Thank you for standing by. Welcome to the Pro Medicus half year results briefing. All participants are in a listen-only mode. There'll be a presentation followed by a question-and-answer session. If you wish to ask a question, you'll need to press the star key followed by the number one on your telephone keypad. If you wish to ask a question via the webcast, please type it into the ask a question box and click Submit. I would now like to hand the conference over to Dr. Sam Hupert, CEO. Please go ahead.
Thanks, thanks, everybody, for joining us on this presentation. For those that have not met us before, we are an ASX-listed company specializing in enterprise imaging and radiology information systems. We work in three jurisdictions. Melbourne, Australia, our corporate office. Berlin in Germany, our R&D base for the Visage product. U.S., which is our largest market. The company has two product streams, Visage RIS, which does the practice management side of the practice, billing, scheduling, and interface to payers, and Visage 7, which is the clinical side. It's the radiologist's desktop. It's the product we sell in North America. In terms of the half year results, I think a few key things. It was a record half for us. We had four contract wins in North America, plus a major renewal with UF Health.
Importantly, we completed three very large-scale implementations in Inova, Allina, and Novant. We had the RSNA, which is the big conference in Chicago at the end of November, beginning of December, and I think it was our busiest to date. We are progressing well with our other ologies and AR, which I'll talk about a little later. We think first half and the base for a stronger second half, and we'll talk about that as well. In terms of the key financial metrics, again, we feel they're all headed in the right direction. Again, the, you know, profit after tax grew by over 30% period on period, and revenue was up 28.3%.
Because of that, we declared a fully franked dividend, interim dividend of AUD 0.13 per share, which is up over 30% period on period. In terms of the revenue splits, the salmon color at the bottom is transaction revenue, which as you can see grew as expected. With the blue, which is support revenue, which is also recurring, did grow as well and in total, the revenue grew in, we think in a healthy fashion. In terms of the actual highlights themselves, as I mentioned, we did have the UF Florida renewal, which was actually at a higher per transaction rate and for a longer period than the original contract.
We had 3 sales we announced as a group, back in August, again, to show the segmentation of the market that we deal in. It's not just the high-end, but also in the medium and some of the smaller practices and things such as all three products or full stack and cloud enabled that. We did announce a new mid-sized IDN contract in Luminis Health. We did the three implementations and as I mentioned before, RSNA 2022 was our most successful to date. The operational model used in the vast majority of our contracts, particularly in North America and Australia. Again, it continued to deliver results. We saw upsides as our exam volumes grew, and it is providing us with an annuity-style revenue stream with far greater predictability. We believe we show good operating leverage.
It's a highly scalable offering. We don't have any CapEx in as much as we tend not to provide hardware. In the cloud, no hardware at all. Our training and installations are charged as professional services. We have continued to contain our cost base and, as in previous periods, the margins continue to grow as our footprint increases. Financial year, twenty-three year to date, we are tracking ahead of budget. I think our chairman mentioned that in November, and it continues to be the case. We are seeing client volumes like for like, at above pre-COVID levels, indicating growth either organically or through acquisition. We're seeing the ramping up of the 3 major contracts that we implemented in the first half. Supplementing that are several of the smaller implementations, including Montage and Bay that we announced back in August.
Early in the new year, we got out of the gate fairly quickly, announcing a tier one major academic in UW Washington based out of Seattle and Samaritan Health, another mid-sized IDN. In terms of the markets we work in, clearly, we still are the most successful in the tier one academic space. UW Washington will add to that in this half because they are regarded in the top 20 hospitals in the U.S., and they have a particularly strong radiology program. We continue to work on opportunities in this academic space. I think the other thing that's really occurred over, you know, seems more prevalent even though it was occurring in background, is our penetration of the Integrated Delivery Network space or IDN space. It is the largest single segment of the market.
We did have existing clients in that space in Mercy, Sutter, Intermountain, and more recently MedStar. We have gained fair momentum in the space with six sales to IDNs over the last eighteen months. All of the sales have been for more than one Visage product, a trend that we see as positive and continuing. All six opportunities are either fully or will be fully cloud deployed, and we are seeing an increased network effect in this market segment. In terms of the risks, it did contribute to growth in the Australian business, which was up approximately 10%. The key contracts that we have with Lumus, previously Primary Care and I-MED, the two biggest providers in Australia. The Lumus rollout is now complete.
It is transaction-based, and as they continue to add new practices, we get some of that upside. There is increased market interest in new opportunities, and I think it's clear to say we are the undisputed leader of RIS in Australia. What makes Visage 7 different from others? I think we are number one in the three key areas of speed, functionality, and scalability, and we believe, if anything, we've extended our lead in terms of technology leadership and our domination of these three brackets. Things that are driving adoption, clearly large datasets. Many of you have seen this slide before, but we just saw a very interesting analysis in the U.S., where breast imaging and screening is rapidly transitioning to breast tomosynthesis from 2D mammography.
That is creating massive data silos for practices, simply because mammography is in hundreds of megabytes. Breast tomosynthesis, which is like multiple mammograms in one image, is in the gigabytes. We're seeing a massive transition to 2DT or breast tomosynthesis. We see breast imaging as almost the canary in the coal mine. When networks crack within an organization, the imaging networks, it's almost always breast imaging that is the first one to crack the network and make it too slow for use, and hence one of the things working in our favor. Legacy technology, the reason for that is it's compress-and-send. You have to compress the file, send it down the network, and a workstation at the other end has to unpack that file and then do all the manipulation locally.
