Consolidation and change are roiling the healthcare marketplace, and the repercussions are being felt throughout the vendor landscape, including the vibrant imaging IT segment that is so fundamental to the practice of 21st century radiology.
Providers and vendors alike are subject to many of the same pressures, according to Jim Morgan, vice president, medical informatics, FUJIFILM Medical Systems, USA, Stamford, Conn. He provided insight into what to look for from imaging IT vendors in the coming year, where development efforts will be concentrated and a surprising view of government regulation of health IT interoperability.
Q: What are the trends that will shape health IT product development in 2016?
Morgan: There is the overall regulatory environment, the consolidation happening in the industry and provider consolidation: All of those added together create some unique opportunities.
Providers need systems that work well. On one hand, there’s the approach of going with one vendor to provide everything, much as with the EMR wave, and on the other hand, customers still want the best-of-breed approach so that they can pick and choose systems as they see fit.
What we see is the convergence of the VNA at the center of the imaging IT space. Customers are trying to figure out how to optimize all of the other systems around it, whether that’s information systems or communications systems—then you throw in emerging systems such as clinical decision support.
I don’t think there are radically new items for the coming year, but there is a new maturity to these systems as the market consolidates.
Q: What technological advances were seen in Fuji’s booth at RSNA?
Morgan: We completed the acquisition of TeraMedica in May of this year, following a two-year partnership. Through that acquisition, we have further aligned the VNA components with enterprise imaging and viewing with the various departments.
Visitors to our booth experienced hands-on, for instance, point-of care-ultrasound integrated into a VNA model, endoscopy integrated and oncology integrated. Integrating nontraditional departments takes VNA to the next level, allowing them to work together within the facility to solve real issues related to image-sharing and IT security.
In the VNA space, there have been various acquisitions: IBM’s acquisition of Merge Healthcare, the more recent announced acquisition by 3D Medical of Mach 7, a pending transaction, and even Lexmark exploring strategic options, including the sale of their company.
All of this says a few things. One, there is certainly a desire for image management within facilities, and there is growth in that market. It also points to changes in the landscape and the market: There is a belief on the part of many companies that they need to be larger in order to compete with the resources required in a complex customer setting and also to meet customer demand throughout the world.
The pressure on providers and all of those associated with delivering care is increasing dramatically, workloads are increasing and reimbursements are decreasing. As a result, the drive for productivity and efficiency is being pushed on providers and IDNs, but also onto healthcare companies like ours.
Q: How is provider consolidation affecting health IT needs and adoption?
Morgan: Whether an academic practice or an IDN, providers are acquiring community hospitals, critical access hospitals and provider groups, and they are pushing their standard of IT across those facilities to achieve efficiency.
The general belief is if you use the same tools across a larger install base, the cost per unit goes down and the overall cost of providing the service goes down. If you are able to keep the same base of patients, then that allows facilities to maintain a positive cash flow.
This [drive for efficiency] is forcing consolidation, and it is key in this marketplace for healthcare vendors to be well positioned to provide IT products into that space. If you are marketing to the critical access or community hospital only, those are being acquired by the larger entities.
Q: There is a lot of frustration with the lack of IT interoperability and even some new legislation (TRUST IT) that would attempt to promote the free exchange of patient data. What’s the upside and what’s the downside for the vendor community?
Morgan: I think the vendor community would welcome having clear standards defining what interoperability is and what connectivity is. As the DICOM and HL-7 standards showed us, just because you have DICOM doesn’t mean you have interoperability.
The more that the governmental and regulatory agencies can establish, once and for all, clarity around what specific data is to be exchanged by what specific standard, I think the vendor community would welcome that. We all would want to have ability to share data in a secure and economical method versus what we have today.
The more the government can get behind that, even going so far as establishing a fee structure for those type of services, all of that would get us where we need to be.
There always will be issues with patient-data sharing when you have the environment we have today, in which there is no unique identifier for patients, so there always is concern about security and privacy. How do we make data sharable and also protect privacy from hackers and anything else that could expose a patient’s data, while at the same time providing it to the right caregiver at the right time and have a trusted resource who is accessing the data?
Q: What about value-based payment? Is this something Fuji is addressing in imaging IT system development?
Morgan: What we continue to try to do is ensure, in our radiology information system for instance, that we are properly capturing all of the work that is completed by the department and that the data is transferred to billing systems and payment systems—as witnessed by the recent introduction of ICD-10.
But, the idea of what is a proper payment and what the number should be, that really is outside our domain. We want to make sure that the system captures all activity, that it is transferrable to any payment management system and that we are being as efficient as possible with the number of keystrokes and the number of touches required to produce the result.
Q: What are the customer pain points, and what did shoppers find to address those in the FUJIFILM booth at RSNA?
Morgan: It’s this whole drive to efficiency. With the wave of consolidation that we’ve seen over the last 12 to 18 months, some systems are being put into end-of-life. Some vendors are choosing to end one generation of product, and it has actually forced customers to forklift their systems for the next generation of products.
As some of these systems change hands, they no longer receive significant development, so customers effectively are faced with the scenario where they have to pay to buy a new system, or they have to be inefficient and loose money on a procedural basis or have their staff work even longer hours.
We continue to see everyone seeking to optimize what they are doing while keeping a high level of patient care, so one of their pain points is just managing this change in the healthcare vendor space and trying to pick the right partners.
Secondly, as providers consolidate, they must transition whatever their landscape of vendors and products are today and come up with a both affordable and effective solution. That includes the introduction of VNA, and when and where they should insert that technology, as well as what is the true purpose of 3D, and how does that affect the overall diagnostic process. Then, what about the EMR and how it fits together with all of these technologies?
Q: How has this affected how you design and market your products?
Morgan: We highlight where our solutions are more ergonomic than others. For instance, with PACS there is a lot of clicking with the user interfaces—or there can be. What we try to do is further optimize our solutions, taking into account our experience with new technologies.
We also are looking at how to best bundle these components and systems in a way that gives our customers the best value. We are both catering our solutions and, then, as we’ve added multiple products to our portfolio over time, we’ve tried to make them all technology-aligned. As a customer learns and uses one of our products, the next products will be easier to maintain and have a lower cost of ownership.
Finally, we are doing everything we can do to eliminate clicks, creating efficiency through ergonomics—that is what we think customers want.
For providers, the biggest issue is how do I make the right choices? Who should be my long-term partner, and how do I make my organization as optimized as it can be? Customers—with these significant investments in a limited capital space—want to have the comfort that they are going with a financially secure, long-term vendor partner.