Tag Archives: Imaging IT

Signify Premium Insight: Confident Where Competent: Fourth Quarter Vendor Sentiment Analysis

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.

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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Signify Premium Insight: What to Expect at RSNA 2022 – Imaging IT and AI

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Much change is afoot in the medical imaging IT and AI sectors. Imaging IT vendors are transitioning to broader, integrated cloud-native enterprise imaging solutions, while AI vendors are increasing the sophistication and clinical value and utility of their products. Amidst these broader directions, here are our  key expectations for the show.

Imaging IT and AI Vendors Will Have Lots to Share

While this year’s meeting of the Radiological Society of North America might be somewhat subdued from a modality standpoint, imaging IT and AI vendors will be ready for some significant product launches. Unlike last year when Covid-19 was still rife in many countries, and there were still considerable restrictions on travel across the world, this year’s event should see attendance figures much closer to the pre-pandemic levels of 2019. Such enthusiasm should see vendors willing to make a lager  investment into the show and use it as an opportunity to promote high-profile new products.

Imaging IT vendors will be keen to highlight the progress made in developing fully featured, cloud-native enterprise imaging platforms. In some cases, this will be demonstrating additional capability that has been added to an existent platform, while other vendors may, for the first time, demonstrate how different capability across their portfolios can be integrated into a more complete enterprise imaging solution.

The event is also likely to be busy from an AI perspective, with vendors keen to promote their products’ progression from technology to solution. AI outfits will look to demonstrate new, more sophisticated solutions, which address a greater number of clinical segments and integrate more seamlessly into providers’ workflows.

Efficiency and Optimisation

Between unprecedented backlogs of patients whose procedures were delayed during the Covid-19 pandemic, a shortage of trained personnel in many key roles, and the increasing requirement for more time consuming and resource intensive advanced imaging procedures, providers are looking for ways to do more with less.

Imaging IT vendors at RSNA will be highlighting solutions that offer customers greater oversight of the operation of their medical imaging departments, their staff, and their medical imaging modality fleets. This focus will be reciprocated by providers, many of whom will adopt workflow tools as one of the nearest-term investments to enhance productivity. Such solutions also represent a sensible strategy for providers for the longer term, enabling them to better assess departmental performance, improve planning of patient care, strategize future needs and maximise resource allocation.

This is particularly important as provider networks become more complex, with centralised workflows allowing providers better oversight of increasingly decentralised networks, amidst the increasing utilisation of outpatient facilities and teleradiology service providers. This may also facilitate the expansion of provider networks through increasing acquisitions, and enable more sophisticated tools, which leverage AI, to be deployed. The interoperability offered by these holistic systems will help empower provider networks for increased automation and operational AI.

Platforms, Platforms, Platforms

Despite the greater interest and greater practical utility of AI, the young technology still faces some barriers to greater adoption. One of these barriers is a means to deploy AI into providers’ clinical workflows as providers look to scale their radiology AI offerings. The most visible method of addressing this “last-mile challenge” at RSNA will be through platforms.

Several vendors have already released platforms, including third-party incumbents such as Blackford Analysis and Terarecon, but more recently specialist AI companies, larger medical imaging IT vendors, and even hardware vendors have released platforms that support the use of many different algorithms. While plans from major international imaging vendors and imaging IT vendors have so far had the most momentum, platforms from algorithm developers themselves could also be a prominent feature of RSNA this year.

This excitement surrounding AI platforms is also likely to shape many of the conversations that AI vendors have with one another. In past years, vendors may have been looking to forge standalone partnerships with other AI vendors which offer complementary solutions in a bid to offer providers solutions more clinically valuable than either partner could supply alone. While that may still make sense in some use cases, in other cases some of the more established AI independent software vendors will look to forge partnerships with multiple prospective partnersto facilitate the development of a platform and scale their radiology AI offerings. This is especially true given that vendors are increasingly focused on enhancing their product capabilities natively, rather than leverage third parties, as may have been more prevalent in previous years.

The Consolidation of Data

One of the longer-term strategic directions that is set to shape imaging informatics over the coming years is the consolidation of data.

