Magnetic Resonance Imaging Business

magnetised Resonance Imaging pipeline1. The Magnetic Resonance Imaging BusinessMagnetic Resonance Imaging (magnetic resonance visualise) is a non-invasive health check imaging way that has emerged in the first half(a) of 1980s and become a pet tool in detecting a wide range of diseases (Yildirim, et al., 2015)1. Since its invention, magnetic resonance imaging has undergone a continuous f pathetic of innovations and proven itself as a versatile tool that addresses an increasing number of clinical problems and enables research in a growing spectrum of clinical and techno put downical fields. Over the course of its evolution magnetic resonance imaging has proven itself has a considerablyhead-established symptomatic tool and enabler in special(a)ly neuro-radiological covers, operative and anatomical imaging of the brain, imaging of the musculoskeletal (MSK) system and the spine, and a sound contender in cardiovascular imaging, breast imaging and imaging of the breadbasket a nd pelvic region.As a result of its versatility and non-invasive nature, magnetic resonance imaging enjoys an increasing fill (Wilson, et al., 1999 Al-Kwifi McNaughton, 2013) and becomes a blind drunk alternative to little addressly modalities much(prenominal)(prenominal) as X-ray and Computed Tomography (Semelka, 2004).Despite each the innovations, and the returnss it offers with respect to otherwise techniques, magnetic resonance imaging remains the most expensive checkup imaging modality, both in terms of crossingion costs and cost of ownership constitutes a globular trade that is currently ab prohibited 5 billion, and is expected to exceed 7 billion by 2021 (MarketsAndMarkets, 2015).Figure 1 magnetic resonance imaging, applications beas and competing technologies.1.1. The MarketOver the ago three and a half decades, the MRI melody has evolved into a close mature merc go onise, curiously in terms of number of installations and subroutiners, which mainly in corpo ordain of academic hospitals and research institutes, public and private hospitals and specialize clinics and centres (Oh, et al., 2004 MarketsAndMarkets, 2015).The MRI commercialize is dominated by three vendors, namely Siemens, General Electric (GE) and Philips, which hatch about 75% of the merchandise, and followed by smaller firms like Toshiba and Hitachi as easy as relatively smaller firms and unfermented entrants such as Fonar, Alltech and united Imaging (MarketsAndMarkets, 2015).Geographically, the MRI foodstuff is dominated by northwest the States and Europe, which happen to be the birth consecrates of the modality (Lauterbur, 1973 Mansfield, 1977), with respective copes of 31% and 29% (MarketsAndMarkets, 2015). These, so to speak, sexagenarian regions argon followed by a younger and dynamic region, Asia, which has a sh be of 25% and observes a demand that is rapidly increasing (MarketsAndMarkets, 2015). The rest period of the MRI market is populated by em erging markets such as Latin America, the Middle East, the Pacific and Africa (MarketsAndMarkets, 2015).Figure 2 Global MRI market (Adapted from MarketsAndMarkets, 2015).The sedulousness is governed by fast technological change and potent heterogeneity in terms of technology and executing among vendors (Krieg, 2004 MarketsAndMarkets, 2015). epoch fruits bed roughly be categorized into groups representing magnetic field strength convey in Teslas (e.g. 1.0T, 1.5T, 3.0T) or architecture (e.g. open versus narrow-bore or wide-bore cylindrical) (MarketsAndMarkets, 2015), differentiation among intersection points and vendors is fixed by features, clinical applications and research techniques that come integrated with a MRI system (Krieg, 2004 Al-Kwifi McNaughton, 2013).In recent years, the line has detect a strong teaching that manifested itself as a clear split in market divisionation, with premium (or high-end) convergences catering to the upper half of the market and abide by crops (or low-end or low-cost) catering to the lower half (Donoghue, et al., 2012 Global Industry Analysts Inc., 2015). This split, which was initially ca utilisation by the demand structure seen in the Asian and emerging markets, to a fault be acceptance and support in Europe and North America, particularly in sectors where cost began to assume a primary role in barter for decisions as tumefy as reimbursement policies (Proval, 2014 Global Industry Analysts Inc., 2015).In aged markets such as North America and Europe, and also in Japan, the crinkle attends to micturate reached a certain level of due date (AuntMinnie.com, 2013). In these regions, the market shows a declining development rate, by and grown as a result of secure market saturation and negative environmental written report outs such as declining reimbursements resulting from much stringent policies implemented by governments and insurance companies (Proval, 2014 Global Industry Analysts Inc., 2015 ). some other(prenominal) development that challenges the vendors is the step-upd number of brand switching, which, to some extent, john be cerebrate to market saturation (Al-Kwifi McNaughton, 2013). Customers