Doubling Down on Software

A new Bain & Company and KLAS Research report suggests that healthcare providers are “doubling down” on software, while revealing key adoption trends that could have a major impact within radiology.

Software Growth – Despite macroeconomic turbulence, the many provider organizations are actively increasing their software investments.

  • During the last year, 45% of providers accelerated their software investments, while just 10% showed software spending. 
  • Looking towards 2023, over 95% of providers expect to make new software investments and one-third plan to invest more than usual. 
  • Software is now a top five strategic priority for nearly 80% of provider organizations and a top three priority for almost 40%.

Problems & Solutions – The major challenges facing healthcare providers also happen to be the primary software adoption drivers.

  • Nearly 80% of providers who accelerated software investments last year cited labor shortages, wage inflation, or restructuring (M&A, change in leadership) as their top adoption catalysts.
  • Going forward, providers are prioritizing solutions that improve staff productivity and efficiency, capture more patient revenue, and improve security.

From a radiology perspective, that likely means a (continued) focus on solutions that enhance staff productivity and efficiency, improve patient intake/flow, and drive hospital revenue.

Streamlining Tech Stacks – Accelerated software adoption and the proliferation of new software vendors has left providers overwhelmed by their tech stacks.

  • Over 50% of providers are struggling with the flood of offerings, and 24% believe that their existing tech stack keeps them too busy to stay current on new solutions.
  • Providers also cite poor cross-solution interoperability as their top tech stack pain point.
  • As a result, 72% of providers will first attempt to add software from existing vendors before considering new companies, and 63% are looking to reduce the number of third-party solutions in their tech stacks.

In radiology, this trend likely favors the leading informatics players, while fortifying the value propositions of AI platform/marketplace vendors, unified imaging IT vendors, and extremely well-integrated point solutions.

The Takeaway

Even if Bain is targeting a broad healthcare audience, it’s clear that the macro trends highlighted in this report are having a similar impact within radiology, giving imaging teams and their vendors a solid framework to guide the next phases of their software adoption.

Imaging IT’s Infrastructure Problem

A heated Twitter conversation revealed widespread discontent with imaging’s outdated and fragmented IT infrastructure, suggesting that it’s draining radiologist productivity and standing in the way of AI adoption.

This tweet by Memorial Sloan Kettering’s Anton Becker, MD, PhD got things started: “95% of radiology departments would do well to direct 100% of their AI efforts and budget towards upgrade and maintenance of PACS, RIS and dictation software for the next 5 years… Our field is plagued by legacy software.” 

And here’s what the ensuing replies and retweets revealed:

  • PACS Productivity – Nearly everyone agreed that their overall imaging IT setup was insufficient, with one rad estimating that a “supercharged PACS” would improve his productivity by 30%, and another noting that workflow customization would “at least double” her speed and accuracy.
  • Imaging IT Revolution – Some called upon the “legacy” PACS, RIS, and voice recognition vendors to make more “revolutionary changes,” rather than settling for tweaks to current setups. Others proposed government intervention.
  • IT Isn’t Flashy – One thing that might be holding some imaging IT overhauls back is “it’s not as flashy to boast” about high-quality infrastructure, and “the people who have authority to allocate resources are more motivated by flash than function.”
  • Holistic IT – Eventually the conversation led to several well received proposals that we “eliminate the idea of PACS as a category and start thinking more holistically about radiology IT.” In other words, this might be more of a “fragmentation problem” than a PACS/RIS/voice functionality problem (or an AI budget problem). 

The Takeaway

Even if RadTwitter tends to skew towards academic radiologists and often focuses on what’s going wrong, this conversation indicates widespread dissatisfaction with current imaging IT setups, and suggests that radiologist productivity (and perhaps accuracy and burnout) would improve significantly if imaging IT worked as they’d like it to work. 

It’s debatable whether this imaging IT problem is actually due to an unnecessary focus on AI (very little of the conversation actually focused on AI), but it does seem reasonable that rad teams with solid infrastructure would be more likely to embrace AI.