As imaging IT vendors’ multi-ology enterprise imaging strategies evolve, there is a greater need for enterprise-wide data to be consolidated into a central data management platform or the VNA. Doing so will enable providers to better leverage the breadth of data they have. While data management platforms are not a conceptually new product, vendors are beginning to assess how providers can leverage the centralised platform and explore the potential they offer. As such, there are likely to be few flashy announcements associated with the VNA. Instead, vendors will, behind the scenes, be discussing it with their customers to identify opportunities that could be realised.

This will be particularly true given the wider context affecting providers at present. The lasting impact of the Covid-19 pandemic, along with other economic pressures, such as rising inflation and spiralling energy costs mean that hospital budgets will, in many instances, be getting tighter. In such circumstances providers are going to be increasingly keen to monetize the data they have already. For providers, this could mean utilising their wealth of patient data for clinical trials or drug development, for example, or utilising their imaging data to develop AI in house. For this to be a realistic possibility, vendors need to respond and offer sophisticated platforms that properly structure and curate data in formats that allow for the commercialisation of imaging and non-imaging data, including deidentification of patient information for pre-clinical use.

There has already been progress on this front. GE HealthCare’s partnership with Enlitic, for example, emphasises this curation, while Intelerad’s recent acquisition of Life Image also shows that it is an emerging trend in the imaging IT market. While there may not be any blockbuster announcements, vendors will be keen to highlight the importance and potential of these unified data management platforms to prospects at the show.

AI Beyond Radiology

So far, the primary focus of the majority of medical imaging AI has been radiology. However, as AI is maturing, and many radiology AI solutions are becoming more sophisticated, medical imaging AI’s domain will expand beyond radiology. This will see the technology’s purview increasingly grow into adjacent areas such as population health tools that may be deployed as part of screening programmes or identifying incidental findings as part of routine clinical practice.

Such moves, forming key discussion topics for AI vendors at RSNA, represents AI’s growing maturity, and the evolution of AI algorithms into more sophisticated solutions. Such momentum stems from two distinct sources. Firstly, this evolution represents vendors’ need to continue to develop their products to create ever greater value to radiologists, and in return, drive commercial traction. More interestingly, however, is vendors’ plans to tap into the current wave of Category III CPT codes awarded for quantitative imaging AI solutions, which could be indicative of potential future reimbursement.

Many of these CPT codes announced for 2022 do not focus on the traditional domains of radiology AI such as detection and triage, but instead seemingly promote population health applications. This emphasis will entice vendors to position their solutions to leverage these codes in the hope that over the longer term they are upgraded to qualify for tangible reimbursement. But, such leanings also raise the expectation that more population health-focused codes are expected in the coming years, thereby encouraging vendors to increasingly develop population health solutions, or adapt their current solutions to fulfill a population health remit.

Summary

Medical imaging IT and AI markets are evolving quickly, and the RNSA conference allows vendors to, above all else, highlight their progress in several key areas. Of equal importance, however, is what isn’t on display, but what is said. Many providers will be looking to commit to enterprise imaging solutions, cloud strategies and AI adoption over the coming years, and vendors’ presence and messaging could help to influence their approach. Ultimately, vendors have the chance to explain to these providers how the application of their solutions can solve pertinent problems in radiology and beyond.

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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: The Trends in Imaging IT at SIIM 2022

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Co-written by Amy Thompson

Although the recent annual meeting of SIIM, the Society for Imaging Informatics in Medicine show is much smaller than many of the other events on the medical imaging calendar, its focus on imaging informatics and the emphasis on business-to-business relationships means that it is still an influential event and a good bellwether of the trends in the medical imaging IT market. As such, while there was only a limited number of product announcements, the debate was stimulating. This was particularly true given that some innovative smaller vendors, which risk being crowded out at larger shows, were able to enjoy the limelight.

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Despite its different composition, however, the trends witnessed at the show were very much a continuation of those seen at other recent events. Such was the case for cloud technologies, for example. Vendors were keen to promote their solutions and marketing boasting of cloud capability was ubiquitous. Despite this promotion, reluctance around cloud technology remains, with providers hesitant to commit themselves completely to a fully cloud-based platform deployment. This reticence is largely a result of providers’ scepticism that cloud solutions can match the performance of on-premise data centres, especially when evaluating performance of core diagnostic tools such as the PACS which plays a critical role in patient care. After all, any slight delay in accessing an image or report, even by a few seconds, for example, is not something a provider is willing to accept when it could impact patient care.

