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 |
|---|
Funded medical, public-health and population research with a lead or member institution in the ten states, grouped by domain. The infrastructure column is the point: it says whether images actually leave the institution, on what platform, and in what format. A tag at the start of each infrastructure cell classifies the movement. Centralized means images are copied to a shared repository; Federated means models move and images stay; Single-site means one institution's own holdings; Data-only means the program shares structured data and no images; Undisclosed means the program publishes nothing about its image platform.
| 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 undisclosed | Centralized 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, TIL maps for 13 cancer types); Frederick National Lab | NCI Cancer Imaging Program; since 2010 | Centralized Native SVS, NDPI, TIFF; IDC is the DICOM front end; ACRIN and QIN legacy collections in DICOM |
| Human Tumor Atlas Network | DCC at Dana-Farber and MSK. Phase 1 centers: HTAPP (Broad/DFCI/HMS/MGH), Pre-Cancer Atlas Pilot (BU), CHOP, Boston HTAN Center (DFCI/Broad/HMS/MIT), PATCH (HMS), Gerry Metastasis Center (MSK). Phase 2: DFCI myeloma, Yale lymphoma | NCI U24CA233243 (DCC); amounts unpublished; Phase 2 from fall 2024 | Centralized OME-TIFF primary, SVS accepted; Synapse (Sage) over S3 and GCS; DICOM subset to IDC; 10,608 biospecimens across 15 atlases |
| Cancer AI Alliance | MSK and Dana-Farber, with Fred Hutch and Johns Hopkins | $40M pooled; AWS, Google, Microsoft, NVIDIA partners; live Oct 2025 | Federated Centralized orchestration layer on AWS; framework unnamed; pathology WSI not publicly listed as a modality |
| Registry-linked digital pathology framework | Rutgers Cancer Institute (Foran) with the NJ State Cancer Registry; NY State Cancer Registry; platform hosted at Stony Brook | NIH UG3/UH3 CA225021, U24 CA215109, U24 CA180924, UL1 TR003017; NSF XSEDE; amounts unstated | Centralized Olympus VS120; .vsi and .svs; WSIs and features on QuIP at Stony Brook; Box for bulk transfer; Oracle warehouse; Google Cloud tested. 772 prostate, 1,410 NSCLC, 268 breast, 48 lymphoma cases across state lines (2022) |
| SEER Virtual Tissue Repository pilot | Connecticut Tumor Registry (CT DPH, Yale collaborates); NJ and NY registries were not in the pilot | NCI SEER contracts plus a PanCAN donation; amounts unstated | Centralized H&E slides scanned at a central laboratory; 175 pancreatic and 196 breast patients processed; scanner, format and hosting undisclosed; a searchable web interface is a stated goal, not built |
| NRG Oncology Biospecimen Bank | Columbus (Nationwide Children's) and Pittsburgh sites | NCI U24CA196067 | Undisclosed 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 | Undisclosed Image-analysis committee exists; infrastructure not disclosed |
| Children's Oncology Group Biopathology Center | Nationwide Children's | NCI | Undisclosed Digital pathology review with slide-scanning robots; vendor and volumes not disclosed |
| Nurses' Health Study and HPFS tumor tissue | Harvard Chan and BWH Channing; DF/HCC Tissue Microarray and Imaging Core | NCI cohort grants; tissue-specific awards not found | Centralized Tumor blocks retrieved from hospitals nationwide to Boston; Leica scanners at the DF/HCC core; one nested study digitized 3,795 WSIs; hosting undisclosed |
| MSK Warren Alpert Center | MSK | Warren Alpert Foundation, est. 2017 | Single-site In-house HoBBiT de-identification and transfer tool; dedicated compute; ~7M slides licensed to Paige, now Tempus, on Azure |
| NCI Quantitative Imaging Network | CHOP (with Children's National), Thomas Jefferson, Weill Cornell, NYU with MSK | NCI U01 per team; program winding down, final funding 2027 | Centralized Historically shared through TCIA in DICOM; current infrastructure not on the program page |