Intelerad Becomes the Image Exchange Leader

Radiology took a giant step towards actually #ditchingthedisk last week with Intelerad’s acquisition of image exchange rival, Life Image. Here’s why this could be a big deal…

Exchange Leadership – Acquiring Life Image makes Intelerad the “clear medical image exchange market leader,” combining two of the top three exchange companies (the other is Nuance), and creating a far more straightforward roadmap towards building a “true nation-wide, electronic image exchange network.”

Demand & Supply – Although imaging vendors always position their acquisitions as patient or clinician-centric (even if it’s debatable), this move actually does address one of radiology’s most glaring problems — it’s far too difficult for providers to share images with each other if they don’t use the same exchange platform.

The Exchange Network Effect – Because the clinical value of image exchanges multiplies as vendor market share increases, Intelerad now has a network effect advantage that you almost never see in medical imaging. If this deal increased Intelerad’s image exchange share to 70% (hypothetically), it would make Intelerad far more valuable to its current clients and far more attractive to its remaining prospects.

Defining “Open” – The announcement alluded to the creation of an “open” image exchange, which is consistent with Ambra/Intelerad’s philosophy. However, it’s unclear how or when that will happen – or whether Nuance and other competitors will decide to join.

Intelerad = Acquirer – This deal also solidifies Intelerad’s title as imaging informatics’ most active acquirer, buying at least seven companies in the last two years that expanded it into new clinical areas (cardiac, OB/GYN), regions (UK), technologies (cloud), and functionalities (image sharing, reporting, cloud VNA). 

The Takeaway

Intelerad’s combined Ambra and Life Image acquisitions should make it the undisputed leader of the image exchange segment. That’s a big deal considering that the value of image exchange software multiplies as market share increases, and because it could actually allow Intelerad to solve (not just improve) one of radiology’s most frustrating challenges.

Intelerad’s Reporting Play

Intelerad continued its M&A streak, acquiring radiology reporting company, PenRad Technologies, in a relatively small deal that might have a much bigger impact than some think.

PenRad has a solid share of the breast and lung cancer screening reporting segments, making it a target of a number of PACS vendors in recent years.

The acquisition is another example of Intelerad using its private equity backing to complete its informatics portfolio, following a series of deals that allowed its expansions into new clinical areas (cardiac, OB/GYN), regions (UK), technologies (cloud), and functionalities (image sharing, cloud VNA).

Adding PenRad will immediately give Intelerad three proven cancer screening reporting solutions to offer to its PACS customers, while bringing Intelerad into an untold number of PenRad accounts that it didn’t work with before now. 

The deal’s long-term impact will likely be dictated by how well Intelerad integrates and enhances its new PenRad technologies. If Intelerad is able to seamlessly integrate its PACS/worklist with PenRad’s dictation/reporting, it could create a truly unique advantage — especially if Intelerad expands its reporting capabilities beyond just cancer screening. 

Intelerad’s PenRad acquisition and Sirona’s unified radiology platform also highlight the differentiating role that integrated reporting might play in future enterprise imaging portfolios, although there aren’t many more reporting companies still available for acquisition.

The Takeaway

Informatics veterans might point out that it’s much easier to acquire a portfolio of companies than it is to integrate all that software — and they’d be correct. That said, most would also agree that Intelerad has assembled a uniquely comprehensive enterprise imaging portfolio and it would be extremely well-positioned if/when that portfolio becomes fully integrated.

Content-Based AI Efficiency

A new study out of Austria provided solid evidence that content-based image retrieval systems (CBIRS) enhance radiologists’ reading efficiency, while potentially improving their diagnostic accuracy.

Eight radiologists reviewed chest CTs from 108 patients with suspected diffuse parenchymal lung disease (DPLD), leveraging contextflow’s AI-based SEARCH Lung CT CBIRS with half of the exams. 