The other thing is the entire file must be there for that manipulation to occur, and the files are just getting too big, regardless of bandwidth. Our model is totally different. We don't know of anyone that's been able to replicate it. What we do is we take the file from near real time. We render that file, do all the 3-D advanced visualization, and then stream the pixels. We don't actually move the file. It's one of the key ingredients behind the on-demand nature of our product that's virtually instant and one of the key features that allows it to work so well in cloud. If you look at our map of the Visage 7 streaming technology, you see the at the top, we have all the other ologies hanging off it.
We have research packs, and we have a whole number of other modules, including our archives and Worklist. The whole concept is the streaming technology. The streaming back-end is the central piece of an entire suite of product that hangs on and around it. The three different contracts that we won, Montage Health, the regional IDN, Bay, which is a private radiology group that were very familiar with our product as they have been reading for Sutter Health now for eight- years and using the Visage platform and decided to then acquire it for their own private practices. CHOP, which is the only one of the three yet to be implemented, that will be implemented within the next 6 weeks. That is the Children's Hospital of Philadelphia, one of the top children's hospitals in the U.S.
I think these three deals do indicate that, you know, we can address a far bigger market segment than people thought before, and we can get to the smaller and medium-sized IDNs, as well as the larger ones that we've traditionally dealt with. University of Florida renewal, again, seven-year, $15 million contract. I think the key thing is both sites are now on a transaction-based model, whereas one was on the capital model before. They've now been put onto the same model and they're renewed for a longer period than the original contract. Luminis Health, this was the last one we did in the half. It's a seven-year, $15 million transaction-based contract at minimums. It is a well-regarded IDN based out of Annapolis, Maryland. It is for full stack, which is all three products, Viewer, Workflow, and Archive.
It is to be fully cloud deployed. As I mentioned earlier, I think, certainly helps increase our footprint in that very large mid-sized IDN market. It's one thing to sell it, another thing to put it in. We believe that one of our key strengths is the way that we are able to seamlessly and rapidly implement these systems, taking what used to be, in some cases, a two-year plus process and bringing it down literally to weeks, months and weeks. All of our implementations are on or ahead of schedule. Those that we've recently sold all being scheduled for at the end of this half or early next half. As I mentioned, the three big IDNs that we implemented back in the first half has cleared the decks to enable us to take on new business.
Why do people buy us when we're the most expensive? I think it's becoming more and more prevalent in the market that we have a proven ROI. That ROI is not just financial, but also clinical, which is equally, if not more important. We allow the radiologist to do more or do things that they otherwise couldn't do or would take too long to do previously. Clinical outcomes is the key one for us. We believe we are moving the needle. There are a few examples that we talked about initially at our AGM. Just to reiterate, we are doing some very interesting work with Dr. Nayan Bhatia at Yale, who's a top pediatric neuroradiologist.
We are doing work that will allow us to segment, in other words, core out a tumor in 3D, whereas currently most of the measurements of tumors are, you know, very poor approximation in a fixed plane at 2D. We are seeing very interesting results around that and greater accuracy, and there are some trials around that being done at the very moment. We do things that are not just AR related. We did do a joint development with NYU Langone, where the head radiologist or the chair, Dr. Michael Recht, always believed that patients really don't understand what a radiologist does. They had an Instagram that said, "Your radiologist is the most important doctor you've never met," which I thought was very clever.
This allows a radiologist to do a quick one-minute video of a normal anatomy and normal X-rays or an MRI of the shoulder, and then show the patient's MRI and what, you know, where the pathology is or where the anatomy is slightly different. That's accessible by patients through the NYU portal. It's been a resounding success, not just with the radiologists, but also the patients and the referring clinicians. The topic du jour, the hot topic in radiology at the moment, it is in other areas of medicine, but radiology in particular, is the concept of burnout. Radiologists are being asked to read many more images in the same amount of time, and it's putting an enormous stress on the system.
You can pick up any radiology magazine, it will be front and center. I think what we've been able to do is certainly we've been able to measure this increased radiologist throughput and productivity, in some cases by up to 50%, but in, you know, pretty much in all cases, 25% plus. Now, this is same radiologists, same type of exams. They're just able to do more in a day or in their components, they don't feel as tired at the end of the day, but in essence, they've actually done more than they used to be able to do. It is becoming a very important factor in purchasing decisions, and it's a key differentiator between our technology and others.
In terms of our growth strategy, many of you will have seen this slide. The key thing is to expand our footprint to new clients, which we continue to do with the additional sales that we get. Transaction growth in existing numbers, as we mentioned, like for like, they're greater than pre-COVID levels. All of our clients are doing more work, either organically, some of it's industry growth, some of it's above industry growth, some of it is via acquisition. We have new product offerings. We started in the U.S. years ago with the Visage 7 Viewer. We then supplemented that with the Open Archive, and then eighteen months ago with the Visage Workflow Manager or Worklist.
As you would have noticed in our recent sales, we're getting a number of clients, an increasing number, that'll take all three, which obviously increases the total contract value. It has another benefit for us. It makes the implementations that much easier because we don't have to interface to third parties. We don't have that complexity, which we can and do handle, but clearly it's easier if we have all of the bits ourselves. I will talk a little bit more about extending to new geographical markets, Germany being the key one at the moment. Last, we have had a number of recent wins over the years in that market, and we are looking to leverage off those wins, particularly in the German market and then the broader European market as the market opens up, particularly with cloud.
