Enterprise Imaging Becomes Reality as Battle for Clinical IT Supremacy Begins

It was clear that AI was always going to steal the show. But despite the hype and mass marketing around deep-learning for decision support and diagnosis, other crucial market shifts were exposed during RSNA that were easily missed.

Two themes were most compelling; enterprise imaging is fast becoming a reality, not a marketing message; and with it, why broader clinical IT is the new battle ground for the top vendors.

Enterprise Imaging Coming of Age

Enterprise imaging has been a contentious term for many providers and vendors in recent years. At a fundamental level, the enterprise imaging concept covers the capture, management, access, exchange and storage of medical imaging data, throughout growing provider networks and user types. Yet, there has been little consensus as to a clear definition, resulting in an array of solutions being branded “enterprise imaging” solutions, but all approaching the concept in a different way, with varying degrees of capability. Worse still, enterprise imaging piggy-backed on the marketing success of vendor neutral archives (VNAs), also initially misunderstood and over-hyped.

Yet, if you peeled back the marketing, most major imaging IT vendors were offering solutions that only partially addressed the full enterprise imaging concept. Furthermore, it was also evident that provider selection of enterprise imaging was no longer just a radiology driven decision comparing PACS vs PACS; instead broader use and diversifying need were opening a completely new competitive arena. In our view, this resulted in five core competencies:

1. Data capture, ingestion, processing and advanced visualisation tools
2. Diagnostic workflow, reporting, peer-review and clinical collaboration
3. Clinical viewing, user interface and mobile access
4. Operational analytics, business intelligence and dashboarding
5. Storage, archiving and exchange

Each competency area is now a market itself, in that providers are comparing capability across each. Some vendors have opted to focus more on expansion of imaging into new clinical use-cases, most notably oncology, pathology, breast imaging, cardiology, dermatology and orthopaedics. Others have stuck closer to their radiology roots, instead pushing focus on smarter workflow, reporting and collaboration tools, while also branching into business intelligence for managing modality hardware, staff training and operational metrics. Further still, VNA and content management specialists have increasingly pushed into the broader viewing, workflow and exchange competencies, intensifying competition.

On reflection, the argument stands that the concept of enterprise imaging has never been closer to reality for providers. However, as no single vendor has market leading capability in all competencies, providers must look for a solution (either single product, or combination of products) that weighs the balance of diagnostic radiology, operational and broader clinical needs. Encouragingly, RSNA seemed to demonstrate that interfacing between competing vendor products has become palatable to vendors, especially as pressure on interoperability has increased in recent years, though there is clearly some way to go. Perhaps then, the show this year signalled the start of a new market phase – a market based on modular competencies, over one-size-fits-all.

A Subtle Battle Between Giants for the Future of Clinical IT

Improving interoperability and easier interfacing between different vendor competencies is a positive development, especially given the murky past of proprietary DICOM-tags and costly data migrations that have plagued the PACS market historically. However, don’t for one second believe that vendor competition has softened. Instead, a new battle is underway between the biggest vendors, to become the central platform for health providers, supporting a broader clinical IT ecosystem – or as we call it, the Agnostic Clinical Enterprise (ACE) platform. There were a few clear pointers at the show to back-up this theory:

1. Almost all the largest vendors in imaging IT and modality hardware were pushing operational analytics, business intelligence and radiology practice management analytics far more than in past shows – a clear push to decision-makers in health provider boardrooms as well as diagnostic department heads
2. Few of the largest vendors had much to show in terms of native development of deep-learning for clinical decision support or diagnosis, instead selectively partnering with the venture-capital backed start-ups clustered in the corner of the North Hall
3. Cloud-deployed solutions were more evident than in the past at major vendors’ booths- a nod to the CIO’s tick-list for new solutions and a possible vehicle for transition to longer-term, managed service or on-demand business models
4. There was more pronounced messaging on supporting broader clinical collaboration and integration outside of radiology

In many ways this makes perfect sense for the largest vendors at the show, especially those with big-iron modality businesses such as MRI, CT and interventional X-ray. These vendors have a deep understand of how their modalities are used and the pain points for users. Therefore, focusing on the competencies and areas where they have most expertise (especially number 1, 2 and 4 above) and largest installed base, is a sensible ploy. This gives them a competitive edge over other market players grounded in data management or storage and archiving in these competency areas. Furthermore, many are also looking to combine this expertise with their other capabilities in high-acuity care, ICU and surgical. In doing so, they essentially embed themselves as the central clinical IT partner at their customer sites, alongside the EMR.

This has many benefits from a business perspective: longer-term contracts, deeper entrenchment of their installed base, new revenue opportunities for professional services and risk-sharing contracting. Moreover, it opens a far greater pool of health provider revenue. Radiology has a finite pool of resource and capital to spend; yet in the broader clinical enterprise, clinical and diagnostic vendors have watched on as huge sums have poured into EMR adoption. Now that provider focus is shifting outside of central administration towards clinical outcomes and integrating the multitude of discrete clinical systems, the largest vendors smell an opportunity for a big payday, especially given that there are few competitors that have the breadth of capability to take on such a central clinical role.

So, if you were wondering why the largest vendors have been so quiet on advanced applications with AI to meet tomorrow’s radiology challenges, or are focusing so much on operational analytics, it’s because they are already into a bigger fight – to be the central ACE platform that supports all clinical IT.