Tag Archives: enterprise imaging

Signify Premium Insight: What Intelerad Hopes to Make with Life Image Acquisition

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Intelerad has continued its streak of acquisitions by buying up medical image exchange vendor Life Image. The move, along with its previous acquisition of another image exchange vendor Ambra in Autumn 2021, means the enterprise imaging vendor has now combined two of the top three competitors in image exchange, and has given itself a clear market leadership position.

Intelerad hopes that the acquisition will enable the vendor to capitalise on the interoperability focus of the 21st Century Cures Act in the US and should help providers more easily share images across their networks, preventing information sharing bottlenecks and use of legacy processes such as burning CDs. Given Intelerad’s recent run of acquisitions and the integration that they require, is adding another company into the mix really the best use of the company’s resources?

The Signify View

As detailed in several previous Premium Insights, since Hg Capital took a majority holding in Intelerad in February 2020, the imaging IT vendor has sought to expand its capability, and secure market share by making a succession of acquisitions. These have included a variety of companies, including cardiovascular information systems vendor LumedX, image management platform provider Digisonics, UK based enterprise imaging company Insignia, mammography screening management software vendor PenRad and several others. By making these acquisitions, Intelerad has not only been able to grow its position in the market, but it is assembling the capabilities it requires to create a cloud-based multi-ology enterprise imaging platform.

One of the acquisitions to pave the way for this ambition was Ambra, a deal which not only netted Intelerad a growing, profitable business, but also helped to round out Intelerad’s radiology offering, bringing cloud-based PACS, image exchange and VNA to its platform. Further, by buying a vendor offering such capability, Intelerad acquired a toolset that can help bring together its other disparate acquisitions into a cohesive whole.

The latest acquisition, of Life Image, builds on this momentum. It adds another, larger, successful image exchange business to the vendor’s portfolio, cements Intelerad as the market leader in image exchange in the US and adds further tools that will help Intelerad integrate its host of acquired companies.

A Question of Acute

Life Image also opens new sales opportunities for Intelerad. The enterprise imaging vendor’s customer base is heavily weighted toward the outpatient radiology segment. While this is a lucrative and growing market, it is also one that is increasingly being targeted by major international vendors with companies such as GE HealthCare and Change Healthcare, amongst others, harbouring designs on the segment.

Life Image, on the other hand, is primarily focused on larger provider networks, and academic institutions. Flourishing in this market has, so far, proved somewhat difficult for Intelerad, so the vendor will look to utilise Life Image’s installed base and network of contacts to aid in its growth of the large, lucrative mainstream acute market, including the government health sector. This is especially true given the vendor agnostic nature of image exchange systems. For a hospital to adopt image exchange from Life Image, there is no requirement that it sever ties with its current image IT vendor and enter into a new partnership with Intelerad. Life Image’s image exchange could therefore not only prove to be attractive as a standalone product, but allows Intelerad a ‘seat at the table’ when providers look to update existing imaging IT systems. This opportunity can be enhanced by the intelligence Life Images’ platform can provide on incumbent imaging IT vendors volume and performance, offering Intelerad useful insights with which to tailor their own sales pitches when contracts come up for renewal.

This isn’t Intelerad’s first attempt at targeting the acute sector, with its previous acquisition of LumedX an earlier strategy for gaining ground in the market. However, the fact that Intelerad is continuing to target the acute sector with Life Image highlights the importance of the acute market .

Additionally, Life Image, as well as Ambra, to a certain extent, are also well placed to make progress in the market thanks to recent changes in policy, with the 21st Century Cures Act requiring providers to be able to provide patients with their medical imaging data. This initially focuses on general health data and medical history, but, over time will increasingly address all kinds of data, including medical images. As the ability to share images becomes a necessity for providers, Intelerad, given its ownership of Ambra and now Life Image, two of the three largest vendors in the image exchange space in the US, finds itself in a position which appears increasingly promising.

Real World Advantages

Beyond offering opportunities for increased sales of Intelerad products within the acute space, the acquisition of Life Image also builds on another revenue stream. With the access to the range of medical imaging data that it brings, even if Intelerad doesn’t itself own the images, the enterprise imaging vendor can better position itself to serve hospitals and customers through the establishment of a real-world data platform.