Using the radiologists’ CT image regions of interest, the CBIRS would search a database of 6,542 chest CTs to identify similar scans, providing the rads with the three most likely disease patterns and supporting information (e.g. a list of potential differential diagnoses). The CBIRS’ added “context” had a notable impact on the radiologists:

  • Reducing their average reading time by 31.3% (197 vs. 287 seconds) 
  • Reducing resident and attending radiologists’ reading time by 27% and 35% 
  • Improving overall diagnostic accuracy by over 7pts (42.2% vs. 34.7%; not statistically significant)

These reading time reductions came despite the fact that radiologists were more likely to search for additional information when using the CBIRS (72% vs. 43% of cases). That’s partially because CBIRS allowed greater speed improvements when radiologists searched for more information (110 seconds faster vs. without CBIRS) than when rads didn’t search for more info (39 seconds faster).

The Takeaway
This study presents a rare example of how imaging AI can significantly improve radiologists’ efficiency, while amplifying their current workflows and diagnostic decision-making processes. It’s also the second study in the last year suggesting that CBIRS might improve diagnostic accuracy, although the authors encourage more research into CBIRS’ accuracy impact to know for sure.

SIIM 2022 Recap

The first in-person SIIM meeting since COVID hit is officially a wrap, delivering the latest in informatics and a family reunion vibe that might have surpassed any other imaging event. Here’s the top takeaways from the biggest imaging informatics conference of the year.

Crowds & Conversations – We understand there were 300 to 400 on-site attendees at SIIM 2022 (excluding exhibitors), with far more attendees in the educational sessions and afterparties than the exhibit hall booths. Still, it was clear that there’s no better place for informatics leaders and vendors to get together than SIIM.

Big Cloud – The shift to the cloud felt more inevitable than ever last week. The cloud was at the center of nearly every vendor and providers’ informatics roadmaps, while the AWS/GCP/Azure “healthcare cloud land grab” appears to be having an underrated influence on cloud adoption. That said, SIIM22’s cloud PACS conversations hadn’t changed much from previous years…

  • Everyone still agrees about the cloud’s security and administrative upsides
  • PACS vendors are still debating cloud native vs. cloud enabled (…and questioning whether providers know the difference or care as much as they do)
  • Nobody is willing to adopt cloud at the expense of PACS performance
  • And because of that, hybrid cloud remains the realistic starting point for many providers

Integrating AI – AI remained a major theme at SIIM, although most conversations focused on how to adopt and integrate AI (and then get ROI), rather than how AI can improve diagnosis. That probably explains why the exhibit hall featured far more AI distributors (AI marketplaces, PACS AI platforms, etc.) than AI developers, and it serves as a good reminder for AI vendors to continue improving their integration capabilities.

Productivity Hacks – Unsurprisingly, radiologist productivity was a common theme through the presentations and exhibit hall booths, ranging from the ultra-logical (fast PACS, administrative AI) to the ultra-ambitious (single-vendor unified imaging IT systems). 

Inconsistent Imaging – This might be old news to many of you, but I was amazed to learn how far many organizations are from achieving informatics best practice. I heard a lot about patched together workflows, outdated PACS versions, inconsistent site setups, antiquated imaging sharing, and narrowly-defined enterprise imaging. The silver lining to that is there’s plenty of room for improvement, but it also suggests that some imaging organizations will need a lot of work before they’re technologically prepared for the next-gen stuff we talked about all week.

The Takeaway

SIIM 2022 made it abundantly clear that there are seismic changes coming to imaging informatics, and even if those changes will probably take longer than some might hope, their impact might be greater than many of us expect. There’s also plenty of opportunities to improve radiology workflows in the short-term, and some of the smartest people in healthcare are ready to deliver these improvements.

Visage Adds Videos

Visage Imaging now allows radiologists to create and distribute video reports from the Visage 7 platform, representing an interesting milestone for radiology patient engagement and multimedia reporting.

