Tag Archives: Stroke

Signify Premium Insight: Viz.ai, Hyperfine and Maximising Mobile MRI

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Last month a partnership was formed between stroke AI specialist, Viz.ai, and point-of-care MRI start-up, Hyperfine. The move aims to give clinicians access to MRI capability at a patient’s bedside, arming them with more diagnostic information for assessing and managing stroke care. This, the vendors hope, will ultimately allow patients suffering from a suspected stroke, a highly time-sensitive condition, to be treated more quickly.

The partnership will see Viz.ai’s care coordination platform utilised alongside Hyperfine’s Swoop portable MRI system, serving as a new commercial opportunity.

The Signify View

Viz.ai has been among the most successful medical imaging AI vendors over recent years. It was, for instance, among the earliest vendors to secure reimbursement for the use of its solution via the New Technology Add-on Payment (NTAP), it has been highly successful in funding rounds, laying claim to more than $250m, and has enjoyed a healthy succession of regulatory approvals. In meeting these milestones, Viz.ai has now found itself facing an ongoing difficulty; how best to get its solution into hospitals.

To this end, the vendor has adopted several initiatives. As well as making direct sales to providers, it has also looked to enhance its offering by partnering with other vendors. It has, for example, sealed a deal with Avicenna.ai in order to bring better care coordination for patients suffering from pulmonary embolism and aortic disease. Elsewhere, Viz.ai has also partnered with Medtronic in a bid to accelerate the adoption of its solution across Europe.

The AI vendor’s partnership with Hyperfine continues this direction, representing another route to market for Viz.ai, and offering another route by which its care coordination platform can get in the hands of users.

This route will not be, for the time being at least, widely used. Hyperfine is, after all, a young vendor with a very small installed base. It does however offer significant clinical potential, allowing MRI imaging to be conducted bedside, and therefore enabling patients in emergency rooms and intensive care units to quickly be assessed for stroke without needing to be moved.

Further, embedding Viz.ai’s solution on Hyperfine’s hardware also ties into the AI vendor’s broader ambition of effectively ‘solving’ stroke care, and addressing and expediting every facet of diagnosing the illness. Viz already offers a solution that can support clinicians along almost every stage of the stroke care pathway. By embedding the solution on a device that will be used in emergency rooms, Viz is continuing to expound one of its core selling points. Even if it is rarely used, having the option to use Viz.ai’s solution in the emergency room further facilitates this end-to-end vision.

Solving Stroke Care

The agreement also makes sense for Hyperfine. The young vendor has previously highlighted stroke care as one of the core use cases for its Swoop portable MRI system. Noting that, as with Viz.ai’s care coordination platform, its use should enable patients to receive treatment sooner, with symptomatic patients able to be imaged right away in emergency rooms or even in ambulances ensuring that they are placed on the correct care pathway and provided the right treatment as quickly as possible.

As such, Hyperfine had already been developing its own neurology imaging AI solution. BrainInsight, Hyperfine’s neurological AI solution, is centred around measurement and quantification, allowing biomarkers signifying neurological damage to be assessed, for example, midline shift following a suspected stroke. BrainInsight will complement Viz.ai’s capabilities and care coordination platform. Adding Viz’s solution to Hyperfine’s Swoop will make the system a more versatile offering, and a more valuable tool for doctors in fast-paced settings such as emergency medicine.

Partnering with Viz.ai also offers other benefits. Several other vendors have targeted the edge deployment route, including Exo and Butterfly Networks (point of care ultrasound), and established brands such as Fujifilm (portable X-ray), who offering image-analysis AI capabilities from Medo.ai, Ultromics and Annalise respectively. While Hyperfine does offer a native AI solution, this partnership will quickly add greater functionality to its scanner.

In addition, it also enables Hyperfine, which is primarily focused on hardware, to quickly scale up the availability and deployment of AI solutions for its modality. This is an important consideration given that in many cases, young challenger vendors offering mobile imaging solutions often sacrifice some image quality in the name of mobility. Such a compromise can, however, be mitigated with the use of AI, enabling these devices to be used for tasks that may otherwise have been beyond the hardware’s limits.

Partnership Planning

At present, partnerships are an effective way for both hardware and software companies to benefit from such collaborations. While in some cases, acquisitions, such as Exo’s acquisition of Medo.ai make sense, allowing the hardware vendor granular control over the AI vendor and enabling it to be specifically tailored, often partnership presents a better route.