| Program | Regional institutions | Funding | Image infrastructure |
|---|---|---|---|
| ADNI4 | BIDMC, Boston University, Brigham and Women's; Albany Medical College, Columbia, Mount Sinai, Nathan Kline, NYU, Rochester; Penn, Pittsburgh; Yale; Butler Hospital, Rhode Island Hospital; Case Western/UH Cleveland, Ohio State | NIA public-private partnership; amount unstated; enrolling since 2023 | Centralized MRI, amyloid and tau PET to the LONI Image Data Archive at USC; up to 1,500 subjects |
| ABCD Study | Pittsburgh, Rochester, Vermont, Yale (of 21 sites) | NIH, NIDA-led; amount unstated | Centralized ~11,878 participants; DICOM and BIDS; access moved June 2025 from the NIMH Data Archive to the NIH Brain Development Cohorts Data Hub, compute-in-place |
| Human Connectome Project Lifespan | MGH (Aging), Harvard (Development), with WashU, Minnesota, UCLA, Oxford | NIH Blueprint; amount unstated | Centralized NIfTI; HCP-A and HCP-D on the NIMH Data Archive; AABC Release 2 is 1,396 adults and 42+ TB on ConnectomeDB (Jan 2026) |
| SCAN (Standardized Centralized ADRD Neuroimaging) | All ADRCs submitting prospectively; in-footprint ADRCs include Penn, Pitt, Columbia, Mount Sinai, NYU, BU, MGH/Harvard, Yale, Case Western | NIA U24 AG067418; launched Jan 2021 | Centralized MRI and PET uploaded to LONI IDA, de-identified and defaced there; derived measures via NACC |
| NACC digital neuropathology pilot | Pilot partners UC Davis and UW; goal is all 36 ADRCs (footprint list as above) | NIA supplement to NACC; amount unstated | Undisclosed Test dataset only; ingest planned through the NACC Data Platform on Flywheel; WSI metadata standard in development. Images not yet centralized. |
| Brain Digital Slide Archive | University of Pittsburgh (Pearce) co-leads with Emory, UC Davis, Northwestern | NIA/NINDS U24NS133949; amount not retrieved | Federated Open-source Digital Slide Archive (Girder/HistomicsTK); "databases hosted on multiple servers at different research institutions"; cloud vs on-prem unstated |
| FeTS / BraTS | Penn CBICA lineage; coordination now at Indiana. Regional members: MGH, Brigham, NYU, Stony Brook, Mount Sinai, Penn, Pittsburgh, Jefferson, Case Western, Weill Cornell | NCI ITCR U01CA242871, U24CA189523; amounts unstated. fets.ai domain has lapsed | Federated Intel OpenFL orchestration, GaNDLF training; data stays on site; NIfTI registered to SRI-24, skull-stripped, pseudo-identified; 2024 challenge drew 1,251 training cases from 23 institutions |
| Framingham Heart Study Brain Aging Program | Boston University | NIA U19 AG068753, $26.56M over five years (2020) | Single-site Brain MRI in native DICOM since 1999, cardiac MRI 2002–2006; access via FHS-BAP data portal; storage platform undisclosed |
| FL4M federated consortium | MGH lead; Lahey | Not disclosed | Federated Rhino Health platform; radiology (aneurysm) |
| Program | Regional institutions | Funding | Image infrastructure |
|---|---|---|---|
| Kidney Precision Medicine Project | Central hub includes Mount Sinai. Recruitment: Boston University, Cleveland Clinic, Columbia, Joslin/BIDMC, Mount Sinai, Pittsburgh, Yale. Tissue interrogation: Ohio State (with Indiana), Yale | NIDDK; ~$3.7M/yr recruitment sites, ~$5M/yr tissue sites, ~$4M/yr hub, ~$2M/yr atlas center, five-year periods | Centralized Biopsy WSIs (H&E, PAS, trichrome, silver), EM; Atlas Repository at atlas.kpmp.org on AWS; format and de-identification undisclosed |
| NEPTUNE | 31 enrolling centers; regional list not found | NCATS/NIDDK U54DK083912; RDCRN; NephCure | Centralized Digital Pathology Repository at Michigan; WSIs scanned at 40x on Hamamatsu and Aperio; surfaced via tranSMART |
| CureGN | Participating clinical centers at Columbia and Penn (of four); 65 sites total | NIDDK UM1DK100845 and related; amounts undisclosed | Undisclosed Biopsy digital pathology implied by the shared DCC; platform not on the program site |
