FS Health Imaging VISION 2027

Platform approach key to constructing an enterprise imaging strategy
VISION FOR 2027

HEALTH IMAGING
A Frost & Sullivan White Paper
www.frost.com
Contact : Nadim Daher
50 Years of Growth, Innovation and Leadership

Frost & Sullivan
Where were headed in health imaging: Vision for 2027........................................................ 7
Health imaging 2027: the clinical scenario..................................................................... 8
Health imaging 2027: the operational scenario.............................................................. 9
Health imaging 2027: the financial scenario................................................................... 10
Getting there: the need for a platform approach..................................................................... 12
The benefit of single-source procurement and vendor for this transition................................ 20
Conclusion: partnerships support accountability for risk mitigation...................................... 25
TA B L E O F C O N T E N T S
Third-generation,
multi-specialty imaging platform
forms the Imaging Health Record,
providing the information base required
to steer clinical, operational,
and financial decisions
OUR HYPOTHESIS
In a not-so-distant future,
medical imaging will be much
less empirical, and almost a
completely value-based and
information-driven discipline.
In the enterprise cockpit,
decision-makers will be able
to base virtually every clinical,
operational and financial
decision on robust and
integrated datasets in gearing
their imaging service line.
4 All rights reserved 2017 Frost & Sullivan

THE RATIONALE
By nature, medical imaging is a data-dependent industry. It ingests a vast quantity of data, typically image
data, and produces a mostly qualitative interpretation of the data. In essence, it consists of diagnosticians
and interventionalists who transform raw medical image data, and to some degree patient information, into
clinical insight and recommendations. Nonetheless, there is quite a big leap to make for the imaging
discipline in going from merely creating and digesting imaging studies, to actually sharing the enterprise
drivers seat with actionable data it produces itself that is, to evolve from a data-rich discipline to an
information-rich one.
Today, were witnessing medical imaging branch out Already, progressive imaging providers are arming
decisively into multi-departmental, enterprise-wide themselves with a stronger base of information
imaging. Imaging services from radiology, cardiology to augment their clinical recommendations to
and an ever-increasing number of other specialties physicians and their engagement with patients, and
are growing in breadth and depth, catering to that they can rely upon in their own operational and
healthcare organizations that are becoming larger financial decision making.
and more complex, but also more accountable to
their payer partners and the patient population that For this, there is a growing trend toward
they serve. recognizing the importance of modern IT
platforms to upgrade or replace their incumbent,
To play a bigger part in the triple-aim of often too siloed, departmental IT systems. These
healthcare, by contributing to improved clinical, operational and financial efforts are starting
population outcomes, enhanced patient to intertwine and, ultimately, they will converge to
experience and reduced total cost of care, give rise to the era of information-driven health
medical imaging will need to adopt a more imaging and the Imaging Health Record (IHR).
information-driven consultative approach.
All rights reserved 2017 Frost & Sullivan 5

THE
STORYLINE
VISION 2027
Where were headed
in health imaging:
Vision for 2027
The clinical scenario
The operational scenario GETTING
The financial scenario THERE
The need for a
platform approach
BENEFITS
The benefit of
single-source procurement
and vendor partnership
for this transition

Vision 2027
Where were headed in health imaging
Painting the scenario in 2027: Fast forward to 2027, the dust has settled on the
recent healthcare system overhauls in various corners of the world. Healthcare is
now delivered in a leaner, more value-focused environment, where medical imaging
has proven its role in achieving desired health system-level outcomes, from treating
patients remotely to getting them out of acute care settings sooner, while optimizing
the cost-efficiency and effectiveness of care pathways through appropriate and
definitive imaging.

Health imaging 2027:
The clinical scenario

Machine intelligence has crossed the chasm: Health imaging specialists are now backed by
big datasets of well curated and documented retrospective patient cases. Active in the background,
machine learning algorithms are tapping into the datasets to outline a few predictable scenarios
based on thousands of similar and identical previous cases. Only 10 years ago in the mid-2010s,
these then-novel deep-learning algorithms were viewed as robots setting out to overtake the
imaging profession. Imaging specialists feel they have come a long way in embracing the technology
and taking advantage of its efficiency gains.
Imaging quantitation complements imaging studies: Health imaging specialists now spend
just as much time analyzing and understanding the interconnections of data points derived from
multi-modality images, as they spend scrutinizing the images themselves. Quantitative imaging has
continued to develop rapidly, and the body of standardized imaging biomarkers has reached a
critical mass. The advent of radiomics has become reality.
Personalized imaging is the new normal: On their holographic avatars, the imaging experts can
now see some precise ties between patients genes, their phenotypic changes, and the corresponding
cellular behavior. Radiomics have been converging steadily with genomics and proteomics, boosting
the personalization of study interpretations for the benefit of individual patients. Imaging is now an
intrinsic part of the move to precision medicine.
Imaging specialists as full-time physician