The growing importance of health data, including medical imaging cannot data be understated, and hospitals are increasingly aware of the value of that data. The acquisition of Life Image allows Intelerad to further tap into the value of this data, as customers from areas such as pharmaceuticals turn to this data to improve the efficiency of drug discovery, for example. While the true value of Life Image will take some time to realise in this regard, given the nascency of the market, the fact that Intelerad is already preparing for such opportunities places it ahead of the curve compared to most of its direct competitors.

Making a Whole

The picture isn’t universally rosy, however. While the acquisition of Life Image is no doubt a sensible move, and invariably will have been somewhat opportunistic, it doesn’t solve Intelerad’s fundamental problem, deriving value from its long list of acquisitions greater than the sum of the constituent parts.

There are also some gaps in Intelerad’s lineup. The vendor, does, for instance, harbour some AV capability, but, in lacking a fully-featured in-house solution, relinquishes some control. The same is true of AI, with a partnership with Blackford Analysis bringing machine learning tools to Intelerad’s customers, but again, offering less control than an equivalent platform owned by Intelerad. Furthermore, those companies that have so far been acquired continue to effectively sit as a ‘house of brands’ rather than a single cohesive whole.

This is understandable, the integration of such a range of capabilities into one holistic platform is no trivial task. However, the imaging IT market is slow moving, with opportunities to tender for contracts and displace incumbents few and far between. To stand a chance of securing such deals, the vendor does not need to have a fully-integrated cloud-based system ready to deploy right away, but it should at least offer potential customers an outline of its plans. Even simply offering a roadmap would help the vendor give confidence to providers attracted to the potential offered by Intelerad’s acquisitions, but hesitant to commit to the company’s system.

This guidance for customers and potential customers should be among Intelerad’s priorities for RSNA. There will likely be some outline for existent customer and key targets already being quietly shared behind closed doors. But, by committing to a roadmap at the industry’s largest event, promoting its vision and building momentum for its upcoming integrated solution, Intelerad can ensure that the acquisition of Life Image adds not just a strongly performing company to its already impressive roster, but, adds a toolset that can help with a much larger ambition.

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Signify Premium Insight: Sectra Believes Future Success Lies in its Genes

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Last month, Sectra revealed that it is launching a new business unit to drive innovation and develop new products within the area of genomics. The Swedish enterprise imaging vendor will, in the future, extend the capability of its diagnostic platform to integrate genetic information. This multidisciplinary approach, the vendor hopes, will enable improvements in cancer care and increasingly allow providers to deliver on the promise of precision medicine.

Sectra also announced a collaboration with the University of Pennsylvania Health System, a partnership initiated to facilitate the vendor’s development of an effective clinical IT solution for the new unit.

The Signify View

Healthcare technology vendors have, for several years, discussed the benefits that precision medicine will be able to offer. Those in the industry have promised more personalised care, enabling doctors to make better decisions about treatments, ensuring they are optimised for individuals and ultimately promising better outcomes for patients.

All too frequently, however, such ambition has resulted in precious little material benefit, with precision medicine, for the most part, remaining an ambition rather than a reality. Sectra’s new initiative in genomics aims to address this shortcoming, and improve the discipline’s utility in clinical care. By adding another layer of clinical information into a provider’s enterprise imaging platform, and enabling genomic data to be used alongside radiology and pathology, Sectra hopes to improve diagnosis and treatment of complex diseases, including, as one of the first focuses of the advancement, cancer.

This has been an expected direction of the market for some time, and was highlighted as one of the upcoming areas set to be integrated into enterprise imaging in Signify’s Imaging IT Core Report – 2021:

Sectra is among the earliest vendors to commit to such integration, although others do also note their longer-term interest in the space, harbour isolated sequencing platforms or have made moves on the research, rather than clinical use cases. For Sectra, this grants a potential early advantage in the clinical market, which it hopes to capitalise on as it has done in digital pathology; an area which it has already successfully integrated into its EI platform.