About Visage Videos – The latest Visage 7 version (7.1.17) allows radiologists to quickly create and edit one minute multimedia video reports (video, audio, 2D/3D manipulations) at their workstations (same setup & dictation system), and use these videos to explain key findings to patients. Visage developed its new Video Reports feature with NYU Langone Health, which already had over 70 rads create more than 1k video reports, and found it to be valuable for both patients and referring physicians.

Patient Readiness – We’ve covered plenty of studies detailing how patients want to review their radiology reports, but struggle to understand them. We’ve also seen video communication and patient portals gain increasingly prominent roles in patient care. Based on those factors, Visage’s new Video Reports seem to have a solid product-market fit… if only patients were the decision makers.

Radiologist Adjustments – Visage’s Video Reports will expand radiologists’ reporting audience to patients for the first time, which would require mindset changes (simple language, referrer etiquette) and add workflow steps (rads would have to create two reports). These adjustments might initially make video reports a better fit for the most patient-centric radiology teams, but that could change over time. Plus, the Video Reports tool comes standard with Visage 7, so it will be available if/when the other groups change their mind.

The Video Trend – Given the telehealth and patient engagement revolutions taking place, it’s a solid bet that all types of clinicians will be expected to increase their digital / virtual patient interactions in the future. For radiologists, this might come in the form of Visage-style recorded videos or real-time primary care teleconsultations like MGH piloted earlier this year, but more patient-centric communications are coming.

The Takeaway – Visage’s new Video Reporting feature might be a small part of the overall Visage 7 platform, and its initial adoption might also be relatively small given most rad groups’ focus on productivity. However, this “small” video feature could prove to be part of a very big change in how radiologists engage with their patients.

Intelerad Acquires Ambra

Intelerad just got a whole lot bigger, acquiring Ambra Health to create one of the industry’s most comprehensive image management companies.

Acquisition Details – The acquisition values the combined companies at $1.7b, expands their reach to nearly 2k global customers (including all of the US’ top 10 hospitals), and brings their headcount to roughly 1k team members. Ambra CEO, Morris Panner, will become Intelerad’s president and will lead the company alongside CEO, Mike Lipps.

Intelerad + Ambra Portfolio – The acquisition combines Intelerad’s PACS portfolio with Ambra’s cloud VNA, image exchange, custom integration services, and research and pathology capabilities. 

Competitive Impact – At least in terms of portfolio breadth, this acquisition moves Intelerad into enterprise imaging’s top tier (radiology, cardiology, archive, sharing), helping it expand beyond its radiology practice legacy and deeper into hospitals. However, the star of this acquisition may prove to be combining Ambra’s cloud VNA with Intelerad’s cloud PACS, which as we’ve seen from Visage and Change’s recent cloud takeovers, can be a very effective combination.

Intelerad Growth – Intelerad has taken full advantage of its PE-backing, making a series of acquisitions since mid-2020 that allowed expansions into new specialties (cardiac & OB/GYN), regions (UK), and technologies (cloud). Ambra is clearly its biggest investment and most significant expansion yet.

Imaging Wire Q&A: Looking Forward to SIIM21

With Christopher Roth, MD, MMCI, CIIP
Duke University, Vice Chair of Radiology for Clinical Informatics and IT

Duke Health, Director of Imaging Informatics Strategy

Like many in healthcare, informatics professionals just made their way through an unprecedented year that included plenty of imaging problems to solve and lessons to learn, but very few opportunities to meet with their peers and improve together. That’s about to change at the upcoming SIIM21 annual meeting, and there’s going to be a lot to talk about.

In this Imaging Wire Q&A, we sat down with Duke’s Christopher Roth, MD, to discuss what he’s expecting at SIIM21, what makes this year’s meeting different, and how informatics professionals can make the most of it.

Tell us about your work and what you do at SIIM.

At Duke University, I’m the Vice Chair of IT and Informatics in the Department of Radiology and the Director of Imaging Informatics Strategy for the health system.

At SIIM, I chair the Annual Meeting Program Committee and I’m currently a chair of the HIMSS-SIIM Enterprise Imaging Community.

