HIStalk Interviews Mark Burgess, President of North America, Agfa HealthCare

Mark Burgess is president of North America of Agfa HealthCare of Carlstadt, NJ.

Tell me about yourself and the company.

I’ve spent the majority of my career in electronic health records. I have worked with a startup and have done tours with Cerner, Allscripts, and NextGen Healthcare, with roles that included strategy, product and solutions management, and business unit leadership. I have enjoyed seeing the progression from the introduction of the EHR into interoperability, and now I’m on the imaging record side.

Agfa HealthCare is a global imaging software business that has been in the market for 25-plus years. We were an early mover in PACS. probably one of the first to bring that to market. The company started the transition into enterprise imaging, which is more of what we do today. We’ve gone from a single system to the enterprise system. That has contributed to the evolution of the image to the image health record.

We have 1,200 employees across the globe. We work with some world -class organizations. We have a talent base that is second to none because we’ve been doing it for so long. We provide diagnostic imaging software solutions to thousands of client sites who read millions of image studies each year.

What are the similarities and differences between the EHR application business and the imaging business?

Imaging software is a medical device that is governed by specific regulatory requirements, agencies, and rules. That’s not true of the EHR side.

With imaging, there’s a lot of work and thought that is put into the design of the technology and the way that the technology needs to show up, because you’re using it as an instrument to diagnose. You can obviously use the EHR to get to a diagnosis, but it’s even more intense with imaging, where you are putting it into the hands of a radiologist who forms a diagnosis with it. There are more regulatory components involved with managing a medical device and maintaining it from version to version. 

The EHR side is more governed by achieving regulatory guidelines or regulatory thresholds. The EHR side has to deal with things that surround the EHR, which we don’t see as much of on the imaging side, although that is changing with things like AI. As the imaging side starts to mature and reach deeper across the enterprise, it is getting more involved with those things, including the EHR itself.

What is the demand for accessing and exchanging the actual images versus the reports that are created to describe them, and how does that align with EHR interoperability?

You want all of that to show up in the EHR. You don’t want to have two systems. You are seeing the convergence of that in the industry. We work with all the major EHRs. The radiologists who use our system produce reports and studies that show up in the EHR for the for the physician and the clinical team to see, or in the patient portal for the patient to see, depending on how the organization makes that available.

The image health record and the clinical record are becoming fused. That fits the direction that we are going in healthcare with regards to IT and how patient records are being managed, which is more of the whole-patient care model.

The enterprise imaging decision is relatively new. It reminds me of the days before people started buying enterprise EHRs instead of those that were specialty based. The EHR  grew up in front of everybody, and then the goal was to create a single patient record across an organization. Organizations want to know how they can get a single imaging record across their organization. We’re spending a lot of time ensuring that organizations know how to go about making this decision.

How has the work of radiologists and radiology staff evolved as imaging volume and expectations have increased?

Diagnostic confidence is above all else. Performance and workflow are fast followers, meaning that radiologists prioritize a high-performing system with intelligent and integrated workflows that presents information when and where they expect it. We’re still in a world where performance is key. Radiologists are still focused on safe productivity where they make no mistakes. They want high-performing systems, so by definition, that includes workflow that gives them what they need, when they need it. That means point-of-care capabilities and the ability to pull a prior or to do a report.

Third is coordinated care and integrated care, the ability to see relevant clinical data when they are reading images as well as having access to care team members to share and collaborate.

Finally, we need little to no barrier to system access, bringing the data and information to the radiologist and not the other way around. Streaming data is the future.

Is it hard to develop a company strategy for incorporating AI when it changes every day?

The idea of formulating an AI strategy is accelerating among the radiology base, especially radiologists in the US. An extraordinary number of algorithms have been FDA cleared. Radiologists are starting look at where they can put those to work. It’s a partnership between their ability to operate at the top of their license in a high-performing way, but leveraging the goodness of those AI algorithms. Clients are 100% prioritizing AI and seeking the initial phase of production use, moving from the proof-of-concept stage to focusing on production clinical use.

We want our clients to have choice, so we are staying nimble. It reminds me of the early EHR days, when we started looking at patient portals, scheduling systems, and other applications that were hanging off the EHR. You wanted your clients to have choice and you started to build an ecosystem.  We are focused on the AI side with building an ecosystem, and that ecosystem will be able to go to the point of care or the point of need.

We make sure that as we bring more AI partners into our ecosystem, we hold them to a standard so that what we put in front of our clients has been pressure tested. But it’s fast and furious. The FDA has cleared more than 500 algorithms, with the vast majority of them targeted to radiologists. We have a team that’s in charge of that. But the most important thing for us is to stay aligned with our clients on where they want to put time and energy relative to AI. We are doing our best to curate those opportunities for them.