This is true in the case of Hyperfine and Viz.ai, with Hyperfine a long way from being able to afford large acquisitions. Even without this financial hurdle, a partnership is likely preferable for both vendors, enabling them to easily enter into an agreement and capitalise on the other’s strengths without needing to commit for the long term if a better option becomes available. For Hyperfine it means it can offer Viz.ai’s solution, while Viz.ai can expand onto another potential growth platform for minimal cost.

Despite its recent valuation, Viz.ai is also unlikely to want to acquire Hyperfine. The fact it remains a nascent, yet innovative, technology, with a relatively modest installed base is reason enough to deter Viz.ai. More broadly, Viz.ai’s other recent partnerships also suggests Viz is not looking to acquire just yet.

Both vendors could also look to make more partnerships. Viz could look to secure more partnerships with other modality vendors, with a more established modality vendor with a sizable installed base a significant opportunity. Such a partnership may be difficult to come by, but it would give the vendor enhanced credibility and visibility among providers.

Hyperfine is also likely to look to embark on additional partnerships. While neurology is one of the vendor’s present priorities, the ability of AI solutions to improve the suitability of the Swoop for other clinical use cases and mitigate some of the limitations of the hardware for certain applications could bring opportunity, in prostate imaging, for example. By partnering with multiple AI vendors, Hyperfine can improve the value proposition of its Swoop, ensuring it is a more versatile system which can be utilised for many use cases by providers. Further, this ensures it can remain focused on developing and fine-tuning its hardware, rather than splitting its focus to develop AI solutions as well.

Such benefits will, however, take time to be realised. The partnership between the two vendors will not be transformative, particularly for Viz, with use on Hyperfine’s portable MRI systems offering limited potential, at least in the near term. It does however make sense, given the low cost of the partnership. The move, as with other hardware/AI partnerships before it, show the synergies that can be found and AI’s ability to maximise hardware’s capability. It may not ultimately lead to a dramatic increase in sales for either company, but other similar future partnerships might.

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Signify Premium Insight: Viz.ai and the Perils of Success

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.

Medical imaging AI has a new unicorn, after Viz.ai secured $100m in funding at a $1.2bn valuation. The series D round brings Viz.ai’s total funding raised to more than $250m. This figure places it higher than almost all other vendors, with only HeartFlow and Shukun Technology having declared greater funding totals.

In the funding announcement, Viz.ai also revealed that more than 1,000 sites are now using its care coordination platform, which aims to expand on the vendors’ current focus on stroke detection and triage in order to aid and improve decision making in other clinical areas.

The Signify View

Viz.ai has, over the last two years, been on something of a roll. In August 2020 the Centers for Medicare & Medicaid Services (CMS) granted the vendor’s diagnosis and triaging solution (as well as others functionally equivalent) the first New Technology Add-on Payment for artificial intelligence software. This ruling meant that unlike almost all other AI solutions, providers could be reimbursed for the use of Viz’s tool. The vendor followed this up with a $71m series C funding round in March 2021 to finance Viz.ai’s expansion of its Intelligent Care Coordination platform into both other areas of clinical care and into other global markets. This round also propelled the vendor into the $100m club, of vendors with more than $100m of funding. Adding another $100m pushes Viz.ai into even more rarefied air, but also begs the question of what a vendor which has raised $170m in little over twelve months will do next.

This rapid progression suggests that Viz.ai could be heading towards listing publicly, with the vendor utilising its series D funding to pay for expensive product development to target other clinical areas, and sales activities to capitalise on other territories beyond the US. With these initiatives underway the time would be for ripe for Viz.ai to target an IPO and raise the capital it needs to attempt a rise to dominance. However, in reality, this path could prove to be problematic. One need only look at the attempts to list publicly by other large medical imaging AI vendors to see the challenges that could lie in Viz’s future. HeartFlow, example, raised more than $540m, with its latest funding round, a post series E, completed in 2019. In 2021 the vendor then decided to list publicly via a SPAC merger.  However, this plan was ultimately unsuccessful with the vendor abandoning the move earlier this year, citing unfavourable marketing conditions and an inability to properly value the company. More generally review of broader healthcare technology sector in 2022 year to date versus 2021 has seen a collapse of IPO and SPAC deal volume.

The Demands of the Market

A similar fate could befall Viz.ai, with the appetite of VC investors not necessarily translating into demand from public investors. However, there are differences between the two vendors. If Viz.ai decided to go public now it would be doing so with a valuation, that, while significant, is still more than half that given by HeartFlow when it announced its IPO. This could make such a move more manageable, with the more modest valuation more attainable than that of HeartFlow. Alternatively, Viz.ai could follow HeartFlow’s lead and continue to secure funding privately for several years, potentially even ultimately transitioning to private equity ownership, similar to Circle Cardiovascular Imaging. While the potential to raise significant amounts of capital is diminished by such a strategy, in the young and still maturing medical imaging market answering only to a handful of private investors, satisfied with nuanced yet strategic progress, rather than being obliged to deliver headline-grabbing figures to countless unsympathetic shareholders may be preferable.

