Tag Archives: IBM

Signify Premium Insight: Google Searches for Imaging Success

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In its most high-profile bid to capitalise on the medical imaging market to date, Google has launched a new cloud-based medical imaging suite.

The suite is comprised of several tools, centred around Google Cloud’s image storage and Healthcare API suite, including NVIDIA’s MONAI for AI annotation and automation, BigQuery and Looker to help providers better navigate imaging datasets and Vertex AI to help accelerate the development of scalable AI models. Google says that by offering these tools in one product, it hopes to make diagnostic data more accessible and interoperable, while also readying providers for the development and implementation of artificial intelligence programmes.

While there has been significant promotion of the new suite, many of the tools were already available individually. What, therefore, does the launch really have in store?

The Signify View

Some well-justified scepticism will no doubt surround Google’s launch of its Medical Imaging Suite. The company has looked to expand its role in healthcare beyond feeding the imaginations of hypochondriacs several times, introducing Google Health in 2008 and discontinuing it in 2012, before rebooting it in 2018 and dismantling it again in 2021. It has, in the past also looked to develop front-line AI tools from its DeepMind division, consumer health products via its FitBit acquisition and apps for medical research among others. None of these tools, however, has yet made the significant, lasting impact that was expected by one of the world’s best-known firms.

Despite the sometimes inconsistency of these attempts, however, the company has been making headway in medical imaging with another, broader part of the business.

The adoption of cloud capability in medical imaging is still nascent, but some cloud providers, including Google, have become trusted partners for many earlier adopters. While Amazon Web Services (AWS) and Microsoft’s Azure are the public cloud providers that have seen the most uptake in medical imaging so far, Google Cloud, having reached some significant agreements with notable imaging IT vendors such as Visage, and Change Healthcare, as well as some notable and well-respected providers such as Mayo clinic, is hot on their heels.

Despite this, however, the Alphabet subsidiary’s presence in the market has been less visible compared to that of Azure and AWS. The launch of the Google Cloud Medical Imaging Suite highlights an end to this quiet and heralds the start of a more aggressive approach.

Remaining Relevant

Making such a transition has become increasingly important for the cloud provider. While Google has made progress, as AWS and Microsoft begin to pull away, Google misses its window to capitalise on the first phase of medical imaging cloud adoption. This is particularly true as Microsoft begins to capitalise on its Nuance Communication acquisition, for example, while Amazon continues to leverage its already extensive list of AWS partners.

Google will not countenance these advantages overnight, particularly given that on the face of it, its Medical Imaging Suite, which no doubt will be preferred by some customers with some specific use cases, is not a revolutionary leap. It may offer some advantages, but there is nothing truly ground-breaking that stands as a major differentiator compared to AWS or Microsoft.

That isn’t to say that there aren’t any aspects that aren’t attractive. The emphasis Google has placed on its AI offerings, for example, could swing some providers in its favour if they are looking to capitalise on their medical imaging data and facilitate its use among AI developers or indeed develop their own tools in-house. Its reputation for AI development could, in some cases aid its cause. This is especially true as many of the customers which have chosen to use Google public cloud are highly influential academic hospitals.

Reputation Management

Reputations work both ways though. While Google holds a staunch reputation for technical prowess, there are other factors that may give potential customers pause for thought. Chief among them are several high-profile incidents and agreements surrounding Google and identifiable patient data, including data from the Royal Free NHS Trust in London, and a deal with US healthcare provider Ascension. In these and other cases, Google’s actual culpability is somewhat moot, with the shadow of data insecurity, even if entirely unjustified, potentially enough to push a would-be customer in the direction of one of Google’s competitors.

Another concern for any potential customers considering turning to Google for their cloud provision is the vendors’ long-term commitment to medical imaging. While the more general aspects of Google’s cloud offering will continue to be supported, Google’s repeated high-profile salvos into healthcare, and the associated withdrawals, give the impression of a vendor that has no compunctions about pulling out of a market, reorganising its business units and ending its involvement in certain segments with little notice. Such an assessment may be unfair, particularly given that other cloud providers including Microsoft and IBM have both made equally high-profile pushes and retreats from some healthcare markets, but, with cloud representing a long-term investment, such concerns may weigh on decision makers’ minds when it comes time to signing on the dotted line.

These spectres are not impossible to exorcise, however. Google along with its peers are increasingly forging partnerships with imaging IT vendors in order to effectively create a joint sales strategy. Cloud providers, alongside vendor partners, are combining their efforts to sell to hospital networks, enabling the partners to highlight the benefits associated with a public cloud deployment, while also utilising the expertise from the imaging IT vendor in radiology.