We're looking to leverage some of the R&D capability in the other ologies. Our North American pipeline, we believe it's extremely robust at the moment. We've seen increased intake of RFPs, particularly over the last eighteen- twenty four months. We had our best RSNA ever. We had the greatest number of leads generated, and we've already received some RFPs as a result of that, which is a lot sooner than we would normally expect, given that the conference finished in December, which is pleasing. Visage 7 Open Archive, I think, again, very instrumental to us. We are seeing more and more clients take it, particularly over the last two years. We do see an opportunity selling it back to existing clients as their archive contracts start to roll off with their third-party vendors.
It is a very integral part of our cloud offering and full stack solution. Workflow, similar. It's the newest of our products. It has been, we have sold it in six out of our last six major contracts, clearly a product that the market wants. It has the speed and performance of both the archive and in particular, the viewer. Again, it's a differentiator in terms of our ability to provide full stack solutions to those clients that want it, and we've seen positive traction with it. One Viewer, this is the one product that can go across other ologies. We have made good progress, particularly in the area of cardiology, which is quite extensive.
We currently do a number of the disciplines and modalities in cardiology, including MRI and CT, and we do ultrasound, but it is adding in the cardiology-specific functionality to bring it out to a full suite. We did highlight an ejection fraction product, which we've been pivotal to coming to that point of having a comprehensive cardiology offering that we highlighted at RSNA 21. It now is in production as part of the normal product suite, and we are looking to then promote other cardiology-specific functionality in the not-too-distant future. The most recent was KLAS, which is the rating agency, ranked number one in universal viewer. I think two things about that. For it to be number one, it must cut across more than one discipline, so radiology and something else.
Clearly, we are being used across more than just radiology, and it does allow for both diagnostic and review purposes. It's the first time that we've been reviewed by KLAS, and clearly we think this is the way the industry's going, away from a sort of core PACS, as they used to call it, to a more enterprise-type viewing platform. We think this will give us a little bit more. People will know us more in this market because of this recent award. Cloud PACS, this is the other trend. It's been massive in the last two years. Pretty much all of our deals that we've done have been cloud-based, and the majority, if not all of them, in the pipeline are either having cloud mandated or as an option.
It gives the same ultra-fast performance or if anything, it's actually even quicker than on-premise, which is counterintuitive, but we've seen and heard that from all of our clients to date. We think it's. We are the only ones that can actually truly put an institution's radiology business in the cloud at scale. We've proven that over the last two- years, and importantly, we currently have large-scale implementations in Amazon's AWS, Microsoft Azure, and Google GCP. If a client has a preference or an agreement with one of the big three, we're able to facilitate that without forcing them into one cloud or another, and we generally see that as a massive advantage. This is recently released. It was a joint promotion vizair between Visage and AWS.
We are seeing more and more interest from the cloud providers because radiology is clearly one of the biggest areas in healthcare cloud. As I said, we believe we are leading the charge to bring large institutions into cloud. Last few things. AI, which again, I know has been a hot topic, particularly lately with all the press about generative AI. Certainly, we see AI in radiology as being key in the future. It is still emerging, but we see it being embedded in equipment. We see it for prioritization so that in an A&E, you know, which of the CTs does the patient have trauma or blood in the head, bring that to the top of the list.
We see it as a second set of eyes, and we see it has functionality in screening and maybe one day, in the midterm or longer term to an automated diagnosis. Certainly, we think, it will emerge. It's a question of when and how. Those that have been following us know that we have certain, tools, including the AI accelerator, which we use with some of our academic clients and allows us to do commercialization with third parties. We have a dedicated team, our two founders in Berlin are both Ph.D. in healthcare informatics. We have two people on the ground in the U.S., doing a fair bit of work in the background to make sure that we're ready for another stage of AI.
Finally, we do have a research center that we established in 21, August at NYU Langone. It took us a little longer because of COVID. That is starting to bear fruit in the number of collaborations, including the video reports and some AI projects that we're currently working on. Finally, at RSNA, I leave you with two thoughts. Our biggest presence to date, both in terms of footprint and staff numbers, and we generated more leads than any other year. Just to give you an idea of the extent of the booth and the effort we go through, this is a picture of our booth. It's, you know, quite a substantial effort.
At the back, there are two meeting rooms that are, you know, one of them will hold about 30 people that we built specifically for the conference. You can see to the left with the Visage splash across it, there's a table in there that sits twelve people plus a theaterette, so it's quite extensive. Now, we did make our biggest investment. We believe that's been vindicated simply because we're able to do more demonstrations and again, get more leads than any previous year. In terms of our staff, there's just a quick photo. There's yours truly colored myself in the middle in blue, but they're all the rest. It is quite a big logistic exercise for us. Finally, finishing off, most successful path in company's history.
North American footprint continues to grow strongly. The full stack solution is being taken up by more and more clients, and we see that continuing. Proven remote implementation and support capability. Even though we're post-COVID, we now have a hybrid model. Cloud is a massive advantage for us that we think will push us even further ahead of competition. We think we have an unparalleled value proposition, both clinical and financial ROI. Anyway, I'll finish there. Thank you very much, and we'll open up to any questions.