Experiential Experimentation

To make this integration useful, however, will not be easy. Unlike many other adjacent areas which have been integrated into EI solutions, many providers have no legacy of utilising genomic data alongside medical images. As such it would be easy for Sectra to focus on less important genomic information, or attempt to integrate too much  genomic data, resulting in an abundance of erroneous information and a subsequent slowing of diagnosis. For this reason, the Swedish vendor’s partnership with Pennsylvania State Hospital is sensible. It offers the opportunity for Sectra to take guidance from a top academic hospital and refine its solution accordingly.

This is in addition to the considerable technical barriers that any enterprise-wide genomics implementation will present. Chief among these is the sheer volume of data created by genome sequencing, with each human genome sequenced approximately 120GB, orders of magnitudes higher than other types of medical image. As highlighted in several past Insights, imaging IT systems will, over time, shift to the cloud, so it makes sense that a new business unit established by Sectra is cloud-native from the outset, but this also offers considerable challenges. Aside from the cost of storing such a potentially enormous volume of data, the vendor will have to develop an effective strategy for managing this data.

In typical cloud deployments, Sectra works in partnership with public cloud vendors which host the data, while the Linköping-based company manages the service element of the deployment. For genomics, Sectra will need to work with both the providers and public cloud vendors to ensure the cost-effective management of storage, discovering which parts of genomic sequences need to be accessed regularly and therefore benefit from the more-costly “hot storage”, and which sections can be relegated to cheaper “cold” or “glacial storage”.

The work Sectra is doing with Penn State University will help inform this process, but the inexperience of both Sectra, and providers themselves, will make effective implementation of genomics data into EI workflows challenging, not to mention the overall burden such an implementation can place in terms of network infrastructure and load on the broader performance of the network.

Time to Grow

Fortunately for Sectra, these challenges do not need to be dealt with immediately. The integration of genomics into enterprise imaging platforms is, most likely, several years away from a commercial launch, so the vendor has time to work with Penn State University and any other partners it may make to refine the service.

Sectra would also be wise to take a sensible approach with regards to not over committing itself. When integrating other areas such as digital pathology into its enterprise imaging platform, Sectra was careful to focus on areas in which it harboured expertise, focusing on the viewer and the ability to visualise pathology slides alongside radiology imagery for effective collaboration. They, in essence, focused on developing the architecture which allowed the vendor to bring in pathology data and enable doctors to usefully interact with it, rather than focusing on the minutiae that other, niche best of breed vendors are likely better equipped to manage.

A similar approach is likely to be taken in genomics. Sectra will allow specialists to provide the research foundation that underlies the value in utilising genomic sequences in patient care, while itself providing the architecture for that foundation to be leveraged in a clinical setting alongside medical images and other sources of diagnostic information.

In such a way, Sectra will be able to expedite the commercialisation of its genomics products. This could help the vendor win mindshare and, ultimately, custom at leading academic and research hospitals. For these sites, genomic integration will not, at present be a deal breaker. But, given the length of medical imaging IT contracts, and the lengthy development processes effective integrations can take, Sectra’s early move and public road mapping could appeal to leading providers as they begin to consider their approach to the inevitable adoption of genomics.

When Delivery is Due

Over time, depending how efficiently other enterprise imaging vendors can develop and commercialise their solutions, a similar impact could be felt at more mainstream hospitals and provider networks, as they themselves begin to consider their options. Now Sectra has launched an opening salvo, other vendors who don’t want to fall behind must react. They do not need to develop solutions immediately, but they should at least begin to convey their plans to their customers, giving providers the confidence that when genomic integration is more mature, their chosen vendor will be ready to deliver.

In the meantime, Sectra must be careful to avoid spreading itself too thinly. Targeting cutting-edge segments and working with prestigious academics gains mindshare and helps reinforce claims of technical prowess, but the vendor must not take its eye off more lucrative deals. Opportunities to displace rivals are few and far between in imaging IT, so the vendor would be loathe to miss a lucrative contract with a large provider for the sake of a development project. Moreover, on the tail of some big marquee wins for EI that are going through implementation and additional phases of go-live, Sectra does not want to risk damaging its reputation for strong client service and support.