consultants: On the majority of patient cases,
imaging experts are collaborating with their peers
across the various disciplines, acting as effective
stewards of imaging information in the service
of patient-centered care. Enabled by efficient IT
collaboration tools, the cross-disciplinary tumor
board model has now been replicated to a
number of other indications. The clinical data that
imaging experts had access to back in 2017 was
indicative and supportive at best, sometimes even
misleading. Thankfully now in 2027, it have given
way to more robust information that empowers
specialists to consistently provide positive,
outcome-driving, actionable recommendations to
referrers.

Health Imaging 2027:
The operational scenario

Information-driven operational management:
In the operations department, health imaging managers
and administrators spend the work day responding to
the data streams flowing from their analytics platform.
They can now track actual metrics against their targets
across each of the key performance indicators for the
productivity, quality, and outcomes that they have set for
their services. Thanks to the holistic view provided in the
cockpit, the imaging enterprise runs smoothly.
Real-time steering of key performance indicators:

The Internet of Things has decisively made its way into
the imaging department. Sensors tied to equipment and
software allow them to measure and monitor almost
every process automatically and in real time, feeding into
the analytics engine. With this trusted data on hand, the
operational executives are now capable of steering the
needle on their KPIs, not just reactively, but proactively.
As they realize how far along they have come, from
descriptive analytics to predictive and even prescriptive
analytics, they, too, like their physician colleagues, are
satisfied that they have come a long way.
Tight integration with the clinical IT systems: Now

in its third generation, their latest analytics platform is so
sophisticated it makes their PACS dashboard from 2017
look like a floppy disk next to their one-terabyte key drive.
They feel they owe a lot to their clinical colleagues; if it
werent for the electronic health record (EHR) and the
integrated diagnostic platforms that were developed over
the past decade, their new analytics platform would not
be nearly as robust. They also feel grateful to their IT-as-
a-service partner, who tapped into their best internal and
external resources to customize this platform.

Health imaging 2027:
The financial scenario

Ability to demonstrate imagings contribution to institutional outcomes: On the side of
finance, health imaging payers and shareholders are now back in their comfort zones after the bumpy
road of the 2010s and the implementation of the value-based payment structures. At last, their imaging
assets produce sufficient reliable data about the costs, and, most importantly, about the value and
outcomes that their consumers obtain from imaging.
Investment confidence under a value-based purchasing framework: Health system

leadership feels they can now fund and invest more confidently in their imaging enterprise than they
did back in 2017. Indeed, when the health system leaders are together at the table, the chief medical
and data officers now have hard-data analysis to drive equitable spending and revenue allocation. As
the integrated health system works to split the income pool across the different service lines, imaging
services have confident expectations to receive their fair share of the pie, thanks to outcomes and cost
data that help prove their value and ultimately optimize their revenue and profit.
Value-based and risk-adjusted payments for imaging services: Health system income
is now a mixed bag of fee-for-service reimbursements, episode-of-care payments, and revenue
from the health plan that they launched when they became a payer-provider entity. The way they
remunerate imaging services is risk-adjusted based on the impact that they have on the health of
patients and populations -- much more straightforward than when the new payment structures
were initially instituted. By monitoring the health data flowing from their covered population, they
are now accomplishing a lot more outside of acute care settings. This strategy, made possible by
the integrated clinical platform, is starting to bend their cost curve noticeably.

2017 2027
ISLANDS ECOSYSTEM
2017 2027
Islands of image datasets in local Single point of access to
departmental archives multimedia patient content
Workflow centered on procedures Patient- and condition-centered

and access numbers diagnosis and decision support process
Separate technology stack for Integrated platform with

each imaging department specialized front ends
PLATFORM PARADIGM
Occasional failure to recognize Automatic patient identification
SILOES SCENARIO
the same patient and presentation
Hit-or-miss availability of Condition-specific and

existing imaging study priors context-aware patient history
Custom and purpose-built IT Standards-based blockchain-type

system interfaces interoperability
Qualitative interpretations of Additional insight from

images quantitation and omics
Some fluidity in intra-enterprise Liquidity of multimedia across

image distribution affiliated organizations
Limited ability for Seamless image and information

cross-enterprise exchange sharing across health systems
Mix of local and server-side Zero-footprint cloud- and data

image data processing center-based applications
ISLANDS ECOSYSTEM
Figure 1 From information islands to an interoperable ecosystem: Management, distribution,
access and integration of medical imaging data assets in 2017 and 2027

Getting there:
The need for a platform approach
Where are we today on this journey to the information-driven medical imaging
discipline? To illustrate the current lay of the land, Frost & Sullivan has spoken
with medical imaging executives at healthcare organizations on both sides of the
Atlantic.
These real-life case studies reveal how imaging informatics are being leveraged
in their respective organizations to serve the growth roadmap and value-based
initiatives that are planned for the next few years. Our representative stakeholders
are different in many regards, notably in the type and scale of their organizations,
as well as their organizational role and professional objectives.

