Tuesday, November 28, 2017

Think Enterprise: Looking beyond radiology

Amy Vreeland is a Boston-based healthcare technology consultant specializing in helping health systems and health IT startups develop and implement imaging strategies. She has been in healthcare informatics for 25 years and for the last 17 has been focused on imaging. In 2014 Vreeland founded Imaging Strategies focusing on consulting with both healthcare startups bringing new technologies for image exchange and telehealth to market, and with healthcare systems to help them look at imaging from an enterprise perspective and develop strategies and governance models to manage it. Vreeland previously co-founded Life Image, a cloud-based image exchange platform and served as Sr. VP for account management at AMICAS one of the first web-based PACS systems (it was acquired by Merge Healthcare). Last year she led a joint SIIM-HiMSS(I’m not sure HIMSS uses the lower case when spelling out the name – only in their logo) work group that produced a white paper on image exchange published in the Journal of Digital Imaging.

Enterprise Imaging, Threat or Opportunity for Radiology?

Herman Oosterwijk, president of OTech and PARCA founder

Herman’s Take

Reprinted from OTech Imaging blog. Herman Oosterwijk is founder of PARCA and long-time evangelist for PACS and the professionals who maintain and manage them.

The majority of the US hospitals are looking for a VNA or Vendor Neutral Archive to facilitate future PACS upgrades and/or changes in PACS vendors and also to allow different specialties to make use of this enterprise-wide asset to archive and manage their images. An additional advantage of the VNA is that it also becomes an access point for inter- and intra-enterprise image access by non-radiology physicians.

RSNA 2017 Looks to Future of Radiology

PARCA eNews – Nov. 26, 2017 – The Radiological Society of North America held its 103rd scientific meeting Nov. 26 to Dec. 1 at McCormick Place, in Chicago.

The annual meeting drew 55,000 radiologists and other radiology and medical imaging professional from more than 136 countries around the world. With 2,000 exhibitors and 2,500 scientific presentations and discussions, it is the worlds foremost meeting for radiology specialists.

6 Imperatives for improving cybersecurity in healthcare

PARCA eNews – Nov. 23, 2017 – The House Committee on Energy and Commerce is calling on HHS to act promptly on all recommendations for medical device security suggested by the Healthcare Cybersecurity Task Force, which published its recommendations last June.

That task force was formed by the 2015 Cybersecurity Act passed by Congress to help identify and address the unique challenges of securing data and information against cyberattacks faced by the healthcare industry.

Intel issues firmware security patches for several products

PARCA eNews – Nov. 22, 2017 – In response to outside researchers, Intel conducted a security review of several of its most popular business platforms. The result is a update for the Intel Management Engine, Intel Server Platform Services and Intel Trusted Execution Engine.

The security review identified ways an attacker could gain unauthorized access to the platforms that would allow the attacker to impersonate the ME/SPS/TXE, which could compromise local security feature attestation validity. They also identified the potential for loading and executing arbitrary code undetected by the user and operating system, or cause system crashes or instability.

Cheryl Kreider Carey named new executive director of SIIM

Executive Director Cheryl K. Carey
PARCA eNews - Nov. 8, 2017 - The Society for Imaging Informatics in Medicine (SIIM) has announced the selection of Cheryl Kreider Carey, MBA, CAE as its new executive director. 

She will fill the vacancy created by the retirement of Anna Marie Mason, MS. Conducted by Vetted Solutions, the selection was made after a national search and selection process and will assume this role on December 4, 2017.

Time to comment on the 2018 Interoperability Standards

PARCA eNews – Nov. 14, 2017 – The Office of the National Coordinator is once again seeking comments from industry on the Interoperability Standards Advisory (ISA).

In reviewing the draft advisory, the ONC is asking stakeholders to trust their instincts for your comments on any last revisions, additions, or recommendations you have for the ISA’s online edition before they lock-in all of the ISA’s 2017 improvements to make the “2018 Reference Edition.”

Patient Matching Algorithm Challenge Winners

PARCA eNews – Nov. Winners of ONC's Patient Matching Algorithm Challenge have been named. ONC designed the challenge to spur the development of innovative new algorithms, benchmark current performance, and help researchers, innovators, and industry agree on common metrics for success. The winning submissions were selected from over 140 competing teams and almost 7,000 submissions using an ONC-provided dataset. Read about the winners.