That aside, the move represents a sensible strategy for Sectra. The vendor is, and will become increasingly, disadvantaged compared to some of its larger peers due to the limitations of only offering software, as managed service deals including modality hardware proliferate. By innovating in adjacent areas, Sectra is somewhat able to offset this, claiming for itself more significant mindshare, and market share than it might otherwise warrant. There are challenges, as an early mover. Sectra doesn’t have the benefit of learning from another’s mistakes as will help other vendors in the future, and the returns on its move will not be enjoyed for several years to come, but, by helping to bring the abstract into the concrete, the Swedish company has now laid for itself a clear path to follow.

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Signify Premium Insight: Making Plans for Pathology

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One of the motivations providers have for increasingly looking to adopt enterprise imaging solutions is to bring disparate departments together. For some vendors, this requirement means venturing into departments that they previously had no exposure to. Sometimes these transitions are relatively straightforward, with departments already meeting the criteria necessary for a shift to enterprise imaging. In other cases, however, the challenge is far more substantive. In pathology, for example, the general lack of digitisation, the poorly defined return on investment, and the nascency of the technology means the integration challenges facing vendors are very significant. However, some vendors are finding ways to rise to the occasion, with the potential rewards providing significant motivation.

The Signify View

Interest in digital pathology has been steadily increasing over the last decade. Some countries, such as the Netherlands, have wholeheartedly embraced the technology, while others, such as the US have been far more hesitant in their rollout. What many of these countries needed was a catalyst to hasten adoption.

Such a prompt came in the form of the Covid-19 pandemic in 2020, which highlighted the disparity in digitalisation between digital pathology and other departments. Many radiologists in mature markets, for instance, were able to work at home almost immediately thanks to the near complete digitisation of their field. Pathologists, meanwhile, had to continue to travel to hospitals, despite restrictions and the spread of Covid. This gave impetus to plans to digitise pathology labs and finally tackle the challenges that had been holding back the market’s progress.

These challenges are not insignificant. Digital pathology’s lack of standardisation makes it difficult for providers to invest heavily in both hardware and software, for fear that their investments will become obsolete as standards change or that they would not be able to take advantage of improved products from other vendors. Another hurdle is the size of the images produced, with files of 2 GB – 15 GB depending on the magnification, far higher than radiology images, which range between 0.02 GB and 0.05 GB for an X-ray, to 0.5 GB – 3 GB for a CT scan, for example. Whether stored in on-site servers, or in private or public clouds, this represents a significant cost that must be shouldered.

Return to Basics

A more fundamental challenge, however, lies in demonstrating the return on investment. When a hospital shifted X-ray imaging to digital radiology, it was able to demonstrate a clear cost saving given the X-ray film processing consumables were no longer needed. This is not the case in pathology, where providers will continue to face the costs of producing a slide as before, but, in addition, will also face the cost of expensive hardware, expensive software and image storage and transfer.

Digital pathology does offer opportunities for cost savings, but these are often poorly defined. For example, downstream care pathways benefit from ready access to images for clinical review (tumour board setting), while secondary consult and peer review is more flexible and efficient with digitalisation. Furthermore, the need for transport of glass slides is reduced and with flexible digital storage models, long-term archiving of glass slides can be reduced or made redundant. However, many of these benefits are hard to measure within conventional working practices, leading to tentative adoption.

Perhaps the greatest saving with digitalisation relates to many healthcare providers’ most prized and increasingly rare assets – its pathologists. Pathologists are in short supply, and digital workflow software and new AI tools which can automate time-consuming tasks, allowing these doctors to attend to cases more efficiently, offer a clear return on investment. However, in the case of AI, digital nascency has hindered development, such is the limited availability of training data. It will therefore be a long time before these AI-driven resources returns can be seen.

There are some positive advancements being made with regards to digital adoption however. Among the most significant is the recent provision of Class III CPT codes from the American Medical Association, which go into effect from January 2023. While these codes do not grant reimbursement for the use of digital pathology, they do allow additional work and service requirements associated with digitising glass slides to be tracked, representing a likely precursor to reimbursement.

