term strategy to current objective.

There will be consolidation in the AI market

Score: 2/10

This prediction fundamentally rested on the assumption that the medical imaging AI market, which at present is worth only several hundred million dollars, was too small to support the hundreds of developers trying to capitalise on the space. This assumption was true in and of itself but underestimated the continued appetite among VC investors to artificially support the market until revenues increased. This was particularly true in some parts of the world, with investors in several countries including China and South Korea keen to continue investing in their country’s young AI outfits.

Many vendors did recognise that success would be difficult to achieve alone, and that they would struggle against more established and better funded competitors, but instead of becoming acquisition targets, some of these vendors forged partnerships with other AI vendors, or indeed became targets for partnerships, allowing multiple vendors to combine their capabilities in a bid to create a more attractive package for providers.

It could be inferred that some vendors did have to make difficult financial decisions. One of the only major examples of consolidation saw Zebra Medical Vision bought by the challenger modality vendor Nanox. As highlighted at the time, Zebra had not secured any VC funding in several years and an acquisition from Nanox, a vendor rich in cash after its 2020 IPO, could have represented something of a lifeline for the Israeli developer. Aside from this, however, M&A activity was limited.

This consolidation is expected in the future, but amid the continuing Covid-19 volatility, healthcare represents a relatively safe haven for investment. Whilst ever this investment is forthcoming, the majority of this consolidation can be staved off.

The Imaging IT market appears relatively robust in the face of Covid-19

Score: 8/10

The difficulties faced by many medical imaging IT vendors throughout 2020’s covid related disruption meant that when this prediction was made the future was very uncertain. The cancellation of countless lucrative elective procedures as well as the swift reprioritisation of budgets at providers meant that for a spell, the outlook for 2021 looked bleak.

As highlighted in the original prediction, Imaging IT’s recurring service-based revenues and the additional Covid funding was expected to be enough to support the market throughout 2021.

However, while all these elements rang true, the prediction was too conservative, and, as illustrated in the chart below, the overall market is forecast to perform more strongly than originally anticipated; largely bolstered by the recovery of mature imaging IT markets. Upsell of home reporting, universal viewing, workflow tools and professional services further also buoyed the market.

The above compares annual growth for the global imaging IT market (inclusive of radiology IT, cardiology IT and advanced visualisation IT). Data points are from: Signify’s original 2020-2024 forecast (pre-covid); the COVID scenario analysis conducted in January 2021 which provided interim guidance on perceived best case / worst case scenarios for the imaging IT market; from the latest Imaging IT Core Report, published August 2021, we’ve included the 2020 actual market numbers and 2021-2024 forecast.

 

Modality Markets

Expanded access to medical imaging

Score: 9/10

This prediction proved to be one of the major trends in medical imaging modalities throughout the year, with many different vendors across different modalities being represented. In ultrasound, and particularly handheld ultrasound where this path has been trod for the last few years there was a major new product release from GE, as well as progress from a growing cohort of challenger vendors. Butterfly Network, which leads this pack, completed its IPO deal earlier in the year, while a number of other handheld players, including, Clarius, Vave, Exo, EchoNous, Pulsenmore, and more were all represented.

This trend was far broader than handheld ultrasound, however. MRI and CT saw progress from the likes of Siemens Healthineers and Philips which both launched MRI systems that enable the modality to be adopted in new clinical settings, through developments such as lower cost, lighter systems, easier to install, and the lack of requirement for helium refills. There were several new mobile X-ray systems launched or teased, including those from GE and Konica Minolta, reinforcing the growth opportunity of this product segment not only in developed countries, but to provide access to imaging in emerging countries. In addition, younger, challenger vendors such as Hyperfine, Turner Imaging and Nanox, also made headlines, although their progress in the market is harder to ascertain.

More broadly, outpatient sites are also playing a larger role in medical imaging, this transition is further expanding access to medical imaging, with many patients now able to access many scan types closer to their homes and places of business than in the past.

AI-enabled imaging acquisition

Score: 9/10

This is another prediction that resolutely came to fruition in 2021. The clearest illustration of this trend was at RSNA, which saw AI image acquisition and quality control solutions form a key part of many of the hardware launches and demonstrations at the conference. These were on both the workflow side with AI-powered automatic positioning and auto-protocolling systems that help improve the efficiency of imaging departments and minimise the need for rescans. There was also a prevalence of AI-enabled image acquisition and enhancement offerings, with AI tools significantly reducing the time it takes to conduct scans, effectively making these modalities more efficient and less resource intensive to use, and therefore enabling them to increasingly be used in non-traditional settings, as per the above prediction. Ultimately, these tools have quickly gone from being an innovative new feature to an essential tool, with any vendor neglecting them looking increasingly outgunned. Within the X-ray market, AI enabled camera-based workflows are also driving this initiative.

There were also other illustrations of this prediction. In the summer Butterfly Network and Caption Health partnered to enable the latter’s AI-guidance tool to be used on the former’s handheld ultrasound devices.