Tuesday, October 3, 2017

Make cloud archiving a strategy not a destination

Dan Trott, Dell EMC
Dan Trott is Healthcare Field Director for Dell EMC. His entire career has been in healthcare, starting as a Physician’s Assistant in Diagnostic Imaging. After several years managing a radiology practice, Dan joined the Eastman Kodak Health Sciences Division where he held numerous sales and marketing positions over 14 years departing Kodak as Vice President of Sales and Marketing for Kodak’s first PACS subsidiary. Dan led sales and marketing teams in several medical imaging startup companies and prior to joining Dell in 2010 was the Medical Archiving Director for IBM. Dan’s first position with Dell was as the Strategy and Business Development Manager for the Unified Clinical Archive that is now part of NTT data. Dan is now the Healthcare Field Director for the Dell EMC Healthcare/Life Science team providing HCLS SME and sales support for North Texas, OK, KS, NE, Western MO, Iowa, MN, SDS, and ND. Dan holds a PA-Diagnostic Radiology certification from the University of Kentucky, a BA in Biology/Chemistry from the University of Texas at Austin and an MBA from Rivier University.

Wednesday, September 27, 2017

FDA’s advice for medical device interoperability

Bakul Patel, M.S., M.B.A.
PARCA eNews – Sept. 15, 2017 – The FDA issued its final guidance for medical device interoperability on Sept. 6, 2017. The guidance offers insight into what the agency is looking for in terms of safety and effectiveness for medical devices that are connected to each other and to other technology.

Bakul Patel, associate director for digital health in the FDA’s Center for Devices and Radiological Health told PARCA eNews that the agency’s intention is to promote development and availability of safe and effective interoperable medical devices.

“The intention for drafting and finalizing interoperability guidance was due to the growing need and desire to connect medical devices to other products, technologies, and systems in the health care community,” Patel said in an email interview.

Special NIST offers guidelines for data breach and recovery

PARCA eNews – Sept. 13, 2017 – The National Institute of Standards and Technology (NIST) and the National Cybersecurity Center of Excellence (NCCoE) issued a set of guidelines for data integrity and recovering from ransomware and other data breach events.

The three-volume guidelines covers all forms of data integrity attacks and includes an executive summary, and addresses approach, architecture, and security characteristics along with "how-to-guides."

What is working in terms of connecting public health systems and HIEs

Report identifies the real-world experiences and best practices

PARCA eNews – Sept. 13, 2017 – The ONC last week issued its report on connecting public health information systems and Health Information Exchange (HIE) organizations. The purpose of the study was to learn lessons from the field in terms of what works and what challenges remain in terms of how HIEs benefit public health jurisdictions.

OCR issues reminders for disaster preparedness

PARCA eNews – Sept. 13, 2017 – In the wake of hurricanes Harvey, the Office of Civil Rights (OCR) that administers HIPAA, issued a reminder for protection of healthcare information during disasters and recovery.

OCR’s guidance reiterated that the HIPAA Security Rule – § 164.308(a)(7) – requires contingency plans to include a data backup plan, disaster recovery plan, and emergency mode operation plan.

ONC seeks comments and feedback on 2018 ISA

PARCA eNews – Sept. 20, 2017 – National Coordinator for Health Information Technology (ONC) is looking for comments on any last revisions, additions, or recommendations that health IT professionals may have for the Interoperability Standards Advisory’s (ISA) online edition before it locks-in all of the (ISA) 2017 improvements to make the 2018 Reference Edition.

PACS Vendor market changes with enterprise imaging

PARCA eNews –Sept. 20, 2017 – KLAS, the Healthcare IT industry market research organization, issued a new report, "PACS 2017: Reconstructing for the Future" in September 2017.

Reports on the market research by Heather Landl of Health Informatics and Subrata Thakar of HealthImaging.com offer similar highlights from the KLAS report.

Major vendors Sectra, INFINITT, Carestream and McKesson continue to lead in PACS performance, and maintain great relationships with customers with continuous meaningful updates.

ONC hosts two interoperability events for National Health IT Week

PARCA eNews – Sept. 10, 2017 – As part of National Health IT Week 2017, October 2-6, the Office of the National Coordinator for Health IT (ONC) will be hosting a public discussion of recent advancements in interoperability and usability.

