Soaring Adoption of Digital Image Technology Driving the Need for Enterprise-Wide Image Management

Soaring Adoption of Digital Image Technology Driving the

Need for Enterprise Wide Image Management

Simone Carron-Peters, Research Analyst

Healthcare

June 30, 2011

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Today’s Presenter: Simone Carron-Peters

Functional Expertise• Experience in market research, issue-based deliverables and analyst briefings for Frost & Sullivan projects on a global scale• Market research in the medical imaging and health IT sector• Generating research service reports , market sizing and market analysis• Lead generation and new market exploration• Best practices and Award research methodology

Industry Expertise • Experience base covering various medical imaging and health IT sectors • Key focus on the trends in various medical imaging technology and modalities• European digital and computed radiography markets• European laboratory information systems market• Women’s health imaging markets

What I Bring to the Team•Efficient and skilled analytics •Broad range of technical knowledge facilitating research in multiple sectors of healthcare within Frost & Sullivan including the medical imaging and health IT sector•Fast-paced, fact-based and pragmatic delivery of high-impact business recommendations

Career Highlights�Over three years of industry expertise covering areas of healthcare such as biomedical instrumentation, medical imaging and cardiology�Quoted in international publications on the trends in the medical imaging sector�Previous related experience as research assistant at Monash University, Melbourne

Education•Masters in Biomedical Engineering, Monash University, Melbourne, Australia•Research studies in biomedical engineering on “The Haemodynamic Measurements of Various Head Tilts during an EVestG (Electrovestibulograph ) Recording”.•Bachelors in Biomedical Instrumentation, Dr. M.G.R University, Chennai, India

Simone Carron-PetersResearch AnalystHealthcare

Frost & SullivanEuropeChennai, India

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Focus Points

� The Need for Enterprise Wide Image Management

� Market Dynamics

� The Future of PACS – What next?

� Market Overview – RIS, PACS, C-PACS and CIS

� Economic and Business Objectives for Deploying an Integrated Solution

� Market Outlook

� Benefits of Integrated IT Solutions

� Potential Markets

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Enterprise Wide Image Management – Beyond Radiology!

WAS

IS

WILL BE

Single Discipline Solutions

Department Based Solutions

Enterprise Wide Management Solutions

Enterprise Wide Image Management –

Beyond Radiology!

5

Lack of Workflow Optimisation

and Inadequate access to

patient information

Medical data errors between

different vendor systems

Lack of consistency between

departments within a hospital

Issues faced by HospitalsIssues faced by HospitalsFunctionalities Required to Functionalities Required to

Overcome IssuesOvercome Issues

Initial Cost

(Investment)

� Reduced Hardware and Installation Costs

� Organizational Efficiency

� Increased Usability

� Improved Clinical Decision Making

� Substantial Productivity

� Efficient Electronic Continuum of Care

Source: Frost & Sullivan

Benefits of Common IT Platforms in EuropeBenefits of Common IT Platforms in Europe

Limited return on investment and customized single

vendor solutions

Interoperability and exchange of patient information and medical data between

solutions

High quality patient care and optimised

work flow

Integration between multiple vendor systems

Efficient and easy access to data and clinical information

Optimized andflexible workflow

Wide and easy access to patient information

Improved patient care

Reduced costs

Efficient data transfer andexchange

Data integrity and business intelligence

Benefits of Common IT PlatformsBenefits of Common IT Platforms

Benefits

Return on Investment

(ROI)

The need for Enterprise-Wide Image Management Solution

The core strategy for vendors is to offer a Common IT Platform and target the key customer

segments for ROI.

The Need for Enterprise Image Management

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Concept to Commerce

• The initial step for an institution is to design the architecture of the integrated network.

• The next is to identify a radiology PACS vendor that can meet the constructs of this design. Most facilities in Europe who have an existing RIS/PACS solution in place would only require the incorporation of the cardiology discipline.

• Vendors would need to overcome not only technical challenges but workflow issues to ultimately streamline radiology and cardiology image retrieval and report generation.

