Tag Archives: workflow

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: Medical Imaging Modality Predictions for 2022

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Co-written by Bhvita Jani, Mustafa Hassan and Simon Harris

By the end of summer 2021, the worst of the coronavirus pandemic appeared to be over. Providers were now tasked with dealing with the enormous backlog of patients whose elective procedures and screening scans were postponed because of the emergency restrictions brought in as a result of the Covid-19 pandemic. As 2022 begins, however, the threat of Covid is back with a new variant threatening to cause further disruption. Against this backdrop, medical imaging modality vendors had been performing strongly, but 2022 will see them need to offer the products and technologies that can help providers with this disruption. They will also need to look after their own houses, and make sure the global and economic volatility does not prevent them doing business. In light of that, here are five predictions that we expect to define the year ahead.

Supply chain management will be crucial

Challenges within hospitals have dramatically intensified as a result of the Covid-19 pandemic, however, there are other, global challenges that vendors must also countenance. Chief among these are the supply chain issues that are affecting companies from almost every sector, with reports from carmakers, food producers, electronics manufacturers and others all being hit.

Medical imaging systems vendors are not immune from this challenge, with almost all the major vendors noting the issue in their latest results presentations. This disruption is likely to have several significant impacts. Semiconductor chips are among the products which have been impacted most acutely. The scarcity of these chips will mean that vendors will have to prioritise their use, using them first in systems that command higher-prices and higher margins, this will drive up the average selling price of systems, compounding increases caused more directly by a shortage of supply.

Smaller vendors are likely to be most impacted by these shortages. Larger vendors have the buying power and international reach to better mitigate against shortages. They have the reserves to stockpile essential resources, and the ability to broker deals with new suppliers across the world.

This supply chain disruption and component shortage will impact every vendor, so will not, in and of itself, favour any vendor over any other. However, how vendors deal with the disruption will have a huge impact. Orderbooks are brimming, but that means naught if vendors cannot manufacture and supply the systems needed to meet them. Management of supply chains will therefore become one of the major differentiators between vendors throughout 2022.

The democratisation of medical imaging will be accelerated by larger vendors

Imaging has already started its journey out of hospital imaging departments. This transition has in many cases been driven by young vendors which mark this decentralisation as their mission. Butterfly Network is among the highest profile of these, having leveraged a new technology and new business models to quickly become one of the market leaders in handheld ultrasound, making its devices an increasingly common sight across inpatient and outpatient settings. Other new vendors, both within handheld ultrasound, such as Exo Imaging, Pulsenmore, and Vave, and elsewhere, such as Nanox, Turner Imaging Systems and Hyperfine, are hoping to imitate Butterfly Network’s success in the transition of imaging out of the hospital.

In 2022 this will change. Large imaging vendors have been a part of medical imaging’s transition away from imaging departments in the past, but this year will see those efforts intensify. This is, in many instances, a result of larger vendors having to create new markets if they are to be able to continue to deliver on their growth forecasts. Growth opportunity within hospital’s radiology departments is limited. This is compounded further by the transition of many providers to longer-term, more holistic vendor partnerships, which further limit sales opportunities for vendors looking to displace competitors.

New clinical settings can provide these sales opportunities. Vendors such as Siemens Healthineers, which late last year announced its MAGNETOM Free.Star MRI scanner are indicative of larger vendors looking to target these opportunities. Siemens, as well as other vendors such as GE Healthcare and Philips have focused on making their products more accessible, with factors such as smaller space requirements and lower infrastructure needs, as well as lower cost and facilitation of less experienced technicians all making their system’s adoption by emergency rooms, orthopaedic, paediatric departments, and outpatient centres more likely in 2022.

Vendors and providers will focus on advanced imaging systems

While there are still growth opportunities across medical imaging, with a range of different modalities performing strongly in 2021, the potential for technical development and innovation within advanced modalities such as MRI and CT means that vendors will be keen to focus on these categories in the coming year.