This event will be hosted by Principal Deputy National Coordinator for Health IT Genevieve Morris and Deputy Assistant Secretary for Health Technology Reform John Fleming, MD.

Monday, July 24, 2017

The challenge of patient matching

Steven Posnack serves as director of the Office of Standards and Technology. In this role, Mr. Posnack advises the national coordinator, leads the ONC Health IT Certification Program, and directs ONC’s standards and technology investments through the ONC Tech Lab, which organizes its work into four focus areas: pilots, standards coordination, testing and utilities, and innovation. He led the creation of the Interoperability Standards Advisory, the redesign of ONC’s Certified Health IT Product List (CHPL), created the Interoperability Proving Ground, and developed the C-CDA Scorecard. In June, Mr. Posnack’s office issued a Patient Matching Algorithm Challenge. PARCA eNews spoke with him about patient matching and challenges of ensuring accurate identification of all parts of a patient record. 

Study of patient matching attributes shows big drop for SSN

PARCA eNews – July 13, 2017 – First and last name, date of birth, gender and address continue to be widely available for patient matching over time, however, use of Social Security Number availability fell from 83.3 percent in 2005 to 50.44 percent in 2014, according to new patient matching research.

The study in the journal Applied Clinical Informatics, led by Adam Culbertson, HIMSS innovator in residence, compiled a list of 36 demographic elements that stakeholders had previously identified as essential patient demographic attributes that should be collected for the purpose of linking patient records. They then analyzed a data sample between 2005-2014 from 9 health care systems in geographically distinct sites around the country to see how much patient demographics varied over time and across clinical sites.

HSS cuts may eliminate ONC's offices of Privacy and interoperability

PARCA eNews – July 18, 2017 – The ONC may need to eliminate the Office of Care Transformation, Office of Chief Privacy Officer, and Office of Clinical Quality if the administration’s proposed budget for HHS is passed, which could slash the ONC’s funding from $60 million to $38 million, according to reports in HIPAA Journal and Politico.

While the House Appropriations Committee sidestepped the administration’s original overall HHS funding cuts, it kept the 37 percent cut to ONC and ONC National Coordinator Don Rucker, M.D. told HIPAA Journal that the office (of Chief Privacy Officer) will be closed out in fiscal year 2018.

OCR updates guidance for HIPAA organizations’ use of cloud computing services

PARCA eNews – July 3, 2017 – The Office for Civil Rights (OCR) has issued updated guidance for HIPAA-covered organizations regarding the use of cloud computing and file sharing tools such as Sharepoint and DropBox and others.

Questions about whether and how organizations can take advantage of these tools while maintaining HIPAA privacy and security compliance. Lumping them into the term of cloud services providers (CSPs) the OCR’s guidance answers 11 questions ranging from "Can a HIPAA covered organization use CSPs to questions about security, privacy and breach notification.

Know a woman who has influenced your or other’s career?

Why not nominate her to the HIMSS Most Influential Women Awards? 

The HIMSS Most Influential Women in Health IT Awards, recognizes influential women at all stages of their career progressions.  The Awards celebrate those females harnessing the power of IT to transform health and healthcare, is unique among power lists and award programs; it’s inclusive of all women of influence, no matter where they may be in the health IT field.

Nominations Now Open
Make someone's day and nominate them for the HIMSS Most Influential Women in Health IT Awards by Monday, August 28, 2017 11:59 p.m. CT.

Click here to submit nomination

ONC to hold forum on interoperability

PARCA eNews – July 15, 2017 – ONC is hosting a two-day, in-person only forum focusing on the technical aspects of interoperability. The Aug. 15-16: "Beyond Boundaries: ONC’s 2017 Technical Interoperability Forum" will focus on how ONC, its federal partners, the health care industry, and the technology sector can come together to shape the technical aspects of interoperability.

The free forum will take place at at the Washington Plaza Hotel in Washington, DC. If you lead, develop, and implement health IT systems or standards, this event is for you. Registration details will be available July 21.

Date & Time: Tuesday, August 15, 2017 at 9:15am - 5:30pm ET & Wednesday, August 16, 2017 at 9:00am - 1:00pm ET. Click for more information.