I’m also on the RSNA Informatics Committee and the ACR Informatics Commission.

What can we expect from the SIIM21 Annual Meeting?

SIIM21 will be a virtual meeting held from May 24th to the 27th.

The first day will be kicked off by Dr. Kimberly Dyan Manning, Associate Vice Chair of Diversity, Equity & Inclusion at Emory University, followed by strong didactic lectures, interactive roundtables, research and applied informatics sessions, and some Global Track sessions to close out the day.

Day two will follow a new format. In the past, it’s been a continuation of those kinds of educational sessions, but the second day of this year’s meeting will focus on the interface between industry and the people on the clinical frontlines. It’s going to focus very hard on getting people together to fuse ideas and learn from each other .

The second day will kick off with a keynote address by Dr. Jonathan Rothberg, a serial entrepreneur, and co-founder of companies such as 4catalyzer, Butterfly Network, and Hyperfine.

In addition, we’re going to have roundtables, but they won’t just be clinical leaders describing problems and imaging vendors at the table participating, it’s going to be a joint conversation. For example, an imaging vendor would partner with clinical thought leaders to approach a difficult problem and then discuss it with the community.

We’ll also have #AskIndustry Sessions where a thought leader will actually present a difficult problem to three or four industry vendors to get their perspectives on it. The point of this is to really attack the middle ground, the interstitial space between industry and users who could be physicians, scientists, analysts, or the technological staff that we all employ to take care of patients.

Day three will start with a keynote address by Harold F. Wolf III, President & CEO of HIMSS, and will largely focus on the breadth of imaging informatics specialties around the health system. So, as I said, that would include pathology, dermatology, obstetrics, cardiology, ophthalmology, and different specialties who create multimedia. Those groups are going to share their successes and their failures.

The highlight and the grand finale of day four will be the Samuel L. Dwyer Lecture, named after one of the real pioneers in imaging informatics, and presented by Dr. Adam Flanders, Professor of Radiology & Rehabilitation Medicine and Enterprise Vice-Chair for Imaging Informatics at Thomas Jefferson University.

Going back to the second day of SIIM21, what are the types of roles that would represent the vendor and frontline sides of these discussions?

The breadth of people and roles at SIIM are what makes it special. We have everyone from the frontline entry-level analysts at our hospitals up through chief technology officers. We have very early-stage members in training who are still residents all the way up to CMIOs.

The second day isn’t going to be so role-focused as it will be expertise-focused. You will hear from some really terrific speakers with engaging personalities and subject matter expertise in the areas that SIIM is interested in sharing. That could even be someone who lives on the procurement side, let’s say, who can speak to a successful RFP as opposed to an unsuccessful one.

Does SIIM21’s virtual format create any other opportunities to do things differently?

Yes. This meeting will be held under the theme of ‘Connecting Without Boundaries,’ supporting one of SIIM’s strategic goals to broaden its international reach, and the virtual format will definitely support this goal. Many of the meetings that we tend to go to have a distinctly North American flavor, and that’s really not the way we should be working.

We developed a global imaging track where thought leaders from around the world will bring experts from their own neck of the woods to share their approach to problems. We’ll have thought leaders from six geographies – South America, Europe, Africa, Middle East, Asia, and Australia – who will have their own opportunities to lecture and meet before, during, and after SIIM21.

The intent of those meetings is to facilitate collaborations between the regional experts and educate SIIM members who just don’t get the opportunity to learn how other parts of the world approach difficult problems.

Are there certain things that you’ve learned at previous meetings that have been particularly helpful in your day-to-day job?

This happens at every single meeting.

When I go to these meetings, it’s almost a joke with my team at Duke that I will come back from SIIM with a wish list of four or five new things. It’s almost an every-year thing that I’ll see something that I get psyched about and I’ll bring it back. We’ll start talking about these ideas and employ several of them over the course of the year.

In addition to that, I go to see the industry partners because I want to know what they’ve been doing over the past year. They’re busy getting new customers, they’re busy doing new development, they’re making new inter-corporate partnerships. I want to know who they’re working with, what they’re doing, and if there’s anything that is beneficial to me.