OUR PANEL
While our panel is diverse, there is common ground between our different respondents, including the most noteworthy:
They all perceive medical imaging informatics as a lever to help them achieve their growth
objectives and vision, and perceive imaging as critical to fulfilling their enterprises mission.
They all align with a standards-based platform approach to healthcare informatics as the
best investment choice.
They all agree on the importance of building a more solid data foundation, and recognize
the value of developing a more information-driven organization.
As they begin to capitalize on their platform investment and their relationship with Agfa, there are numerous benefits
that these five imaging organizations have identified as already being realized or expect to see as their implementation
of Agfa Enterprise Imaging (EI) deepens. These results span across clinical, operational, and financial fronts.
Organization Respondent Facility Type Location
UC Irvine Medical
Dr. Scott Rudkin,
Center; 411-bed, Orange County,
UC Irvine Health Chief Medical
university-based California, USA
Information Officer
hospital
Community and
teaching hospital
Zuckerberg San RJ Merck, San Francisco, California,
(UCSF School of
Francisco General Radiology Supervisor USA
Medicine) and Level 1
trauma center
Hospital Federico Beltrn

230-bed, standalone
Intermutual de Carbonell, IT Valncia, Spain
hospital
Levante manager
Amersfoort / Baarn,
Meander Medisch Paul Bauwens, ICT
General Hospital Barneveld / Nijkerk /
Centrum Architect
Leusden, Netherlands
Max Rosen, Chair of

Academic, four- Area of Worcester,
UMass Medical the Department of
hospital network Massachusetts, USA
Radiology

TOP 10 BENEFICIAL RESULTS:
ENTERPRISE IMAGING (EI) PLATFORM TO BUILD THE IMAGING HEALTH RECORD IN THE
1
CONTEXT OF THE EHR
As part of an effort to harmonize and standardize their health IT ecosystem, several organizations are
working to consolidate their IT vendor relationships to a few select strategic partnerships. This effort,
usually driven by IT, seeks to ultimately elevate two vendors to a partner-based relationship, one for
their enterprise EHR, and the other for their enterprise imaging. Such is the strategy for Zuckerberg San
Francisco General, as Merck explains:
Our EHR platform and our EI platformthese are the two towers that are going to be left standing after the next
big health IT earthquake thats coming. Those two towers will run most of the hospital.Yes, there are a lot of other
imaging systems out there, and theyll be around for some time, but they will all feed into EI and will be integrated
with the EHR.
The same synergies between these two core platforms are expected at UMass Medical, as Rosen points
out: We are integrating our entire radiology system onto Agfa. All of radiology at our four hospitals will be on a single
Agfa platform.When we go live with our enterprise imaging platform from Agfa, we also go live with our enterprise-
wide electronic health record solution.
IT INTEROPERABILITY TO ENABLE
2
CONSOLIDATION AND INTEGRATION OF
PATIENT DATA
The enterprise imaging platform that our respondent

organizations have set out to build using Agfa
technology is poised to serve as a way to aggregate
into a patient imaging health record the imaging
studies acquired over time, and, more broadly, to
integrate multimedia content in a patient-centric
fashion.
This is the case at Bauwenss facility, for example:

With our migration from Agfa PACS to the enterprise
imaging platform, including VNA, we are expecting a
centralized location not just for our radiology images, but
for all patient-related data and information. Thats our
vision. For the first time we have an overall view of the
patient along the continuum of care and the ability to see
imaging studies in the context of other care episodes.

