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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.
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.
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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