Tag Archives: VISAGE

Signify Premium Insight: Sectra Believes Future Success Lies in its Genes

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Last month, Sectra revealed that it is launching a new business unit to drive innovation and develop new products within the area of genomics. The Swedish enterprise imaging vendor will, in the future, extend the capability of its diagnostic platform to integrate genetic information. This multidisciplinary approach, the vendor hopes, will enable improvements in cancer care and increasingly allow providers to deliver on the promise of precision medicine.

Sectra also announced a collaboration with the University of Pennsylvania Health System, a partnership initiated to facilitate the vendor’s development of an effective clinical IT solution for the new unit.

The Signify View

Healthcare technology vendors have, for several years, discussed the benefits that precision medicine will be able to offer. Those in the industry have promised more personalised care, enabling doctors to make better decisions about treatments, ensuring they are optimised for individuals and ultimately promising better outcomes for patients.

All too frequently, however, such ambition has resulted in precious little material benefit, with precision medicine, for the most part, remaining an ambition rather than a reality. Sectra’s new initiative in genomics aims to address this shortcoming, and improve the discipline’s utility in clinical care. By adding another layer of clinical information into a provider’s enterprise imaging platform, and enabling genomic data to be used alongside radiology and pathology, Sectra hopes to improve diagnosis and treatment of complex diseases, including, as one of the first focuses of the advancement, cancer.

This has been an expected direction of the market for some time, and was highlighted as one of the upcoming areas set to be integrated into enterprise imaging in Signify’s Imaging IT Core Report – 2021:

Sectra is among the earliest vendors to commit to such integration, although others do also note their longer-term interest in the space, harbour isolated sequencing platforms or have made moves on the research, rather than clinical use cases. For Sectra, this grants a potential early advantage in the clinical market, which it hopes to capitalise on as it has done in digital pathology; an area which it has already successfully integrated into its EI platform.

Experiential Experimentation

To make this integration useful, however, will not be easy. Unlike many other adjacent areas which have been integrated into EI solutions, many providers have no legacy of utilising genomic data alongside medical images. As such it would be easy for Sectra to focus on less important genomic information, or attempt to integrate too much  genomic data, resulting in an abundance of erroneous information and a subsequent slowing of diagnosis. For this reason, the Swedish vendor’s partnership with Pennsylvania State Hospital is sensible. It offers the opportunity for Sectra to take guidance from a top academic hospital and refine its solution accordingly.

This is in addition to the considerable technical barriers that any enterprise-wide genomics implementation will present. Chief among these is the sheer volume of data created by genome sequencing, with each human genome sequenced approximately 120GB, orders of magnitudes higher than other types of medical image. As highlighted in several past Insights, imaging IT systems will, over time, shift to the cloud, so it makes sense that a new business unit established by Sectra is cloud-native from the outset, but this also offers considerable challenges. Aside from the cost of storing such a potentially enormous volume of data, the vendor will have to develop an effective strategy for managing this data.

In typical cloud deployments, Sectra works in partnership with public cloud vendors which host the data, while the Linköping-based company manages the service element of the deployment. For genomics, Sectra will need to work with both the providers and public cloud vendors to ensure the cost-effective management of storage, discovering which parts of genomic sequences need to be accessed regularly and therefore benefit from the more-costly “hot storage”, and which sections can be relegated to cheaper “cold” or “glacial storage”.

The work Sectra is doing with Penn State University will help inform this process, but the inexperience of both Sectra, and providers themselves, will make effective implementation of genomics data into EI workflows challenging, not to mention the overall burden such an implementation can place in terms of network infrastructure and load on the broader performance of the network.

Time to Grow

Fortunately for Sectra, these challenges do not need to be dealt with immediately. The integration of genomics into enterprise imaging platforms is, most likely, several years away from a commercial launch, so the vendor has time to work with Penn State University and any other partners it may make to refine the service.

Sectra would also be wise to take a sensible approach with regards to not over committing itself. When integrating other areas such as digital pathology into its enterprise imaging platform, Sectra was careful to focus on areas in which it harboured expertise, focusing on the viewer and the ability to visualise pathology slides alongside radiology imagery for effective collaboration. They, in essence, focused on developing the architecture which allowed the vendor to bring in pathology data and enable doctors to usefully interact with it, rather than focusing on the minutiae that other, niche best of breed vendors are likely better equipped to manage.