Radiology Cardiology

CT MRI NM US

DR/CR X-Ray

Echo Cath Lab

Nuclear Cardiology

Common IT Network for Radiology and Cardiology

HIS RIS CVIS

OR’s

ICU’s

Common Radiology and Cardiology Archive

Physician’s Office

Imaging Clinic

Outpatient Facility

ED

Common IT Architecture for Radiology and Cardiology

Common IT Architecture for Radiology and Cardiology

Radiology Workstations

CardiologyWorkstations

7

In radiology, workflow is structured around an order and studies are read sequentially.

Radiology for the most part deals with images.

DICOM standards in radiology allows the transfer of images regardless of vendor.

Radiology comprises predominantly of grey scale images as opposed to color maps in cardiology.

Radiology images are static and single frame.

Radiology Cardiology

• The capacity needed to store cardiology images and data represents a further challenge. Facilities or healthcare practices are unable to collate data effectively because of the lack of integration between various information systems and cardiology modalities.

• Many practices are adopting the single-vendor approach. The current trend among vendors is to provide hemodynamic systems and reporting systems that communicate with each other. The process is bi-directional and allows automatic report updating.

Differences Between Radiology and Cardiology

In cardiology, the workflow is less structured and procedures are not done in an order. In most modern Cardiology PACS a structured is created interactively only at the time of interpretation.

Cardiology on the other hand deals with a myriad of data such as Images, ECG waveforms and haemodynamic information and more.

The absence of such DICOM standards in cardiology is one of the major reasons that makes integrating cardiology data challenging.

Cardiology has a lot more data elements to integrate and is heavily dependent on paper and film.

Cardiology and most interventional radiology images are dynamic and require more bandwidth and storage space.

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Huge volume of data

Industry Challenges

Absence of DICOM standards in cardiology

Political environment in hospitals

Cardiology deals with myriad patient data

Compliancewith

physicians

Varying cardiology and radiology workflow in

Europe

Dissimilarity between radiology and

cardiology images

Industry Challenges (Europe), 2010-2016

Note: Size of the bubble represents the level of importance.

Industry Challenges – The Hurdles in Integrating Radiology

and Cardiology

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- Impact +

1-2

Yea

rs3

-4 Y

ea

rs

Push from hospitals to keep track of the patient throughout the continuum of care.

Vendor consolidation leading to greater consideration of integration issues

Emergence of Enterprise Imaging Management solutions bring greater workflow benefits

Increasing workload and insignificant reimbursements driving the need for enhanced productivity solutions.

Ma

rke

t D

rive

rs

The need for seamless access to patient images and information to provide optimal care.

Impact of Market Drivers (Europe ), 2010-2016

Market Drivers – Factors Influencing the Uptake of

Integrated Solutions

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- Impact +

3-4

Yea

rs1

-2 Y

ea

rs

Ma

rke

t R

es

tra

ints

The possibility of shared infrastructure for radiology and cardiology would negatively impact hardware revenue.

The high infrastructural costs of installation of cardiology PACS and information systems are a purchase barrier.

System integration continues to be hampered by political and social issues.

Lack of funding and budgetary cut backs

Impact of Market Restraints (Europe), 2010-2016

Market Restraints – Factors Retarding the Growth of

Integrated IT Platforms

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Mini PACS

Departmental PACS

Hospital PACS

Enterprise PACS

De

ve

lop

me

nt

La

dd

er

Modality Specific

Department Specific

Digital Archiving/ Filmless Environment

Integration of Medical Informatics of All ‘Ologies’

The role of PACS systems in hospitals has evolved from a storage archive to a solution that can provide image

processing and enhanced work flow.

2010-2016

More ModularCan be configured according

to end users preferencesMore convergence in

cardiology

Fu

ture

of

PA

CS

PACS Development Ladder (Europe), 2010-2016

Future of PACS (Europe), 2010-2016

The Future of PACS – What Next?

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IS Market: Legacy RIS and RIS Level of Penetration (Europe), 2009R

Overview of Radiological Information Systems (RIS) Market in Europe

Level o

f L

eg

ac

y R

IS P

en

etr

ati

on

(%

)

ScandinaviaUnited

KingdomFrance ItalySpainGermany Benelux

Country

99.0 99.0 99.0 99.0 99.0 99.0

43.5

35.5

41.037.5

33.5

46.5 45.5

99.0

0.0

20.0

40.0

60.0

80.0

100.0

Level of Legacy RIS Penetration Level of RIS Penetration

At present the average penetration level of Modern RIS in Europe is around 40 to 42

percent. Hospitals and end users comprehend the importance of purchasing a

Modern RIS that is capable of driving the PACS solution as a result of which many

hospitals are likely to opt for new RIS installations in the next five to six years


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PACS Market: Level of PACS Penetration (Europe), 2009

In Europe the university based research hospitals have almost 100

percent PACS penetration while smaller hospitals and private imaging

centers have a lower level of PACS penetration.