Enterprise Opportunity

As such advancements facilitate and accelerate the uptake of digital pathology solutions, the opportunity for enterprise imaging vendors to capitalise also increases. For several significant lab equipment and consumables vendors offering digital pathology solutions, software, and even in some cases scanner hardware, was not a priority. Instead, it was merely a complementary business to their strong consumable products. Unlike the companies which are encumbered by this legacy, enterprise imaging vendors are free to be more disruptive within digital pathology. As healthcare providers are looking for more holistic imaging solutions, and decisions are increasingly being made at a higher level within a hospital, at a c-suite rather than departmental level, enterprise imaging vendors have the opportunity sell cross-department solutions. Offering a solution which includes significant digital pathology capability will appeal to a provider’s c-suite, helping them realise their ambitions of digitalising their pathology departments and enabling pathology to be used more closely alongside other types of medical imaging.

Different vendors are ensuring they can offer this capability in different ways – some such as Philips and Sectra offer digital pathology solutions in-house. This is a strategy which can offer advantages in the long-term, as these vendors can keep all revenues from digital pathology deals, while also having meticulous control over strategic direction and product development. This, however, comes at a cost. Significant time and investment is required to develop competitive solutions, which may still appear too late to trouble more established competition. What’s more, developing a solution in-house can also lack flexibility. Given adoption of digital pathology remains very nascent, particularly in some key markets such as the US, a vendor risks expending significant resource on developing a system, only to discover that it doesn’t meet the needs of potential customers.

An alternative strategy which, in the near term at least seems preferable, is the partnership route. Siemens Healthineers’ partnership with Proscia and Fujifilm’s partnership with Inspirata are the most high-profile examples of this strategy. In both instances an established medical imaging vendor is bolstering its enterprise imaging offering with tried and tested expertise from digital pathology specialists. While such partnerships lack some of the advantages of a solution developed internally, increased flexibility makes it a smart choice, certainly in the near to mid-term.

A third option is acquisition. While such a move requires greater commitment, the longer-term opportunity of digital pathology, in addition to the relative affordability of many digital pathology vendors means this could also be an attractive route. If a vendor can ensure it makes the right acquisition, in doing so it could pay dividends in the long term.

The Need for an Answer

Regardless of which strategy is selected, what is increasingly important is that a strategy is selected. One of the reasons Siemens Healthineers made a deal with Proscia when it did is that deals in Western Europe increasingly include digital pathology as key component. These providers, and for provider in the US also adopting the requirement, are stipulating pathology provision in deals, but may not wish to include digital pathology as part of a broader enterprise imaging strategy immediately. They may not even have the infrastructure and equipment to do so. However, these providers know the opportunities digital pathology offers in the future and need to ensure that the imaging IT vendor they select, an agreement which could last 7-10 years, must have a strategy in place for facilitating their transition to digital pathology when they need it.

Imaging IT vendors looking to secure such holistic deals need to show providers they are knowledgeable about the needs of digital pathology and options for implementation. This includes accommodating hardware preferences and the input from pathologists (e.g. scanner fleet, best-of-breed research, and clinical analysis software applications), while also helping providers to capitalise on external possibilities including transitions to cloud deployments etc. More importantly, however, IT vendors must be able to highlight the economic benefits that become possible with a connected digital path lab.

Ultimately this is what will help informatics vendors win deals that include pathology. The scanner hardware used, and the specifics of digital pathology set ups will vary from provider to provider, but, if potential value can be realised and measured at the point of diagnosis and across the wider enterprise, adoption will grow.

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Signify Premium Insight: Imaging IT and AI: The Key Trends on Display at ECR 2022

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In mid-July, the European Society of Radiology met in Vienna at their annual gathering, the European Congress of Radiology. The show, returning to an in-person format after two years of Covid-enforced cancellations, was also rescheduled switching to summer from its usual late-winter timeslot.

This schedule likely contributed to one of the biggest changes at the show, a reduction in attendees, as radiologists, hospital management and other buyers may have been enjoying vacations or taking advantage of public holidays such as Bastille Day in France. This change was significant and, in some ways, set the tone for a more focused affair than had been enjoyed in previous years.

The Signify View

This fall in attendance was also exacerbated by the show’s layout, which deviated from a traditional format. Major imaging vendors were given more floorspace, but at the expense of being dispersed and in some cases, harder to find. This allowed them to simulate “care pathway experiences”, reflecting the interests of many of the show’s attendees. Interestingly such experiences were only offered by the largest vendors, with mid-size and smaller vendors sticking to more traditional booths, serving neatly as a visual representation of the differences between these two tiers of vendors.