Thank you. If you wish to ask a question, please press star one on your telephone and wait for your name to be announced. If you wish to cancel your request, please press star two. If you're on a speakerphone, please pick up the handset to ask your question. Please limit your question to two per person. If you wish to ask further questions, please rejoin the queue. If you wish to ask a question via the webcast, please type it into the Ask a Question box and click submit. Your next question comes from Garry Sherriff, RBC. Please go ahead.
Morning, Sam and Clayton. Just confirming you can hear me okay.
Yes.
Perfect. Two questions. First one, cash flow. That investments in financial assets, that's gone up materially in the first half to AUD 13 million versus AUD 1 million, in PCP. Maybe just remind us what exactly is that spend, and how should we think about that one going forward?
The overall financial assets haven't gone up that much, so it's just what we've sold. If you're looking through the cash flow, that's just purely the amount that we've bought over that period, but it's offset by the amount that we've sold during the period as well. The investments are AUD 12.9 million, but we've sold AUD 11.1 million through the same period. Overall, we still have AUD 29 million of other financial assets compared to AUD 27 million last year, last or same period, 30 June.
Got you. Okay. It's just netting off one another. That's no trouble. The next question I've got, just in regards to that tax paid, that really jumped up and I know that's outside of your control. Again, how should we be thinking about that? It is a big jump from what it was on PCP, AUD 12.5 million versus AUD 4.5 million last time.
Sorry, what was that? I missed that, Gary.
The twelve and a half, yeah, tax paid last year, this year versus, you know, AUD four and a half last year. Just a very big jump. Is there anything changed there? I know it's out of your control largely, but just trying to check on that.
Purely especially after 30 June, the first half, you're doing pay-as-you-go as you go throughout the period, and then if you lodge a return or you think you know what your return will be for 30th June within the first half and there's some additional tax to pay, that's when you'll have to pay it. Unfortunately, we're making or fortunately we're making more profit, but unfortunately we're paying more tax.
All fine. Last one, just on new products. When should we expect some first material revenues, I guess, from other ologies and AI revenue?
I think we've always said this calendar year. We are Just to qualify that, we're talking about, you know, first revenues, how material they'll be. That will be, you know, obviously we'll have to wait. We are still aiming for this calendar year.
This calendar year, Sam, for revenues, but not necessarily, I guess, material from the new product.
They could be material. I just want to temper it because it's one of those things, how long is a piece of string? We are getting close to commercialization on a few things. Materiality is the fact that our other revenues are going up, even, you know, quickly. Look, it could be material. I am just saying we are looking at, you know, first half of this year.
Okay, good. I'll jump back into the queue. Thank you.
Thank you.
Your next question comes from Josh Kannourakis with Barrenjoey. Please go ahead.
Hi, Sam and Clayton. Thank you for taking my call. First question, just with regard, obviously, you talked about the big RSNA, best ever RFPs coming a little bit sooner. You've won $84 million worth of contracts to date. Historically, there's sort of been a bit more in the second half. How should we think about, I guess, the pipeline into the second half of the year and just what visibility you have on some of the progression of those contracts and RFPs into the second half of 2023?
Yeah. Look, it's like a continuum. We're actually working on some of the opportunities from the previous year 'cause as you know, these opportunities are usually 12, 18 months, sometimes longer if they're bigger. They're all continuing. I think the important thing is we are seeing more inbound. As we contract with a number like Luminis and, you know, the others before and recently UW and Samaritan, clearly they drop out of the pipeline. To have a robust pipeline, you need new things coming in. I think we're happy that our conversion rate is still very, very high, much higher than the industry, and that there are new things coming in to replenish it.
I think the other thing about the pipeline is, you know, in the past we may have been a bit pigeonholed, tier one academics, there are 30, 40 of those. You've got 10. You know, you don't have much runway left. I think recent sales show the spread of opportunity across different market segments, and the pipeline reflects that spread. I think that's important as well.
Sam, just to follow up on that first question. You mentioned obviously the relationship and the interest from the cloud providers. You know, are you starting to see any leads from some of those major cloud providers? How do you sort of see that relationship developing over time? Obviously, they've got, you know, significant sort of, hooks into government and other big institutions. Yeah, interested to see how you think that could develop over time.
We don't expect any cloud provider to exclusively work with us. I don't think, you know, that's the case. The more success we have and the more business we do in the cloud, the broader the cooperation. I think it is fair to say we are receiving broader cooperation from the cloud providers 'cause success begets success. Also we're one of the few, if not only ones, who have proven that we can put large scale implementations in their cloud. It's a known entity. We are, you know, working collaboratively with all three of them, and I think the AWS video was part of a joint marketing budget that they have allocated towards us for that joint collaboration.
Yes, look, we can't predict what will come our way, but certainly, we are hopeful that there will be certain leads coming.
Thanks, Sam. Just second one for Clayton. On the margins, Clayton, just into the second half, obviously you've got the RSNA impact. You might also mention just around that change in capitalization, obviously impacted the first half by, you know, AUD 1.25 million. Just how should we sort of think about the cost profile into the second half of the year and any other investments, you know, that you're expecting?