| ISIC Archive | MSK is the lead institution (Rotemberg); UPMC Hillman contributor | Shore Family Fund; size undisclosed | Centralized 549,571 public and 1,203,225 total dermoscopic, clinical and 3D images in an AWS S3 bucket (us-east-1); per-image CC licenses; 10,413 registered users |
| Children's Brain Tumor Network | CHOP (D3b) lead. Members: UPMC Children's, NYU Hassenfeld, Weill Cornell, Westchester Medical Center, Hackensack Sanzari, Akron Children's, Dayton Children's (of 34) | Foundation-supported; amount undisclosed; since 2011 | Centralized 7,986 enrolled; 29,119 clinical MRI sessions across 1,976 subjects in Flywheel; genomics on CAVATICA; histology slide count and WSI format undisclosed |
| Kids First Data Resource Center | CHOP lead, with Velsera, UChicago, Vanderbilt, UNC, Sainte-Justine | NIH Common Fund U2CHL138346; amount undisclosed | Centralized 53,000+ patients, 1.56M+ files (Feb 2026); imaging listed as a data type; CAVATICA (Velsera); cloud provider and imaging format not named |
| e-ROP retinopathy of prematurity study | Penn Center for Preventive Ophthalmology and Biostatistics (data center and reading center) | NEI; completed ~2014 | Centralized RetCam images from 12 NICUs uploaded to a study server at Penn; ~2,000 infants |
| Program | Regional institutions | Funding | Image infrastructure |
|---|---|---|---|
| fastMRI | NYU Langone CAI2R with Meta | NIBIB P41EB017183; launched 2018, updated May 2025 | Single-site Raw k-space in ISMRMRD, DICOM de-identified with the RSNA Clinical Trial Processor; ~1,500 knee and 6,970 brain raw cases plus 10,000 clinical DICOM; NYU under DUA and mirrored on AWS Open Data |
| TMIST (ECOG-ACRIN EA1151) | 145 sites, 411 mammography units; regional list not published | NCI; closed to accrual | Centralized 136,742 screening studies through 2022; de-identified and transmitted via ACR TRIAD in DICOM; archive location unstated |
| ACR Connect / AI-LAB | 13 US hospitals as of 2022; names not disclosed | ACR | Federated On-premise Linux appliance; DICOM from PACS and FHIR from EHR; anonymization profiles; model weights exchanged, images stay |
| MGB and Microsoft imaging foundation models | Mass General Brigham | Commercial collaboration, July 2024; no figure | Undisclosed Azure AI platform; Nuance Precision Imaging Network as distribution; centralized vs federated unstated |
| Aidoc Diagnostic AI Consortium | Northwell, Mount Sinai, University Hospitals Cleveland, WellSpan among 12 (Aug 2026) | Vendor-led | Federated Aidoc aiOS; radiology; not an image archive |
| I-ELCAP lung screening consortium | Mount Sinai coordinating center (Henschke, Yankelevitz) | Simons Foundation International $12M over five years (2023) for the AIRS open-source triage system | Undisclosed Web-based management system for member sites; whether CT DICOM is centralized is unstated |
| Program | Regional institutions | Funding | Image infrastructure |
|---|---|---|---|
| HuBMAP | Integration hub at CMU/Pittsburgh Supercomputing Center, Harvard Medical School, NY Genome Center. Tissue mapping centers: CHOP (two), Penn, Rochester, GE Global Research, BIDMC, UConn. Technology sites: Yale, Columbia, Broad, Harvard. Demonstration: Brigham, CHOP | NIH Common Fund U54, UG3/UH3, OT2, U01; amounts unpublished | Centralized Spatial and multiplexed tissue imaging on portal.hubmapconsortium.org; format and hosting not confirmed from pages that rendered |
| SenNet | Coordination center at Pittsburgh. Human tissue centers: Yale, Pittsburgh, UConn, Columbia. Murine: Yale, Jackson Laboratory (Maine). Technology: Columbia, MIT | NIH Common Fund; UG3 to UH3 transition Sept 2024; amounts unpublished | Centralized Portal at data.sennetconsortium.org (Pittsburgh); format and cloud undisclosed |
| Program | Regional institutions | Funding | Image infrastructure |
|---|---|---|---|