A similar approach is likely to be taken in genomics. Sectra will allow specialists to provide the research foundation that underlies the value in utilising genomic sequences in patient care, while itself providing the architecture for that foundation to be leveraged in a clinical setting alongside medical images and other sources of diagnostic information.

In such a way, Sectra will be able to expedite the commercialisation of its genomics products. This could help the vendor win mindshare and, ultimately, custom at leading academic and research hospitals. For these sites, genomic integration will not, at present be a deal breaker. But, given the length of medical imaging IT contracts, and the lengthy development processes effective integrations can take, Sectra’s early move and public road mapping could appeal to leading providers as they begin to consider their approach to the inevitable adoption of genomics.

When Delivery is Due

Over time, depending how efficiently other enterprise imaging vendors can develop and commercialise their solutions, a similar impact could be felt at more mainstream hospitals and provider networks, as they themselves begin to consider their options. Now Sectra has launched an opening salvo, other vendors who don’t want to fall behind must react. They do not need to develop solutions immediately, but they should at least begin to convey their plans to their customers, giving providers the confidence that when genomic integration is more mature, their chosen vendor will be ready to deliver.

In the meantime, Sectra must be careful to avoid spreading itself too thinly. Targeting cutting-edge segments and working with prestigious academics gains mindshare and helps reinforce claims of technical prowess, but the vendor must not take its eye off more lucrative deals. Opportunities to displace rivals are few and far between in imaging IT, so the vendor would be loathe to miss a lucrative contract with a large provider for the sake of a development project. Moreover, on the tail of some big marquee wins for EI that are going through implementation and additional phases of go-live, Sectra does not want to risk damaging its reputation for strong client service and support.

That aside, the move represents a sensible strategy for Sectra. The vendor is, and will become increasingly, disadvantaged compared to some of its larger peers due to the limitations of only offering software, as managed service deals including modality hardware proliferate. By innovating in adjacent areas, Sectra is somewhat able to offset this, claiming for itself more significant mindshare, and market share than it might otherwise warrant. There are challenges, as an early mover. Sectra doesn’t have the benefit of learning from another’s mistakes as will help other vendors in the future, and the returns on its move will not be enjoyed for several years to come, but, by helping to bring the abstract into the concrete, the Swedish company has now laid for itself a clear path to follow.

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

Signify Premium Insight: Rads to Take the Lead in Visage’s Videos

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.

Among the Imaging IT vendors announcing new capability at RSNA was Visage Imaging, which announced the inclusion of radiologist video reports as a standard feature included in the latest version of the Visage 7 Enterprise Imaging Platform.

The update is focused on facilitating the communication between radiologists and patients, enabling them to record a report of approximately one minute in length in order to explain key findings to patients in “plain speak”. However, Visage has stressed that these reports aren’t designed to be comprehensive in nature, nor are they meant to replace the traditional radiology report for referring physicians. According to Visage, it is easy for radiologists to create the videos, which can include 2D and 3D image manipulations, directly within Visage 7, while patients are able to access the video reports at home or on mobile devices via their electronic health record.

The Signify View

The role of the radiologist has always been conceptually very simple. While the profession requires a great deal of knowledge, skill and insight, radiologists are fundamentally tasked with interpreting medical images and passing their findings on to other physicians. If Visage’s new feature gains traction, this job could undergo an essential change and radiologists may also be charged with explaining their findings directly to patients. Forcing radiologists away from the learned language of radiology, and the comfort of its specificity and clarity may prove difficult for some. This reshaping of a radiologist’s role and the challenges it presents, is not necessarily a problem for Visage and the providers that it will serve, but that is also dependent on how much of a difference the additional feature makes. The development of the video reporting concept was made in partnership with a specific customer, NYU Langone, but now Visage believes it is viable in other customer settings. Several vendors in different areas are focusing on improving patient engagement. In doing so, and by keeping patients more involved in their treatment, they hope that patients can be more invested in their own care, avoiding appointment no-shows and avoiding unnecessary care, for example, and resultantly enjoy better outcomes. Visage will hope for similar benefits in making radiology reports more accessible to the patients themselves.