Yeah. In terms of the capitalize, that'll be repeated in the second half compared to prior periods. So that'll continue. Clearly RSNA won't. Costs, you know, should be relatively flat for or go down slightly obviously from the marketing spend from RSNA. In terms of margins, we're clearly with the three implementations with Allina, Inova and Novant . Novant being mid-December, so we didn't get much revenue from that. That should help increase the margins for the second half.
Awesome. Thanks. I'll give someone else a go. Appreciate you taking the time.
Cheers. Thanks, Josh.
Your next question comes from Melissa Benson with Wilsons Advisory. Please go ahead.
Morning, guys. Thanks for taking my questions. The first one was just, perhaps for you, Sam, around the One Viewer, and you're speaking to adding kind of more cardiology features to that product.
Yeah.
How should we think about the pricing of that product in the sense of it being relative to Are you guys adding kind of a price increase if they do have those cardiology features, are they kind of optional and as you add more kind of comprehensive features, will that be the case or it's all captured within your standard kind of viewer price?
No, we're looking to sell it as a separate offering in terms of cardiology, because of the feature function that if you're not using it for those modalities, you most probably wouldn't need it in the standard offering. It is on the same platform that's purely a licensing. In terms of the pricing, that's yet to be determined. I think our research, and I think even yours in the market, has shown that there is a higher per transaction fee for cardiology specific software, look, it's still to play out. I think the main thing is it will be an extension of the same platform rather than a separate product. We do think, you know, it'll have its own pricing with it.
That's helpful, thank you. Perhaps one just to clarify with Clayton. You mentioned a change to the treatment of R&D expense. If you could just kind of clarify what the change will be moving forward, how R&D is kind of captured versus the past.
Yeah. It's just a lowering amount. It's an application of how we view their capitalized development costs. It'll be similar to this half. To me, you know, the second half will pretty much repeat what the first half was, and then going into next year that'll consist of lower amortization.
Is that in the sense that you guys are kind of getting to a point where you're comfortable you're not needing to invest more in R&D or that's being captured in other expense lines?
No. We could increase the amount of development staff we have. It's the amount that's applicable for capitalization.
Yeah. Okay. Got it. Thank you.
Your next question comes from Andrew Paine with CLSA. Please go ahead.
Yeah, morning. Thanks for taking my question. Just following on from an early one, talking about the volume of contract wins, you know, in the near and medium term. Just trying to think about this in the context of whether there could be an inflection point, where you do see some accelerated adoption by the remaining IDNs, as they look to deploy the software, especially leading up to AI and cardiology becoming more prevalent?
Yeah. Look, I think the market is one where you don't have this massive inflection point where nothing happens and all of a sudden everything happens. The organizations do come out to RFP fairly late in the piece, usually where they can't, you know, they can't exist with their current system. They leave it very late, believe it or not, in most cases. We are seeing more and more of those coming, and I think a few things are driving, and datasets being the big one, and breast imaging being the sort of canary in the coal mine for big datasets. We are seeing an increase. I think the second key driver is security. I think people have realized cloud is far more secure than on-premise for multiple reasons.
Those two things are pushing more and more people to look to replace their system maybe sooner than they otherwise would have been, hence, the increased numbers of RFP. As we mentioned, look, we think cloud is a huge driver, and as far as we know, and I think the market knows, to date, we're the only ones that can actually take these organizations and transparently, you know, migrate them into public cloud. If anything, as I mentioned, performance is even higher, which is counterintuitive to having your own data centers than it is. I think cloud, large datasets go increase cadence of opportunities going forward.
Sure, that's great. Just also, looking at some commentary from one of the competitors in the PACS space, they recently said that they think they've overcome the functionality gap between their product and Visage, when you compare it to a couple of years ago. Just wondering if kind of get your comments on, you know, the state of the competition today and how you see that evolving in the coming years.
Yeah, that's an interesting one. We've always thought we're 18 to 24 months ahead, and if anything, we think that that gap has actually widened. We don't know anybody that has been able to provide reliably the streaming platform that we have, which is so fundamental to being an on-demand system. We also don't know anyone that's been able to integrate into one product everything from basic 2D chest X-ray to very advanced visualization with Fusion 3D, 4D. So look, again, I can't talk for others. I know what we see in the market, what we compete against, and pretty much most of them are still compress and send, or pretty much most of them are largely 2D and can't do all the advances. You've got scalability.
You know, it's one thing to do it in a, you know, one thing to do it in a, in a small practice, but when you get to the large sizes of an Intermountain or a Mayo Clinic or an NYU, scalability is mandatory, and most people can't scale to even a quarter of that.
That's great. Thanks. I'll jump back in the line.
The next question comes from Mathieu Chevrier with Citigroup. Please go ahead.
Yeah, good morning, Sam. Good morning, Clayton. Thanks for taking my question. My first one was again on competition. We saw GE HealthCare being spun off, and then Philips was undergoing a restructuring. Was just wondering if you've seen changes in behavior or level of investments from these players and others in the last few months?
In terms of the equipment manufacturers, no. We haven't seen any change in response from GE. I think, you know, whilst they've been active with their equipment, but certainly this area of informatics, we really have not seen anything. I think Philips, you know, their major play was somewhere around two years ago when they bought Carestream, the ex-Kodak, that informatics business. I think the major thing we see there is them trying to just hold on to market share, but we haven't seen any new product offering, and we certainly haven't seen cloud from either of them. Whilst it's possible in, you know, in lab they have something, and usually they sort of telecast it, as I call it, you know, at RSNA well in advance of its release.
