HIStalk Interviews Torbjörn Kronander, CEO, Sectra

Torbjörn Kronander, PhD, MSEE, MBA is president and SEO of Sectra of Linköping, Sweden.

Tell me about yourself and the company.

Sectra started out as a cybersecurity company in Sweden. In 1990, I had just completed my PhD and started up the medical imaging side of the business. Our first foray was in teleradiology and then we moved into radiology. We took what we learned in radiology, and we’re now focusing on enterprise imaging and have added modules for cardiology, ophthalmology, orthopedics, and pathology.

We are seeing the same trend in imaging that we’ve seen in EMRs, where there was a separate information system for every single department of the hospital. Then Epic and Cerner came around, and the CIOs said, we want as few systems as possible, and consolidated all the departmental information systems on one EMR.

What are the most significant trends in medical imaging?

Efficiency is important. There is an alarming risk of burnout among US physicians. You need to have systems that are fast and effective to use.

We see a trend toward consolidating to as few IT systems as possible. Having multiple systems is expensive and people underestimate the costs involved. You may have 100 IT people on your staff in a hospital, but without consolidation, a lot of them are doing the same thing on different systems. We are the only vendor who can manage all images in one system.

Cloud is also becoming increasingly important. Having a lot of hardware on site is expensive, and it is challenging to stay on top of the many updates of the underlying operating systems. If you can use Google or Microsoft to manage the cloud operations, they are, cybersecurity-wise, in a better place than almost any on-prem solution.

Combined, we see a large trend towards cloud and a single system for all your images — let’s call it a “pixel EMR,” which is a quote from one of our customers — and then within that space, digital pathology, which is rapidly coming along.

What role does AI play?

AI is very interesting. It will be large, but it will not be as fast as people anticipated. There is a famous quote that the first law of technology is that we always overestimate the impact in the short term of transformative new things, but we also inevitably underestimate the long-term impact. We see this exact trend in AI.

AI is not where it was a few years ago, when people predicted there will be no more radiologists needed to be trained after 2022, which of course is not a bit true. But we will see AI gradually coming into prominence. I’d like to quote one of our customers, Dr. Langlotz of Stanford, who says, “AI will not replace radiologists, but radiologist who use AI will replace radiologists who don’t.” It will drive efficiency, but it will not replace the radiologist. You will still need that human being in medicine. 

We see a lot of AI vendors right now in the market. At Sectra, we have said that you can’t compete with the hundreds and hundreds of AI startups, so we are going with the open systems approach. We have the Sectra Amplifier Store, where customers can use any AI application that they like. If we’re going to accept the AI software for their use, we will do the cybersecurity evaluation on it and ensure that it is secure.

Cybersecurity is a grossly underestimated trend in medical IT systems, because ransomware attacks are increasing, and healthcare is a primary target. Eighty-five percent of Sectra’s business is medical IT, and the other 15% is cybersecurity, which gave us our name — “SECure TRAnsmisson.” We are one of the most prominent cybersecurity vendors in all of Europe. We protect networks with high-level security. We provide secure mobile workplaces and phones for the entire European Union. We are using that same knowledge when we build our IT systems.

Is the company’s cybersecurity expertise a competitive advantage over companies that just sell imaging systems?

That is a very true statement. For many years, we have run our security and medical divisions in parallel. Over the last two to four years, this philosophy has increased in value. Cyberthreats are dangerous for healthcare because typically health systems have to pay the ransom. If other industries get attacked by ransomware, most of them will not pay if they can at all avoid it. But in healthcare, patients die unless you pay those who are responsible for ransomware. The cyber mafia knows this.

We see huge benefit from having defense-level and national government-level security knowledge in the company. We build our systems to be as safe as possible. We are one of the highest-ranked cybersecurity companies in the entire medical sector today. To have that knowledge in house is important. It’s also interesting to see that KLAS now ranks vendors for their cybersecurity preparedness and they consider Sectra to be very mature and safe in that aspect.

What challenges and opportunities have arisen due to the pandemic, especially with telehealth and teleradiology?

I would say the largest impact has been in telepathology. Pathologists are embracing the ability to digitally send images for second opinions as well as to read from remote locations. Previously, a pathologist had to sit at the site of the biopsy and wait for the sample to arrive from the operating room. Now they can see the slides digitally and make quick and easy diagnoses.

How would you assess the status of image sharing?

That is an important question, because sending images in a taxi from one end of New York City to the other is not very effective and it’s also dangerous for the patients. Sectra has the largest image-sharing network in the world, located in the UK, in which every single hospital is connected through our system which sends approximately 40,000 exams per week. There are no CDs in the UK anymore, thanks to us. We are also applying this technology to some places in the US, but the UK network is our biggest reference as of today.

How much of the company’s strategy and product design has to reflect the healthcare policies of the US that don’t apply anywhere else in the world?

The US is our most important market at this time. We have a market share of greater than 50% in many Northern European countries where we operate, whereas we have about 10% in the US. We do, however, have the happiest customers, as evidenced through KLAS and the Best in KLAS awards, and that gives us the ability to grow. We have some important American partners that we collaborate with for research, and some very prominent hospitals as customers. We spend a lot of effort and emphasis on the US market.

There are differences between regions in the world, but not as many as you might think in the imaging space. Images are images, and the way you need to work with them to complete the diagnosis is very similar in all countries.

You’ve said that the way you beat big imaging competitors is to have better employees, stick with your goals, and treat your customers better. How do you make that happen as a global company?

I’m a good friend with Judy Faulkner of Epic, and she told me once that the only way you can become big in the US is by having more happy customers. That resonates very well with my basic philosophy of life. You need to make money, but there’s more to life than money. Happiness is also very, very important. You cannot create happy customers without happy employees. We work a lot with employee satisfaction and recruiting to finding the best people.

It’s very interesting that the competitive advantage for product innovation is a fairly short timeframe. If a vendor introduces a new feature, by the next year, everybody has it embedded in their product. But that’s not the same thing with customer satisfaction. The only way you can sustain a high level is if you have happy employees who are motivated and who will do the best for customers. That culture will always win.

We also recruit the best possible people to join the company. I personally interview every single one, worldwide, before they get an offer. To maintain exceptional quality, every interviewer has the right to veto a candidate. We also have high employee retention, with many people working at Sectra for 15 or 20 years because they like it. And of course, if they like it, they also do a good job for our customers.

What will be important to the company over the next few years?

As I mentioned earlier, enterprise imaging is crucially important. The CIOs cannot afford to have multiple IT systems and they need to partner with companies who can manage all their departmental images in one single system. We have changed to a subscription-based, SaaS model which allows the customer to acquire new technology without large capital investments and we guarantee the cost for the underlying cloud infrastructure which no other vendor does, to our knowledge.