OPTIMIZED ENTERPRISE IMAGING WORKFLOWS TO CREATE NEW EFFICIENCIES

3
In trying to become more cost efficient, healthcare organizations need to pursue a mixed bag of tactical
objectives, such as doing more with less, but also a number of strategic initiatives for the mid to long
term. In this context, there is a clear realization today that new workflows must be devised and fine-tuned
to optimize the buy-in and contribution of the different stakeholders at the departmental and enterprise
levels.
For example, at the departmental level, Rosen points out the opportunity for a redesign of the imaging
workflow tied to the new EI platform: The Agfa solution will allow us to manage our workflow real-time, level-
load between radiologists, and facilitate having the most appropriate radiologists interpret each study in the shortest
amount of time.
In another example, Bauwenss organization has created new workflow and collaboration efficiencies at the
level of the multi-hospital network: Our future IT configuration will be that, at particular times in the day, some
hospitals can take over the workload of other hospitals, specialists always get assigned relevant studies, and we can
give our extended team remote access to all our studieslike primary care physicians in their clinics, which really
helps tighten the relationships.
A third example, this one from Rudkins organization, pertains to new workflows that must be created for
encounter-based, point-of-care imaging, which are very different from conventional order-based imaging:
Take point-of-care ultrasound as an example; it is becoming much more prevalent. Being able to capture images,
which can be done anywhere from the ER to the bedside, by a tech or by a doctor, we need the right tools to support
these new workflows. We have an e-consult [electronic consultation] project, where we provide consultants with
patient-specific images.We can consult a dermatologist about a patient that has a skin rash, show them a picture of
a rash, and within half a day or so they will respond back in the EHR with their recommendation based on the case,
never requiring us to call or have the dermatologist physically see the patient.
The other aspect highlighted by Rudkin is the opportunity to

optimize the use of high-cost internal resources, to ultimately
become a self-sufficient healthcare system: If Im a highly specialized
neuroradiologist reading 10 studies a day, and now I can cover my whole
region, this:
1. Reduces the disparities in care
2. Creates new options for accountable care organizations to fill

the voids which were previously filled with more costly contract
services (such as Stat-Rad and Nighthawk)
3. Achieves 24/7 real-time coverage in an in-sourced fashion.This is

the kind of place-shifting technology that is going to start to bend
our cost curve.

EFFICIENT REFERRER ACCESS TO IMAGES

4
FOR MULTI-DISCIPLINARY COLLABORATION
The first generation of PACS enabled the transition to a digital workflow and generated significant
productivity gains in image-intensive departments such as cardiology. The second generation of these
systems brought in further incremental improvements, but kept these systems largely confined to primary
end users within the four walls of these individual departments. Now, the third-generation enterprise
imaging platforms are expanding the reach of imaging IT, providing access to images and associated tools
to any relevant and credentialed stakeholder who can benefit from them.
In Mercks words, Radiologists have been focused on their own systemsthe PACS and dictation systems. We
are moving in a direction with EI where the radiologists work on the same platform as the ordering doctors,
collaboratively.
Rudkin highlights the contribution of technology to the value that radiologists provide to their referrers,
beyond high-quality reports: Our more proactive radiologists are starting to leave the basement and becoming
more consultative with our physicians. Our new technology is helping immensely in that, but this kind of change is
about people, process, and technologyin that order.
Its important to note in this context that the synergies work both ways, since radiologists also often
benefit from having easy access to more contextual information about their patients. As Bauwens puts it,
While diagnosticians will still rely on their viewing workstations for their interpretations, the ability to see the timeline
of patient care will help drive multi-disciplinary collaboration.
UBIQUITOUS BUT CONTROLLED IMAGE ACCESS TO ENABLE A MULTI-SPECIALTY,

5
CARE-CENTRIC APPROACH TO IMAGE INFORMATION
While efficient physician access to images is a clear value-add, it can be a burden as well if it results in
overloading the different specialties with imaging studies that are not relevant to the patient condition they
are trying to solve. In this context, a sophisticated rules-based engine is required to automatically route
the right study to the right caregiver.
As Rosen explains, All of the imaging thats done across the enterprise has to be readily accessible in a seamless
way to our healthcare providers. We dont necessarily need every piece of imaging data available to everybody all
the time, but we do need the relevant information readily available to each individual provider. Our VNA will facilitate
having all our imaging from our healthcare system in one location, but each department will be able to decide what
images they view and when they view them.

