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How universal viewers could affect imaging strategies

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At SIIM 2018, the latest trends in universal viewing and enterprise imaging were of special interest. It is clear that most universal viewing vendors have a common focus—workflow. While this may not come as a surprise to many industry observers, it does show that many of these firms have realized two things:

  • In-house development of advanced clinical and diagnostic tools is too expensive to compete with the largest incumbent vendors in advanced visualization.
  • High expectations from diagnostic users requires a narrowing of focus and investment around a specific application or subset of the market to compete.

Therefore, most universal viewing vendors have concluded that in today’s market of growing network scale and scrutiny around operational efficiency of imaging departments and accessibility of clinical content, the most lucrative opportunity lies in promotion of their products as part of a full enterprise imaging solution.

Universal viewers were initially developed to offer freedom from proprietary platforms and standards limitations, functioning as additional clinical review viewers between sites and departments, while diagnosis was still done on PACS or advanced visualization (AV) platforms. However, healthcare providers quickly became accustomed to these viewers and their zero-download multi-content nature and increasingly expected more functionality and breadth of content. The market had quick initial growth earlier this decade, often tied to the rollout of vendor neutral archives (VNA), although the revenue numbers have some way to go to reach comparable levels to AV or PACS.

The development of clinical tools for universal viewers to compete with AV and PACS platforms for diagnosis is an expensive and time-consuming process; most PACS and AV firms have spent decades and millions of R&D dollars developing and refining their extensive portfolio of tools. Therefore, many universal viewers still only have relatively basic functionalities such as MIP/MPR, 3D reconstruction and simple measurement tools. Consequently, providers often viewed universal viewers as a non-essential additional viewer, especially when decision making was made from within radiology, which often scoffed at the simplicity of this feature set in comparison to their full-featured PACS. There are outliers to this trend though, exemplified by the recent success of Visage Imaging, showcasing how a clinically capable universal viewer can compete in the market, most notably the academic provider segment.

Most recently, universal viewing vendors have been adding additional functionalities to increase the value of these viewers to users, targeting integration to the EHR and patient timeline as the most important. Vendors today are focusing on viewers that can form part of a full enterprise suite, either from their own portfolio or through partnership with other third parties. In doing so, they hope to support providers in consolidating the patchwork of legacy viewers and applications currently in use, towards a single viewing and reporting environment.

When it comes to the current focus on workflow tools, Intelerad introduced InteleOne Maestro, which is their new enterprise workflow orchestration solution for study assignment, order management, worklist, workload balancing and reporting, thus adding workflow capabilities previously associated with its IntelePACS to their InteleViewer universal viewer. Client Outlook and Mach7 announced a partnership for a vendor-neutral framework combining Mach7’s workflow management and Client Outlook’s universal viewer for diagnostic reading, which will make Client Outlook’s standalone universal viewer an integrated part of a full enterprise solution.

Other universal imaging products released at shows prior to SIIM have also exhibited common characteristics, namely collaborative working tools to enable remote consultations and cross-discipline collaborative working, intuitive user interfaces and adaptive menus for tools based on study type, and improved integration into reporting and the more expansive clinical record. In addition, larger vendors have also been focusing on more seamless integration with specialist third-party tools from within their user interfaces, although more work here is required in many cases.

These developments and new product releases are intended to meet the changing needs of the market today, most notably:

  • The growth in scale of healthcare networks, creating a challenge for providers with interoperability of clinical content, something that traditional PACS and AV vendors have been poor at for non-DICOM data in the past.
  • Increasing demand for clinical context in diagnosis, pulling in priors and related diagnostic information, especially as radiology diagnoses moves towards use of decision support.
  • Providers wanting to limit the number of viewers and user interfaces within their organizations and simplify their supply chains to fewer vendors.

Universal viewers have gained great popularity from their initial role as a link between disparate PACS systems and providing viewing capabilities as additional viewers. But to turn this popularity into revenue, the UV vendors are now making clear strategic decisions to try and blur the line between clinical review and diagnostic reading and reporting. They also want to tap into AV and PACS revenue streams by incorporating some of those capabilities into their popular viewers and transform these into the main interface for a full scalable enterprise platform.

Moving deeper into diagnostic imaging IT requires heavy lifting and skills many of the standalone UV companies don’t yet have, but some may be able to overcome this through extensive third-party partnerships. Although the larger modality and imaging IT companies may have a head start, given their depth of diagnostic experience and functionality of their solutions, a more prominent position of the universal viewer as an interface to the whole system, is here to stay.

Radiologists want a simple interface with advanced capabilities, which they can access from their office or their home, as well as the reading room. For many of them, the viewer and interface represents the system. At the same time, broader clinical use and integration with EHRs will also create a new customer base for vendors; satisfying multiple user types will be difficult for vendors, but the rewards for viewer supremacy will have significant bearing on longer term success in enterprise imaging.

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