These modalities offer strong opportunities for growth. Innovations can represent significant steps forward and will give customers and potential customers impetus to buy new systems or replace existing systems. Vendors have responded to this opportunity, and  have already been making sizeable technological leaps forward, with Philips launching a new detector-based spectral CT system early last year, and Siemens officially launching its photon-counting CT system, after it received regulatory approval in September. There were several other products launched at RSNA too, with GE, Canon and Fujifilm launching new MRI and CT products at the event.

These advanced systems will be key battlegrounds for vendors who will look to use their systems to satisfy providers’ ever-present appetite for increased image quality, and, bolstered by improved software and automation, be keen to sell the systems into more departments and clinics than ever before.

There are also other facets to this greater adoption of advanced imaging systems. Another element is the increasing uptake of hybrid systems. As clinical precision continues to play a paramount role in delivering positive patient outcomes and first-time right diagnosis, the adoption of hybrid imaging systems in high-end facilities will accelerate the convergence of different imaging modalities, offering benefits such as seamless workflows with all required imaging modalities to be easily accessible in one room. One of the more recent examples of this is Philips’ latest spectral CT system, which can be used for both CT and interventional applications, for advanced guidance during procedures.

Some of the biggest advances will be seen in medical imaging workflow

Providers’ ongoing desire to acquire better image quality means that they will continue to rely on MRI and CT imaging. However, using these systems can be relatively time consuming and resource intensive.  For providers facing an unprecedented backlog of patients amidst a shortage of fully trained and experienced personnel, this could present a challenge.

However, 2022 will see this obstacle partly addressed by the increased adoption of advanced workflow tools. Providers will, for instance, adopt AI-powered workflow solutions that can be used to maximise the efficiency of medical imaging and increase patient throughput, thereby effectively resulting in a higher return on investment.

These tools, in essence, look to improve patient scheduling, increase the speed at which scans can be conducted and reduce the need for time consuming rescans. This will be achieved through the use of several types of solutions, including those which help support patient positioning; automatic and intelligent protocolling tools which ensure that the parameters of systems are set correctly for the patient to be scanned; and automatic image accept and reject tools to make sure any scans which are not of the requisite quality can be caught early.

Such tools will be particularly valuable in 2022 as providers will try to address the backlog of scans that were postponed in the midst of the Covid-19 pandemic, when many providers across the world stopped carrying out elective procedures. Such workflow tools will be critical to ensure that radiology departments can operate efficiently. These tools will also benefit vendors, with the new solutions helping convince providers to replace or upgrade existing systems.

AI will benefit the technician as well as the radiologist

AI’s use in medical imaging has, until now, predominantly focused on how the technology can help with the reading and interpretation of medical images. This year that will change, with tools increasingly being used to aid in the capture of medical images. In a climate where high staff turnover is a challenge that healthcare providers are facing, increased support at the point of image acquisition is paramount.

In some scenarios, particularly in ultrasound, this will see AI being used to guide users in the acquisition of diagnostic quality images. There have already been some steps in this direction, with the likes of Caption Health’s Caption Guidance software being offered to help novice users correctly perform cardiac ultrasound scans. This ties into the earlier prediction of enabling imaging to be more widely used outside of imaging departments, where technicians are often less experienced and more likely to benefit from guidance. In addition to helping technicians perform the scans, these tools can also be used to automatically take some quantitative measurements from patients, such as calculating the bladder volume and the ejection fraction.

In other modalities the focus will be on reducing the time it takes to capture images and improving the efficiency of radiology departments. MRI and CT scans in particular are time consuming. AI-enhanced workflow optimisations tools, such as intelligent protocolling, can help to mitigate this issue and significantly reduce the time it takes for images to be captured by analysing an initial set of images and then suggesting the most appropriate next sequences based on the initial findings. Additionally, deep‐learning models for image reconstruction in MRI are delivering high-quality images with shorter scan times, overcoming the historical trade-offs in MR between scan time and image quality.

In general radiography, AI can identify potential technical problems during imaging capture to ensure the images are suitable for interpretation and potentially avoid patient recalls when they are not. For example, CXR from annalise.ai can identify technical image factors (exposure, patient rotation etc.) and devices (lines, implants, stents etc.).  Similarly, Fujifilm offers foreign body detection tools on its diagnostic X-ray products.