Do radiologists question how algorithms were developed or do they evaluate them on their level of transparency?

They are curious and have asked many questions about it. I don’t know that we are seeing as much of that healthy skepticism as before, now that we are starting to see some of these organizations gain track records of success. That is lending more clarity and confidence to the radiologist. They are starting to look at, how do I get a better experience with an AI algorithm? How can I improve it in another part of the body?

While we work with a lot of scientists who are always interested in how something was built, what it was based on, and how it was tested, we are seeing more curiosity around how it can be applied to a particular workflow or to a particular part of the body than we saw two years ago.

What is the company’s vision of a enterprise imaging solution?

As I mentioned,  this organization was an early mover on the PACS side. As organizations started digitizing images, they also started standing up multiple PACS. Health systems are coming together and finding that they have three, four, or five of these different systems, and they don’t really don’t talk to one another. It’s not very efficient.

We want to be that single imaging platform. We want to be able to serve not only the needs of the core radiologist user, but start to expand out into all of the different service lines that have imaging needs and imaging demands. We absolutely want it to be treated as a platform. We want to be able to put more capabilities into the hands of these different medical professionals to enhance what they do with medical imaging, and that’s starting to get into the reaches of analytics, research and teaching and how that incorporates into the medical record.

We want to be all things from an imaging software standpoint on this single platform, much like the way the EHR has developed. And then of course the fusion of those two things, so that medical professionals can look at an image with clinical data, or look at clinical data with an image. We don’t want limitations to that.

One of the final frontiers of imaging is digital pathology. What trends are you seeing?

This is one of the most complex parts of the hospital that is moving to becoming digitized. We are certainly seeing more and more of our clients that are moving in this direction. We have been tracking this with some of the largest organizations in the in the world, and certainly in the US, there’s a great appetite to start moving pathology into a digital state. They are hungry for more efficiency, the ability to do more with the slide samples and unlocking more of what they can do with that. Whether it’s data insights, driving better outcomes, or better synthesizing that data into the medical record, they are hungry to unlock more opportunity with what they are doing today.

I see it as maximizing the use of the data to increase efficiency and improving turnaround times, enhance clinical collaboration with the care team, increase access to care, and streamline workflow. Like radiology, pathology is seeing an accelerated
demand for services and a shrinking base of pathologists. Maximizing pathology resources through digital modernization enables the pathologist to better force multiply their expertise to accelerate and advance specialty care like oncology, decrease surgical time that includes reading samples during the procedure, plus comprehensive clinical collaboration through networking with specialists and subspecialists.

How much imaging volume has shifted to non-hospital locations, and how has that affected interoperability requirements?

As patients, we demand more. We want a better experience. We want more options. We don’t want to be tied down to going to one one place at a certain time. The idea of imaging becoming more pervasive in the community is popular and well documented.

The demand for medical imaging continues to go up year over year. In the US, we are hovering around a billion imaging studies annually. The aging population contributes to that. As you capture images, store them, and move them around, you want to make it convenient for the patient. You don’t want patients carrying images on a CD. I had scoliosis as a child and  my parents carried around a jacket of x -rays to different doctors. Those days are gone. It’s like the fax machine in the medical practice, where you just want to be done with that and build the network.

We think about it as an image health network. We want to connect all the different places that are using our platform, and other platforms to some degree, so that these images can be moved in an intelligent, safe, and a effective way. Physicians should not be seeing a patient without having access to the image that will help get the best outcome for them. The image health network is the key to that.

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

In addition to our ongoing client success activities such as continuous engagement and collaboration, meeting the accelerated demand to replace PACS with enterprise imaging, and continuing to innovate and expand the utility of our platform and eco-system, we want to make a dent in addressing burnout. Burnout among radiologists is higher than in most specialties. That drives our work around curating high-performing workflows, leveraging AI, and building the next-generation imaging health network.

We are in a high-growth situation. We want to cover the market properly, continuing to serve those who have an interest in what we do and how we do it. There’s a lot of activity in this market, with a lot of interest in moving to an enterprise imaging solution. First and foremost, we want to be able to accommodate everybody who has an interest.

We are on this journey to cloud, which is essential for us. We recently struck up a partnership with Amazon Web Services and we are pretty excited about working with them. We are starting to move clients into our own AWS private cloud model. The level of interest in that is growing exponentially faster than even the upper reaches of the model we created a couple of years ago. We are excited about what that means from a modernization standpoint, getting organizations away from legacy worries about storage and compute power. We can neutralize that through our cloud offerings.

As we continue to build the ecosystem, we will continue to curate the ability to give our clients the most options that we can give them. AI will have a part. It’s all about continuing to serve across the enterprise, helping all the medical specialties that are in need of medical imaging, where it lives inside our platform that sits on top of this image health network and is connected to the EHR.