We haven't heard of anything, and we've not heard of anything from our clients either, that either of these two are looking to bring out a new platform.
Understood. Thank you. Sam, you mentioned previously, that there could be potential changes to EU privacy laws that could help the adoption of the cloud across healthcare in Europe. I was just wondering if you had any update on that you could give us, and I'm sorry if I missed it earlier.
Yeah, look, we hear it is all progressing. I think it still needs to be ratified, the Trans-Atlantic Pact. Certainly, the cloud providers, the big three we're speaking to, are all eyeing off Europe as we speak, which is not surprising because clearly there's a, you know, there's a lead time for them. I think they're looking at it as a new greenfield site, certainly for cloud. You know, there might be some, you know, some things that need to be done slightly differently. You might need something like a German telecom in there involved. Have someone local. Again, I'm not the one on the ground, but certainly, we do get the distinct impression it is progressing.
Understand. Then, maybe I can just clarify quickly on the pricing strategy or what you can say about the pricing strategy of cardiology. I'm sorry if I missed it earlier. I think you mentioned.
Yeah.
it would be included in the overall platform price. Am I correct?
No, it would be separate. We'll price it as a separate module. It's just based on the same technology platform. You won't need new hardware. It's purely licensing software and functionality.
Yeah. Understood. Thanks very much.
The next question comes from Sarah Mann with Moelis Australia. Please go ahead.
Morning, guys. just wanted to ask a question on pricing as well. clearly we're in an inflationary environment. Are you seeing any of your competitors use that to kind of step up pricing? secondly, like, when you come to kind of contract renewals or I guess, you know, new contracts, does that kinda give you an extra leg to increase pricing again over what you normally do?
Yeah, well, I'll answer the second one first. I think the main thing that allows us to step up is that our clients know what we charge for the software in the current market, aka what they paid for it. There's a clear delta. You know, it's gone up about 70+%. I think that's the main lever. Inflation, yes, some, but it's pretty recent. In terms of competitors, look, we never see their quotes. I think, you know, it's possible, but I think, you know, some of them we hear the opposite. We hear that some of them have dropped prices because they're finding it hard to compete on ROI and technology. Like I said, that's anecdotal because we don't see the quotes ourselves.
We are still told we're the most expensive, but the only thing I can confirm 100%.
Got it. Okay, cool. The other question was just on the cost front. I mean, you know, you'd flagged clearly you're adding headcount and we've seen it in the numbers.
Yeah.
Just wanted to understand, like, how much of the increase came from headcount versus, I guess wage increases and then how you kind of see that playing out. Clearly with, you know, the layoffs in tech, I mean, hopefully that meant some of the pressure comes off. Plus maybe you can hire, you know, more people. Just trying to understand that.
I think the majority thanks, Sarah. The majority would come from headcount. We flagged at the AGM that we'd be bringing on some corporate costs and some new people. We also flagged that we'd be increasing headcount across all 3 jurisdictions, which we've done. US implementations in sales and also in Europe, you know, product development and support. That's been the majority of it. I think we mentioned, you know, wage inflation. There's been some, but majority would be through headcount.
Got it. Maybe if you wanted to add extra people, you should be able to, if the, if the pressure's coming off and there's more people available, that's just potential benefit, I guess, going forward.
Yeah, we see that more in the U.S. You know, you read every day in the paper someone's laid off 10,000 or 15,000 people. It's, you know, it's hard to believe, but it's true. We see that more in the U.S. There has been some repercussions here, but it's still early days. Again, look, we're, you know, a bit over 100 people, so any inflationary pressure is mitigated clearly by the numbers. Yes, I think if anything, we've felt a little bit of easing in the, you know, the job market simply because it's not as hot as it was, let's say, 12 months ago.
Right. Sorry, last question from me. Just on like M&A, which I guess kind of ties into the comment about tech before. Like, I mean pricing clearly has come down.
Yeah.
Can you give us an update on your strategy, around, I guess, potential M&A in the AI tech space?
Yeah, look, you're right, prices have compressed. I think that, you know, that's a given. Have they compressed enough? Can you still find value? They're the two magic questions. Look, we are looking at more and more opportunity. You know, we've had Nick Peace join us in June, July last, you know, 2022, largely tasked with that. He was at RSNA. We were actually close to all the AI vendors. You know, he and Clayton went round with two AI guys or the two guys we have and looked at a lot of stuff. Look, we are spending more time and resource on it. We will be very, very picky. If we don't find anything, we still think we can satisfy our growth requirements and ambitions organically.
We feel it's incumbent on us to look and with the way the market's going, you know, makes it more attractive. It doesn't guarantee us an opportunity.
Great. Thanks very much, guys.
The next question comes from Peter Meichelboeck with Select Equities. Please go ahead.
Hi, guys. Just a couple of questions. Just you specifically mentioned the network effect, you know, particularly in the IDN space. I mean, I've always thought that that sort of would be felt through sort of, you know, more incoming requests, et cetera, and things like that. I'm just trying to get a sense of how else that might be felt. I mean, I'm wondering in particular, does the network effect have any does it help you get through your pricing with new people perhaps a little bit easier than it was earlier on?