 

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Signify Premium Insight: Imaging IT and AI Predictions for 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, Dr Sanjay Parekh & Steve Holloway

A new year has arrived. Despite the numerous new releases and innovations throughout 2021, and vendors laying foundations for longer-term technological shifts, vendors enter 2022 under similar circumstances to 2021. A new variant of Covid-19 is sweeping the world, causing disruption to both healthcare services as well as the wider economy. Providers are looking for efficiencies and must find ways to address the enormous and ever-present backlog of patients, while vendors must raise their eyes and continue to deliver on longer term strategies, without neglecting providers’ needs of the moment. Despite this uncertainty, however, there are several key trends and developments we can expect to see in the coming year.

Vendor focus will intensify on structured data aggregation 

Vendors and providers alike are increasingly understanding the potential that clinical data offers healthcare. This is true not only in a singular department such as radiology, where the use of data has, in the past, primarily focused, but throughout the wider clinical workflow, including in preclinical and clinical research, companion diagnostics and precision medicine.

To realise this potential there must first be progress in several other areas. One of the most pressing challenges will be getting standardised and machine-readable data from the radiologist reports and automating the population of the findings into the clinical workflow in the first place. Structured reporting tools will help facilitate this inclusion of standardised diagnostic data into the clinical workflow. Over the course of the coming year, vendors will continue to develop structured reporting technology, either in house, or through partnerships that help lay the foundation for a greater role of data in diagnosis. Further, data management platforms will continue to technically evolve, focusing not only on image management, but broader structured “holistic” data management of images, annotations, reports and clinical documentation.

Federated learning also looks set to be increasingly adopted by vendors. This will enable AI developers to create generalisable AI solutions without the need to host third-party data. As such, federated learning will enable AI developers to leverage healthcare providers’ local data to train their algorithms without that data leaving hospital infrastructure. This means that algorithms can be trained on larger and more diverse datasets that are more representative of local case mix, ensuring that the algorithms have a high sensitivity and specificity.

Thirdly, a host of new partnerships will be made between imaging vendors, healthcare providers and the pre-clinical sector (clinical trials, CRO’s, pharma). Demand for Real World Evidence (RWE) to support a new era of drug-development and companion diagnostics will present new commercial opportunities to leverage the vast datasets held by imaging vendors and providers alike.

 Pathology will play a greater role in medical imaging IT

The longer-term direction of medical imaging IT systems to fully fledged enterprise imaging solutions is well understood, but so far, the number of solutions that have expanded beyond radiology and into other departments is minimal; the combination of radiology and cardiology has been the primary example from vendors when displaying multi-ology functionality. This will begin to change in 2022, with digital pathology becoming a focus area for many vendors and where significant progress will be made.

Digital Pathology is being adopted in three ways: primary diagnosis, supporting pathologists’ primary reading and reporting; secondary use, including clinical consult, tumour boards and medical education; and preclinical use, in research, clinical trials and drug development. Adoption has been ramping up significantly in preclinical use. However, the limited deployment of primary use systems pre-Covid limited the scope for secondary adoption and integration into enterprise imaging.

The advent of the global Covid-19 pandemic has dramatically shifted provider focus. There has been much greater investment in diagnostics and the digitalisation of pathology with the inefficiencies of lab processes highlighted during the pandemic. Furthermore, loosening regulation for primary use in the USA has opened-up the largest market globally, while VC/PE investment in digital pathology reached record levels in 2021.

For imaging vendors, digital pathology will increasingly become a key topic and differentiator in enterprise imaging deals in 2022. For the majority, offering primary use applications will only be tenable via partnership, so we expect to see more deals announced between imaging IT vendors and specialist digital pathology vendors in 2022, following in the wake of announcements such as that of Fujifilm and Inspirata.

