Tag Archives: IT

Signify Premium Insights: AI Generating Headlines at HIMSS 23

Last week saw the annual global conference of the Healthcare Information and Management Systems Society (HIMSS). The meeting was vibrant, with visitor levels far higher than the 28,000 seen in Orlando last year, at more than 35,000. There was good reason for this excitement. Aside from the usual bounce a ‘return to normality’ can offer, there were also many interesting subjects to discuss, some of which are crucial as vendors, providers and other stakeholders plan their strategies over the coming years.

The Signify View

Of these topics, there was one that stood out. Thanks to its novelty, its recent and sometimes controversial explosion into the public consciousness, and the far-reaching possibilities some

Signify Premium Insight: Where AI and IT Belongs in Radiology at ECR 2023

With the European Congress of Radiology (ECR) now squarely behind us, it is time to reflect on last week’s Vienna event.

Last year’s meeting, which took place in July, was somewhat subdued, with a limited presence from many Asian vendors thanks to lingering Covid restrictions, while other would-be attendees from Europe were instead on their summer holidays. As such, this year’s conference had a something of a make-or-break atmosphere, with some vendors ready to re-evaluate their commitment to the show, should the 2023 event also fail to excite. Fortunately for the European Society of Radiology, vendors, for the most part, went home satisfied. While the events’ opening day was a little shy of footfall in some quarters, the overall number of visitors and the presence of some new vendors brought positive energy to the exhibition’s halls.

Signify Premium Insights: The Imaging IT and AI Trends on Display at RSNA 2022

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.

Although empirically quantifying the success of a conference is a difficult thing to do, last week’s meeting of the Radiological Society of North America (RSNA) certainly ticks a lot of boxes. While there are some useful metrics that can be employed – attendance at the show, for example, was 31,000, a dramatic improvement on last year’s 19,000 – more significantly, however, are the less objective measures. This is where RSNA 2022, for AI and imaging IT vendors at least, really shone. There was an energy and enthusiasm about the show, with exhibitors and attendees alike keen to engage in meaningful discussions about the latest products and their place in a provider’s radiology departments.

Was this buzz however a true reflection of the innovation on display in Chicago? Or was it just a symptom of an annual meeting returning to normality after several years of disruption?

The Signify View

While it is true that there will always be a strong contingent of radiologists and clinicians who attend to keep abreast of the latest developments in radiology, there was a real sense of purpose to many of the conversations, with vendors both keen to show off a fair catalogue of new products, as well as highlight some of the subtler, more strategic elements they were engaging in, such as partnerships and collaborations. There were some gaps at the show, with a lack of Chinese vendors a particularly noticeable absence due to domestic Covid restrictions still being enforced.

This was particularly true in AI, with several developers exhibiting at the show for the first time. These growing ranks were something of an incongruity given the inevitability of consolidation in the medical imaging AI market, however there are several factors that explain this abundance. There were some vendors, which, freed from the Covid travel restrictions of recent years, or better established in their domestic markets, were keen to show their products in the US. There were also other, younger, vendors present. While the nature of investment is shifting towards later stage investment at more established vendors, there is still a lot of capital being poured into young AI start-ups, especially those based across Asia. Visibility is important if these vendors stand a chance of converting funding into revenues over time, so even with consolidation looming, they need to be working to make inroads.

Another factor going against these newer vendors at RSNA is that radiologists are becoming more discerning. There is a plethora of tools that offer accurate image analysis for certain exam types. Vendors joining this cohort face an uphill battle as market leaders are emerging, offering a broader range of capabilities beyond detection, adding additional tools that incorporate AI into clinical pathways beyond image analysis, or diversifying their product portfolio by targeting a broader range of use cases, for example.

AI Opportunity

A corollary to this, which was in evidence at RSNA, is that vendors are also realising that the overall financial opportunity from image analysis is ultimately limited; there will, after all, only ever be a certain amount that can be paid to read a medical image. As such, some of the more established vendors are now endeavouring to deliver products that offer value along a broader aspect of the care pathway. Further, products that key into the far more significant opportunity of addressing providers’ operational challenges will, in turn, enable these vendors to tap into healthcare providers’ large operational budgets rather than smaller departmental software or research budgets. Several large healthcare technology vendors have already shifted their focus in this direction, often working on the incorporation of AI into the modality fleet rather than image analysis itself.

This broader focus wasn’t the sole preserve of AI vendors. There is always excitement around a market’s, significant, longer-term technical directions, such as imaging IT’s expansion into other ‘ologies’ as enterprise imaging solutions become ever more complete, and cloud capability, for example. On this front, the increased presence of AWS and Azure, along with the arrival of Google highlighted the continuing interest providers have in cloud, as well as the opportunity medical imaging offers for cloud vendors.