I think that's actually exactly it. Sometimes in the past we'd get the, "Well, of course Mass General or Mayo or NYU would buy you guys. You know, they buy Rolls-Royce. They have big endowments, a lot of money. You know, we're a much smaller regional RBM, and, you know, we can't afford you because X." Clearly, the more we get, the more we can prove the ROI in that segment of the market. It's just as compelling. One of the key things people forget is our solution, both in terms of the software and with cloud, you only pay for what you use, right? Which has never been the case in the industry before. The smaller guys are prejudiced if they have to buy all this hardware and data center and only use a fraction of it.
I think exactly as you said, the fact that we can show more and more coming on board, more and more the ROI in that segment of the market, it sort of takes away some of the concern that we're only for the big guys. There are a large number of them, and just like any other group, they do talk a lot. Referenceability is always very important. The more we get, the I won't say easier, maybe I'll use the words less harder, even though that's not proper English, but it, you know, it does pave the way for a simpler, a more simpler large sales process.
Right. That's great. Just one other question I had was, I suppose over the years, you've spoken about sort of the potential to sort of pick up some extra exam volumes, I guess, from your existing client base as they, you know, there's a bit of consolidation in the industry and they pick up additional, you know, competitors, et cetera. Are you able to give us a sense of what those additional volumes might be by now?
They vary enormously from client to client. Some of them are small bolt-on, but we've had two, in Mercy and Northwestern, where they bought, you know, quite a, quite a large hospital, roughly 10% of their work on top. In both cases, they've rolled us out there. We've got sort of, you know, we've been able to take up that volume as it comes. What we are finding is that every single client is growing now pretty much at, you know, industry rates or above. A lot of them are actually able to do things that they couldn't do before or in some cases, they take the radiology in-house where they couldn't. You know, we had one client that had massive big city hospitals, but they're more regional hospitals.
They had to have an outside reading group that they had to pay for to read those exams. They've now been able to take them all in-house with the same radiologists. You know, there's all of those dynamics going on. We'd like the client to make a huge acquisition and enroll us out. That would be a free kick. Look, you know, as I said, some are really small bolt-on, some are a bit more material. It just depends on the client.
That's great. Thanks, guys.
Your first webcast question comes from Curtis Larson with North Capital. Do you see much growth in existing clients taking up additional modules, e.g., archive workflow, that they did not initially subscribe to? Do customers tend to stick with the modules they took when they signed the contracts?
We do see this as a, you know, growing field for us, particularly, in areas such as archive and worklist, which are the two additional modules for two reasons. One, the original vendors, some of them have fallen by the wayside and as contracts roll off, we think we could pick up some of that work. The other, I think driver for them is, you know, moving them to cloud. Most of the organizations that are on-premise, you know, have some plan within the next few years to migrate to cloud, and that's a, you know, that in their mind is a logical step as to when to maybe use our archive, put it in cloud, or if the worklist vendor that they've got is no longer independent, that will push some.
The answer is yes, we do see this as a future opportunity with pretty much every client that doesn't have all three.
The next question is from Claude Walker with Virtual Life. How much overlap is there in terms of the customer needs satisfied by the workflow products versus Visage RIS? For example, would a Visage RIS customer also buy workflow? Also, are you able to give us any sense of how much the workflow product contributes to PACS revenue?
Well, thanks, Claude. The answer is usually not. The people in Australia that use Visage PACS, and that's, you know, an emerging number. They use the Visage RIS workflows because it was there first, and it satisfies their requirements. In the U.S., we don't sell the RIS. We either did our own Worklist, which we did, or not have one. They're two separate markets, and in the U.S. it's all Visage workflows. Here in Australia, currently it's all the RIS workflows. In terms of dollar value, the highest dollar value product is the viewer, then the archive, then the workflow. Having said that, the workflow we are looking to bring out some additional modules to it, which will increase the total contract value for workflow if they take those modules.
They're, you know, they're in process. We, you know, we'll announce to the market when that happens. You could find workflow come up with additional modules to around archive. At the moment it's the least expensive of the three but, you know, incredibly well supported by the market.
The second question from Claude: Has Pro Medicus lost RFPs out of the pipeline since the last report? If so, why did the company lose that opportunity?
Not since the last report, no. We've lost one or two small ones, usually around cost. No. None of the major ones, no.
The next question is from Prasad Patkar with Platypus. Hi, Sam and Clayton. Can you please confirm how much more product development has to be done for you to make a headway into the other ooglies?
That's an interesting question because it really depends on. First of all, the platform is ideally suited. We can show every image type, Radiology images, CT, ultrasound, MRI, CT, which are all becoming part of cardiology. In most cardiology systems, those different modalities are actually handled by different software vendors. The second thing is we can show all reflective light photos, videos, what makes Visage good for radiology images, you know, is just as applicable to those. It's really a matter of how much feature functionality do you need in certain areas to get version 1.0, so cardiology. Having said that, you know, if you look at, read the sort of what's behind the KLAS, sort of, you know, award, we are being used across more than one department.
Because you have to be, to be the universal viewer to satisfy that category. I think it's more being used in more diagnostic instances rather than review, because it's a diagnostic instance where you can charge the most. look, we think we're getting closer, but like everything, once you get to version one dot zero, someone will say, "That's great, but we need this," and we'll go to one dot one dot two, et cetera. it's not a set and forget, but we are, you know, we are looking at, as I mentioned earlier, hopefully commercializing some time this calendar year, more towards the middle, hopefully.