moving from one vendor to another as such is notice to accelerate price erosion and scandalize profitability authoritatively.In developing markets and markets showing a positive growth rate, like the emerging markets and Asian regions such as China and India (AuntMinnie.com, 2013), cost of investment and operation emerges as the primary f acquitor affecting the pipeline (Global Industry Analysts Inc., 2015). Additionally, the billet, particularly of the incumbent firms (i.e. the big five) is challenged by governmental policies that at present or indirectly favour local competition, particularly in the low-end segment (Torsekar, 2014 Rizzo, 2016 Business Standard, 2016). Access to a larger portion of these markets is blocked by either complicated bureaucratic procedu res (Torsekar, 2014), elevated import taxes (Business Standard, 2016), or by directly backing local manufacturers by means of targeted subsidies or interior contracts (credible tooth root needed). 1.2. Product InnovationHistorically, MRI has been a technology set industry, and as it is typical for high-tech businesses, yield innovation has been critical to market per numberance and central to sustainability of the business (Krieg, 2004 Paladino, 2006). Different than most high-tech industries, however, MRI has potently benefitted from a co-creation culture where most innovations make water emerged from interactions and partnerships amid vendors and key, and in the main academic, users (Figure 3). This culture led to a symbiotic vendor-user relationship that resulted into a rapid pace of product innovation, which, in turn, boosted demand for more(prenominal)(prenominal) advanced and specialized products (Krieg, 2004).Figure 3 A history of co-creation in MRI (Adapted from P hilips Healthcare, 2016)However, the rate of ground-breaking and truly differentiating innovations is facing a slowdown (Holloway, 2014). In the last 10 years rattling few breakthroughs led to a significant or long lasting technological and warlike improvement, or father open(a) new areas of application and research. In the fields where MRI has proven itself as a mature diagnostic apparatus, such as neurology, MSK and brain imaging, all major vendors products are cognize to deliver very similar performances and satisfactory quality as far as general purpose use is concerned. Only in case of very specific needs, a particular vendor is seen to differentiate itself from the others and gain advantage in winning a bid or public tender. This situation, which can be delimitate as technological equilibrium, and relatively long presence of the modality in old markets, with an average age of about 15 years in North America, is believed to propel brand-switching (Al-Kwifi McNaughton , 2013), and more importantly, to move the accent of product innovation outdoor(a) from revolutionary breakthroughs to more evolutionary changes that particularly improve ease of use, long-suffering comfort and productivity (Global Industry Analysts Inc., 2015).1.3. Established Marketing StrategiesAlmost every major MRI vendor is part of a multi-national conglomerate that is ready in multiple areas of business. Therefore, the strategies followed by individual companies draw a fortune from the business group they belong to, and show differences particularly in ethnical background, brand positioning and messaging. Yet, over time the medical device business, and particularly MRI, has developed its own common ground and generally accepted and adept traditions. The business commercial heart-beat is primarily set by the annual forum of the Radiological Society of North America (RSNA), which is held towards the end of the year and know to be the stage for new product launches, and s econdarily the annual coming upon of the International Society of Magnetic Resonance in Medicine (ISMRM), which takes place in spring time and lays the emphasis more on scientific and technological advancements in the field.While aligning their annual activities with these dickens events, vendors seem to show little indifference in the marketing strategies they follow, resulting into an equilibrium disk operating system very much similar to that seen in product innovation. Even, marketing materials, such product brochures and whitepapers give the impression as if they originate out of same(p) hands, aside from small nuances in messaging, branding and company culture2.Inferred from marketing materials and product pricing, target market definition is predominantly base on pricing, which is strongly correlated with computer hardware characteristics (e.g. field strength, gradient system, receiver architecture etc.) and pragmatical capabilities (Figure 4).Figure 4In practice, ho wever, the market seems to be far from consisting of two segments clearly separated from each other, as such. In his empirical plain investigating the effectiveness of marketing strategies in medical markets, Brian Smith (Smith, 2003) identify that the segments are divided into sub-segments based on varying conductal and prejudiced characteristics of users. However, the study also established that, despite such