I love to be able to say to them, “I think this feature is really, really cool. If you did this it’d be even cooler. Can you do that, or can we do that with you?” Really advocate for the things that we need to have in the imaging space to be successful.

In addition to that, SIIM is where I do my shopping. If I know I’m in the market for something, SIIM is probably the first place I’m going to go look for it, because it’s a very practical meeting. There are other industry meetings that are humongous and difficult to navigate. SIIM is a more intimate, practical place to have some of those difficult conversations.

What should people planning to go to SIIM do to make the most out of this year’s event?

To have success in any in-person meeting you have to plan ahead. You need to know when the sessions are going to be and make sure you block off the time to be there.

It’s the same thing with a virtual meeting. You have to look ahead and be sure you’re not going to be doing a biopsy at the time that you’re supposed to be attending a session.

I would also think about your infrastructure, the tools that you have, the applications you use and if there’s any problems that you may be able to improve or solve at SIIM21. Be prepared to have challenging discussions with vendors.

Additionally, I would take a look at your imaging strategic plan and see what gaps there have been over the past year and a half as COVID has consumed so much of our day-to-day activities. So, there’s probably a lot of opportunity in your imaging strategic plan that you can catch up on and the industry partners that you would be engaging have been developing as well. You may have a lot more to learn than in typical years.

I would make time to visit the vendor booths and have individual meetings or group meetings with thought leadership from other hospitals who are all facing the same thing. I know that there are a few of us who all share the same viewer, the same vendor-neutral archive, the same image sharing platform. There’s nothing against getting a group of you together to go talk to that group of corporate entities to provide a little more oomph to the things that you’re asking.

I would also recommend talking to your clinical colleagues if you’re in the hospital. Find out what they like, what they don’t like, and take those things to those corporate partners to see if anything can be done about them.

What’s the type of person that should be going to SIIM21 but doesn’t realize that it applies to them?

I’ll steal an anecdote from a dermatologist, Veronica Rotemberg, from Memorial Sloan Kettering that I heard recently. She is essentially doing dermatology informatics, but she had no idea that she was doing it.

The people that should be coming to SIIM are the people that work in imaging, IT and clinical quality improvement and process improvement, people who are trying to handle the integrations of their images with the electronic health records. Those are informaticists and they oftentimes don’t even know that they are.

It could be derm, it could be path, it could be cardiology, it could be a number of different specialties. People that care about clinical care, care about integrating the images that they’re capturing and longitudinally following the problems that their patients bring to them. These are people that are doing imaging informatics but maybe haven’t been a part of SIIM before. And really, those are the kinds of people that we need to be engaging.

Similarly, there are industry and researchers and clinical people, like myself, who are doing artificial intelligence, who are creating algorithms and trying to deploy packages and get them into the point of care. Maybe they’re in pathology. Maybe they’re in dermatology. Maybe they’re looking at wounds on a smartphone using AI or they’re looking at a mole and evaluating whether or not its cancer.

Those are people that really have a home at SIIM but they just may not have gotten exposed to it yet. That’s really where the enterprise imaging community comes in.

That’s where a lot of SIIM’s educational outreach and liaison committee work comes in. We are trying to reach these people and help them realize that SIIM is the right place to come when you are looking to interact with and learn from people who face the same day to day challenges.

What are you most looking forward to at SIIM21?

What I look forward to most at every single SIIM meeting is seeing my friends. It’s quirky. It’s kind of cliché and folksy, but SIIM really has created a community of people who all see eye to eye. We’re all seeing the same problems. We’re all actually very similar type personalities. And it’s a special team to feel a part of, because it’s people and conversations that resonate with me.

The longer I’m at SIIM, the more I learn from them. I learn a lot from the other docs like me around the country and around the world who do some of this. And the deeper I go, the more I realize there’s a wealth of knowledge on the industry side that I’m still learning.

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