LIQUIDITY OF IMAGE DATA TO FOSTER PATIENT

6
ENGAGEMENT
Perhaps the most critical stakeholder in the healthcare value chain

is the patient. With the rise of consumerism in healthcare, and
the call for more patient-centered care, patients are increasingly
informed, active participants in the decisions of their caregivers.
This calls for easier accessibility and higher usability of the patient
record as part of a fast and user-friendly experience that contrasts
widely with the past paradigm, when film jackets and difficult-to-
view CDs and DVDs were the standard means of sharing patient
images. There is no doubt that an enterprise imaging platform
is an essential building block of this patient empowerment,
with unfettered access to visual information contributing to
understanding.
Bauwens said, Our patient portal allows patients to access their

radiology images from their own record, which they can export to their
own public or private record. One of the building blocks for us to achieve
that is building a single data repository, along with advanced information
lifecycle management capabilities.
LEVERAGE OF IMAGING ANALYTICS TO ADVANCE CLINICAL LEADERSHIP

7
There is currently considerable untapped value in imaging studies, especially as the volume of archived studies
mounts to hundreds of thousands, if not millions of studies in a health system. Imaging organizations are
essentially sitting on a goldmine of clinical, operational and financial insights that they are barely starting to
capitalize on. Our respondents organizations, who are at various stages of these promising analytics efforts,
agree that a platform-based approach acts or will act as a key accelerator of these efforts.
Such is the case for Rosens organization, which emphasizes the potential for research: As part of our medical
schools IT strategy, were building a data repository for all of our clinical data, which were calling a data lake.The idea
is that all of the clinical systems data will sit in the data lake in a de-identified fashion and be available for research and
teaching.
The same applies to Mercks organization: Weve been able to look at it from a strategic perspective and think
of how we can, as a teaching hospital, leverage our IT systems and take care of patients while teaching residents and
medical students and other staff. Speaking more broadly to the downstream potential these foundational efforts
will have at the enterprise level, he adds: Well be much more able to measure our outcomes when weve finished
building the new PACS and connecting it to the new EHR in the next two years.

SECURING A PROACTIVE ROLE FOR IMAGING IN POPULATION HEALTH EFFORTS

8
Following years of massive investments into patient record digitization such as EHR implementations, the
focus of health systems is rapidly shifting to population health management (PHM). The goal is to be able to
efficiently organize care pathways around well-defined populations, in a way that helps improve outcomes
most relevant to each group. Today, the involvement of imaging in PHM efforts is rather limited to aspects
such as imaging-based screening programs for prevention and early detection or dose reduction through
utilization management of imaging.
However, there is immense untapped potential for imaging to contribute more actively to PHM, and the
right enterprise imaging platform is a key driver of transforming medical images into a strategic asset for
organizations. As Rudkin explains: Population health has many phases; at the most basic phase, its about how
you can render care to a patient thats outside the confines of the hospital, and that you dont necessarily want to
bring to the hospital or the clinic.Whether it is by preventing patients coming in unnecessarily to the ER, or moving
them through the ER faster, if you can impact any of these aspects as were doing with telehealth, it will help. Our
Agfa XERO [universal viewer] platform is part of that, with the ability to upload patient content remotely to the
EHR.
BECOMING AN IT-AS-A-SERVICE PROVIDER TO THE COMMUNITY

9
For leading-edge organizations developing a state-of-the-art enterprise imaging platform, this opens up
a whole new range of opportunities for them to act as a technology hub in their region. For example,
this can enable a facility to champion efforts for image sharing across the region, or for image-enabling
healthcare information exchanges (HIE) that are already in place. Another, more lucrative, opportunity
is to provide access to the local technology as-a-service to other providers in the vicinity that may be
resource challenged or not as technologically advanced. As Bauwens points out: We are now in a position
to become an IT service provider to neighboring facilities, which would help fortify our position as a general hospital
in our region.
OPTIMIZING THE IT GOVERNANCE STRUCTURE FOR ENTERPRISE IMAGING

10
In virtually every organization, the initial phase of developing an enterprise imaging strategy is marked by
a trial-and-error approach to finding the optimal governance model for the new IT solutions involved.
Because these solutions cross over the enterprise IT and the clinical departments, there is not a single,
unique way for striking the right balance in the roles and responsibilities of the different stakeholders.
However, the platform approach, as opposed to the best-of-breed approach, offers the opportunity to
revise or devise a lasting, overarching governance structure for enterprise imaging.
As Rosen explains, We completely rebuilt our governance structure in IT about two years ago, with an EHR
steering committee and an overall IT steering committee that controls the IT budget and evaluates and prioritizes
new requests.With Agfa in place, we will be forming a third enterprise imaging steering committee, which will make
decisions about the VNA and any related systems that store or retrieve data from the VNA.