variation, the market does not show a continuum of homogeneous and distinct motivator based sub-segments, as seen in most consumer businesses, but rather consists of a discrete partitioning with limited degrees of freedom, which most possibly arises from the rather rigid, dominant and costly hardware characteristics of the modality and the highly regulated nature of the business environment. Of course, the relatively low number of incumbents, and their close collaboration and interaction in determining the industry standards under the directive of the International Electro technical Commission (IEC), also plays also a significant role in the setting and rigidity of the boundaries of the business.Despite the constraints internal to the nature of the modality and business environment and financial boundaries set by the customers budgetary considerations, vendors seem to seek strategic strength and competitive advantage by recognizing behavioural and preferential differences and formulating value propositions that match the specific needs of the users (Smith, 2003). In MRI, this is mainly done by fine-tuning the product bit, particularly the applicatory capabilities, which, age universe very dependent on the underlying hardware course of study, are defined by the software capabilities, namely data-acquisition routines (a.k.a. pulse-sequences), image reconstruction algorithms, and post- act uponing tools. The value-proposition is only augmented with service and support, as well as more intangible offerings and benefits of secondary and tertiary i mmensity, such as membership of strong user network, participation in advanced research activities etc. much(prenominal) customization approaches, however, are mostly left to the discretion of the local marketing and gross revenue teams, and observed to show strong variation depending not only on the needs of the customers, but also on the specific circumstances of the dialogue and/or bidding process and position with respect to competition.From general and orbicular marketing activities perspective, the business seems to trust on downstream activities, which centralize somewhat new product offerings in terms of new hardware platforms and configurations, and applications consisting of myth pulse-sequences, reconstruction algorithms and post- touch methods and counsel mostly on the RSNA, and upstream activities, which involve stimulant gathering from the customer base, particularly from the so called key opinion leading (a.k.a. key users), research collaborations with a sel ect number of sites as well as general user surveys, feedback from local marketing and gross sales teams, and competitive analysis of market changes. While downstream marketing and the show to be put on stage during the RSNA help the vendors catch the attention of the market, and, more importantly, the prospective customers, it is mostly the upstream activities, and the subsequent product definition and development process, that paves the way of success, and embodies the disposal dynamics the organization.1.4. Governing business modelWhile exact implementation may vary from one vendor to another, it is observed that the majority of the major players follow product definition and development processes that are quite similar in the general sense. According to this, input self-possessed from upstream activities are converted into a user requirement specification, which afterwards is translated into one or more product definitions, and evaluated as a unite or individual business cas es, with market and sales projections based on feedback from local marketing and sales teams and competitive analysis. Based on the value offered by each case product proposals are accepted to the annual operations plan (AOP), and are programmed for feasibility studies, if any needed, and product development. close to vendors, divide their annual plan into two parts, first spanning the first half of the year and catering to the installed base in terms of service releases and product updates, and second spanning the second half of the year and tensioning on the new product introductions intended for the RSNA.1.5. Changes in the MarketHistorically, the target audience of medical devices in general, and MRI in particular, has been the medical practitioners (e.g. radiologists, specialists), administrators of medical institutions and clinics and research scientists from variant medical and engineering science. In the earlier years of the business, the composition of this audience was mostly dominated by researchers and medical professionals with strong understanding of the physics and engineering of MRI, and driven by the desire of exploring new fields of research and application disciplines (van den Brink, et al., 2015).However, as the modality matured, the market evolved into a state where the focus shifted more to utilizing MRI as a robust and reliable diagnostic tool, than just a research platform (Holloway, 2014). Paired with this change, the proportion and influence of the medical professionals, including administrators, started to exceed those of researchers and scientists