As we reach the halfway point of our research for the HBI Intelligence Teleradiology report, here are five things you may not know about the sector.

While growing fast at 10-30% CAGR, the markets are still tiny 

While all the markets we have surveyed so far are growing at between 10% and 30% a year, they are starting from a low base. The UK is the only major European third-party teleradiology market, at around £80m (€90m) in 2018: by ‘third-party’ we mean teleradiology services provided by one institution to another, as there is a lot of internal network activity that cannot be measured, nor is considered to be part of the market by the sources we’ve spoken to.

Even Norway and Sweden, which are known for being more open to teleradiology and the oldest markets for pioneers like Unilabs-owned Telemedicine Clinic (TMC) are under €3m according to a hip-shot estimate by a source close to the group. Poland and Hungary are also single-euro-million-digit market sizes; Germany and France a little bigger in the low double-digits.

Cross-border teleradiology is not the panacea some hope it will be

Substantial cross-border streams exist but most markets are dominated by a few small local players. The business model of the international groups (those serving foreign markets) has come under fire for pinching radiologists and exacerbating the problem they claim to solve.

We hear that a Swedish hospital tried to use a Polish teleradiology provider a few years ago but it was fairly disastrous and the contract was terminated. Language barriers remains a major issue, even when regulatory barriers are lower, and those willing to up sticks to another country and be pure-play teleradiologists with no clinical face-time are rare.

Prices per report vary massively by country 

A German teleradiology operator tells us that average fees in radiology vary between €50-100 per report – which is huge. We are told the figure is much lower in the Nordics while in Hungary it is €5-15.

As does the business model

In the UK, Nordics and France, elective and on-call (emergency out-of-hours readings) are growing in equal measure and are equal portions of the market (UK player and Europe’s largest provider Medica’s sales are roughly 50% divided between on-call and elective). In Germany, the market is only on-call; in Hungary, only elective. So-called radiologist-filled ‘hubs’ that TMC, Medica and Indian Teleradiology Solutions have popularised are non-existent in the latter two, with all radiologists working from home.

Outpatient groups have little interest in growing third-party teleradiology sales  

Another pattern that has emerged is that in all countries, bar Poland, the largest third-party teleradiology providers are not the big outpatient imaging providers. Pan-European Affidea has previously said it is a single-digit-euro-million provider of teleradiology, i.e under 2.5% of sales. Groups like it have all the capabilities, from the radiologists through to the digital infrastructure, to easily become large teleradiology providers.

Why? A pure-play operator tells us that teleradiology is too low-reimbursement for the big outpatient groups to be interested. Teleradiology companies are basically digital plays with young founders more likely to have an MBA than a radiology qualification, while the outpatient imaging sector is led by radiologists of a, generally speaking, older persuasion.