Tag Archives: Informatics

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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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

Signify Premium Insight: The Trends in Imaging IT at SIIM 2022

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 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.

Continue Don’t Counter

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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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

Signify Premium Insight: Trends and Takeaways from RSNA 2021 – Imaging IT and AI

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 Steve Holloway, Amy Thompson and Dr. Sanjay Parekh

For the first time in two years, radiologists, vendors and providers all gathered in the halls of Chicago’s McCormick place as RSNA 2021 got underway. While attendance was down at the show compared to previous years, and some vendors were notably absent because of continuing Covid policies and restrictions, many key decision makers were still present. For some vendors, this thinning out of the crowd enabled focus only on the best prospects, with most reporting time at the show as more beneficial than had been expected.

More With Less

As well as enabling vendors to utilise the show more efficiently, the subject of doing more with less will also have been a central facet of many conversations. Providers have, after all, endured a very turbulent period over the past two years, with the coronavirus pandemic exacerbating existent trends that have seen radiologists forced to deal with greater numbers of increasingly complex medical images.

Providers are looking to their imaging IT vendors for assistance in tackling this challenge, and vendors, as demonstrated by many solutions at RSNA are acquiescing. Chief among the imaging IT vendors’ contributions were operational workflow and analytics tools. In the current environment, providers are less concerned about grand product announcements and instead, they are hoping for tools and refinements that allow them to achieve more, without a commensurate increase in spending. Notably, this need was highlighted at the show with vendors increasingly promoting tangible improvements in operational outcomes.

RSNA also saw these operational concerns addressed with tools beyond that of improvements to imaging IT solutions, with vendors looking deeper into their quivers for answers. One such direction sees tools to help with patient engagement, such as patient self-scheduling, with vendors reporting how their tools reduced patient no-shows. Other tools, including patient portals and the previously discussed radiology video report functionality from Visage, also focused on improving patient engagement in their care. This improved engagement, it is hoped, will allow providers, to better manage their resources and maximise their care provision.

An adjacent problem is a shortage of technicians and radiologists compared to the volume of patients. As well as providing software tools that can help, RSNA saw vendors such as Siemens Healthineers touting their radiology scanning and remote image acquisition support as extensions of their radiology IT packages, while yet more still are set to follow with partnerships. While these changes are more subtle to detect versus the “louder” product releases, it is evident that healthcare IT platform vendors have a renewed focus not only on technology deployment with customers, but also on supporting customers from a service-line perspective. This was especially evident from imaging IT vendors with broader modality business, who see upside in combining a range of software and service options (fleet management, operational workflow, professional services) to secure long-term customer partnerships.

Strength in Numbers

Partnerships was another of the event’s themes particularly evident in the AI exhibitor section. Partnerships are already a well-established method for vendors to improve their capability and add products from other vendors in areas where they do not have the resource or expertise. Some partnerships were announced before the show but saw the fruits demonstrated for the first time, while in other instances RSNA 2021 would have seen future partners make their introductions and take their first steps to collaboration.

There are examples of AI developers partnering with larger imaging IT vendors, such as those held by Cortechs.ai, Behold.ai and Riverain with IBM Watson Health, as Big Blue emphasised in its launching of its AI Orchestrator platform. More commonly however, the partnerships on display at RSNA saw two or more AI vendors come together to combine their capabilities and give themselves a broader offering that could more successfully compete, such as Viz.ai partnering with Avicenna.ai. Market leaders are starting to emerge, and conditions are becoming more challenging for smaller vendors, which could increasingly find capital investment hard to find, and revenues more difficult to secure. Under these circumstances, a meeting at RSNA which results in two vendors being able to take advantage of each other’s AI solutions to offer providers broader tools and better clinical value will help both vendors retain relevancy in increasingly crowded markets.

Algorithms Delivered

Beyond the tools themselves, some vendors also used RSNA as an opportunity to highlight the steps they were taking in solving the last mile challenges of selection, purchase, integration and deployment of algorithms within providers’ clinical workflows. As detailed in a recent Premium Insight, IBM Watson Health’s AI Orchestrator was one such innovation. This new AI orchestration platform is vendor agnostic, and should allow providers, regardless of their chosen PACS or broader imaging IT supplier, to easily deploy, integrate and take advantage of AI solutions. IBM’s solution takes a disparate approach however as it is not integrated into the vendor’s AI marketplace, and therefore not helping providers in the potentially onerous task of selecting and purchasing AI tools.

IBM was far from the only vendor touting the benefits of its platform at RSNA, with vendors such as Blackford Analysis, which was one of the earlier vendors to take up the marketplace plus platform approach, and Aidoc, which has more recently offered an AI platform, albeit with its own flavour, at the event.