disciplines (van den Brink, et al., 2015).Over the years, and driven by increase in demand for clinical MR scans, the business also saw the trance and influence of a new type of user, namely the operator, also known as the technologist or radiographer. In time, in the clinical, as well as in a considerable portion of the research settings, the periodic of operation of the systems wer e seen to be taken over from highly companionshipable medical professionals, engineers and scientists, by operators whose sole responsibility was to operate the MRs disciplines (van den Brink, et al., 2015).Hence, as a combined result of these changes, the practical knowledge of utilizing MR in a clinical setting increase, together with the demand for clinical MR scans, and number of MR installations, and the average knowledge of MR physics and engineering of the people sitting on the operators chair declined (Yildirim, et al., 2015). This, together with the demand for higher productivity (i.e. higher number of scans per day) and desire for shorter formulation investments brought new factors into the equation of product formulation, namely, workflow and usability (Holloway, 2014 Duszak, 2012).Aware of the increasing importance of workflow and usability, the vendors experience implemented marketing strategies that emphasize the productivity and expertness of their existing produ cts, in attachment to the technical capabilities. At the same time, vendors introduced product changes that focus on higher patient throughput, simplified patient treatment, alter usability of the MR console etc. As a consequence of these changes the jargon governing product and marketing materials slowly shifted from a technically savvy vocabulary to a softer language expressing customer excellence, efficient workflow, easy scanning.In addition to the changes in market demographics and demand structure, which mostly arose from the internal dynamics of the market, the MR business is also observed to be influenced by external changes, particularly advancements in mobile communications, information technologies (IT), the internet and social media.As mentioned before, the MR business is based on a strong co-creation culture and close interaction between customers and vendors. As an integral part of this culture, there is strong empathy among MR users for the complexity of the techno logy and challenges vendors face during product development and manufacturing. However, the empathy of MR users may not last very long. In a recent survey conducted among MR users (Yildirim, et al., 2015), it was observed that the MR user becomes less tolerant to lengthy product service update cycles and new product introduction cycles that are measured in months to years. There is a significant lack of empirical studies addressing this change. However, this behavioural change believed to be an extension of the observed impact of technological advancements on consumer behaviour, particularly in e-commerce, online services, IT and telecommunications products. Studies conducted in these businesses have shown that the consumers have become more and more accustomed to high responsiveness from companies in acquiring goods and services, as well as prompt feedback in case of inquiries and complaints.2. Purpose of work2.1. Problem StatementIn promiscuous of the changes and trends observed in the market, as well as the level of maturity reached in about 65% of the world-wide market, the number of challenges the MR business is facing, and ordain likely continue to face in the foreseeable forthcoming can be summarized as followsHigh costs associated with high-end scannersIncreasing demand for low-end scanners mental retardation in ground-breaking innovationsHomogenization of technologyBrand-switching in mature markets Changing market demographics and declining technical proficiency of usersShifting of demand from novel applications to clinical practice and efficiency Weakening of co-creating culture and increasing impatience of usersOn global dictateed series the MR market is far from stagnation. However, challenges above make maintaining market share and gaining new grounds a difficult task. Some of these problems, particularly those related to high costs of innovation, manufacturing and ownership, are not new to the industry. But problems arising from the change s in the market, particularly those related to the maturation of the market, changes in user profile and behaviour and demand structure are new. Strategies based on technological innovations, while being helpful in preserving brand image and presence in high-end segment, will not suffice to address these issues and sustain competitive advantage and profitability. In order to stay afloat, the business, and particularly an incumbent, will need to search new strategies and solutions to deal with the emerging problems. This work, aims at contributing to such an geographic expedition by addressing the following problem statementHow can the MR business, particularly an incumbent, get over the challenges arising from market changes, without resorting to costly technological innovations? Obviously, such