Typical roadmap of
Enterprise Imaging initiatives
Stage I Stage II Stage III Stage IV

Gastroenterology/
Oncology
Endoscopy
Neurology Plastics
Radiology Wound Care
Pathology Physical Therapy
Cardiology Urology
Dentistry/Oral Surgery Radiotherapy
Orthopedics Ophthalmology
Surgery, Anesthesiology Psychiatry
Dermatology
Bariatrics
OB/GYN
DICOM Imaging
Point-of-care Ultrasound
Visible Light Imaging
Digital Pathology
Figure 2 Typical roadmap in Enterprise Imaging initiatives

of image-using and image-producing clinical specialties

Benefits
The benefits of single-source procurement
and vendor for this transition
The concept of deconstructed PACS consists of procuring each of the core
functions of PACSmainly the data management, viewing and workflow layers
through independent and interoperable IT solutions, possibly from different
vendors. The adoption of this model is significantly less than the recent industry
discussion, with the US market the main testing ground for this model globally. It is
interesting to note that, to date, only 3 to 5% of US hospitals are actually investing
in the multi-vendor approach.
This model may seem disruptive to the way in which PACSs have been traditionally purchased and deployed,
but it is actually not new. It builds on a longstanding transition to a best-of-breed approach to completing the
IT stack, which should not to be confused with a multi-vendor approach.
Today, a single vendor may provide the best-of-

breed components that comprise a full-fledged
image management solution. This becomes truer as
a few of the leading imaging IT vendors, including
Agfa HealthCare, have modularized their solution
set in a way that can support a phased and partial
deployment of the solution components based on
customer needs and preferences.
Our five respondents share the conviction that

their respective strategic goals can only be attained
through a certain level of partnership with their
vendors, including with one core imaging informatics
vendor. In fact, all five belong to organizations that
have elevated Agfa HealthCare as their primary
medical imaging informatics vendor.

The benefits of such a single-vendor, partner-oriented approach

are multi-fold, including:
COST CONTAINMENT
1
Frost & Sullivan research finds that the total cost of ownership of a multi-vendor, deconstructed PACS
approach is likely to be higher than under a single-vendor approach. This is due mainly to the additional
time and effort of reconstructing the technology stack, which requires substantial in-house IT bandwidth
and skills, in addition to the cost of managing several vendors and maintenance contracts.
In line with this assessment, Bauwens explains: Managing a single repository, along with our plans to off-load
part of our data storage to the cloud, will ultimately bring down our total cost of ownership. He added: With our
new platform, we will be much more performant in our operations, achieve higher speed in accessing studies, and
leverage the advanced tools on the new viewer for our medical interpretations and diagnoses. Along the same
lines of thinking, Carbonell said: The total cost with one vendor is much smaller. Perhaps, the individual vendors
might be less expensive at first, but in the end, it would be much higher overall. The support cost would be greater
with multiple vendors. Integration and administration are the most important issues in our IT organization. I believe
that we may have reduced our managing costs by 30% or so.
ALIGNMENT WITH STRATEGIC OBJECTIVES

2
A single-vendor solution from a trusted vendor elevates the vendor/provider relationship to a strategic level,
beyond the core imaging departments that the solution serves primarily. As such, a vendor partnership in
imaging IT acts as a conduit toward contributing actively to institutional outcomes. Mercks assessment of
their relationship with Agfa is very telling in this regard: As a partner they have elevated the conversation
where healthcares going and how can we serve that need for you? Its been a pretty good partnership on that level.
ENGAGEMENT OF ENTERPRISE STAKEHOLDERS

3
Imaging IT decisions have become the shared responsibility
of departmental and enterprise stakeholders. However,
getting top-level decision-makers interested in imaging
IT, as they have been with EHR investments, means there
has to be direct value toward their institutional priorities.
Merck estimates this can only be achieved through a build
it, and they will come approach: As we start knitting this all
together, our C-suite is starting to take notice of the impact of
imaging IT on our enterprise-level outcomes. Once the EHR is
working in an integrative way with enterprise imaging, they will
see the exciting potential and get more involved.

ENHANCED RESOLUTION OF POTENTIAL ISSUES

4
Having a single vendor in charge of the complete solution is ideal for keeping clear lines of responsibility
and accountability when an IT issue arises, while avoiding finger-pointing between different vendors. Merck
shares this opinion: The problem between vendors amplifies when anything goes wrong. Every vendor
thinks their product is right; the other vendor is wrong. Whereas with our core vendor I can say, Hey,
you own the whole stack, if it isnt right, youre fixing it! I can pick up the phone anytime. They listen, they
react.
Carbonell shares this opinion, stating that with a multi-vendor stack, You could spend the rest of your life
trying to find the source of a problem. Rudkin values, having a single vendor I can point my finger at when
something goes wrong and I can say, You own the whole thing, make it work!
OPTIMAL INTEGRATION OF THE TECHNOLOGY STACK