The next question is from Ian Wilkie with Morgans Financial. You mentioned IDNs are the largest segment of the market, but is that by hospital number or by patient volumes? Number of conflicting reports in the market which say teaching hospitals are 25% of the buildings, but 50% of the patient volumes, and IDNs are 50% of the buildings, but 25% of volumes. What do you guys see?
When we did the analysis, I think it was by. We don't look at buildings 'cause we charge by patient volumes, so that's what we look at. Volumes, yeah.
As you say, Ian, it's very very difficult to find any two reports that you can triangulate the data from and get a reasonable amount. We do see, and look, IDNs is a loose-ish term that basically in our mind means non-academic hospital groups. Now usually they have community centers, outpatient centers. That's why it's called an integrated delivery network rather than just a hospital network. No, our research indicates that by volume, they are the biggest. Either way, we play equally well in either space, and if it turns out they're equal, that's fine too.
Your next question is a follow-up phone question from Melissa Benson with Wilsons. Please go ahead.
Thanks for the follow-up. This is actually related. I'm just wondering, Sam, you mentioned kind of the volume of diagnostic imaging that you're seeing in the system is well above COVID levels. I mean, is that in your mind kind of a catch-up or you're seeing, we're seeing a fundamental shift in organic volume growth? Like, you know, maybe that 3%
Yeah.
per year level is no longer appropriate and that's jumped up or is there a bit of a catch-up?
I think, and again, we don't have hard and fast evidence, but I think most of the catch-up has occurred. You know, because, you know, the things that in the U.S. particularly returned to normal pre-COVID even earlier than Australia. You'd think if someone was, you know, overdue for screening mammogram, they would've had it by now. I can't say that empirically, but it's the sort of, that's what we feel in the market. I think it's purely that our clients are able to do more and, you know, I think most of them are growing at baseline, you know, in an industry or organic growth, which is, you know, mid to low single digits. I think they're growing more than that.
Clearly they're either doing more work or they're opening more centers or able to just do more per unit time, which we think they are. It's all of those things.
It's more that there's kind of a, not infinite, demand, but it's more just the ability to kind of fill that is seems to be the, I guess.
Yeah.
the answer, right?
I'll give you an example. We, one of our ROI drivers in CT is we enable them to do up to 20% more CTs a day with the same equipment, same staff. If they have that demand, they can actually do more. Even if they do 10% more, it's still material. I know it's one modality, but it's still a big one. They're all sort of different reasons, but we are finding they're actually, and I'm doing like for like, that they're actually doing more now than they did pre-COVID and consistently doing it. We thought maybe like, you know, you're alluding to, we'd see a little bit of a hump and then it'd come back. We've seen the hump, but it hasn't come back.
Thanks.
Your next question is a follow-up question from Andrew Crane with CLSA. Please go ahead.
Yeah. Thanks for the follow-up. Just a quick one. Just looking at the forward revenue of greater than AUD 450 million over 5 years. It's the same as what you said at the AGM late last year. You've had a few contract wins. Would've expected that to go up. Just checking if, you know, that's just an estimate or something else is going on there.
Yeah. Look, that's an estimate, or it's the amount, but it's up to the end of December. We've had the U Washington And the-
Samaritan
... Samaritan since. That figure will actually be higher than that now, but we just take it to the end of the period, so the end of the December period.
Okay, that's great. That's all I had, Chief.
Thanks, Jamie.
Thank you. Just on the webcast question from Sally Warneford with Schroders. Is there an opportunity in pathology and histopathology, cytology for PACS or AI?
The answer is absolutely, you know, related to different fields. The platform's ideally suited. Pathology creates even bigger files than radiology. They're massive because they're multi-pixel depth, and they're colored. It's only a pathology, most of it, in terms of volume, is mostly biochemistry. You know, blood glucose, cholesterol. None of that requires a PACS or visualization system. Really, it's for histopathology and blood films. Look, it is a separate area. Is it suitable for the platform? Yes. It would be a development into the otherologies. Clearly, it's related but not exactly the same. I think the one thing with pathology is the volumes that they do are far smaller because it's only a subset of pathology.
Look, definitely something we could look at, something the platforms are suited to, but it's not just a drag and drop.
The next question is a follow-up phone question from Peter Meichelboec k with Select Equities. Please go ahead.
Hi, guys. Look, just actually something probably for Clayton. Just on the cash flow, the trade receivables or balance sheet cash flow. The trade receivables, jumped, and I know there's that point there around the increase in new customers with installations towards the end of the period. Would I be right in assuming that the cash flow from that should come in in this next half or the one we've now moved into?
Yes, that's right. Yep.
Right. Okay. Just on the cash flows, a bit of a follow-up from an earlier question, just on the tax. Am I right in thinking that that big jump in the tax is a bit of a timing issue between the halves or?
Yeah. During the year, you pay as you go, so it depends how much you're paying based on the previous years. It's the correct amount of tax. It's just a bigger jump in the period.
Okay. Thank you.
No worries.
Again, we've come to the end of our Q&A session. I'll now hand back to Dr. Hupert for closing remarks.
Thanks very much. Look, I just wanted to say thanks everybody for joining us this morning. Really appreciate the questions and if there are any others, by all means, if, you know, you'd like to email them to us, if we can, we'll look to respond to that. Once again, thanks for joining us.