a statement is very broad and may require a comprehensive solution, also including product innovations, and probably a total overhaul of the business strategy. But in respect to imitation s inherent to a dissertation, the scope of the work presented will mostly focus on solutions that will address changes in demand structure and user profile.2.2. Proposed SolutionReducing manufacturing costs and cost of ownership, improving lustiness and usability and introducing products that meet the needs of the low-end segment will require solutions that greatly rely on innovations in product design and manufacturing. However, these issues, and specifically issues related to changes in demand structure, demographic composition, focus of utilization as well as competitive elements involving homogenization and brand-switching can also be addressed by innovations in organizational and operational approach to the business.Today MR vendors seem to focus too much on the future in terms of the contiguous novel technology and new markets or users to be conquered. The business process is almost sole based on this focus. Next to being future oriented the business may also find benefit in focusing on the ancient, or more accurately, the existing installed base. This idea, encouraged largely by the level of maturity of the market, entails learning from collective experience of users, and on the larger scale, from the collective experience of the whole MRI world, and formulate product improvement, marketing and sales strategies based on this learning.Learning as such can be realized in many ways and, in fact, is not new to the MR business. Vendors, collect information from their customers through regular and coordinate surveys, or occasional direct contact by marketing and sales teams. Also annual events, like RSNA and ISMRM, form a viable platform for information and feedback gathering. Next to these, firms also collect information and receive feedback from third base party sources like Net Promotor Score surveys and market research reports, which also contribute to the business intelligence activities of the companies.In addition to such business and market orien ted feedback gathering, vendors also receive feedback from another type of source customer complaints. A customer complaint, as the name implies, is an expression of dissatisfaction (Landon, 1980), and is a formal and regulated entity in MRI in particular, and medical imaging in general. Customer complaints, may entail literal product defects, that is, accidental behaviour or malfunction of the product or a character thereof, or annoyances that arise from the intended behaviour or design of the product. no matter the reason, customer complaints are issued using formal tools, and monitored by regulating bodies with grim rules regarding handling and processing (U.S. Food and Drug Administration, 2015). While in general, a low number of customer complaints, is very much desirable, feedback as such is an invaluable opportunity for vendors to learn from their mistakes.Sources mentioned so far, while all beneficial, have one character in common. They are, in one form another, express ions of intelligible feedback, which is known to mostly capture the part that is immediately visible, and therefore is wedded to being incomplete or insufficient in uncovering actual user experience and value (Vargo, et al., 2007 MacDonald, et al., 2011).As a complementary source, this work proposes the utilization of implicit feedback, which is tacit in nature and captured in unlike forms of data generated by the user, or more accurately, the use of MR systems. The data consists of so called machine-data, which are mostly log files that are generated by the MR systems automatically, as well as human-data, such as clinical protocols that are created by users and contemplate preferred ways of system use, and scientific output in the form of publications and conference contributions, particularly generated by academic users.Currently there are about 35 to 40 thousand operational MRI systems, with a yearly expansion of 2500-3000 systems. That means that, currently, a major incumben t would have had about 10 thousand operational systems, and over the past 10 years about 7500-8000 in average. Considering has been producing at least one log file per day, the minimum number of log files estimated to have been accumulated would be about 30 million. Assuming that each file is of 100 MB ins size, such a collection will yield 3000TB of data, large exuberant to fill more than half a million DVDs. Adding, protocols, publications and other sources to this, the data will multiply massively in size reaching the zettabyte scale (Raghupathi Raghupathi, 2014).In information science, datasets of such size and complexity are defined by the term gigantic info (Russom, 2011 Singh Singh, 2011 Madden, 2012) whereas the processes and techniques used to structure and read such complex data and retrieve meaningful information out of it are brought together under the term selective information Analytics (Russom, 2011 Singh Singh, 2011). The proposed solution relies