Which hospitals and academic centers in the Northeast and Ohio already move digital images across scanners, PACS and institutions, what estates they run, and which funding routes reach them without a hospital IT capital request. Prepared for Tiger Health Software as a vendor-neutral orchestration layer entering the US as non-diagnostic infrastructure.
The multi-site pathology programs in this region that publish their infrastructure do not agree on a format. NCI's Imaging Data Commons converts whole slide images to DICOM Slide Microscopy on Google Cloud and AWS. The Cancer Imaging Archive's histopathology portal stores native SVS, NDPI and TIFF. HTAN's primary format is OME-TIFF with SVS accepted, on Synapse over S3 and GCS. The cooperative-group biobanks in Ohio and Pennsylvania that scan at volume disclose no format at all.
A layer whose function is to move images between those systems without committing the institution to one of them has a defined place in that landscape. That is a description of the problem, not evidence that any institution has budgeted to solve it.
Primary-diagnosis pathology software in the US sits behind FDA clearance and, at the hospital, behind the value analysis committee, which is triggered by PHI and LIS integration rather than by dollar value and takes three to twelve months. Research, archive, tumor-board and cross-site collaboration use cases avoid both.
The cost of that entry point is that it lands in research budgets rather than clinical ones, which are smaller, grant-cycled, and controlled by cancer-center and department leadership rather than by hospital operations. The funding instruments below are sized accordingly. This research treats a $30K ARR as a vice-president-level decision by assumption, not by verification: no institution's director-level signature threshold was confirmed, and no public benchmark for US hospitals exists. The gate map's own inferred director ranges reach $100K at the largest systems, so a director-level close at $30K is possible at some of them and unverified at all of them.
Pathology is what is publicly documented for whole slide imaging. Imaging estate is the radiology PACS and archive stack where it could be found; "undisclosed" means the viewer contract is public but the archive vendor is not. Greenfield means a search found no deployment, pilot or program. Revenue is the most recent published fiscal year; NIH is FY2025; CCSG is the FY2025 P30 obligation from HHS TAGGS. Systems under roughly $1.5B in revenue appear only when they are among the largest in their state.
| Institution | St | Pathology | Imaging estate | Signals | Revenue | NIH FY25 | CCSG FY25 | Funding route |
|---|
Programs with a lead or member in the geography that share pathology or radiology images across sites. The infrastructure column is the point: it is what an orchestration layer would have to interoperate with, and most programs do not disclose it.
| Program | Regional institutions | Funding | Image infrastructure |
|---|---|---|---|
| NCI Imaging Data Commons | Brigham and Women's (co-PIs Fedorov, Kikinis); MGH | NCI via Cancer Moonshot, contract through Leidos Biomed; amount not disclosed | DICOM Slide Microscopy for all WSI; Google Cloud and AWS public buckets; open-source SliM viewer |
| Cancer Imaging Archive, histopathology portal | Stony Brook (Saltz group contributes TIL maps, 13 cancer types); managed at Frederick National Lab | NCI Cancer Imaging Program; since 2010 | Native SVS, NDPI, TIFF; IDC is the DICOM front end |
| Human Tumor Atlas Network | Data coordinating center at Dana-Farber and MSK; Phase 2 precancer atlases launched fall 2024 | NCI U24CA233243; amounts not published | OME-TIFF primary, SVS accepted; Synapse over S3 and GCS; DICOM subset to IDC; 8,425 biospecimens as of Sept 2024 |
| Cancer AI Alliance | MSK and Dana-Farber, with Fred Hutch and Johns Hopkins | $40M pooled; AWS, Google, Microsoft, NVIDIA as partners; platform live Oct 2025; wider application process planned 2026 | Federated learning with a centralized orchestration layer on AWS; framework unnamed; pathology WSI not publicly listed as a modality |
| NRG Oncology Biospecimen Bank | Columbus (Nationwide Children's) and Pittsburgh sites | NCI U24CA196067 | 51,333 slides scanned across 32 trials through Dec 2022; scanner and platform not disclosed |
| Alliance Biorepository System | Ohio State and Brigham and Women's, with WashU and Mayo | NCI NCTN | Image-analysis committee exists; infrastructure not disclosed |
| Children's Oncology Group Biopathology Center | Nationwide Children's | NCI | Digital pathology review with slide-scanning robots; vendor and volumes not disclosed |
| MSK Warren Alpert Center | MSK | Warren Alpert Foundation, est. 2017 | In-house "HoBBiT" honest-broker de-identification and transfer tool; dedicated compute; ~7M slides licensed to Paige, now Tempus, on Azure |
| FL4M federated consortium | MGH lead; Lahey | Not disclosed | Rhino Health platform; radiology (aneurysm), not pathology |
| Aidoc Diagnostic AI Consortium | Northwell, Mount Sinai, University Hospitals Cleveland, WellSpan among 12 systems (Aug 2026) | Vendor-led | Aidoc aiOS; radiology; not an image archive |
Not found: TCGA/GDC slide-image infrastructure, any Labcorp or Quest digital consortium, Owkin or NVIDIA FLARE pathology pilots with sites in the region, and the 2025 DICOM WSI Connectathon participant list (article blocked).
