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As 2022 ends, medical imaging AI vendors are looking ahead to 2023, and planning to implement and execute the next stage of the strategies they carefully constructed throughout the passing year. There are some challenges that these vendors will be pleased to put behind them, with the worst of the Covid-19 pandemic, and the steepest increases in inflation, for example, hopefully in the rear-view mirror.
However, there are still numerous hurdles impacting vendors, and the providers which they supply, alike. While increases in the rate of inflation may be slowing in many markets, the rate of inflation itself is still high. Providers may not be as impacted by Covid itself, but its fallout, the backlog of elective procedures, the fatigue and exhaustion of staff, and the budgetary considerations are as difficult to manage as ever. For AI vendors, consolidation in the market is coming and funding, especially early-stage, is becoming ever harder to come by.
The Signify View
Against this backdrop, it would be understandable for vendors serving the medical imaging market to be feeling bearish. However, as illustrated in Signify Research’s Q4 Vendor Sentiment Index – one of the deliverables of the AI in Medical Imaging Market Intelligence Service – both independent software vendors and imaging IT vendors are relatively upbeat about their prospects for both the coming quarter and the coming year measured by the index.
For this Q4 edition, which saw vendors surveyed between October to December 2022, about their confidence in Q1 2023 and the coming 12 months (January 1st – December 31st, 2023), some findings were consistent with previous surveys – independent software vendors remained more bullish compared to their imaging IT peers, over both the coming three and 12 months. This is understandable. However, there was some convergence between their confidence levels over the quarter.
There are several reasons for this convergence. One of the reasons independent software vendors have typically been more confident than their imaging IT counterparts is likely down to a mix of necessary optimism as well as a touch of naivety. These vendors, often young start-ups trying to commercialise a technological development, in a new market burdened with considerable hyperbole, inflated expectations, scepticism and suspicion in equal measure, needed absolute belief in their solutions, and confidence that their solutions offered a product would ultimately be valued by providers.
However, there are more tangible barriers too. Factors that are necessary for any medical device to be sold such as regulation, budgetary allocation and reimbursement are still very real hurdles for these vendors to tackle. The scale of these challenges, already well-known to long-established imaging IT vendors which have fought to establish share in other markets, may only now becoming truly known and appreciated by the AI vendors. This comes as radiologists and key provider stakeholders are becoming more discerning. Amidst such scrutiny, ISVs are realising that their technology alone is not enough without, for example, more sophisticated workflow capabilities and clinical and economic validation studies. As the ISVs are more deeply ingrained in the market, these challenges are becoming more apparent. This shifting sentiment is illustrated by the changes in results of the VSI survey over time. Throughout 2022 AI vendors’ market outlook for the next quarter has held steady at between 6.9 and 7.1 (out of 10), IT vendors’ confidence levels have fluctuated more, seeing a low of 5.2 in Q2 amidst macroeconomic headwinds and other factors, before climbing to a year-high of 7.2 in Q4, overtaking AI ISVs for the first time.
Successful is as Successful Does
IT vendors are also more confident than they were in previous quarters. This confidence will have no doubt been bolstered by the emergence of market leaders in AI which are making considerable commercial inroads into the market. This will be particularly true for imaging IT vendors with AI orchestration platforms, an increasingly attractive capability as vendors look to solve the last-mile challenges of algorithm deployment and integration. Further, the increasing success of AI’s market leaders will also improve the confidence of imaging IT vendors with a considered enterprise imaging strategy. Most of these vendors consider AI an important component of those strategies, so seeing AI succeed elsewhere will be heartening.
Another major factor, which will have improved the confidence of ISVs and imaging IT vendors, is RSNA. The show is a chance to see how rapidly the AI market is growing, how it is becoming an ever more important technology across medical imaging, rather than being constrained to one small niche area. What’s more, again bolstering the confidence of IT vendors and AI vendors offering their own platforms, are the vendors announcing new and expanded solutions that will be available to other platforms, therefore also inadvertently bolstering other vendors’ AI offerings.
This optimism, however, may be short-lived. While RSNA saw an increase in the number of medical imaging AI vendors in attendance, with new logos in the mix, the trend to consolidation has already started to accelerate. In 2022 there were six acquisitions and two exits from the market, with a greater number expected next year. For a few market leaders, this market consolidation could be a source of confidence, for many more, however, it is likely to lead to growing pessimism across 2023.
Pilots Landing Deals
Another notable trend to emerge out of the latest VSI survey was falling confidence in the deployment of pilot sites for both AI vendors over the coming year, with confidence dropping slightly from 7.1 to 7.0 in the coming quarter, versus the coming 12-months. This could outwardly be read as a bad omen, with providers more focused on workforce shortages, staff burnout, and clinical challenges, rather than expending effort on experimental deployments of new technology. However, this is a one-dimensional interpretation. While it may be a factor for some providers, another, more positive reason is that in some cases, AI vendors have progressed beyond the stage in their development where pilot sites are required. Instead, these vendors are now directly targeting commercial contracts. These vendors have enjoyed commercial traction, so can demonstrate a return on investment from using their tools and have a growing portfolio of positive feedback.
Another reason for this diminishing importance of pilot sites is that vendors are “locking-in” commercial deals quicker. They have growing confidence in their tools and trial periods are increasingly reliant on some level of commercial commitment from providers.
The overall market outlook is expected to stabilise, global economic risks are now built into both AI and IT vendors’ expectations for the coming year, and with RSNA over, opportunities for new disruptive partnerships and products are reduced for at least a quarter or two. There is predicted to be a slight downturn in confidence as some of the broader macroeconomic conditions bite, but also as industry-specific challenges come to the fore. For example, for vendors looking to trade in Europe, the transition to the new MDR approval system, and the delays for approval already being experienced by some, could significantly hurt the confidence of several vendors.
Ultimately, every challenge overcome is another reason to be confident for both AI and IT vendors. Each type of vendor will have to fight its own unique battles over the coming 12 months. For some AI vendors, it will be the first time they are truly tested, and, depending on their aptitude (or naivety) could result in significant swings in confidence. For IT vendors meanwhile, such travails are less of a novelty, and the knowledge that they have overcome in the past will give them quiet assurance they can overcome again. With this resolve, watching the market deliver more success stories will merely be a succulent addition. Vendors will be embattled over the coming year, but those that legitimately have reasons to be confident, such as successful pilot sites, good commercial traction, huge funding rounds and reimbursement, can be. The vendors with none of those attributes meanwhile, should similarly be far less brazen.
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This Insight is part of your subscription to Signify Premium Insights – Medical Imaging. The content is only available to companies that have subscribed to this paid-for service. To view other recent Premium Insights that are part of the service please click here