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Feature: Imaging, Agfa HealthCare and Sectra

In our Imaging feature, we speak with two industry leaders to go in-depth into digital imaging and discuss new innovations on the horizon.

In this feature we speak with Franz Tiani, Vice President of Agfa HealthCare, to hear about some of Agfa’s projects that are currently running, what’s coming up over the next 12 months, as well as sharing some of the main challenges that he and Agfa have faced.

We also hear from Chris Scarisbrick of Sectra, who discusses AI in imaging, and answers how can we make AI invisible in healthcare diagnostics?

As new NHSX guidance around artificial intelligence is digested in healthcare, Sectra’s Chris Scarisbrick argues that AI should barely even be noticed by the professionals who use it, and that it needs to be made easy to procure.

AI has become a big focus in healthcare. It even continues to make headlines in the fight against coronavirus, with reports of researchers looking to validate AI models that they hope could help predict which patients are most vulnerable to COVID-19.

In the healthcare diagnostic space particularly, there is enormous potential for AI, where it is now being looked to in order to transform the delivery of crucial diagnoses for a whole range of illnesses and patient cohorts.

AI is here for the long term. And with real world application now beginning to take hold at pace, AI design and the manner in which it is procured and implemented could be big factors in determining whether algorithms are successful or whether they could actually become a hinderance.

Whether we are applying it to specialisms in radiology, pathology, cardiology, or any other profession harnessing diagnostic imaging, AI should improve accuracy and efficiency for end users, and it should speed up the work that they do. If it adds any extra steps, or slows down our clinicians in their mission to improve patient care and the patient experience, then it is a wasted exercise.

So, how do we minimise disruption both for our professionals and for the healthcare enterprise? Well, this can very much start before hospitals even acquire AI applications.

Can trusts be expected to manage multiple vendors?

Though the recent national crisis has shown that technology can be deployed quickly in the NHS when urgently needed, the traditional way the NHS procures IT is to go through a lengthy procurement process, in which organisations evaluate several vendors, shortlist the ones that look most promising, go to a best and final, make a five to 10 year commitment, and sign a contract, all before the IT or digital department needs to think about deploying it. It is a familiar scene in the diagnostic space, as much as any part of healthcare technology, and it can be a complex and intensive experience both for trusts and for suppliers.

The NHSX AI Lab released A Buyer’s Checklist for AI in Health and Care in May 2020, as a short reference to assist the decision-making for procuring AI solutions in the NHS. It is a very comprehensive and well thought through document, addressing the challenges we see today for accelerating safe AI adoption.

Although the document provides a good and clear checklist, it is still quite a burden on both trusts and smaller/emerging AI developers to run through a lengthy procurement process each time.

Does a commercial function in an NHS trust really want to repeat the same process and payment terms with potentially dozens of different AI imaging providers, dozens of different times?

And can AI vendors, who might be start-up companies or small businesses and who might never have navigated NHS procurement processes, manage to get their solution through the front door?

There are opportunities for established suppliers of traditional IT systems to play a role both in following the new buyer’s guide, and in relieving these burdens and in making AI acquisition easier, and imaging technology providers could certainly help.

Sectra is committed to doing so, in particular by supporting the hospitals that use our imaging systems by conducting some of the due diligence process on AI vendors where appropriate. We want to be a partner in the buyers’ journey and create a dynamic marketplace from which hospitals or professionals themselves can choose from a range of AI apps, safe in the knowledge that those apps meet necessary regulatory standards and comply with information governance standards.

And we are in continual dialogue with our customers to understand what is really important in clinical practice – which AI applications will make the most impact on the lives of imaging and diagnostic professionals.

The aim of this is to remove a lot of the complexity from the process, and to overcome barriers like the limitations of contracting resource, the scalability of IT, and the ways applications interact.

Automatic and invisible – matching workflow

The manner in which applications interact is particularly important to ensuring they fit within clinical workflows.

By using the enterprise imaging system provider as the point of coordination for imaging AI acquisition, more thought can be put into standardisation and maintaining user control over how images are displayed on screen for professionals. Our ethos is to tailor this to a close and ever evolving understanding of workflow on the ground. We can also ensure an AI app is integrated into the picture archiving and communication system (PACS), where radiologists spend 80% of their working lives, before it is even procured.

But in essence, for the most part, AI should be invisible to the user. Whilst AI will not replace our professionals and for the foreseeable future a human will always need to remain in the loop in delivering diagnoses, most of the time our professionals shouldn’t even notice it is there. If you are using an AI application that measures lung lesions – only scans that meet these criteria should be forwarded on to the AI, and should be sent automatically, without the need for human intervention. The AI can then run its analytics in the background and push results back to the PACS to alert the professional to urgent cases and to help them prioritise and improve the quality and efficiency of their work.

Vendor neutrality

The growth in AI continues at pace. We as technology partners have a responsibility to help hospitals acquire the best applications to meet their needs. This is not about what AI Sectra can develop, for instance. It is about providing a channel in which the fantastic innovation emerging can reach those working hard to support the frontline of healthcare.

We asked Franz Tiani, Vice President of Agfa HealthCare a few questions about their customer projects and what’s coming up over the next 12 months:

Can you tell me about your customer projects that you’ve been involved in at the moment in the UK market?

