Radiology services continue to be stretched in Europe. Imaging volumes are increasing year-on-year, with a greater proportion attributed to complex scan types. Radiologist numbers are also declining. This clear impacting diagnostic care quality and patient outcomes, with publicised instances of health systems struggling or failing to meet demand in recent years.

Given these challenges, it would be assumed that health providers in Europe are actively looking to improve efficiency and maximise utilisation of radiology services. Use of artificial intelligence for image analysis and decision support has been touted as a solution. However, its use diagnostically has many financial, ethical and regulatory hurdles to overcome.

Alternatively, there are a growing number of radiology-specific software products available today that can support maximising radiology service efficiency. Some are provided embedded as part of a new generation of radiology IT platforms. Others are being sold as standalone offerings, able to be deployed on top of any PACS or digital radiology environment. We classify the standalone market as follows:

Operational workflow tools: workflow orchestration, smart enterprise worklist, assignment engines, modality fleet management services, protocol management, administration support tools.

Business intelligence (BI) tools: analytics and dashboarding of all radiology service performance metrics; includes data and analysis of key performance indicators, system downtime and service utilisation for single, multiple or enterprise network radiology services.

Analysing market data for adoption of these products globally suggest Europe has been slow in adopting these products (see Figure 1); spending on additional standalone products in North America last year was approximately five times larger than in Europe, a significant difference considering spend on all radiology IT in North America is only double that of Europe.

Given that these products have been available on the market for a few years, why is adoption in Europe so low? There are a few reasons. Electronic Medical Record (EMR) adoption in Europe has been slow. While some smaller markets in Northern Europe would be classed as mature (such as the Nordics and the Netherlands), many of the largest European markets have struggled with EMR implementation. From tracking both EMR adoption and radiology IT trends globally, we know that EMR adoption can have two main impacts for radiology. Firstly, it drives more connectivity across all parts of the health system, thereby increasing hospital management focus on the performance of each clinical department. Secondly, standalone Radiology Information System (RIS) software is commonly substituted for an integrated EMR-vendor RIS module, often lacking the same rich feature set or capability as the replaced RIS. Both drive demand for additional operational workflow tools and business intelligence.

Europe has also been slow to embrace the concept of enterprise imaging as a strategy for consolidating the management of all imaging content in healthcare systems. Radiology Picture Archiving and Communication Systems (PACS) and RIS software sold standalone still account for 80% of market spending in Europe today. This fragmented approach makes measuring performance across health systems challenging, stifling demand for analytics and BI tools. Most deployed radiology IT systems also have limited connectivity between radiology departments in neighbouring systems, limiting opportunity for case-load balancing and sharing reading resources.

Recent long-term systematic reform has gone some way to supporting more of an enterprise focus; tendering and purchasing in many European countries has moved to larger clusters or regional frameworks, supporting harmonisation. However, the rate of replacement and complex procurement process is often very slow, with some systems not being updated for up to ten years, limiting opportunity for new technology implementation.

Combined, this has supressed demand for radiology operational and BI software adoption in Europe, representing a missed opportunity. For example, few health systems in Europe today actively monitor and track technician performance in detail on metrics such as protocol selection by imaging order type, dose administration, time per scan, re-scan rate and scan quality. All have operational and patient care implications. Identification of technicians operating outside of institutional parameters using specific BI tools should lead to more specific training, reducing patient safety risk and improving the quality of imaging scans.

Use of smart-worklist capability and caseload balancing tools at scale also remains nascent; even fewer health systems track patterns in demand with BI tools to better learn why demands spike or how to avoid bottlenecks in reading and reporting. Prioritising more urgent cases, routing cases to other specialist consulting partners and management of teleradiology partnerships is all possible with the new generation of software tools available today.

Use of these solutions can improve care outcomes for patients in terms of safety, diagnostic turnaround and diagnostic quality. For radiologists, chance of burn-out is also reduced with improved workload management. For health systems, efficiency and utilisation of radiology services can be significantly improved.

Therefore, isn’t it time Europe started to catch up and invest in the next generation of operational workflow tools and BI in radiology?

Stephen Holloway is Principal Analyst and Director at Signify Research, a UK-based independent supplier of market intelligence and consultancy to the global healthcare technology industry.