Netherlands-based AI company moves toward lung cancer prediction

PARCA eNews – July 1, 2017 – Amsterdam-based Aidence expects its first CE marking for the European market in the third quarter of this year, according to a press release.
The company, which is developing AI technology for imaging diagnostics, recently raised 2.25 million from a group of investors that includes HenQ, Health Innovations, Northzone,  and physicians from the Hague-based Haaglanden hospital group.

Survey shows 65% of organizations have reported security incidents

PARCA eNews – July 12, 2017 – Netwrix Corporation, a security and privacy auditing provider has published its market research study looking at IT risks aimed at the current status of security and privacy concerns of IT managers and officers.

With the 2017 IT Risks Report, Netwrix analyzed how organizations are working to combat various IT risks based on a survey of IT pros concerning the IT risks they deal with on a daily basis. They looked at processes and resources they have in place to address those risks, and how prepared they are for today’s cyber threats. Key findings presented in the report include:

SIIM 2017, well attended, looks at future role of AI in clinical data

PARCA eNews – June 17, 2017 – The SIIM 2017 (Society of Imaging Informatics in Medicine) wrapped up June 3 at the David Lawrence Convention Center in Pittsburgh, PA. PARCA founder and board member Herman Osterwijk says it was well attended and attracted more exhibitors than last year. 

Monday, May 22, 2017

Is cloud-based medical imaging archiving the future of PACS?

Ed Marshall, CPO,
Ambra Health
Ed Marshall is chief product officer at Ambra Health, a provider of healthcare cloud services. Before Ambra, Ed held roles as senior vice president and general manager of the Services Industry business unit at NetSuite, as well as vice president of sales and marketing for OpenAir, which was acquired by NetSuite. A seasoned speaker, Ed has presented at industry events such as the Gartner Symposium/ITxpo, the annual Technology Services World (TSW) conference, and the CFO Leadership Council.

First digital pathology system gets FDA go-ahead

PARCA eNews – April 12, 2017 – Phillips IntelliSite Pathology Solution (PIPS) announced today it has been given FDA approval to market its first whole slide imaging system ushering in the era of digital pathology.

The FDA evaluated data from a clinical study of approximately 2,000 surgical pathology cases using tissue from multiple parts of the body (anatomic sites). Results of the study found that clinical interpretations (diagnoses) made based on the PIPS images were comparable to those made using glass slides.

HHS Office of Civil Rights Guidance on HIPAA specific to WannaCry

PARCA eNews – May 22, 2017 – Health and Human Services Office of Civil Rights issued breach notification guidance on it’s website in the wake of the WannaCry ransomware attack last week.

As outlined in its guidance available on its website, OCR presumes a breach in the case of ransomware attack.

Lucky is back with new ransomware attacks

PARCA eNews – April 21, 2017 – Phishing security company PhishMe is reporting that the Locky ransomware that staged many of the ransomware attacks in 2016 has re-emerged with a PDF twist.

On their blog, the anti-phishing firm is reporting that the methods used to deliver the Locky payload are significantly different that the previous version. The new version uses the Dridex malware in conjunction with a PDF document that breaks from the expectations for how IT security and potential victims about how this threat looks.

Homeland Security alert warns of emerging malware campaigns

PARCA eNews – April 27, 2017 – The National Cybersecurity and Communications Integration Center (NCCIC) has become aware of an emerging sophisticated campaign, occurring since at least May 2016, that uses multiple malware implants. Initial victims have been identified in several sectors, including Information Technology, Energy, Healthcare and Public Health, Communications, and Critical Manufacturing.

A win in Congress for patient data matching

Copyright: robeo / 123RF 
PARCA eNews – May 9, 2017 – Congress unexpectedly gave a big boost to proponents of developing a national patient identifier system that would accurately link patients to their health information.

Less than a month after a coalition of providers, payers, and Health IT companies joined forces to ask Congress in a jointly signed letter to clarify its 1999 ban on universal patient identification, the group was pleasantly surprised by the FY 2017 Omnibus bill. The bill included language from the letter allowing HHS through the ONC and CMS to provide technical assistance to private-sector led initiatives to develop a coordinated national strategy that will promote accurate identification of patients and their health information.

The rapid response to their letter was so unexpected that the group had already made plans to repeat the request for the FY18 Labor-HHS spending bill, however, Congress seems to have agreed to the request by industry, putting the changes in place less than a month after the letter was submitted.