| Breast Cancer Surveillance Consortium registries | Vermont Breast Cancer Surveillance System (UVM, Sprague); New Hampshire Mammography Network (Dartmouth, Tosteson); two of seven active registries | NCI; cycle 2022–2027; UVM cites P01 CA154292 and AI grants R01 CA262023, R37 CA292399 | Data-only Structured exam, BI-RADS, pathology and registry linkage centralized at the coordinating center; the only image set is a 2005–2008 teaching dataset of 40,000 mammograms. UVM's AI grants use UVMMC images plus other registries' images through an undisclosed platform |
| ACR National Mammography Database and Lung Cancer Screening Registry | National; facility lists by state not retrieved | ACR facility-fee registries | Data-only MQSA/BI-RADS and Lung-RADS data elements by manual entry, flat file or vendor transmission; no image submission |
| NIOSH Coal Workers' Health Surveillance Program | NIOSH-approved facilities in PA and OH (map not enumerable); 184 B Readers nationally (Oct 2024) | CDC/NIOSH appropriation | Centralized By regulation (42 CFR 37): facilities transmit DICOM chest radiographs to NIOSH within 14 days by secure transfer or portable media, then delete local copies; B Readers classify on calibrated workstations; anonymized images shared with Michigan State for AI research under a DUA |
| World Trade Center Health Program | Clinical centers of excellence: Mount Sinai (25,388 members), NYC H+H (19,716), NYU (18,375), Northwell (15,056), Stony Brook (14,899), FDNY, William Street, Rutgers (3,216); General Responder Data Center at Mount Sinai; 143,340 enrolled (Mar 2026) | Federal (Zadroga Act); $348M medical claims in the past year | Undisclosed Annual low-dose CT for eligible members; a Mount Sinai R21 analyzed 2,284 members' chest CTs. The data center manages health and exposure data; no cross-center imaging archive is described |
| UPMC point-of-care diabetic retinopathy program | 94 primary-care sites across UPMC and non-UPMC facilities in Pennsylvania | Beckwith Institute, departmental funds, local foundation camera grants; amounts unstated | Centralized 21,960 exams 2008–2020 on Centervue and Topcon cameras; UPMC sites store and forward through Epic, non-UPMC sites by secure email |
| NYC Health + Hospitals teleretinal screening | Coney Island, Elmhurst, Lincoln, Queens, Woodhull; planned across all 11 acute hospitals and Gotham Health | NYS DOH Digital Healthcare Network grant; amount unstated | Single-site Non-mydriatic retinal photos read through the EMR within five business days; camera and archive undisclosed; 1,886 patients in the first four months |
| Program | Regional institutions | Funding | Image infrastructure |
|---|---|---|---|
| Penn Medicine BioBank Vision Initiative | Penn Medicine (Witschey) | Unstated | Single-site More than 875K CT, 500K MRI and 100K PET linked to 265K+ consented participants; Penn AInSights open-source AI orchestrator has screened 24K+ patients since May 2023; platform undisclosed |
| Mount Sinai AIR·MS and Imaging Research Warehouse | Icahn School of Medicine at Mount Sinai | NIH pilot for the warehouse; amount unstated | Single-site Radiology DICOM metadata for 2.06M patients, echo for 886K, pathology for 3.5M; on-prem Minerva HPC; de-identified image and EHR warehouse of 1M+ patients by REDCap request |
| Geisinger MyCode | Geisinger | Biopharma partnerships; 370,000+ participants | Undisclosed Genomic and EHR; imaging holdings not disclosed |
Not found: TCGA/GDC slide-image infrastructure; any Labcorp or Quest digital consortium; Owkin or NVIDIA FLARE pathology pilots with regional sites; the 2025 DICOM WSI Connectathon participant list; TB chest X-ray programs at NYC, NJ or MA health departments; diabetic retinopathy tele-screening at Mount Sinai, Penn or Yale; any state newborn or congenital heart imaging registry; regional site lists for NEPTUNE, CureGN and TMIST; ReSPOND's current lead and members; HuBMAP and HTAN image formats from pages that rendered; imaging linkage in the MGB Biobank, Yale Generations and the Black Women's Health Study.