There are also technological differences between the two vendors that could grant Viz.ai a very different experience to HeartFlow. While the latter remains, in essence, a vendor with a single tool, albeit one which is clinically very valuable, with a strategy to add other tools targeted at cardiovascular disease, the former is a vendor which has already progressed from offering a single algorithm into a vendor with a fleshed-out stroke care coordination platform, expanded beyond neurology. Conversely, HeartFlow is reliant on a single FFR-CT tool, this is an area with, at present, less competition. While there are vendors such as Keya Medical offering similar functionality, they remain focused on the Chinese market. Several young heart health AI developers could begin to offer their own alternatives, but at present HeartFlow is at limited risk from other vendors. In the stroke care space, however, there are numerous competent competitors, some such as RapidAI have already made headway in the US, Viz.ai’s key market, while others are operating and growing in other territories; potentially a significant challenge to Viz.ai’s international ambitions.

Options & Opportunities

This availability of other stroke detection algorithms could also prove a challenge for other reasons. Viz.ai’s image analysis capability is solid and dependable, but not unique. Instead, what presently sets Viz.ai’s Care Coordination Platform apart is the solution’s workflow element. Instead of focusing myopically on the tool’s diagnostic capabilities, the vendor sought to improve stroke diagnostic capabilities into a clinical care pathway, ensuring that the results of the diagnostics could actually benefit doctors, providers and patients. Even if Viz.ai’s stroke detection algorithm could be technically bettered,  its integration may allow it to have a greater impact.

Successful integration also breeds new challenges in terms of regulation and changing care workflows. While not specifically targeted at Viz.ai, the US-FDA’s recent public reminder on April 11th 2022 was a clear warning to vendors of AI-based triage tools for stroke care to be clear on intended use when marketing to providers, while also reminding providers that adoption of CADt must not replace radiologist diagnostic reporting on potential stroke cases regardless of triage prioritisation result.

Viz.ai has gained significant traction by touting its workflow capabilities more so than its AI image analysis capabilities. However, by securing sales based on this workflow integration, Viz.ai leaves itself more open to competitors. These, on the one hand could be other stroke solution providers, RapidAI for example has worked to improve the analytics and prehospital elements of its own product. As Viz.ai boasts of ever-increasing user numbers and ever higher valuations, other vendors, even those outside of stroke imaging could also be attracted to the space. Large healthcare IT vendors could use their scale and breadth of capability to target the market, offering solutions that link stroke care to other departments and either utilising in-house stroke detection algorithms or partner with one of Viz.ai’s competitors.

Electronic Health Record (EHR) vendors are another type of company that could be interested, these vendors are deeply integrated into hospital networks, but could use workflow tools as an opportunity to expand their reach.  There is some precedent for this, with several EHR vendors already offering breast imaging modules for mammography reporting as part of their Radiology Information System (RIS) modules.

With this heritage there is opportunity for the likes of Cerner or Epic, for example, to build on their existent platforms and develop workflow modules, leaving providers to simply partner with a stroke detection algorithm vendor of their choosing. The impetus for such moves will only increase should reimbursement become permanent, rather than the temporary NTAP at present. Although with this reimbursement being renewed for 2022, all signs point to reimbursement for stoke imaging AI becoming permanent. Not only would such a move make the space more lucrative, but including stroke detection within broader tools could make billing and claiming reimbursement more straightforward, attracting provider’s interest.

Suffering from Success

Despite the potential of such prospects, they remain in the longer-term future. For the time being Viz.ai will continue to gain traction. The company now has the necessary funds to enact its short and medium-term strategic objectives, adding significantly to the list of 1,000 sites it caters for and expanding beyond stroke care to take advantage of other lucrative clinical segments. What’s more, through its own activities as well as through partnerships, such as that with medical device company, Medtronic, Viz.ai should increasingly gain a footing in new markets, e.g., Europe, going toe-to-toe with local stroke detection algorithm developers.

How long these good times can continue to roll remains to be seen. Viz.ai has successfully built a useful and commercially viable product, which is enjoying great success in the meeting rooms of VC investment firms. This success, however, could bring more attention to the space and ultimately be responsible for a humbling of the vendor. Viz.ai must acknowledge this threat and act to capitalise on its current momentum and look to make itself indispensable. Now, like HeartFlow before it, Viz.ai will find that more money, really can mean more problems.

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