Despite this increased presence at the show, many announcements weren’t headline grabbing developments that came out of the blue. Instead, RSNA witnessed predominantly incremental changes, with vendors diligently continuing to work on re-architecting their solutions in order to capitalise on the potential of cloud. So far, viewers and data management have been among the greatest beneficiaries of this focus, although hinting at the market’s most-likely future direction, hybrid, rather than fully cloud-hosted deployments, have so far gained the most traction.

Vendors are also myopically focused on the difficulties providers are facing at any given moment. At present that means offering solutions that can help vendors with their operational challenges.

Between staff shortages and burnout, enormous backlogs of patients waiting for elective interventions that were delayed by Covid, rising energy prices and wider economic issues, there are lots of difficulties providers are currently facing. These issues were being widely addressed. For vendors who offer modalities as well as IT tools, there was considerable focus on fleet optimisation, ensuring that providers can efficiently utilise their medical imaging hardware and get the highest quality images from it in the least amount of time.

Playing to Strengths

Those imaging IT vendors which don’t also offer modalities however, had to instead play to their own strengths. At RSNA, this, in many instances manifested in vendors highlighting advancements in workload balancing, tools that intelligently assign radiology cases to the most appropriate radiologist at the most appropriate time and incorporates metrics such as Relative Value Units (RVUs).  An operational workflow strategy alone will not play a role in disrupting the competitive landscape; it merely means vendors are meeting a different set of needs for a provider, which address alternative pain points.

One of the ways vendors are attempting to address these pain points is by focusing on their unification strategies and continuing to consolidate capability from across vendor portfolios into the singular imaging IT platform. One example of this at present is the increasing incorporation of advanced visualisation (AV) within the PACS. This development of the diagnostic portion of enterprise imaging will not happen overnight, largely thanks to AV’s legacy as a modality-linked standalone workstation. However, as seen at RSNA, vendors are increasingly focusing on the integration across their entire ecosystems. The same is also happening with AI-based image analysis and AV. A development increasingly expected of vendors as providers look to streamline the diagnostic user experience and improve the efficiency of radiologists.

Similar expectations are also growing for the interoperability of medical imaging data. While such connectivity is still limited, the convergence of enterprise data has begun with relevant EMR data becoming progressively available within the diagnostic viewer, the overarching drive towards structured, standardised and curated data remains in its infancy. The power of such data however, can translate into benefits beyond informatics, in scenarios such as analytics, AI development and real world data applications. Informatics data will increasingly be a valuable resource across provider networks and beyond.

Partners and Provision

Another trend on display at the show evidenced by all vendors developing AI solution, is the question of how to support radiologists and other clinicians in adopting them. AI orchestration platforms are an increasingly common way of bridging this gap and are now being offered by all manner of vendors from the incumbent platform specialists, AI independent software vendors (ISVs) themselves, mid- and large imaging IT vendors, and even some modality vendors. However, for the AI ISVs and platform specialists, they still rely upon a final integration point into the PACS, which ultimately, creates an additional layer in the workflow that PACS vendors with native AI platforms can overcome.

Without being able to partner with an imaging IT vendor, independent AI platform vendors will have to target individual providers directly, which will severely hamper their ability to scale rapidly. This aversion isn’t universal, and there are some vendors that realise the importance of the working more closely with PACS vendors, and some of those exhibiting at RSNA highlighted partnerships which involved providing their orchestration platforms to the imaging IT vendors.

There is progress in other ways too. Large imaging IT vendors themselves are making inroads, more thoroughly incorporating orchestration platforms into their digital strategies, in order to effectively connect ever more components across their entire digital ecosystems.

Strategic Direction

Another development is in imaging IT vendors becoming increasingly discerning in their choice of platform partners. Informatics vendors offering platforms have, for the most part been happy to partner with a vast array of medical imaging AI vendors, on the grounds that it was better for their customers to enjoy a larger breadth of capability. In many cases, though, these wider platforms failed to gain significant traction. At RSNA there were several moves towards altogether fewer, but more carefully chosen platform partners. This isn’t to say that looser integrations, enabling the hosting of the broader range but, based on RSNA there is likely much greater selectivity for actual collaborative partners. Further, some vendors remained committed to developing AI tools natively to retain greater control on the workflow, and only turning to partner vendors for niche use cases.