Ranked by fit for a non-diagnostic software layer. None of these passes through a hospital IT capital committee.
The structure of these gates is documented. The dollar values are not: hospital delegation-of-authority matrices are internal and essentially none are published. Every figure in this table is inference [I]. The working assumption for this research is that a $30K ARR lands at the service-line/VP row; the director row's inferred upper ranges overlap $30K at $7B+ systems, and neither has been verified at any named institution.
| Gate | $1.3–7B system | $7–12B | $12–23B | $23B+ | Cost |
|---|---|---|---|---|---|
| Capitalization line | commonly $5,000; below it, expense rather than capital | None. Subscription software is expensed; perpetual licenses and hardware are not. | |||
| Department director | $5K–25K | $10K–50K | $25K–75K | $25K–100K | A purchase order. Overlaps $30K at $7B+ systems on the inferred range; unverified. |
| Service line / VP | $25K–100K | $50K–250K | $75K–500K | $100K–1M | Legal review. Weeks. Working assumption for $30K, not a verified threshold. |
| Value analysis / IT governance | triggered by PHI, LIS or EHR integration, or clinical workflow change, not by dollars alone | Three to six months, up to a year. Committees meet monthly or quarterly. Non-diagnostic scope avoids it. | |||
| Capital committee / CFO | annual cycle; 39% of systems budget 2–5% of revenue to capital, 35% budget 5–10% | 12–18 months, ranked against every other request. | |||
UPMC, Ohio State, NYU Langone, Mount Sinai, MSK, Cleveland Clinic, HNL Lab Medicine. The image management system is chosen and, at several, contractually locked for years. The open question at each is the archive and the cross-site or cross-modality movement of images, which the IMS vendor does not always own. Where the archive vendor is undisclosed, that is the first thing to establish.
University Hospitals Cleveland, Nationwide Children's, Columbia/NYP, MetroHealth, Yale, Brown University Health, Mass General Brigham. Live but narrow, and several have said publicly what comes next.
Beth Israel Lahey Health, Penn Medicine, Rutgers Cancer Institute.
All of New Jersey, Northwell, Montefiore, Jefferson, Geisinger, most of New England outside Boston and New Haven, and most Ohio community systems.
In July 2026 CMS proposed removing computational pathology from the Clinical Laboratory Fee Schedule in both the OPPS and PFS rules, reclassifying ten algorithmic-analysis codes as "Software as a Medical Service" on the position that analysis of whole slide images does not require CLIA-regulated laboratory services. CAP opposes, citing checklist items GEN.50630 and GEN.52860. A non-diagnostic layer is not directly in scope, but every pathology informatics buyer is watching it.
Tempus acquired Paige in September 2025 for $81.25M, with the ~7M MSK-licensed slides and Paige's Azure commitment. AstraZeneca acquired Modella AI, the Brigham Mahmood Lab spinout, in January 2026. Sectra completed its first US cloud migration (Emory) in June 2026. In KLAS's 2025 data Sectra is considered in nearly 60% of PACS decisions and most often selected; Philips, Optum/Change and GE customer bases are the ones most frequently evaluating options.
In 2025 CAP added a Laboratory General Checklist section, "Digital Pathology Including Remote Data Assessment": validation records, reports generated through digital analysis, scan-failure rates, image-quality criteria and QMS integration. The 2022 validation guideline still governs at 60 cases and greater than 95% concordance. This applies to diagnostic use and is one reason a non-diagnostic entry is faster.
Jefferson −$196M FY2025 and −2.3% in H1 FY2026; UC Health $256M cumulative losses with 56 days cash; Yale New Haven −$196.8M FY2025 with no permanent CFO; Tufts −2.0%, fourth straight loss year; UMass Memorial −3.4%; Boston Medical Center −$240M with $129M from ex-Steward hospitals; UVM Health Network under a required $300M three-year cut; Mass General Brigham's largest layoffs in its history (Feb 2025); MSK −$47.9M with $177M of Epic go-live cost. Massachusetts' median hospital operating margin was −2% in FY2024. Against that: RWJBarnabas 6.4%, Cleveland Clinic 5.0%, MaineHealth 4.9%, ProMedica 8.1%, NYU Langone 3.1%.