4 Initiatives aim to advance interoperability in 2017

Providing timely, seamless patient information across the spectrum of the US healthcare system is key to improving patient care. While progress has been made, additional efforts are needed to continue the progress. 

Four initiatives have been announced in the past few weeks that aim to continue the progress toward interoperability. 

Saturday, April 1, 2017

International recognition of PARCA certification adds value

Independent RIS/PACS 
Consultant and Trainer
Clive Daniell is a qualified electrical engineer with more than 30 years of experience in the medical imaging field. He started his career with Siemens Medical where he trained as a CT, MRI and X-ray technician. In 1996 Clive shifted his focus to PACS, RIS and Information Management systems. He was responsible for the implementation of the first digital department in South Africa at Little Company of Mary Hospital in Pretoria.

In 2006 Clive started his own consulting company to offer an independent view on PACS and RIS in Africa. Clive has also been involved in many training initiatives, including organizing the 1st and 2nd African PACS, RIS Edu-conferences held in Cape Town and Johannesburg in 2009 and 2012 respectively. Clive is the founder of In2pacs and the In2pacs Academy. In a recent post on LinkedIn, Daniell explained why he chose to pursue the PARCA certification. PARCA eNews talked with him about that decision to get his perspective of the value of PARCA and certification for PACS administrators and other healthcare IT professionals.

New certification recognizes growing importance of DICOM

Image used by permission DICOM committee
PARCA eNews – April 1, 2017 – The PACS Administrators Registry and Certification Association (PARCA) has announced a new certification for PACS and IT professionals. 

The new DICOM certification will replace the Certified PACS Interface Analyst (CPIA) certification and will more specifically focus the course material and the exam on DICOM, the international standard for Digital Imaging and Communications in Medicine.

Charles Willis, PhD, DABR, president of PARCA said it was time to add a certification focused on DICOM.

Thursday, March 30, 2017

Study finds HIE improves efficiency, lowers cost and improves outcomes

PARCA eNews – Feb. 18, 2017 – Following implementation of the New York HIE (health information exchange), quality of care improved along with operational efficiency, resulting in considerable cost savings and improved patient outcomes, according to a study published in the Feb. 10, 2017 issue of SSRN, the journal of the Social Science Research Network.

One of the first studies of the effects of HIEs, the study examined almost 86,000 emergency department encounters over a period of 19 months between July 1, 2012 and January 31, 2014 at four emergency departments linked to the HealthLinkNY Health Information Exchange.

WEDI white paper offers tips on reducing health IT risks

PARCA eNews – March 20, 2017 – The Workgroup for Electronic Data Interchange (WEDI), announced the development of an industry white paper, entitled The Rampant Growth of Cybercrime in Healthcare.”

The paper explores common vulnerabilities that are typically exploited by cybercriminals in today’s healthcare environment, as well as best practices organizations can implement to mitigate these vulnerabilities.

HiMSS17 education session recordings available online

Photo courtesy of HiMSS 17
PARCA eNews – Feb. 28, 2017 – If you missed HiMSS17, held in Orlando, Feb. 19-23, 2017, or were unable to attend some sessions you can now catch recordings of more than 200 of the sessions online.

Starting April 1, HIMSS will offer session recordings to allow the health IT industry to recap or experience the conference education for the first time. 

Will interoperability and PACS minimize the role of radiologists in patient care?

J. Van Goethem  led the panel discussion
PARCA eNews – March 10, 2017 – That’s the question a panel of radiologists led by Dr. J. Van Goethem addressed in one of the sessions at the ECR 17 (European College of Radiologists) meeting held in Vienna March 1-5. 

With the advent of PACS most clinicians have gained direct and immediate access to radiology images. Many clinicians have at least the basic knowledge and capacities to interpret radiology studies and some clinicians are even highly skilled in interpreting studies in their specific field of expertise.

Health IT Playbook Updates

The ONC Health IT Playbook has been updated to include the newly revised guides and training modules.

The ONC’s Health IT Playbook is an online resource for health IT professionals that offers help selecting technology, sharing health information securely, aligning health IT with quality measures, and even finding technical support.