Broader Responsibilities

Such evolution in sales strategy is also being mirrored in service provision. Along with the broader medical imaging market, deals are increasingly transitioning to managed service agreements. In terms of cloud deployments this is beginning to manifest as public cloud providers managing deployments much more closely, with for example, infrastructure and costing falling under the cloud provider’s remit.

Whether any of these factors are enough to sway a decision towards or away from Google, and indeed what influence they ultimately have on a providers’ choice of public cloud vendor, is still overarchingly dependent on individual deal context.

Google’s new Medical Imaging Suite will make the firm’s solution more attractive to many vendors, but any advantages will likely be overshadowed by much more significant influences. A deal’s locality, for example, may be a far more important factor in a provider’s decision if that provider is in a country which stipulates that cloud providers must have datacentres within-region, for instance, or if it is in a market sector that already has a preferred supplier.

As such, there are in most cases considerations far more significant than the differences between comparable cloud competitors. That, however, does not mean that Google’s latest efforts do not represent a significant step.

While the launch of its Medical Imaging Suite is unlikely to reverse the lead that AWS and Microsoft’s Azure have for public cloud departments, it does show Google’s intention. It highlight’s the vendor’s ambition in the space and lays the foundation upon which it can build over the coming years. Moreover, the launch also enables Google to remain competitive as other cloud providers such as Oracle and IBM which have already made their intentions clear, begin to more aggressively promote their own solutions.

Or, to put it another way, Google’s launch ensures it remains on the first page of search results, but, it has not yet offered anything to warrant rapidly climbing through the rankings.

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Signify Premium Insight: IBM Watson’s Path From Jeopardy to Jettison

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IBM proved right well publicised industry rumours last week in announcing that it is selling its healthcare data and analytics assets, which currently fall under the Watson Health business.

The assets have been purchased by investment firm Francisco Partners, and include extensive data sets, products, and image software offerings, including the Merge product line and imaging AI products. Financial details of the deal have not been disclosed, although Bloomberg places the value of the sale at more than $1bn.

The deal is expected to close in the second half of 2022. Existing customers will continue to be served by the new independent company, while the current management team is also expected to remain in place.

The Signify View

The news that IBM is pulling out of healthcare might, at first, seem incongruous given that other recent stories have seen tech companies doing the opposite. Last April Microsoft acquired radiology transcription specialist Nuance for almost $20bn, while more recently Oracle announced it was buying up EHR vendor Cerner for close to $30bn. Other rumours, meanwhile, such as those suggesting that Amazon is looking to establish a presence in healthcare with an acquisition, potentially of M*Modal, also contribute to the overall sense that healthcare presents a significant opportunity for tech vendors.

IBM’s divestiture, however, brings its strategy more closely in alignment with its peers than news of a sale would suggest. What has changed is that, like Microsoft, Oracle and others, IBM is no longer trying to capitalise on departmental healthcare, and is seeking to derive revenues instead from the provision of cloud architecture and technical support for AI development, a path that promises a  larger return on investment. As highlighted in our previous Premium Insights, Microsoft’s move on Nuance, and Oracle’s move for Cerner, are deals which, in essence, give the technology firms an expanded customer base in which to sell their core cloud products. IBM will now be able to bring the same focus to the healthcare market as its cloud competitors, providing the architecture and environment for healthcare-specific vendors to develop cloud-based products, without developing and selling imaging IT products itself.

Solving Problems With Spending

This indirect approach to healthcare, which sees the industry simply become one of a number of potentially lucrative markets for IBM’s broader cloud offering, does however represent a marked shift in strategy. In 2015, when IBM launched Watson Health, it almost immediately began buying up companies, including Phytel, Explorsys, Merge Healthcare and finally, Truven Health Analytics, during its first year of operation. Overall, reports suggest IBM spent around $4bn in establishing the new unit, which is, at present, bringing in around $1bn in annual revenue. A figure that shows no significant change compared to the combined revenues of the constituent vendors when they were acquired.