Ultimately, however, as is so often the case at RSNA, the greatest significance stems not solely from what was on show, but from the further reaching trends that the announcements and demonstrations indicate. Most significantly for imaging IT and AI vendors, was the greater awareness of contemporary challenges facing healthcare providers. The tough economic climate means providers are even more stretched, but, by the same token they are receptive to digital solutions that may seek to alleviate this. More sophisticated AI solutions, workflow tools which allow greater oversight of medical imaging departments, and more considered deployment and utilisation of tools. Perhaps not the most headline-grabbing year for RSNA, but an event set to have a sizable impact, nonetheless.

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Signify Premium Insight: Imaging IT and AI: The Key Trends on Display at ECR 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.

In mid-July, the European Society of Radiology met in Vienna at their annual gathering, the European Congress of Radiology. The show, returning to an in-person format after two years of Covid-enforced cancellations, was also rescheduled switching to summer from its usual late-winter timeslot.

This schedule likely contributed to one of the biggest changes at the show, a reduction in attendees, as radiologists, hospital management and other buyers may have been enjoying vacations or taking advantage of public holidays such as Bastille Day in France. This change was significant and, in some ways, set the tone for a more focused affair than had been enjoyed in previous years.

The Signify View

This fall in attendance was also exacerbated by the show’s layout, which deviated from a traditional format. Major imaging vendors were given more floorspace, but at the expense of being dispersed and in some cases, harder to find. This allowed them to simulate “care pathway experiences”, reflecting the interests of many of the show’s attendees. Interestingly such experiences were only offered by the largest vendors, with mid-size and smaller vendors sticking to more traditional booths, serving neatly as a visual representation of the differences between these two tiers of vendors.

This reduction in turnout was not mirrored by vendors, who, for the most part, were not deterred. This was particularly true among smaller European vendors, including a significant number of AI start-ups taking advantage of the show, which typically have not exhibited at RSNA. These vendors, for whom the expense of exhibiting at RSNA is currently too high and US FDA regulatory barrier daunting, could use the show to interact with Western European radiologists, the same clinicians that could well be among their earliest customers.

Cloud Considerations

The show’s location also was significant. Cloud adoption is one of the ongoing trends in medical imaging IT. The nature of this trend is very different in different regions, with Western Europe and North America especially divergent. This is particularly true when it comes to public cloud. There are some instances of public cloud in certain European countries such as the UK, evidenced by GE HealthCare’s recent deal for its first Amazon Web Services-based deployment of its True Pacs software in Europe, at the Royal Orthopaedic Hospital. However, such deployments are exceptions.

More typically, European cloud deployments centre around private cloud, with the imaging IT vendors themselves providing the cloud capability for providers. There are pockets of public cloud adoption, with the UK’s National Health Service (NHS) fostering a close relationship with Microsoft and pursuing a cloud-first strategy, while Italy also has started along a path to public cloud adoption. More generally though there is distrust of public cloud and a reluctance to, in essence, share patient data with large US-based big tech cloud providers.

This hesitancy was on display at ECR. At RSNA, where catering primarily to the North American market, public cloud is widely promoted. At ECR however, vendors were more muted in their promotion of cloud capability, engaging in conversations with attendees, but none of the major vendors made significant product announcements.

Instead, much of the focus, particularly for the large medical imaging vendors, centred on the best utilisation of hardware, with radiology service line, operational workflow and other tools aimed at improving radiology departmental efficiency. This focus reflects where the surest return on investment is for many customers in the near term.

The show’s location also influenced other facets of the show. The North American EMR market is very established with just a handful of players accounting for most deployments. As such, it makes sense for medical imaging companies to promote tools that consolidate diagnostic imaging into the EMR. In Europe, however, the EMR market is very fragmented, rendering such approaches, as yet, unfeasible. In 2020, for instance,  no vendor had a share of the inpatient EMR market in EMEA of more than 16% (as detailed in Signify Research’s EMR/EHR Market Intelligence Service).  The opposite is also true in other areas. Europe is far more advanced than North America in terms of digital pathology, and customers could be feasibly looking to adopt solutions soon. As such, at present, ECR represents a better opportunity to promote such solutions, than many other events.

Competitive Categories

Unsurprisingly, one of the areas that did have a large presence at the show was AI. Despite this presence however, the level of new and unique products was minimal, with many of the young vendors at the show adding products to already well-established categories such as breast imaging (e.g., b-rayZ) or brain volumetric analysis (e.g., Mediaire). This is, in part, a result of those categories being seen as a safer, more conservative option where there is already known demand, while the AI market remains nascent. This desire to stick to established  toolkits may prove sensible in the near term as vendors are able to ride on the rising tides of those areas, but longer term it seems very risky, with many of these smaller players likely to be displaced or made redundant by other, better-established companies with more sophisticated products that already have sizeable installed bases.