The level of PACS penetration in Scandinavia and Benelux is 98 and

92 percent respectively. In terms of technology, specifically regarding

PACS installation, Scandinavian countries are the most advanced in

Europe.

Overview of PACS Market in EuropeP

en

etr

ati

on

Level

(%)

Country

94.0

65.0

78.072.0

63.0

98.092.0

0.0

20.0

40.0

60.0

80.0

100.0

Level of PACS Penetration

United

Kingdom

France Germany Spain Italy Scandinavia Benelux


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• The total RIS/PACS Market amounted to $739.0 million in 2010 and expected to reach $1353.3 million in 2016.

• The RIS market comprised of 21.9 percent of the total RIS/PACS market Revenues in 2010. While the PACS market accounted for 78.0 percent in 2010 it is expected to capture 80.9 percent of the total RIS/PACS market in 2016.

European RIS Market

European PACS Market

2010

Total RIS/PACS Market: Revenue Forecasts (Europe), 2009 and 2016(Europe), 2009 and 2016

Total RIS/PACS Market in Europe: PACS Systems will capture 80.9% percent of the Total RIS/PACS Market by 2016

2016


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2010 2012

Cardiology PACS Market: Percent of Revenues by Geographic Region (Europe), 2010 and 2012

• Germany represents one of the largest C-PACS markets and is likely to remain one of the most potential markets for healthcare IT. The country accounted for 34.6 percent of the C-PACS market revenues in 2010.

• Benelux and Scandinavia represent two of the most technological advanced countries in terms of healthcare IT in Europe and are expected to be the key adopters of enterprise wide image management.

Overview of Cardiology PACS Market in Europe

$54.3


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Cardiology Information Systems Market: Revenue Forecasts by Geographic Region (Europe), 2010 and 2017

• The CIS Market in Europe amounted to $54.5 million in 2010 and expected to reach $104.8 million in 2017.

• Germany represents the largest CIS Market in Europe and accounted for $21.2 million in 2010.

Overview of Cardiology Information Systems (CIS) Market

in Europe

U.K Germany France ItalySpain Scandinavia Benelux


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Key: Level of Importance

1 - LOW 10 - HIGH

Economic and Business Objectives for Deploying an Integrated Solution (Europe)

Economic and Business Objectives for Deploying an

Integrated Solution

8

8

7

7

7

6

6

6

6

Support higher standards of care

Help increase patient throughput

Help face increasing workload

Aid in outcomes-based reporting

Consolidate IT management and

contain IT-related costs

Increase the profitability of

imaging procedures

Support the sub-specialisation of

the cardiologist workforce

Help face declining reimbursement

Help face the shortage of

cardiologists Source: Frost & Sullivan

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Workflow Objectives For Deploying an Integrated Solution

Workflow Objectives for Deploying a Common IT Platform for Radiology and Cardiology (Europe), 2010-2016

8.07.5

7.0 7.0 7.0

6.0 6.0

5.0 5.0 5.0 5.0 5.0

Key: Level of Importance1 – LOW 10 - HIGH

Provide a single point of access to all images

and information

Optimiseworkflowefficiency

Offer anytime-anywhereaccess toimaging

Support and

enhancecurrent

workflow

Develop a fully

integratedstructuredreportingcapability

Allowsharing

of data withother

organization(s)

Replace some of the

currentworkflow

steps

Foster greater

collaborationamong the

cardiovascularteam

Allow newpracticemodels

Helpphysicians

achievework-lifebalance

Enableteleradiology

services

Simplify the

accreditationprocess


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Who are they…

These countries have an existing These countries have an existing

high level of PACS penetration high level of PACS penetration

and are expected to be early and are expected to be early

adopters of Common IT adopters of Common IT

platforms for radiology and platforms for radiology and

cardiology.cardiology.