When these vendors were acquired, IBM’s vision was to revolutionise healthcare, and utilise the power of data to solve some of the biggest challenges facing healthcare. These ambitions were never realised. While the vendor has released some innovative technology and enjoyed some small successes, it ultimately failed to live up to IBM’s own, considerable hype. New initiatives, such as Watson for Oncology, failed to live up to expectations and were mothballed.  Not only was healthcare not revolutionised, but IBM seemed, in many instances, to underperform in more established product sectors relative to its competitors. The legacy Merge imaging IT business has hung on to some key customers but has struggled to grow share or win new customers in core markets in the face of stiff competition from vendors such as Visage and Sectra. In emerging technology product sectors, IBM has also faltered. When it launched its AI marketplace, for example, not only was it behind several other imaging IT vendors, it featured algorithms from just five partners. Similarly, with its Imaging AI Orchestrator platform release; with just one confirmed partner and only a small number of other potential partners, the release was relatively underwhelming compared to IBM’s AI promise.

Resultantly, instead of heralding a revolutionary new era in healthcare, Watson Health started to become a disappointing distraction, diverting attention and resources away from IBM’s other interests, even potentially impacting IBM’s reputation. Despite all the original promise and potential, when viewed in such a light it is no surprise that IBM has sought to cut its losses and shed the unit. Although arguably on a more significant scale, IBM isn’t the only technology company to have failed to revolutionise healthcare, with Microsoft, Google and others also having to renege on earlier promises and pull back from well-publicised healthcare investments spectacularly.

Where Next?

As well as highlighting IBM’s strategy, the sale also raises questions as to the future of the divested assets. In this regard, Francisco Partners has several options. One scenario would see the new owner try to succeed where IBM hasn’t. This is unlikely, although Watson Health’s new-found distance from one of technology’s longest-established giants may offer it a new level of agility and freedom to focus, while Francisco Partners may be keen to invest into it. A second option could see Francisco Partners maintaining the vendor as essentially a managed asset. Watson Health’s constituent vendors were, after all, individually successful before they were combined, Francisco Partners may choose to streamline where possible, but otherwise allow its new acquisition to continue delivering revenues, safe in the knowledge that it is relatively secure investment in a stable and saturated market.

A third, more active option, would see Francisco Partners paring off the imaging IT part of the business, which was formerly Merge Healthcare. Not only does this segment sit apart from the rest of the divested assets, Watson Health’s imaging IT business could be an attractive proposition for the right buyer. As well as a market share of around 7% in the US radiology IT market in 2020 (and just under 4% globally), the unit brings a fully featured enterprise imaging solution to a new owner, with platforms to target acute care, outpatient imaging sites, a cardiology solution, the recently released workflow orchestration solution, AI capability and a large amount of valuable data.

Several vendors could be interested in such a package. Intelerad would be among the obvious candidates, with the additional market share taking the vendor straight into the top five of imaging IT vendors in the US. IBM’s technology would also strengthen Intelerad’s offering, creating an opportunity for Intelerad  to retire or replace its legacy PACS component and bolster its larger data management capability, one of Intelerad’s present omissions. Intelerad is also in the midst of a particularly aggressive acquisitive run, having recently purchased Ambra, Insignia Medical Systems, and Lumedx among others. Moreover, IBM has a substantial customer base in the large acute hospital market, an area for which Intelerad has been actively pursuing. With the might of its private equity owners HG Capital, and an obvious appetite for acquisition, Intelerad could be a good match.

The imaging IT market in the US is one which is well-established and saturated, providing very little in the way of organic growth opportunities for vendors. With this being the case, the prospect of an additional 7% market share in the US could also appeal to other vendors. There are a limited number of potential suitors that have both the available funds to make such an acquisition, and the business strategy to acquire and integrate rather than natively build. This still leaves some big names, such as Siemens Healthineers which has been losing share in the US market, or Fujifilm, which may be attracted with the prospect of an instantly increased footprint, or even a smaller vendor, such as Mach7 Technologies, looking to boost its presence and portfolio as possible buyers should Francisco Partners decide to sell. Ultimately, the imaging IT market in the US has long been on course for further consolidation, especially as deal volumes fall, deal sizes increase and contract terms lengthen. Assuming Francisco Partners have been robust in its due diligence and market analysis ahead of the deal, it will know the IBM Merge business line could be a tempting asset for a vendor with ambitions of playing at the top table of imaging IT.

Back to Reality

The sale of Watson Health is the long-expected end to one of the most ambitious projects in imaging IT and wider healthcare. This end was, however, somewhat ingrained in the start. IBM committed to healthcare, but, like some other large tech firms, did so with the boasts and bravado that may please investors but fail to acknowledge the complexity of the healthcare market. Instead of looking at the nuance, the finer detail and clinical intricacy of healthcare, IBM purchased capability and gave itself impossibly broad targets. Making progress in healthcare is hard, it is slow, and what’s more, it isn’t necessarily all that profitable. The humbled IBM will now have a much better appreciation of that.