In releasing a single-purpose chest CT tool, for example, a vendor must do something unique to gain traction, otherwise a product risks being overshadowed, not only by the plethora of other point solutions, but increasingly by more advanced comprehensive solutions, which can identify multiple findings at once.

These better-established vendors with more sophisticated products are also facing important decisions of their own. These vendors must continue to evolve and further develop their products to ensure that they remain attractive in what is an increasingly competitive market. In many instances it is the direction of this development that they must focus upon, whether they should choose to expand first into different modalities (multi-modality approach) or if it is better to expand across different pathologies (multi-ology approach).

Where Next?

There are merits to both approaches. Expanding into different modalities could allow a vendor to create ever more sophisticated end-to-end solutions, to cover a patient’s entire care pathway (e.g., lung cancer screening). This may also bring regional opportunities, enabling an AI solution to be used in areas where specific modalities are preferred for certain tasks, for example. However, it could put AI vendors into greater competition with large imaging vendors such as GE HealthCare and Siemens Healthineers, which offer a complete range of modalities, imaging IT systems in-house and develop algorithms for their modalities natively. In such circumstances, the large international medical imaging vendors are likely to have the advantage.

Decisions of a similar significance will have to be made by vendors of all size, and, as consolidation begins to take hold in the market, the consequences are likely to become ever more severe. The evidence of these decisions will be seen at coming trade shows, with RSNA the next opportunity for AI vendors to show, once again, that they are able to offer improvements in and beyond radiology to bring greater value to clinicians. To do so, vendors must continue to progress, either by developing new tools, or enhancing existing tools. However, funding runways for many medical imaging AI are limited, especially for those vendors that have not managed to raise capital investment in the past couple of years, so vendors must take what they can to ensure long-term viability.

The picture is less dramatic for imaging IT vendors. Here the broad direction is known; a shift toward cloud-native muti-ology enterprise imaging solutions. This change is coming, and all vendors have begun working towards such products, but many still need to secure buy-in from providers. This will be a particular focus at RSNA, where several significant launches, which were held back at ECR, are expected, once again propelling the market forwards.

Despite it being quieter than “normal”, ECR was still a positive show, giving vendors a chance to explain their visions to a predominantly European customer base. Now, however, they must look ahead and prepare to help a much larger audience realise those visions in Chicago at the end of the year.

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Signify Premium Insight: Establishing a Commanding Position

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.

This Premium Insight is the first in a two-part series assessing the impact and strategy of command centre solutions for the medical imaging sector.

Hospitals are more connected than ever before. Hardware across hospital networks is increasingly being linked by software, while individual IT systems and separate departments are being joined together, helping doctors and other hospital professionals to reap the benefits of improved access to patient information and advanced technology.

However, some vendors are also increasingly offering tools that can help providers maximise the benefits of these more connected software solutions, supporting operational and clinical decision-making. Such tools look to bring together fleet management solutions for imaging modalities and imaging workflow analytics and business intelligence, for example, along with patient information from the EHR, and aim to make the data more useful to hospitals using the systems. This could help hospitals improve their hardware utilisation, reduce no-shows for appointments, and improve efficiency, among other benefits.

The Signify View

There are, however, several different approaches that vendors are taking to these broad command centre solutions. Some vendors, such as Philips, which offers its Radiology Operations Command Center (ROCC) is, as the name suggests, focused on radiology. The tool is designed to help radiology departments operate more efficiently, allowing patients to be seen more quickly, saving costs for the hospital and utilising collected data to improve the departments in the future. This is a similar strategy adopted by Siemens Healthineers, which offers some similar functionality through its Virtual Cockpit and teamplay/Medicalis product offerings.

Other vendors meanwhile are adopting a more enterprise-wide strategy such as GE Healthcare with its own Command Center solution. GE’s tool primarily looks to bridge the gaps in the EHR, layering analytics dashboards and a user-friendly interface in a bid to create a collection of tools that address pinch points in a hospital’s operational workflow, such as bed management or clinical decision support for certain types of patients, for example. GE’s Command Centre does extend into a hospital’s imaging department, but as yet doesn’t offer an integrated deep radiology focus from the Command Centre platform.

Despite these different strategies, with the different sales channels and different implementations, both vendors offerings have the same ultimate goal – improving a hospital’s efficiency, albeit starting with divergent top-down vs bottom-up approaches.

Mundanity to Profundity?