As much as these video reports could offer clinical advantages, they could also improve a patient’s care experience. With the growing trend toward outpatient imaging and the proliferation of smaller imaging centres all competing for a patient’s patronage, this is an important consideration. If patients feel comfortable, valued and involved in their diagnosis, they are  more likely to return to, and recommend an imaging centre and radiology group, whether that is selecting one outpatient centre over another, or an outpatient centre over a larger IDN. This could be particularly pertinent given the increase in telehealth adoption during the coronavirus pandemic, with patients becoming more used to accessing healthcare on their phones or computers. Payers are also increasingly aware of the higher costs of in-hospital imaging versus outpatient settings (exemplified in the recently announced study from John Hopkins: Commercial Negotiated Prices for CMS-specified Shoppable Radiology Services in U.S. Hospitals: Research Letter).

It is unlikely this capacity for improved ‘customer service’ alone will be enough to make providers choose Visage’s imaging IT software over competitors, but it will add another measure to the balance. This will be particularly true if imaging centres find they can charge patients an additional fee for a video report.

Setting the Stage

The success of video reporting may also depend on the setting in which it is used. The functionality has been developed and tested at a provider known for its preference for multimedia-enriched radiology reports. Academic providers such as this have the resource and inclination to incorporate such reporting developments, but for other providers the demands placed on radiologists may be too great.

With acute and worsening shortages of radiologists in many countries, and general increases in both the volume and complexity of medical imaging, expecting radiologists to devote an additional two minutes to record a video report may prove unfeasible. These two minutes would be particularly impactful on less complex images that are more quickly read. Guidance from the Royal College of Radiologists in 2012 suggests radiologists could (with no confounding factors) read 3-6 CTs or MRI scans per hour. An additional two minutes to record a video report on each of these scans would therefore represent the loss of almost one hour of reading time per day.

A Star Upstaged

Another challenge facing the adoption of video reports is that it could somewhat undermine the role of the referring physician. Presently, the referring physician interacts with the patient, explains his condition, details the radiologist’s findings, conveys details of his case, and addresses the patient’s concerns and questions. Increases in the prevalence of video reporting could somewhat devalue the role of the primary physician, with the radiologist breaking down findings for the patient. This could also be the root cause of some issues further down the line.

These could be as simple as disagreements or inconsistencies between the radiologist and the referring physician, if the referring physician has additional or supplementary information about the patient’s lifestyle, for example. More seriously, it could open a provider up to legal challenges. Language in radiology reports is, by necessity, subject specific, mostly very precise and unambiguous. Common language, in contrast, can be vague, have multiple meanings and be figurative or rich in analogy. Such ambiguities could leave a patient uncertain as to the severity of a diagnosis or unclear about the prognosis, potentially leaving a provider open to lawsuits and litigation.

The Critic’s Choice?

Despite these headwinds, there is still intriguing potential for video reporting. Perhaps it will not be suitable in all situations – receiving news of a terminal cancer via a video on a mobile phone, for example, is a possibility that doesn’t bear thinking about. But for the right provider, if the technology is handled sensibly and utilised carefully, and radiologists given the right training, the innovation could be a powerful competitive differentiator. Patients could be bestowed with a feeling of control over their care and ultimately given a far better experience.

What’s more, the inclusion of video reporting shows that Visage remains willing to innovate and, alongside advanced academic partners, is both trying to push enterprise imaging forward, while also supporting innovation in radiology. Developments such as video reporting may not gain traction and be forgotten as a novelty, but, Visage’s willingness to explore it ensures that it retains mindshare far larger than its market share warrants.

Alternatively, video reporting could prove popular and win the vendor business. Given the comparatively low technical barriers, other vendors would surely add the functionality to their own products. Video reporting could, in time, become a standard feature, patients could become more engaged and the role of radiologists could be fundamentally changed forever.

The reality, as is usually the case, will likely fall somewhere between the two extremes, but the potential rewards mean that Visage would be remiss not to take the chance.

 

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