For the divested imaging IT unit meanwhile, although the future is uncertain, it harbours a lot of value. It has a sizeable market share, competent technology, and continuing development as illustrated by its releases at RSNA 2021. Freed from Big Blue’s orbit, the business formerly known as Merge now has the chance to focus on the detail and the nuance. It may never revolutionise healthcare, but the chance to work on smaller, more tangible problems means that its future could be bright nonetheless.

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Signify Premium Insight: IBM’s RSNA AI Platform Push

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.

Co-written by Dr. Sanjay Parekh

At RSNA 2021, IBM Watson Health revealed a new cloud-based AI orchestration platform, which the vendor says will allow health networks to deploy and use medical AI applications more easily and efficiently. The new platform is vendor neutral and, IBM believes that along with its existent marketplace, will help providers solve the ‘last mile’ challenges of selecting, deploying and integrating imaging tools from multiple AI developers into their clinical workflows.

The Signify View

Signify Research’s Machine Learning in Medical Imaging report has, for several years, highlighted that one of the key barriers to greater AI adoption is the current lack of its integration into clinical workflows. The advantages of a key AI solution could be myriad and profound, but that will count for naught if providers are faced with challenges around integrating these tools and doctors are unable to utilise the tools easily and effectively in their everyday clinical practice.

The impact of this lack of integration could be particularly acute in imaging, where there is both a growing volume of diagnostic imaging, and distinct shortage of radiologists, often leading to intense time pressures. Adopting AI into the clinical workflow to address these challenges may improve productivity, but this will be negated if solutions require physicians to leave and enter distinct software packages, wait for tools to run, and make extra clicks. AI orchestration platforms aim to overcome these problems, by, for example, curating AI solutions that provide greater value to the radiologist, enabling them to focus more on patient care.

IBM Watson Health’s new AI Orchestrator platform aims to minimise these inconveniences, with the platform making it easier for providers to leverage the advantages of a range of AI tools, without deploying and integrating them individually. Under IBM’s AI Orchestrator, solutions from developers which have partnered with IBM such as Cortechs.ai and Behold.ai (under development), will be seamlessly available to users of IBM’s Orchestrator, regardless of their PACS or other informatics systems. However, curiously, there is still a disparate approach from the company, as it has not yet incorporated any of its AI marketplace partner applications onto its AI orchestration platform. Whether IBM chooses to do so remains to be seen, at this instant it seems a missed opportunity in terms of swiftly expanding the value of its AI orchestration platform at its launch.

Cloud First

One of the notable things about IBM’s new solution is that it is entirely cloud-native. While increasing numbers of vendors have developed cloud native AI platforms, and, as detailed in Signify Research’s Cloud Adoption in Imaging IT report, it is one of the clear directions in which the medical imaging IT market is heading, IBM’s relative strength in the broader cloud infrastructure could be an advantage. Furthermore, the AI orchestrator platform was announced in sync with a new broader cloud-native workflow platform, Imaging Workflow Orchestrator, in which IBM has brought to market what it believes will the new industry standard in diagnostic workflow environments.

This solution is, in some ways, more important than the vendor’s AI platform, given IBM’s additional exposure to the PACS and VNA markets compared to the AI platform. The Workflow Orchestrator brings some significant features to IBM Watson Health’s portfolio, namely integration of advanced enterprise worklist (including AI triage results), diagnostic viewer and pertinent EMR-based patient data (Watson Patient Synopsis) into a singular user interface. This is, in part, achievable because the new platform is heavily tied to the IBM VNA. Watson Patient Synopsis, utilises AI to identify the most relevant data from a patient’s record in an EMR system and makes it readily available to a radiologist, addressing an increasing focus in diagnosis in bringing relevant patient data to front line diagnosticians in a digestible format. The integration of these functionalities, and the fact that it is cloud native, gives IBM an advantage over some similar enterprise radiology products from the other larger informatics vendors, which are less progressed in terms of their cloud native strategy; Workflow Orchestrator’s seamless integration with the AI Orchestrator could also give the vendor a further competitive edge.

IBM also hopes that its cloud expertise within the broader company, particularly on the back-end through its acquisition of Red Hat in 2018, should help sway customers. Some providers might be wary of entrusting their precious medical data to public cloud from the likes of Google, or Amazon, but being able to gain cloud capability from the same vendor that facilitates their AI toolset and broader imaging IT platform could be enough to convince them. As such IBM Watson Health will hope that the new AI Orchestrator, Workflow Orchestrator and its cloud capability will drive business to the vendor and bring with it opportunities to sell additional products. However, IBM is also not wed to its own cloud services as the new AI Orchestrator can be deployed on any cloud.