This reduction in turnout was not mirrored by vendors, who, for the most part, were not deterred. This was particularly true among smaller European vendors, including a significant number of AI start-ups taking advantage of the show, which typically have not exhibited at RSNA. These vendors, for whom the expense of exhibiting at RSNA is currently too high and US FDA regulatory barrier daunting, could use the show to interact with Western European radiologists, the same clinicians that could well be among their earliest customers.

Cloud Considerations

The show’s location also was significant. Cloud adoption is one of the ongoing trends in medical imaging IT. The nature of this trend is very different in different regions, with Western Europe and North America especially divergent. This is particularly true when it comes to public cloud. There are some instances of public cloud in certain European countries such as the UK, evidenced by GE HealthCare’s recent deal for its first Amazon Web Services-based deployment of its True Pacs software in Europe, at the Royal Orthopaedic Hospital. However, such deployments are exceptions.

More typically, European cloud deployments centre around private cloud, with the imaging IT vendors themselves providing the cloud capability for providers. There are pockets of public cloud adoption, with the UK’s National Health Service (NHS) fostering a close relationship with Microsoft and pursuing a cloud-first strategy, while Italy also has started along a path to public cloud adoption. More generally though there is distrust of public cloud and a reluctance to, in essence, share patient data with large US-based big tech cloud providers.

This hesitancy was on display at ECR. At RSNA, where catering primarily to the North American market, public cloud is widely promoted. At ECR however, vendors were more muted in their promotion of cloud capability, engaging in conversations with attendees, but none of the major vendors made significant product announcements.

Instead, much of the focus, particularly for the large medical imaging vendors, centred on the best utilisation of hardware, with radiology service line, operational workflow and other tools aimed at improving radiology departmental efficiency. This focus reflects where the surest return on investment is for many customers in the near term.

The show’s location also influenced other facets of the show. The North American EMR market is very established with just a handful of players accounting for most deployments. As such, it makes sense for medical imaging companies to promote tools that consolidate diagnostic imaging into the EMR. In Europe, however, the EMR market is very fragmented, rendering such approaches, as yet, unfeasible. In 2020, for instance,  no vendor had a share of the inpatient EMR market in EMEA of more than 16% (as detailed in Signify Research’s EMR/EHR Market Intelligence Service).  The opposite is also true in other areas. Europe is far more advanced than North America in terms of digital pathology, and customers could be feasibly looking to adopt solutions soon. As such, at present, ECR represents a better opportunity to promote such solutions, than many other events.

Competitive Categories

Unsurprisingly, one of the areas that did have a large presence at the show was AI. Despite this presence however, the level of new and unique products was minimal, with many of the young vendors at the show adding products to already well-established categories such as breast imaging (e.g., b-rayZ) or brain volumetric analysis (e.g., Mediaire). This is, in part, a result of those categories being seen as a safer, more conservative option where there is already known demand, while the AI market remains nascent. This desire to stick to established  toolkits may prove sensible in the near term as vendors are able to ride on the rising tides of those areas, but longer term it seems very risky, with many of these smaller players likely to be displaced or made redundant by other, better-established companies with more sophisticated products that already have sizeable installed bases.

In releasing a single-purpose chest CT tool, for example, a vendor must do something unique to gain traction, otherwise a product risks being overshadowed, not only by the plethora of other point solutions, but increasingly by more advanced comprehensive solutions, which can identify multiple findings at once.

These better-established vendors with more sophisticated products are also facing important decisions of their own. These vendors must continue to evolve and further develop their products to ensure that they remain attractive in what is an increasingly competitive market. In many instances it is the direction of this development that they must focus upon, whether they should choose to expand first into different modalities (multi-modality approach) or if it is better to expand across different pathologies (multi-ology approach).

Where Next?

There are merits to both approaches. Expanding into different modalities could allow a vendor to create ever more sophisticated end-to-end solutions, to cover a patient’s entire care pathway (e.g., lung cancer screening). This may also bring regional opportunities, enabling an AI solution to be used in areas where specific modalities are preferred for certain tasks, for example. However, it could put AI vendors into greater competition with large imaging vendors such as GE HealthCare and Siemens Healthineers, which offer a complete range of modalities, imaging IT systems in-house and develop algorithms for their modalities natively. In such circumstances, the large international medical imaging vendors are likely to have the advantage.