5
The last few years have seen a move away from proprietary mechanisms and increased adherence to IT
standards and commitment to IT interoperability on the part of vendors. However, despite that move,
single-vendor solutions remain the best, if not the only, viable way to reach optimal integration and data
flow between the different IT components.
Rudkin agrees with this finding: I want to have patient information flow easily across the health system, and not
have to worry about it. We are past that debate now with our enterprise EHR strategy. Enterprise options are the
way to go. This opinion is not just personal, but is based on UC Irvines past experience: In the ER, we
used to have a number of really great niche options, but we found that ultimately enterprise offerings work more
fluidly, they share the same database in the back-endthat is so crucial to make systems actually talk to each other
effectively. Our niche vendors kept saying,Were going to have an open API and let all the information flow and make
things talkbut no.
Rosen shares this strong opinion against taking on a multi-vendor, best-of-breed approach: We considered
it very early on but almost immediately eliminated that option. At UMass we had gone with a deconstructed strategy
for all of our IT systems in the past.We had about 40 different systems which were supposed to communicate with
each other, and they never seamlessly communicated. We spent a lot of time building and maintaining interfaces
which often failed. Because of that negative experience we were pre-disposed to have as few vendors as possible.
REDUCED IMPLEMENTATION COMPLEXITY

6
The single-vendor approach benefits the management of the live solution, but also the early stages of
implementation, roll-out and training. Per Mercks assessment, We did it pretty damn quickly because we had
Agfa as a partner. Managing vendor-to-vendor integrations is rarely pleasant.
Carbonell echoes this view: We used to have an imaging offering from a local vendor based on open-source
technology.The local vendor didnt have the ability or capacity to meet our technical or support needs like Agfa can.
With Agfa, everything is integrated in one solution.

IMPROVED DATA OWNERSHIP AND LEVERAGABILITY

7
In the opinion of our respondents, the ability to engage with a
single vendor facilitates the opportunities to capitalize on the
enterprises datasets. As Bauwens explains, Our centralized
platform will make it easier to manage the encryption of metadata and
gain higher control over our data.
Deconstructed PACS advocates argue that a vendor-neutral

archive needs to be provided independently in order to liberate
the data from proprietary single-vendor solutions. While this
argument may be valid with regard to previous-generation
monolithic proprietary PACSs, it actually becomes irrelevant in
the case of current third-generation, modular and standards-based,
single-vendor solutions. As a matter of fact, the opposite becomes
true considering a third-party VNA incurs an additional database
that must interface one to one with multiple departmental and
enterprise-wide systems, thereby creating more challenges.
AVOIDANCE OF THE DECONSTRUCTED PACS

8
CAVEATS
Having experimented with a multi-vendor, best-of-breed approach

to IT and having experienced the downsides of this approach, our
respondents are convinced this is not the right way to go. Merck
explains: Deconstructed PACS? Its a myth. It will never happen. Its a
lot trickier than it may look to pull off.The different components are not
so easily plug and play.
Carbonell is of the same opinion, that a multi-vendor deconstructed

PACS, will never work because there are too many components to a
complete solution, too many different tools and too many systems. It
would be difficult to go on a different way than having one core imaging
IT vendor in place. Substantiating this view, he adds: This requires too
much experience. It isnt simple or trivial. Our organization just doesnt
have the experience to integrate or support all of the different parts.
Having too many vendors is very difficult to maintain and it would be
impossible to manage them all. It wasnt even a consideration for us.

MAXIMIZED WORKFLOW CUSTOMIZATION POTENTIAL

9
Recollecting the vendor selection process that led UMass Medical to select Agfa as its preferred imaging IT
vendor, Rosen emphasizes the importance that workflow customization and optimization have played in
the decision making: We narrowed [our search for a PACS vendor] down from eight to two vendors and at that
point felt that Agfa had the most technologically advanced platform and the most flexibility, from a clinical point of
view, for us to customize our workflow.
Highlighting the advantages of Agfa in this regard, he adds: Agfa seemed very in tune with understanding our
current workflow in order to help us design a future system that will facilitate further improving our workflow.
WIN-WIN VENDOR-CUSTOMER-VENDOR
10
DYNAMICS
For all of our respondents, the engagement with

Agfa HealthCare goes well beyond a simple
purchase of imaging IT products. They look up
to Agfa as a clinical and technology expert that
can benefit their organization, and as a group of
dedicated professionals who are looking to learn
from their healthcare providers perspective as
well. As Merck puts it, It works both waysour input
is helping Agfa design future parts of the platform, their
expertise is helping us design a platform to improve our
patient care.
As he contemplates what his organization has gone

through over the past few years, since Zuckerberg
San Francisco General set out to build its enterprise
imaging strategy, Merck recalls: A few years ago in
my talk at SIIM I said this enterprise imaging venture
feels like Im jumping off a cliff and building my wings on
the way down. Our vendor has been building it as they
go, too.There is a strong trust element to that.