intemperately on heavy(p) information and data Analytics, or shortly adult data Analytics. But rather than being an exercise of solely academic nature, the work aims at defining a framework that integrates risky Data Analytics into the operational and organizational structure of an incumbent MR vendor. The work also includes practical examples of how to utilize bear-sized Data Analytics in identification of implicit and hidden user needs, product formulation as well as, and particularly, in marketing and sales and create value for both the company and customers.3. larger-than-life Data AnalyticsBig Data is a term used for massively large data sets with complex and heterogeneous structure that cannot be handled, i.e. stored and analyzed, using schematic techniques (Russom, 2011 Singh Singh, 2011 Madden, 2012). Data Analytics, on the other hand, is a collection of techniques and procedures that are used to process and analyze massive amounts of data. Brought together under the name Big Data Analytics, the purpose of this toolset is to identify hidden correlations and patterns in data, and convert a seemingly unordered pile of data into meaningful information and insights (Russom, 2011 Singh Singh, 2011).Although the purpose of Big Data has emerged no longer than a decade ago, the use of data analytics in business practices is not a new idea. In 1950s businesses were analyzing information captured in electronic spreadsheets manually in order to uncover and understand trends and changes in data (Handfield, 2013). With the advances in of computer technology, the spreadsheets have been evolved into large electronic databases and later into data-warehouses, whereas the labor intensive manual processing practices made room for computer programs capable of running complex algorithms in an automated and efficient manner.In time and with technological advances particularly in computing and communications, the number of events and amount of information worth recording inc reased dramatically, and with decreasing cost of electronic storage, so did the record keeping. It is even utter that, more than 90% of what is described as Big Data, has been created in the past few years (Dragland, 2013), and has the potential to transform business, provided that it is processed and consumed properly (LaValle, et al., 2011).Nevertheless, handling Big Data, and converting it into meaningful and actionable insights is not a trivial task. In their field work, LaValle et al. (2011), identified that there are three levels of capabilities, or stages, in which organizations go through on their Big Data Analytics journey aspirational, experience and transformed. Organizations in aspirational stage are described to be furthest of achieving the analytic targets they set, and lacking some of the essential requirements such as expertise and tools. Organizations that are described to be experienced, are those have managed to lay down a basis that enable better ways to colle ct data, conduct analytics and act upon insights. These organizations, also look to go beyond the immediate benefits of Big Data Analytics, which is typically in cost management, and create value in other domains as well. It is however the transformed organizations that make most of Big Data Analytics. Transformed organizations are those that have passed the stage of acquiring expertise, implementing tools and exploring new uses of Big Data Analytics beyond cost management. Instead, they are deemed to be proficient in data driven resource management and optimization of tools and processes and they use Big Data Analytics to create competitive advantage (LaValle, et al., 2011).3.1. The Five Vs of Big Data AnalyticsIn order to progress from the aspirational stage towards the transformed stage, a business first needs to develop a solid understanding of Big Data and what makes it big and challenging to deal with.Technically, Big Data is characterized by a set of attributes, which are cal led the Vs of Big Data Variety, speed and masses (Laney, 2001). As the name implies, Volume represents the amount of data, whereas Variety represents the heterogeneous composition of data sources and data originating thereof. It is particularly Volume and Variety that make Big Data really big and complex (Laney, 2001 Qureshi Gupta, 2014). Velocity, on the other hand covers the flux of data inflow, as well as the rate of change. Velocity also has implications regarding the speed of processing and analysis of data, and is a source of a different type of challenge that manifests itself in constraints and complexities in operational implementation and execution (Qureshi Gupta, 2014).Beyond the basis laid down by Laney (2001), recent studies in the field have extended the Vs of Big Data further by adding Veracity (Morgan, 2012) and Value (Qureshi Gupta, 2014). Veracity mainly deals with the quality and reliableness of data. Expectedly, and particularly considering the high volume an d velocity, Big Data is far from being 100% correct and usable. Nonetheless, it has to be valid and of good quality at a certain level to be useful. Without Veracity inte