ADOPTERS

RELUCTANT

EXPECTANTS

Profile (high values)

Country

Scandinavia

Benelux

Germany and

France

Market Outlook - Early Adopters of Common IT Platforms for Radiology and Cardiology are likely to be Scandinavia, Benelux, Germany and France

?

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Enterprise wide infrastructure for image management becoming a standard deployment

model

Capital spending freezes increasing the demand for optimised workflow and

efficient handling of procedure volumes

Shortage of cardiologists increasing demand for productivity solutions

Increasing end-user expectations for interoperability and system

integration

Market Shifting Towards (Europe), 2010-2016

Market Shifting Towards

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Benefits for the Industry

Benefits for Governments

Benefits for End Users

• Adoption of common protocols and standards

across Europe will create a more uniform market

for healthcare IT equipment, software and

services.

• A harmonised market will also lower the costs of

acquiring best of the breed solutions for facilities.

• Greater adoption of enterprise wide image

management will enable the healthcare IT

industry based in Europe to compete

internationally. This would in turn increase

employment and enhance the development of

this sector of activity in the European economy.

• Governments see a solution in integrated health information

systems that can deliver greater efficiency and productivity.

• These initiatives will support alternative healthcare delivery

such as in home care.

• A system for identification of patients shared across Europe.

• Seamless access to patient information anytime and anywhere.

Benefits of Integrated Solutions (Europe)

Benefits of Common IT Platforms for Radiology and

Cardiology

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Market Potential

Market Potential (Europe), 2010-2017C

-PA

CS

Pote

ntial

Re

ven

ue

s ($

Mil

lio

n)

Italy

France

Spain

United

Kingdom

Benelux

Germany

� Scandinavia, Benelux and Germany will continue to be

the dominant markets for integrated solutions.

Scandinavia

RIS/PACS Penetration (%)

Key: Bubble size denotes the potential of the marketSource: Frost & Sullivan

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High

Medium

Low

Country Attractiveness

• Cities have been ranked based on their

market potential and PESTLE factors.

• Push from hospitals to follow the patient

throughout the continuum of care and

the need for seamless access to patient

data and images will be key growth

drivers.

• Healthcare IT spending, level of

RIS/PACS penetration and adoption

levels of IT solutions are the key

considerations for city attractiveness.

Cities With Announced Healthcare IT Projects

Countries With Active Project Plans

Market Attractiveness in Europe, 2010-2016

SPAIN

UNITED KINGDOM

FRANCE

GERMANY

SWITZERLAND

NORWAY

NETHERLANDS

ITALY

FINLAND

Key Markets Based on Healthcare IT Expenditure and Potential

Market Size


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Conclusions

.

The market for common IT solutions for radiology and cardiology is in its early phase, and is expected to show strong overall growth in the next 3 to 4 years.

Push from hospitals to follow the patient throughout

the continuum of care and the need for seamless

access to patient data and images will be key

growth drivers.

From a hospital’s perspective, the key strategy would be to achieve integration so as to provide clinicians with all the data in order to give them the best possible view of the patient’s condition.

Increasing end-user expectations for interoperability and system integration and shortage of cardiologists increases demand for productivity solutions.

Radiology and cardiology have reached a saturation point in terms of the amount of patient data, information and images. Healthcare IT plays an important role in managing and making use of the data.

PACS initially was developed for radiology. However, for most hospitals the next stage of implementation involves the integration of cardiology. This level of integration enables a hospital to store all medical images in a single repository for improved image data management.

The challenge for vendors is to develop a common system that is flexible enough to address the specificities of each specialty within a facility.

Key Take Aways

Greater adoption of enterprise wide image management will enable the healthcare IT industry based in Europe to compete internationally. This would in turn increase employment and enhance the development of this sector of activity in the European economy.

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Noel AndersonEuropean Vice PresidentNew Business Development+ 44 (0) [email protected]

For Additional Information

Siddharth SahaDirector of ResearchHealthcare – Medical Technologies+44 (0) 207 343 [email protected]

Simone Carron-PetersResearch [email protected]

Katja FeickCorporate CommunicationsHealthcare+ 49 (0) [email protected]