Such platforms are not yet universal, however. Some larger vendors are taking different approaches, with Siemens Healthineers and Agfa HealthCare, for instance, taking a more integrated approach. There are other vendors still, some of which were perhaps expected to show more at this year’s RSNA, which have still not launched similar solutions. This will not be a hindrance in the immediate term, with many providers happy to wait for their replacement cycle before sourcing new systems. There are also legitimate reasons why they have not launched such systems, with the process of ensuring all integrated algorithms are clinically robust, particularly resource-intensive. However, these absences will only become more glaring over time, and could quickly become a significant differentiator

For AI developers themselves, being on a platform is not necessarily a lucrative proposition, with many inclusions unlikely to be making significant revenue. However, to be on a growing platform as the recognised solution for a given clinical application comes with a certain degree of cachet and puts them in a position to capitalise later. Particularly when the time comes that VC funds press for returns on their investments, and it becomes increasingly tenuous to be a small AI developer. Ultimately, the race is on for many AI image analysis developers to prove their standing as top in their category and demonstrate customer uptake at scale and differentiation within the category. This is no mean feat in an increasingly crowded market, so many view platform partnerships as a means to get to customer scale faster. One could already argue based on RSNA this year that the leaders in each vertical are starting to emerge and that market consolidation and a thinning of the field is on the near horizon.

Covering All Bases

RSNA also saw some progress on some of imaging IT’s more typical themes, including the adoption of cloud. Although in many cases,  ‘cloud capable’ and ‘cloud native’ as marketing terms took more of a backseat comparatively to last year’s RSNA.

Although cloud remained present in vendor conversation, vendors centred messaging more on operational outcomes and enterprise imaging, with less hype around the technology, the actual underlying strategy and implementation has taken steps forward, with providers having a clearer idea of their aims and a better understanding of how cloud can help. Providers and vendors are, for example, having increasingly productive conversations about the conversion to cloud. Some of these focus on providers’ reasons for adopting a cloud strategy, whether it is to take advantage of more flexible business models such as SaaS-based models and the options that brings. Other details are more pragmatic, aligning renewal cycles for both Imaging IT and data-centre hardware contracts, and determining whether full public cloud or hybrid cloud architectures would suit a provider’s business and budget more effectively.

There were, however, also clear differences in how much of a priority the subject was for different vendors, with some such as Philips focusing on other parts of its portfolio, while those with cloud as a more central component of their offering such as Visage and Sectra, unsurprisingly, far more enthusiastic about its use. Fundamentally, few vendors are able to truly leverage cloud technology natively across their complete portfolios, such is the R&D investment and re-architecting required. Those that are further ahead in the process are pushing cloud more as a differentiator to customers; those slower to transition will instead downplay the importance of cloud-native near-term.

Overall, it was clear the importance of cloud is growing in customers’ minds. For a growing proportion of the market, it is now just around the corner and so theoretical conversations on cloud deployment are transitioning to more detailed discussions on execution. This includes factors like cybersecurity and operational and maintenance costs as well as looking for guarantees on comparable system performance. For others, cloud remains a longer-term aim, with nearer-term focus on operational workflow more prominent. However, evidence at the show clearly shows that cloud is becoming more important in provider considerations and highlights that its time will come sooner rather than later for imaging IT.

Good to be Back

RSNA 2021 was an exciting event. This may have, in large part, been down to the general positive feeling of meeting in person after so long, particularly under conditions that are just stringent enough to ensure only serious, engaged professionals attend, allowing vendors to have fewer, but more focused conversations.

The technologies and products being touted by the vendors weren’t revolutionary. Many vendors had used the “lull” offered by COVID-19 to optimise and refine their product portfolios as opposed to breaking substantial new ground. Nowhere was this more evident than in imaging IT, where enterprise radiology integration appeared to have finally matured, with most of the top 20 vendors now providing an integrated radiology offering.

There were some interesting new approaches, and illustrations of the growth of key technologies within the imaging IT and AI markets also; the closer incorporation of AI vendors into the wider conference rather than tucked away in the basement was particularly symbolic. Against this backdrop there were also some more intriguing topics. Digital pathology, for example, is one area that garnered sizable interest, with both regulation changes in the US and the pandemic shining a light on the analogue nature of pathology, encouraging interest in the field. Further visions, often the progenitors of longer-term strategies, were also being discussed, with topics such as AI-based triage for pathology being incorporated into radiology workflow tools, making an appearance.

Closer to the present, however, RSNA was a show centred around an industry that is performing strongly in a period of relative quiet. As the conference took place, before the Omicron variant rose to prominence, the worst of the pandemic appeared to be over, and vendors appeared on a strong footing (see Signify Research’s recent financials roundup). Looking ahead there are several broader technological trends set to increasingly make an impact, with AI, more mature enterprise imaging and cloud capability all growing in strength. Vendors, alongside providers, are laying the groundwork for these technologies and solving pressing issues that will open future opportunities. RSNA 2021, therefore was important. It was an event that helped culminate the past and hasten the arrival of medical imaging IT’s future.

 

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