Decisions of a similar significance will have to be made by vendors of all size, and, as consolidation begins to take hold in the market, the consequences are likely to become ever more severe. The evidence of these decisions will be seen at coming trade shows, with RSNA the next opportunity for AI vendors to show, once again, that they are able to offer improvements in and beyond radiology to bring greater value to clinicians. To do so, vendors must continue to progress, either by developing new tools, or enhancing existing tools. However, funding runways for many medical imaging AI are limited, especially for those vendors that have not managed to raise capital investment in the past couple of years, so vendors must take what they can to ensure long-term viability.

The picture is less dramatic for imaging IT vendors. Here the broad direction is known; a shift toward cloud-native muti-ology enterprise imaging solutions. This change is coming, and all vendors have begun working towards such products, but many still need to secure buy-in from providers. This will be a particular focus at RSNA, where several significant launches, which were held back at ECR, are expected, once again propelling the market forwards.

Despite it being quieter than “normal”, ECR was still a positive show, giving vendors a chance to explain their visions to a predominantly European customer base. Now, however, they must look ahead and prepare to help a much larger audience realise those visions in Chicago at the end of the year.

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Signify Premium Insight: In Step with the HIMSS Set, Intelerad Marches Forward

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Returning after a Covid-imposed break, the 2022 Healthcare Information and Management Systems Society (HIMSS) Global Health Conference and Exhibition was the backdrop of several significant product announcements from key players in medical imaging IT. Among them was Intelerad, which chose the event to launch a new enterprise imaging software suite.

Intelerad says its new Enterprise Imaging and Informatics Suite ties together several components from the vendor’s recent acquisitions and will enable secure image sharing, improved workflow efficiencies and enhanced integration with electronic health records (EHRs) to improve image management for radiologists.

The Signify View

Over the past year Intelerad has been rapidly arming itself with new tools. Boosted by the financial clout bestowed upon the vendor following its purchase by HG Capital in early 2020, it has been aggressively pursuing acquisitions. These deals have seen the vendor amass a raft of capability which will form the core components of a rounded out, multi-ology enterprise imaging solution. However, up until HIMSS, there was no clear strategy on how the vendor will bring these disparate tools from several different vendors together.

Last week’s show began to tell that story, offering an initial outline of the solution it is working to develop. As it stands Intelerad is moving carefully, largely in a bid to continue to benefit from the reputations built up by its acquired brands; it is, after all, very hard to win back a lost customer that has become embedded in a competitor’s ecosystem. As such, the vendor has for the time being decided to maintain the branding and feel of the individual components of the products in its enterprise imaging suite.

This light-touch integration, which has resulted in a suite of different brands under the one Intelerad banner is only a temporary solution. Over time Intelerad will follow the lead of several other imaging IT vendors and invest in creating a single, cohesive platform, but the present ‘house-of-brands’ approach will allow Intelerad to service customers in the meantime.

Making Intentions Clear

As importantly, the announcement of its product suite will also signal to Intelerad’s customers its direction of travel. When a solution is relied upon for the efficient operating of a hospital, providers look to their vendors to have roadmaps aligned with their own strategic planning. Providers may not need a fully consolidated multi-ology enterprise imaging solution with advanced AI and cloud capability today, but they need confidence in their vendor selection that such as solution can be adopted in the future.  As such, providers will become increasingly unwilling to commit to long and expensive imaging IT contracts with vendors that haven’t at least laid out a roadmap for developing that capability. With imaging IT deals being signed for longer periods, for a provider, a vendor’s future offering is almost as important as its current portfolio.

This focus on future capability means that there is still a lot of work to be done on Intelerad’s part. With providers committing to vendors for longer periods of time, vendors need to show that they are continually innovating and developing for the future. One objective Intelerad must work towards in this regard is the increased integration of the separate tools. Over the coming years Intelerad must fully bring together the constituent elements of its portfolio, if its customers are to enjoy the full benefits of a true, multi-ology enterprise imaging system.