The original prediction did suggest that AI developers offering acquisition and enhancement solutions could be acquisition targets for large modality vendors. While this hasn’t come to pass, all other aspects of the prediction did.

Extracting value will be key

Score: 6/10

The importance of value was clear in 2021. In acknowledgment of the tighter financial circumstances that many providers found themselves in as a result of Covid 19, vendors were keen to promote their more affordable performance systems and help solve providers everyday challenges. In addition to promoting these systems, vendors also worked to expand the feature sets of these lower-tiered systems, while also in some cases moving to smart contracts which enable older systems to be regularly updated with the latest features, keeping them current and allowing providers to gain maximum utility of the systems. Within the MRI market, GE Healthcare’s ARTIS EVO enables bore size to be upgraded without the need for reinstallation, increasing longevity of the system.

This also went hand in hand with the increased focus on workflow efficiency throughout the year, as providers were often forced to attend to more patients with fewer resources.

This shift hasn’t been as dramatic as expected, however. Covid relief funding has continued to support providers’ purchasing of higher-end systems. In fact, for some modalities such as ultrasound, it has actually been the higher-end products driving growth in some regions. This has also enabled providers to continue to purchase from vendors they have had long-time relationships with, and therefore not given the opening to cheaper Asian vendors as originally expected.

Value was and will always be important to providers, but their spending has been more robust than originally predicted.

Shared service systems will increase in uptake

Score: 8/10

This prediction was mostly accurate. While there were no single key moments highlighting the development of this trend, a number of releases throughout the year indicated its steady growth.

In ultrasound, where the trend has perhaps been building the longest, several new products were released, including Samsung’s new V8 ultrasound and Esaote’s new MyLab X75 ultrasound, which can both be used as shared service systems. Shared service was also developing in other modalities. Siemens Healthineers announced its first install of its Luminos Lotus Max Fluoroscopy/Radiography system, while Fujifilm’s newly revealed mobile C-arm also offers DR functionality.

The growing prevalence of these shared service systems is, in many cases hindering the uptake of dedicated systems, even if on paper they can claim some advantages. As vendors and providers are increasingly entering into broader purchasing arrangements, and purchasing decisions are being made higher up within a provider, these shared service machines can represent better value, and therefore look to be an increasingly attractive option.

AR will gain traction in surgical rooms

Score: 2/10

While augmented reality remains an interesting technology which harbours significant potential for surgical rooms, for the most part, it hasn’t moved on since this prediction was made a year ago. This is understandable. As hospitals have reopened after the worst of the coronavirus restrictions in 2020 and early 2021, they have had to deal with an unprecedented backlog of postponed elective procedures. This influx of patients has absorbed the attention of providers and left little resource or desire to experiment with incorporating advanced technologies which may not bring tangible benefits immediately.

Although progress has been minimal over 2021, there have been some developments that do suggest interest in the technology will continue to grow over time. Most recently, Philips expanded its ClarifEye augmented reality surgical navigation solution to two new international sites, in Oman and Spain, with successful clinical outcomes.

AR will come to surgical rooms, but that tipping point didn’t come in 2021.

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Signify Premium Insight: Intermountain Subsidiary Leaves Hospitals Behind

This Insight is part of your subscription to Signify Premium Insights – Medical Imaging. This content is only available to individuals with an active account for this paid-for service and is the copyright of Signify Research. Content cannot be shared or distributed to non-subscribers or other third parties without express written consent from Signify Research. To view other recent Premium Insights that are part of the service please click here.

Amid growing pricing pressure on medical imaging in the US, Intermountain Healthcare recently announced it is launching an outpatient imaging subsidiary under the Tellica Imaging brand name. The first three locations of the new chain of standalone outpatient imaging centres are set to open in late 2021, with five more set to follow in 2022.

As well as operating under a new brand name, the outpatient imaging centres will also offer MRI and CT scans at flat-rate prices which are lower than the same imaging exams in a hospital-based setting.

The Signify View

Some types of imaging examinations will always need to be performed in hospitals. The nature of emergency or interventional imaging, for example, negates the possibility of it being performed elsewhere. For many non-emergency diagnostic imaging exams, however, there is a growing trend for some exams which would typically have been performed in a hospital, to increasingly be taken on by outpatient imaging centres.

The Covid 19 pandemic has been one factor in this shift, with providers trying to keep patients out of hospitals wherever possible in order to minimise their potential exposure to the coronavirus. However, in a bid to rein in healthcare spending in the US, payors have also been increasingly pushing their customers towards outpatient imaging centres, where the cost of imaging exams can be significantly less than in a hospital setting.

More broadly, changes to reimbursement brought about in the latest fee schedule from the Centers for Medicare and Medicaid Services (CMS) is also set to alter the complexion of the medical imaging market. There is a growing body of evidence that suggests the changes brought about in the fee schedule are going to affect single site imaging centres most severely. These smaller independents will therefore find it increasingly difficult to compete with the larger outpatient imaging networks, which can leverage the economies of scale to be more aggressive on pricing. This is one of the factors driving consolidation in the outpatient medical imaging market, which, to an ever-greater degree, is being dominated by large outpatient networks.