Conclusion
Partnerships support accountability
for risk mitigation
Along with the growing importance of measuring value
in healthcare comes the overarching notion of the shift
and re-distribution of risk across the value chain.
In the context of value-based imaging for instance, an inappropriate
or inconclusive imaging study that ends up not being reimbursed
becomes a cost-risk incurred by the imaging provider. Ultimately,
the effective transformation of healthcare will hinge on the ability of
the various stakeholders to quantify and mitigate their own risk.
As important stakeholders in the value chain, the vendors, too,
must step up to play their part in this risk framework, despite
the disruption this may bring to their traditionally risk-adverse
organization.
In the context of enterprise imaging for example, no provider
organization can afford to underestimate the risk of sub-optimally
managing protected health information (PHI); it is in their best
interests to attach to vendors who demonstrate similar concerns
for contemporary best practices.
A single-vendor solution means fewer systems are vulnerable
to data leaks or exposed to security breaches. It means more
IT resources can be dedicated to one comprehensive IT system
to ensure constant monitoring, hardened security, simplified
upgrading, operational excellence, and continuity of care.
In order to evolve into the value-based, patient-first ecosystem
that our times demand, dedication to finding new, effective
models is required of all stakeholders: health providers, vendors,
and patients.

NEX T S TE PS
Schedule a meeting with our global team to experience
our thought leadership and to integrate your ideas, opportunities and
challenges into the discussion.

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Platform approach key to constructing an enterprise imaging strategy

VISION FOR 2027

A Frost & Sullivan White Paper

Contact : Nadim Daher

50 Years of Growth, Innovation and Leadership

Where were headed in health imaging: Vision for 2027........................................................ 7

Health imaging 2027: the clinical scenario..................................................................... 8

Health imaging 2027: the operational scenario.............................................................. 9

Health imaging 2027: the financial scenario................................................................... 10

Getting there: the need for a platform approach..................................................................... 12

The benefit of single-source procurement and vendor for this transition................................ 20

Conclusion: partnerships support accountability for risk mitigation...................................... 25

4 All rights reserved 2017 Frost & Sullivan

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6 All rights reserved 2017 Frost & Sullivan

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Health imaging 2027:

The clinical scenario

Imaging specialists as full-time physician

8 All rights reserved 2017 Frost & Sullivan

Health Imaging 2027:

The operational scenario

Real-time steering of key performance indicators:

Tight integration with the clinical IT systems: Now

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Health imaging 2027:

The financial scenario

Investment confidence under a value-based purchasing framework: Health system

10 All rights reserved 2017 Frost & Sullivan

Workflow centered on procedures Patient- and condition-centered

Separate technology stack for Integrated platform with

the same patient and presentation

Hit-or-miss availability of Condition-specific and

Custom and purpose-built IT Standards-based blockchain-type

Qualitative interpretations of Additional insight from

Some fluidity in intra-enterprise Liquidity of multimedia across

Limited ability for Seamless image and information

Mix of local and server-side Zero-footprint cloud- and data

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12 All rights reserved 2017 Frost & Sullivan

Organization Respondent Facility Type Location

Hospital Federico Beltrn

Max Rosen, Chair of

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TOP 10 BENEFICIAL RESULTS:

The enterprise imaging platform that our respondent

This is the case at Bauwenss facility, for example:

14 All rights reserved 2017 Frost & Sullivan

OPTIMIZED ENTERPRISE IMAGING WORKFLOWS TO CREATE NEW EFFICIENCIES

The other aspect highlighted by Rudkin is the opportunity to

1. Reduces the disparities in care

2. Creates new options for accountable care organizations to fill

3. Achieves 24/7 real-time coverage in an in-sourced fashion.This is

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EFFICIENT REFERRER ACCESS TO IMAGES

UBIQUITOUS BUT CONTROLLED IMAGE ACCESS TO ENABLE A MULTI-SPECIALTY,

16 All rights reserved 2017 Frost & Sullivan

LIQUIDITY OF IMAGE DATA TO FOSTER PATIENT

Perhaps the most critical stakeholder in the healthcare value chain

Bauwens said, Our patient portal allows patients to access their

LEVERAGE OF IMAGING ANALYTICS TO ADVANCE CLINICAL LEADERSHIP

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SECURING A PROACTIVE ROLE FOR IMAGING IN POPULATION HEALTH EFFORTS

BECOMING AN IT-AS-A-SERVICE PROVIDER TO THE COMMUNITY