Two recent projects spring to mind. The first is with the Yorkshire Imaging Collaboration (YIC), a long-term Agfa customer. The YIC is a combined technology and business transformation project involving eight trusts across Yorkshire, as well as the recently established NHS Nightingale Hospital Yorkshire and the Humber. We have been working with them to roll out our XERO Exchange Network (XEN), which is essentially a piece of technology which allows imaging to be viewed from anywhere across the region. Historically clinicians used large workstations to be able to read an image, but you can now have it so that images can be viewed securely via browser technology and even available on iPads. This is definitely one of the projects I’m extremely proud of, particularly given the benefits it has unlocked during the pandemic.

Another project is at the Princess Alexandra Hospital NHS Trust (PAH), who have been using our Enterprise Imaging platform since 2018. They are really maximising its potential and the trust made significant steps in improving efficiency, by cutting down the time it takes to report images and, thus, waiting times for patients.

After a patient has had a referral, they typically need imaging, such as X-ray — which is not usually a big problem in the NHS; the current infrastructure in most hospitals is sufficient to deal with this. The problem, however, is how fast they can get the images reported; once the imaging is completed, someone needs to look at it and potentially diagnose/report. This process in the UK has always been quite time consuming, but by introducing a technology that allows stakeholders to share this information, image analysis can be completed much quicker, allowing the clinician to be more efficient. This has helped PAH keep up with the workload, unlike many hospitals which are operating with relatively large imaging backlogs.

Princess Alexandra from a technological standpoint, is using most of the pieces of the Enterprise Imaging technology — voice recognition, 3D analysis and soon, artificial intelligence. It’s a lighthouse project.

From the work that you’ve mentioned there, what are/were the biggest challenges and what advice would you give to those on a similar path?

You can have the best technology but, in reality, it’s about people, collaboration and team work. This is why we take a partnership approach with our customer projects. Good leadership is also required, with good management, to get all the stakeholders involved in the IT projects aligned. If that works, you’re halfway there, and the rest will fall into place.

Over the last six months there have been some fantastic examples of how technology can be delivered, often remotely, to help and support the NHS, both now and in the future. We have also seen the NHS taking a pragmatic approach to IT projects. We are all living and working in challenging times, but we are proud to have been part of a positive consequence that resulted in a significant improvement to the way clinicians collaborate and care for patients.

What’s coming up in digital imaging for Agfa over the next 12 months?

Agfa HealthCare’s focus is medical imaging IT; and continually enhancing our platform to maximise technological advances. It is very important for us to keep up with the needs of our customers, to continue our programme of implementations and to support our customers as partners. There have also been quite a few tender wins that we will be announcing over the coming months.

I agree with NHS CEOs when they say “we have too many IT solutions”; we see a number of examples where trusts have well over a hundred different software solutions across their healthcare organisation. That’s a lot to manage, keep up-to-date and integrate. So, for us, one of the most important things is to continue with a go-live schedule of Enterprise Imaging implementations, so that our customers have a modern robust imaging platform that can manage all their imaging data and image-enable their Electronic Patient Records (EPRs).

We are also looking into our technology, and analysing areas that can be improved further. For example, when Microsoft Teams was rolled out across the NHS, we acted quickly to integrate our image viewer with the platform so that staff could easily, quickly and securely communicate. The integration allows for a more complete view of the patient, and it saves a lot of time.

We are also working with a couple of trusts on a range of exciting digital programmes, such as artificial intelligence (AI) in imaging. The progression in AI will have a huge impact on radiology – one aspect is the way in which it will help staff to prioritise work in the right way, finding critical cases automatically. Another aspect is deep learning image analysis, where the technology can help the user do two things: find critical issues in an image and highlight it to the clinician to seek a second opinion.

What will stay at the top of the agenda is ‘sharing’, which will further be improved through increased collaboration between trusts. If you want to be efficient in medicine, you need to provide the data to the right specialist, and data sharing is vital to helping this.

What are the challenges with creating interoperable systems?

Across imaging departments, there is already a high degree of standardisation. Radiology has been working with standards for many years to intercommunicate, even with complex data sets. The challenge in front of us is when you want to integrate beyond the scope of the traditional imaging domains and utilise other enterprise technologies. The Microsoft Teams image viewer integration is a prime example of this, and was also a global first. Microsoft Teams is a new communication technology across the NHS, so it was about how our systems can easily and quickly integrate with such systems for more effective and efficient working.

When we speak about the Enterprise Imaging platform outside of radiology it’s about connecting imaging data from various other departments around a hospital, such as cardiology, ophthalmology and endoscopy. This means the imaging data can be universally viewed using browser technology, alongside other patient data in EPRs, so healthcare professionals are able to get the complete longitudinal patient picture (alongside data). With the Enterprise Imaging platform, hospitals are able to manage all their imaging information in one solution, removing complexity for the benefit of all healthcare professionals.

The challenge with achieving image-enabled EPRs across healthcare organisations is to get CEOs and their leadership teams to develop robust IT strategies that include Imaging IT as a key component. Transitioning to Enterprise Imaging enables improved productivity and flexibility, in turn to improve healthcare. More image access, more insight, more collaboration.