AI Answers

Many providers, however, are not yet ready for full cloud deployments. Some have invested heavily into their own on-site data centres or have preference for keeping their data on site for other reasons. There are others still which aim to take advantages of the benefits of cloud-based deployments, but do not wish to entirely give up on premise solutions and so are looking to utilise hybrid deployments, either as a temporary measure on the way to complete cloud nativity, or as a preferred permanent solution. IBM’s new AI Orchestrator can facilitate these hybrid cloud deployments, opening up its use to a far greater range of providers and allowing for more flexible deployments. However, whether the need to accommodate a range of different deployment architectures will harm its functionality, remains to be seen, but it is critical the availability and performance of its solutions aren’t offset by its need to appeal to a very diverse range of providers. This could simply lead to a poor experience for a greater range of people.

There are also other challenges set to weigh on IBM’s strategy. One of the keenest is the increasing levels of competition from both other vendors and other solutions. There are now several platform solutions available. Some offer advantages that are unique, or at least uncommon. Aidoc’s, for example, focuses on a means to deploy its growing portfolio of native applications, supplemented by AI solutions from third-party vendors. Blackford Analysis, on the other hand, has curated a much broader ecosystem of applications from third-party vendors, with the ability for providers to select the AI solutions that work best on their populations and case mix.

Other platforms created by larger imaging IT vendors, such as GE Healthcare and Sectra, are potentially better integrated into a broader imaging IT workflow but focus on partnering with AI vendors for their content.  On the other hand, vendors such as Siemens Healthineers have chosen to develop most of their AI tools in house, carefully creating and curating only a choice selection of native and close-partner integrations, ensuring they are fully integrated into the vendor’s wider imaging IT solutions.

IBM will have to demonstrate real additional value and a unique proposition if providers are going to select its AI Orchestrator over these tools from competitors. This could come from the platform itself, or from the range and quality of AI tools integrated into the platform. Or, as is more likely the case, from leveraging its Patient Synopsis and Clinical Review tools that integrate upstream and downstream of the clinical workflow. Watson Patient Synopsis, utilises AI to identify the most relevant data from a patient’s record in an EMR system and makes it readily available to a radiologist. Clinical Review is a retrospective analysis tool that compares the radiologist’s report (including image analysis) to determine potential areas for reconciliation.

A Persuasive Proposition

Whether it can achieve this and therefore secure commercial success remains to be seen. This question is particularly pertinent given the year’s earlier rumours of a sale of IBM Watson Health. A previous Signify Premium Insight commenting on the rumours suggested that one of the motivations for the sale was the broader company’s increasing focus on cloud. Offering customers a desirable cloud-native platform could bolster sales in the company’s cloud business, in much the same way as Microsoft’s acquisition of Nuance is at least partially driven by the big tech firm’s ambition to use healthcare to bolster its own cloud business.

Regardless, IBM Watson Health’s platforms are unlikely to materially change the fortunes of the business unit, and ultimately a sale is unlikely to prevent its software from being run from IBM’s cloud. But, the fact that IBM is still investing in its R&D suggests that the businesses fate is not yet sealed.

As it stands, the vendor has a mid-single-digit share of the North American medical imaging IT market, this share could render it difficult for IBM to have a sizeable market impact by only focusing on its own Imaging IT customers. Instead, the new AI orchestrator’s vendor neutrality should be emphasised, and IBM should highlight the platform’s ability to enhance other vendors’ packages and provide an effective software infrastructure to providers looking to add AI capability. Moreover, the vendor’s cloud focus in its foray into AI platform deployment could also prove beneficial and could form an integral part of a future cloud-based enterprise imaging deployment.

For the time being though, IBM has brought together a lot of existing capability into a single, cohesive, cloud-native package. Many providers will pay little mind to this development, and duly wait for comparable capability from their current imaging IT vendor. The relatively few integrated AI applications may also leave some potential customers waiting a little longer to see how quickly the firm can scale up to a more comprehensive AI partner ecosystem, especially with no version combining the marketplace and orchestrator yet available. For others, however, IBM’s AI Orchestrator brings together its existing upstream and downstream AI capabilities within a single, flexible platform, promising streamlined participation in the growing trends of cloud and AI. This may just be enough to help providers forgive the overpromising of the past on AI and convince them of a potentially bright future second time round.

 

About Signify Premium Insights

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