While providers are yet to be fully convinced of the merits of a transition to cloud, vendors also still have some work to do. Although almost all vendors offer some cloud capability, and some vendors can offer some cloud-based enterprise imaging, no vendor is yet ready to offer a complete cloud-based enterprise imaging platform at scale. While interest in cloud continues to grow, these challenges mean that providers will continue to favour hybrid cloud solutions as opposed to fully hosted public cloud. This approach could cause a provider to miss some of the more sophisticated opportunities offered by full cloud deployments, though in the near term retaining some core components, such as AV or the core diagnostic PACS on premise represents a sensible compromise. Further, in many cases it will allow providers to enjoy the benefits of the evolution towards a SaaS-based business model, without risking any detriment to performance that they fear from a full cloud deployment.

Cybersafety in the Cloud

Despite these reservations however, there are some reasons motivating providers to adopt cloud solutions. Among the most prominent of those at SIIM, especially compared to previous years, was cybersecurity. Although cybersecurity has been a concern for a number of years, the growth in the numbers of ransomware attacks has helped mean that cybersecurity has become one of the main catalysts driving the transition to cloud, especially at larger organisations.

Progress is slow, however. This is particularly true as the transition to cloud isn’t occurring in isolation, with the development coinciding with the broader adoption of enterprise imaging strategies. As such, vendors and providers aren’t merely focused on the technical challenges, they are also determining how departments other than radiology, such as cardiology and pathology will sit in the cloud. Digital pathology images, for example, offer unique challenges compared to radiological images, in part due to their sheer size and differing workflow. These are challenges that will be addressed, but at present, despite some vendors’ fanfare, adoption of cloud technology has been fastest at specific customer segments, such as smaller outpatient sites (looking to remove IT administration burden), and academic sites (leveraging cloud for research). The bulk of the market has still not made the jump, and in many cases, won’t do for some time.

Pathologically Minded

Another of the major technological changes that vendors and providers were discussing at the show was digital pathology. There has been more interest in digital pathology since the Covid-19 pandemic, which highlighted the possibilities of digitisation for a number of clinical areas and hospital departments. In the US this is being reflected by the easing of FDA rules on primary diagnostic use of digital pathology, which is offering the opportunity for imaging IT vendors to enter the market and create interoperability between two departments and their specialists.

While there are some imaging IT vendors that do already offer capability in digital pathology, the fact the topic was being very visibly discussed at a traditionally radiology-focused show, shows that it is becoming a more mainstream opportunity. The fruits of vendor investment in this sector will take time to be realised however. Significant questions need to be answered such as whether a specialist viewer is required, or if it is preferable to be able to view pathology images in the radiology viewer, and whether radiologists need access to slides or if access to the report is sufficient, must all be determined. Notably, some imaging IT vendors are circumventing this learning curve by partnering up with digital pathology specialists, with traction already evident in Europe. The same is expected in North America in the near-term future.

 Exchange of Information

The technology to underpin image exchange is very attainable for a large imaging IT vendor, but whether it is worth attaining is still unknown, with vendors keen to understand the market opportunity for such solutions. This is in part because, at least in private markets, it represents something of a double-edged sword, with providers interested in the ability to share images between their own sites (intra-network exchange), and the ability to use the technology as a differentiator to entice patients in. However, making images easier to share also means patients will find it easier to leave one provider network (inter-network exchange), a loss of business that hospitals will not wish to facilitate.

Despite these questions, from a market perspective the additional interest from providers does make sense. Spurred on by the need for digitisation during the Covid-19 pandemic, image exchange is becoming a dedicated budget item for providers, giving imaging IT vendors more of a reason to target the segment for upsell opportunities. However, particularly in comparison to the core imaging IT platform, it is still a very small market. Moreover, it is also likely to be a market that will increasingly become integrated into enterprise imaging platform competency as providers continue to consolidate contracts and streamline technology.

Putting Words to Good Use

Such discussions surrounding upcoming technological shifts will have been useful for vendors. The show highlighted that vendors must be able to demonstrate considered, deliverable strategies for several technologies instrumental in the development of the imaging IT market. Providers might not be looking to make the switch to new technologies and systems today, but they need to know that when it comes to cloud capability, AI integration platforms and enterprise imaging and interoperability tools, their chosen vendor must be ready when they are.

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