Friday, January 27, 2017

Radiologists continue to lead the charge to 3D printing

Dr. Adnan Sheikh is Associate
Professor at the University of
Ottawa, where he is Medical
Director for 3D printing
PARCA eNews – Jan. 30, 2017 – Many surgeons and other specialists have recognized the incredible potential of 3D printing. Using 3D printers, patient data is essentially turned into actionable, physical objects. The applications are numerous ranging from individualized prosthetics, to surgical models for preoperative planning, to anatomical replacement implants. At last year’s American College of Radiology annual meeting, a team of radiologists presented a paper showing how 3D printing could become a new service of the radiology department. At this year’s Radiology Society of North America (RSNA) annual meeting, 3D printing was one of the hottest topics with several presentations and workshops, culminating in the establishment of the RSNA 3D Special Interest Group. One of the organizers of the 3D printing area at RSNA was Dr. Adnan Sheikh, Medical Director for 3D Printing at the University of Ottawa, one of a handful of institutions that have already established 3D printing services.

DICOM committee looks to extend standards to 3D printing

Many 3D printed medical models
were on display at RSNA 2016
There were more than 40 presentations pertaining to 3D printing at the RNSA 2016 annual meeting held in Chicago last November, among them was a discussion at the DICOM committee meeting attended by PARCA advisory board member Herman Oosterwijk. Among the issues 3D printing presents to the PACS administrators community is a lack of standards for the additional metadata to the print file to allow it to be managed in the PACS.

The risk is that the 3D printing medical imaging standards void will be filled with a variety of work-around solutions that will separate imaging-derived data from the patient’s imaging record. To address this risk, Oosterwijk reports that a DICOM working group has been resurrected to specifically extend and promote the use of DICOM for the creation, storage and management of 3D printing models.

Which PACS administrator certification is best for South Africa?

Clive Daniell, Independent PACS-
RIS consultant
For independent PACS/RIS consultant and In2PACS co-founder Clive Daniell the answer was the PARCA Certified PACS Associates (CPAS) exam, which he chose over other options for several reasons. 

In2PACS is the leading consultancy and training organization in South Africa. In a LinkedIn post, Daniell listed his reasons and what he learned by taking, or "writing" the exam as they apparently say in South Africa.

"In the future I intend writing the other certifications," Daniell concluded. "I have a feeling the level of knowledge and exam will be more intense, but this would be appropriate as an advanced PACS administrator certification."

HHS lights FHIR with interoperable medication lists to consumers

The agency also announced a new challenge to create tools to generate user-friendly “snapshot” of model privacy practices for digital health products

PARCA eNews – Jan. 30, 2017 – The Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) in December, in partnership with leaders in the private sector, as well as patient and consumer advocates, coordinated a live demonstration of consumer-friendly applications (apps) that import data from some of the largest health information technology (IT) vendors in the country to allow individuals to access a consolidated list of their medications from a variety of sources in one place. 

Lack of timely breach notification costs Presence Health $475,000

First HIPAA enforcement action for slow notification

PARCA eNews – Jan. 30, 2017 – Presence Health has agreed to settle potential violations of the HIPAA Breach Notification Rule by paying $475,000 and implementing a corrective action plan. 

The U.S. Department of Health and Human Services, Office for Civil Rights (OCR), Jan. 9 2017, announced the first Health Insurance Portability and Accountability Act (HIPAA) settlement based on the untimely reporting of a breach of unsecured protected health information (PHI). 

Healthcare data breaches up but number of records breached slashed

PARCA eNews – Jan. 30, 2017 – The total number of healthcare records breached in 2016 were more than 16.5 million was down substantially from the 113 million records breached in 2015, but the 324 breaches of 500 or more records reported by healthcare organizations was higher than in any other year since the Office of Civil Rights started publishing breach summaries in 2009. 

Registration for SIIM 2017 Annual Meeting opens

PARCA eNews – Jan. 30, 2017 – Registration for SIIM 2017 in Pittsburgh, PA, June 1-3, 2017 is now open. SIIM is one of the top conferences for imaging informatics professionals and covers the latest cutting-edge technology for enterprise imaging education.

Robust growth expected in European PACS market

The global market for PACS is expected to continue to grow by 6.2 percent in terms of revenue, according to Persistence Market Research, which published its report online Jan. 18, 2017.

While the North American market will continue dominate with 31 percent of the value share, increasing demand for PACS from hospitals, diagnostic centers and imaging centers in Western Europe, especially in the EU5, is expected to fuel a 6.0 percent compounded annual growth rate projected out to 2026.