Furthermore, we expect to see more focus on bespoke workflow tools that support the use of pathology data and reports in radiology, as well as broader multidisciplinary workflows (e.g., tumour boards and alike). Fundamentally, most healthcare providers in mature markets are still early in terms of primary and secondary use adoption of digital pathology. However, most are looking to leverage existing and future investment in enterprise imaging where possible to deploy an integrated offering that can support access to digital pathology and integrate a primary diagnostic offering. Therefore, vendors must be prepared with a clear roadmap for how to address this need for enterprise imaging capability to support secondary use, while also supporting primary use system integration. With many prominent EI deals due for renewal or tendering in 2022, competency around digital pathology could be a dealmaker or a deal-breaker.

 AI product categories will blur as Imaging IT vendors increasingly control channel

AI is still a very young market within medical imaging. As such, the technology itself as well as its application and use are evolving quickly. Leading AI tools have already progressed from being single point solutions which assess a medical image to identify a single radiological finding, into more complete and more mature solutions which offer greater value to providers. At present these more sophisticated solutions may be categorised into one of three categories, which exist alongside advanced point solutions, such as FFRCT:

– Comprehensive solutions that can identify many findings on an image and make a more meaningful difference to a radiologist’s workflow than single point solutions, whose clinical value is often limited. Additionally, they may pick up secondary or incidental findings that the radiologist may not even be actively looking for, avoiding missed diagnoses.

– End-to-end solutions, which offer care coordination and solve problems along the length of the clinical workflow, adding value beyond the diagnostic slice, for a given clinical condition such as stroke care.

– AI body area suites or workflow packages, typically provided by imaging IT vendors, which curate multiple native and third-party AI tools and other capabilities

These are currently well-defined categories, but over 2022, the distinctions between these groups will become less clear. Comprehensive solutions will begin addressing providers’ requirements outside of the diagnostic portion and expand into care coordination and clinical decision making. Third party platforms and marketplaces will combine more specialist tools from vendors into suites that are able to address many different aspects of a high value use case, by combining several single-use solutions. Workflow packages will expand beyond single use cases, creating greater value solutions for radiologist.

Beyond this evolution of the solutions themselves, however, 2022 will also see imaging IT vendors taking a more central role in the deployment of AI and enabling its broader use. This will see these vendors expand comprehensive solutions to take on an end-to-end approach. In addition to image analysis capabilities, imaging IT vendors could also leverage worklist triage, structured reporting, advanced visualisation and other workflow components in more cohesive packages creating further value for the radiologist.

 AI tools will not be sold on the basis of their technology

Until recently, medical imaging AI solutions have advertised themselves based on their use of machine learning technology and accuracy. However, in a transition that will accelerate and become more prevalent in 2022, the focus will be instead on the clinical advantages of the products. AI developers will, instead of selling a technology, highlight their solution’s ability to solve problems for providers.

Providers are becoming more knowledgeable about AI, and the number of vendors offering AI solutions has increased dramatically over recent years, so highlighting a solution’s machine learning credentials alone is no longer enough to differentiate a product in the market. Instead, vendors are having to highlight the overall value they can bring to a provider. This is a challenging task in many cases, especially as many providers currently do a poor job of measuring clinical and diagnostic outcomes accurately.

This has been seen already in stroke care, for example, where some vendors have moved away from touting the technical performance of their stroke detection algorithm, and instead positioned themselves as stroke care vendors by creating a care coordination platform, emphasising their capability across the entire stroke care pathway. Crucially, the importance of the technical specifics of these stroke care vendors’ algorithms have been displaced by a metric that providers are much more interested in; a solution’s ability to deliver the best outcomes for patients.

This trend will gather pace over 2022 and will be prevalent across acute (e.g., pulmonary embolism) and chronic (e.g., oncology) use cases. While algorithm developers will be keen to show that they are able to integrate into medical imaging departments with more thorough solutions, other companies such as marketplace and platform providers will also look to better meet providers’ needs. This need to offer solutions that solve vendors’ problems mean that partnerships continue to proliferate as AI vendors are too small or too specialist to offer the broader clinical capability to providers look to partner to bolster their value proposition.