Despite the grander long-term vision, however, the actual utilisation of many offered tools is still in its infancy, with many of those that have been adopted pertaining to administrative or QA tasks. While customer presentations highlight intelligent systems that provide hospital networks with actionable insights to improve the running of their imaging departments, many of the tools that are being utilised by hospitals are more utilitarian.

Tools such as smart scheduling to ensure experienced professionals are available to conduct scans as they are required, auto-protocolling to streamline the process of conducting scans and tools prioritised because of Covid, such as those allowing patients to self check-in for imaging appointments are all proving their worth. While these tools can be valuable to providers, other capabilities offered under the banner of command centres can also tie into the broader strategic directions being taken by vendors.

At the broadest level, vendors are increasingly transitioning from making transactional sales of medical imaging hardware or departmental software to effectively become ongoing service providers for large hospital networks. These command centres, particularly the more imaging departmental offerings from Philips and Siemens Healthineers, contribute to this broader aim. By deploying a command centre solution centrally, a provider should gain visibility over the performance and efficiency of its imaging department. In doing so, a command centre should be able to help identify underutilised pieces of hardware, areas of inefficiency or spare capacity that can be employed. Collaboratively with providers, vendors can also utilise this information to help schedule maintenance and minimise equipment downtime allowing providers to maximise the value of the systems they have purchased.

At Your Service

This fleet management aspect to command centres can become more valuable as the size and sophistication of a provider’s imaging fleet, particularly those across multiple sites using hub and spoke models etc, increases in complexity. It is also a potentially lucrative channel for vendors, for several reasons.

Firstly, and most immediately, the pressures exerted on medical imaging departments by the backlog of procedures that were delayed because of the Covid pandemic, as well as the budgetary challenges that the pandemic created means that operational workflow and departmental efficiency is a significant driver for healthcare investment. If vendors offer providers a solution that can demonstrably improve their efficiency and therefore save them money and time, hospitals could be willing to purchase new tools, upgrade their systems, or even switch to a new vendor, particularly if a renewal is due.

More significantly, and, arguably more lucratively over the longer term, is that vendors can leverage such tools to become increasingly embedded as service providers at hospital networks, allowing them to tap into operational budgets, a pool far larger than, say, a radiology department’s IT budget.  Beyond selling hardware and software to a provider, vendors will be able to use command centres to upsell professional services. For example, a vendor could look to embed consultants, which could utilise the data streams collated by command centres to drive greater utilisation of the platform, improve the providers’ performance and ensure they meet their KPIs. Effectively, vendors could charge providers to save them money.

This has the benefit of both bringing about short-term revenue gains, but also further tying providers into a vendor’s ecosystem and solidifying a vendor’s position at a provider. Furthermore, such are the revenue possibilities of these service-based offerings, vendors may enter these deals with a “loss-leader” strategy, with limited margin in the first few years, with the reassurance that service upsell will more than compensate over the duration of a 7-10+ year partnership with a provider. This is particularly true if a provider enjoys growth of its own, either through acquisition or expansion, with a vendor being able to organically grow as its customers succeed and extend existing contracts to new sites.

Size Matters

While vendors across medical imaging and beyond are focused on improving customer retention and fostering growth through the development of managed service partnerships, at present, only GE Healthcare, Philips and Siemens Healthineers have grasped the nettle. Fujifilm and Canon, particularly after their respective recent acquisitions of Hitachi and Toshiba, do have the scale to offer such packages, but not the same market demand in the vendors’ key markets such as Japan, therefore, they are yet to prioritise command centres and the analytic tools which would facilitate the same professional services and consulting opportunities GE Healthcare, Philips and Siemens Healthineers are hoping to capitalise on.

These Japanese vendors, over the longer term at least, will be able to offer comparable services. Other vendors may struggle in this regard. EHR vendors are well placed to offer broader, network-wide efficiency tools, albeit ones which lack the richness for imaging departments that large international imaging vendors can offer. Smaller specialist imaging IT vendors, whose nimbleness has allowed them to pinch business off large medical imaging vendors over recent years, may be able to offer some workflow or analytics tools comparable to their larger competitors. However, the size of the vendors, as well as the lack of hardware, limits the opportunity to match the service offering from the larger vendors. Other vendors will not let GE Healthcare, Philips and Siemens Healthineers have entirely free rein over such markets, and more focused, specialist vendors will seek to capitalise on the same trends with purpose-built analytics solutions. However, while providers’ full utilisation is low, having so far only embraced a fraction of the solutions being offered by vendors, over the longer term they will be a key weapon in the large vendors’ fights to further consolidate their positions in the market and derive further revenue from those sites.

 

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