An Equal Fight

Hospital groups will be loath to lose business to these imaging groups, and so, in Intermountain’s case, establishing an outpatient network of its own makes a lot of sense. The newly formed Tellica will be able to compete for outpatient imaging business on an equal footing with the other outpatient networks. It will, like its competitors, be able to offer lower cost imaging than in Intermountain’s hospitals.

Payers in the broader market have also played a substantial shift towards outpatient imaging focus, with a number, such as Anthem and UnitedHealthcare, now refusing coverage for non-emergency hospital-based imaging, such is the current discrepancy in price between in-hospital and outpatient-based imaging.

There are many reasons for the discrepancy. Outpatient groups can focus solely on imaging, so are able to tailor their services to efficiently addressing less complex, higher volume imaging exams. In contrast, hospitals must maintain the ability to conduct a broader array of exams and more advanced scans, even if it means purchasing more expensive equipment that is infrequently used and facing the additional staffing costs that comes with more specialised doctors.

Tellica’s spending can also be more focused. The provider will not, in most cases, have to stretch to purchasing the most premium specialised imaging equipment, and instead invest in imaging solutions that can expedite its workflow and enable it to attend to patients more efficiently. Increasing volume and capacity of imaging can also offset the lower reimbursement rate per scan, while also creating opportunity for the health system to bring in new patients. The deployment of AI tools in the outpatient setting may also have a material impact in terms of efficiency and care quality for the provider given its much more myopic focus, with the outpatient setting expected to experience faster adoption of AI versus the hospital setting.

More, and More Affordable

The effects of this shift to outpatient imaging will ripple out across the medical imaging sector. Modality vendors are likely to see an overall increase in the volume of medical imaging equipment being sold. However, this will be balanced by a fall in the premium models as hospitals, which typically purchase the more advanced products, will require fewer systems. Conversely, there is set to be an increase in mid-range ‘workhorse’ models, which will, in most cases, be an outpatient centre’s preference. As such, the market average selling price of systems will fall. This change in the complexion of the market could also see sales leak from premium international vendors, to other cost-competitive vendors, such as United Imaging, which may not be able to compete in the upper echelons of the imaging market but are competitive in the mid-range and keen on pricing. This will move the focus away from top end features, forcing vendors to highlight the fundamental value and efficiency of their systems more clearly.

These changes are also set to have an impact in the imaging IT market. Providers such as Tellica, which grew out of a hospital network, will likely become license extensions opportunities of the  original hospital network’s imaging IT system, utilising the same vendors and the same solutions. This may give the likes of Tellica an advantage from a deal size perspective, enabling them to take advantage of their larger buying power.

There are still some benefits unique to specialist outpatient imaging networks. The opportunity for imaging IT amongst these newly formed networks, is from their nimble structure, allowing them to be reactive to shifts in the market quicker than larger hospitals. In a similar vein these providers are also typically more innovative in adopting new technology, due to the drive for efficiency to remain competitive and profitable. These growing outpatient imaging networks  are therefore likely to be among the first providers to take advantage of informatics vendor’s efficiency-focused products. This could be particularly true as products are increasingly tailored to address the needs of outpatient imaging providers, such as GE’s recently released TruePACS system, for example.

Scale and Efficiency

Intermountain’s launching of Tellica fundamentally represents a hospital network responding to the changing tides in the medical imaging market, and effectively cutting its pricing in the outpatient space to maintain competitiveness. Intermountain is not the first to make such a move but it does highlight the increasing interest in the space. As this interest in outpatient imaging centres grows and more providers look to compete in the space, prices will continue to fall, and margins will  tighten. This will ensure consolidation continues, with it becoming increasingly unfeasible for small independent imaging centres to thrive given they will be unable to capitalise on economies of scale or take advantage of larger, network-wide plays to adopt tools to drive efficiency forwards.

Resultantly, smaller imaging IT vendors will also find it more difficult to compete. Many of their customers are the smaller, independent outpatient imaging providers; as these are replaced by larger outpatient networks with much larger and complex network-wide deals, some of these smaller imaging IT vendors could falter.

Intermountain’s creation of Tellica shows it is willing to adapt to a changing market. It has entered an increasingly competitive and rapidly consolidating space and is hoping to go toe-to-toe with some of fastest growing providers in medical imaging. It can utilise its broader buying power, and the nimbleness that a new brand affords, but key to this success will also be its ability to scale rapidly. The outpatient imaging market is one where scale and efficiency bring success. If Intermountain’s Tellica can achieve both, then it has a strong future ahead.

 

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This Insight is part of your subscription to Signify Premium Insights – Medical Imaging. This content is only available to individuals with an active account for this paid-for service and is the copyright of Signify Research. Content cannot be shared or distributed to non-subscribers or other third parties without express written consent from Signify Research. To view other recent Premium Insights that are part of the service please click here