Plugging the Gaps

The corollary to that is that the vendor must also continue to fill the gaps in its portfolio. Through its acquisitions of LumedX, Ambra, Insignia and others, Intelerad has acquired broad capability that will complement its own PACS offering. There are, however, still some obvious gaps. Some, like advanced visualisation and other ‘ologies such as digital pathology, which could be resolved either through partnership or acquisition – which path will be taken remains to be seen. The firm’s longstanding partnership with Blackford Analytics for AI is a prime example of the partnership approach.

With the backing from HG Capital, Intelerad has the means to continue acquiring capability, however the question will be raised on the value of acquisition over partnership. In the instance of AV, white labelling of specialist AV tools and competency is common, so an acquisition may make little business sense. Other areas are less certain. Intelerad will increasingly need to offer advanced AI solutions to its customers to remain relevant, however, with the AI market being so nascent, and the technology changing so quickly, an acquisition near-term looks unwise. Such a move may be warranted in the future, but at present an acquisition represents a commitment to a particular solution far larger than seems sensible or indeed necessary. Furthermore, the Blackford partnership provides core Intelerad customers access to a broad array of AI tools. While there are some difficulties associated with partnerships, they are, in the short to medium term, a pragmatic option for Intelerad, allowing it to offer AI capability to its customers, in an essentially risk-free way.

The imaging IT vendor could alternatively look to develop some capability in house. For AV and AI this is the least practical route, but for cloud capability, developing its new platform cloud-natively will require some intensive R&D investment, especially considering the technical complexities and nuances of its new “house of brands”. Although some cloud expertise and technology assets  were brought in-house with the Radius acquisition in 2020,  a complete cloud-native platform represents a complex challenge for any vendor, but it is one that must be undertaken. From a provider’s outlook, similarly to enterprise imaging strategies, the importance for vendors currently is to have a clear cloud strategy, outlining the roadmap for cloud-based products and maintaining flexibility to support different customers strategies, whether on-premise, fully hosted cloud or a hybrid approach.

Persistent Progress…

These challenges are not a surprise, nor, for the time being at least, are they causes for concern. Although the vendor’s announcement at HIMSS wasn’t a revolutionary product release, it did clearly signal to Intelerad’s customers that progress is being made on the most important strategic objectives, and the vendor remains a stable supplier, although one that does not dance on imaging IT’s bleeding edge.

This is enough today, and, assuming similar progressive steps continue to be taken, the vendor is positioned well. What’s more, as evidenced at the Floridian show it is also reflective of the broader state of imaging IT.

HIMSS 2022 represented an evolutionary step on from vendors’ offerings at RSNA in December. Many of the key priorities remained the same, with a heavy focus on operational workflow, business intelligence and interoperability, reflected in some of the announcements from GE, Philips and others. More broadly vendors began to offer answers to the question of how data can be brought together across an enterprise. Integrating patient data from sources such as the EMR alongside diagnostic imaging data offers significant potential, and vendors such as Hyland have begun to show solutions that facilitate this kind of integration.

These, and other similar plays, offer a glimpse of the true potential of the use of data in healthcare. Rather than looking retrospectively to assess the past performance of an imaging department within a wider hospital network, vendors are making headway on solutions that offer analytics which are proactive and predictive, drawing out actional insight and useable suggestions to support providers. This centralisation of data is still in its relative infancy, but, as seen at HIMSS, the appreciation of the value of data is increasing and the first foundations are being put in place.

…To Dizzying Peaks

HIMSS, like RSNA 2021 before it, was a somewhat smaller and quieter affair compared to previous years, but also like RSNA, the show’s return brought with it a renewed vigour and focus. Vendors at the show can see the dizzying peaks of possibility that new technologies offer, but their expeditions have only just started, and they have barely left the foothills.

On a smaller scale the same is true for Intelerad. It has amassed many of the components it needs to be successful and will have no doubt made plans to bring on board those which are not yet in its clutches. It has begun the process of integration of these components and signalled its future direction to reassure customers of its commitment to their enterprise imaging objectives. And, as a trump card, its capital backers mean that it is ready to further add to its ranks with another strategic acquisition should the opportunity arise.

Intelerad is, in short, comfortably placed. If it can continue to demonstrate that it is steadily progressing, there is no reason to doubt its ability to realise its vision.

 

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