Operational workflow’s importance will only grow and increasingly influence business models

There were several releases of operational workflow tools in 2021 as imaging IT vendors sought solutions that could improve the efficiency of their customers. These vendors have focused on developing solutions which grant providers better oversight of the operation of their medical imaging departments, their radiologists, and their fleets of medical imaging equipment. The continuing development of these solutions will allow these providers to attend to more patients and more precisely manage their patient’s care pathways.

The development and inclusion of these tools are, in the longer term, also set to give providers better oversight of their departments and generate data about their operation, which will lead to better planning capability, and improve their ability to strategise. This will become particularly important as acute providers utilise teleradiology or outpatient imaging centres for additional reading, or as provider networks grow through M&A activity and visibility over multiple sites is required.

To make the most of this demand for operational tools from providers, vendors will focus on ensuring their solutions are, for the most part at least, vendor agnostic. This will enable these vendors to sell their solutions into any provider, regardless of which other imaging IT systems they use, and grant the vendor an entry point into providers served by competitors. However, the incumbent imaging IT vendor is still best placed to offer providers the richest feature set, making it the most likely to be chosen by providers.

The importance of such solutions will be highlighted in 2022, but different vendors will take different approaches. Vendors which specialise in imaging IT and are targeting the development of enterprise imaging systems will focus on worklists, triage and departmental or operational analytics, while the vendors which also offer hardware will ensure that the use of their modalities, particularly those that are more time consuming such as MR and CT, can be optimised and departments can maximise the use of their resources. These vendors will look to hone functionality such as virtual image acquisition, automatic patient position and protocol efficiency.

The intensified focus on workflow will also present more opportunities for layering on professional services to operational workflow deals, placing vendor specialists within a provider organisation to support improving operational efficiency and workflow evolution. This will be the first step towards tighter vendor-provider relationships and the advent of contracting and business models based on specific performance indicators and operational targets. While a significant risk for the vendor, providers are already coming round to “performance” focused contracting, thereby ensuring a level of service and operational competency while de-risking capital investment. Therefore, providing analytics and workflow tools that identify inefficiency within radiology service-lines will no longer be enough, providers will expect their vendor partners to help solve these problems and support more efficiency care delivery.

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Signify Premium Insight: The Key Trends of RSNA 2021: Imaging IT

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Co-written by Steve Holloway & Amy Thompson

This year’s meeting of the Radiological Society of North America (RSNA) will, for many attendees, be the first in person sales and networking opportunity in two years. In many countries the worst effects of the pandemic appear to have subsided, making visiting RSNA a possibility. However, some vendors, notably Canon, have already pulled out in favour of a virtual presence, while others will have to carefully create a hybrid show, catering to both those that are able to attend in Chicago as well as those that are only able to attend virtually. The necessity of this dual approach could be costly, and, with fewer in-person attendees, may not prove as fruitful as it has in the past. As such vendors could increasingly move away from making their product releases around the established show schedule. Despite this, there are still some key trends expected to be on display at this year’s conference.

 The Signify View

At present, one of the primary focuses in medical imaging, as well as in the broader healthcare sector, is on improving efficiency. Hospitals and health networks have been under growing pressure for many years with factors such as aging populations and worsening staff shortages all taking their toll. These factors have, however, been exacerbated by the Covid 19 pandemic. This, combined with increases in remote working, and the need for flexibility has, in some instances, left providers struggling to keep up and as a result turning to their suppliers for solutions.

Efficiency and a Back Door to Long-Term Share Gains

Imaging IT vendors have responded to this need, highlighting the capabilities of their existing platforms, while also adding additional products  to meet this need; something expected to be in evidence at RSNA.  Operational workflow and analytics tools will take a leading role to meet the growing need for  efficiency. To begin to recover from the pandemic, providers will want to have better oversight of the operational activities of their  medical imaging departments and their fleets of medical imaging systems. These tools will allow them to attend to more patients, and manage their patients’ care pathways more efficiently. Furthermore, with many acute providers considering outsourcing to outpatient settings for routine imaging procedures, evidential data generated from these new tools will help support future strategy planning.

To best capitalise on this demand, many vendors  are making their analytics and operational workflow tools vendor agnostic. This benefits providers as it allows them to take advantage of solutions that have been developed by vendors other than those that they have supplier deals with. However, in many instances, the richest featured product would be one sold from the provider’s incumbent imaging IT vendor, with the two systems most commonly natively built to complement each other and maximise efficiency for customers.

Although ideally sold in conjunction together (PACS/core imaging IT platform and operational workflow or analytics),  a “vendor neutral” version is also advantageous for vendors. By ensuring that its operational workflow tools can be used by any provider, vendors are able to sell into new  customers. These vendors can build relationships with these providers to be  in a better position to win business and displace the incumbent imaging IT platform competitor when contracts are next put out to tender. In addition to establishing a presence with other providers, these tools also grant a vendor access to a provider’s data, granting it a better understanding of a provider’s operations, and enabling it to make a more compelling sales pitch when the provider next tenders for larger medical imaging contracts.

Back to the Cloud

Another trend returning to the show floor at RSNA is that of cloud capability. Providers are becoming increasingly interested in the cloud, while vendors are continuing to develop cloud-native solutions and adding cloud capability to their existent products. However, providers’ aspirations for deployment of cloud capability are also maturing, with vendors having to offer more sophisticated and flexible hybrid solutions for those health networks that don’t want to deploy cloud capability on an all or nothing basis.

As well as harbouring massive potential, there are, for the time being and into the foreseeable future, also some trade-offs with cloud deployment. As such, moving some parts of a providers’ system to the cloud makes sense, but not at the expense of performance if an on-premise solution would work better. Vendors will reflect this division, working to add cloud capability to their offering where it makes sense, but not releasing a cloud product that cannot match on-premise performance, often having to wait until the core cloud platform meets existing market standards.

Vendors will continue to operate flexibly to address the needs of different providers. The transition to cloud is one that will not just affect a providers’ radiology department, but one which could have repercussions, both good and bad, network wide. Imaging IT vendors therefore must accommodate specific needs and be flexible in terms of the modules and functionality a provider wants to be cloud-based, or in terms of the cloud provider that a customer wants to partner with. Cloud is coming, but as well as highlighting their technical progress at RSNA, vendors will also want to illustrate their flexibility and how they are able to accommodate a provider’s needs.

Matching the Market

This flexibility will also have to extend to customer groups, where more attention is set to be focused on outpatient imaging and radiology reading groups. This growing customer base is one area where the aforementioned operational workflow tools and other efficiency advantages are set to be particularly well received. These groups, after all, are judged on their ability to read scans quickly, so any solution that can allow them to improve this metric will be heartily embraced. This focus, as well as the circumstance in which these groups operate could continue to drive product differentiation, with the likes of GE Healthcare and its TruePACS diagnostic reading and workflow solution already setting its sights firmly on the outpatient market, along with other newer vendors such as Sirona Medical. More products which serve that segment can be expected to be released, especially as it is a segment growing readily. While RSNA may lack any huge product launches focussed on the outpatient imaging space, it will be a growing consideration for vendors. We therefore expect to see more focus on referral workflow, consultation workflow tools, enterprise load-balancing, patient smart scheduling and considerably more discussion around AI deployment in this segment, particularly as providers’ reliance on outpatient imaging facilities increases.

Uncertainty as to whether the congress would go ahead in an in-person format, as well as which vendors and industry personnel would be able to attend has meant that for some, scheduling product launches around trade shows, is, for the time being at least, not the best strategy. There are also other buyer-side issues. Providers will have seen their revenues heavily disrupted by the pandemic and are now facing unprecedented demand in some areas. Given this backdrop, advanced, futuristic feature sets will be lower priorities than efficient and affordable functionality. Vendors at RSNA will therefore be primarily concerned with demonstrating how they meet these requirements. Beyond that, there will be innovation and development, towards  more integrated, AI-powered, cloud-based imaging IT systems that providers will rely on in the future. Yet most of this innovation will still be at the roadmap or pilot stage, and an iterative product generation (or three) away. RSNA will this year therefore be a showcase for small, efficient  steps in product development, not giant transformative strides. Given the biggest challenges facing providers today, many customers will think this can only be a good thing.

 

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