Ranked by fit for a non-diagnostic software layer. None of these passes through a hospital IT capital committee.
Private nonprofit systems do not publish delegation-of-authority matrices. Public and university-owned systems do, and the ten states plus federal grant rules supply the rest. Everything below is quoted from a published policy or statute unless the row says [I], which marks the two rows that remain inference. Rows are the gates a $30,000 annual non-diagnostic software subscription passes through, on either the institutional or the grant-funded path.
| Gate | What triggers it | Published thresholds | Where $30K lands | Who signs |
|---|---|---|---|---|
| Institutional purchasing — the path when the hospital or university pays | ||||
| Capitalization line | Whether the spend is capital or expense. A subscription with no perpetual license is expense. | Commonly $5,000 [I]; no published hospital-specific benchmark found. | Below it. Never enters the capital cycle. | Nobody. This is why SaaS moves and perpetual licenses do not. |
| Departmental discretion | Dollar value only. | Ohio State: department may issue a PO under $5,000. Rutgers "Quick Order" up to $5,000. Temple: unit-level small dollar under $5,000. UVM: PurCard at or below $2,500. SUNY Upstate: detailed quote at or under $2,499.99. UConn: directors under $25,000. | Above it nearly everywhere. Only UConn's $25,000 director band comes close, and $30K still clears it. | Department head or administrator. Not reachable at $30K. |
| Purchasing office, quotes required | Dollar value. This is the band $30K actually sits in. | Penn State: $25,000–$99,999, "minimum three supplier bids required." SUNY Upstate: $2,500–$49,999.99 document price reasonableness, vendor responsibility profile from $15,000. UMass: $10,000–$50,000, two to three quotes, and the policy names "licenses (including software)." UVM: over $25,000 to $250,000, three quotes or a sole-source form. Ohio State: Purchasing approves at $5,000 or more. | Squarely inside it at every institution with published numbers. Expect a quote exercise or a sole-source memo. | Purchasing office, with a director-to-AVP signature. UVM: Director of Purchasing signs to $250,000. UConn: dean under $250,000, AVP under $500,000. |
| Formal bid or RFP | Dollar value, and in two cases the word "software." | Ohio State: no bid required under $75,000. Penn State: $100,000+. Rutgers: formal competition at $40,000 and above. SUNY: five sealed bids at $125,000 or more. UVM: RFP above $250,000. UMass: competitive procurement required at $10,000 per year. Erie County Medical Center: RFP over $20,000 for professional services and software. | Below it at most, above it at three. ECMC, UMass and Rutgers would put a $30K subscription into competition. | Purchasing, on a published solicitation. |
| Sole-source justification | Buying without competition. | Rutgers: waiver of bid required if the purchase is $50,000 or greater. UVM: single or sole source justification form in the $25,000–$250,000 band. UMass: no-bid justification. Ohio State: waived bids over $250,000 reported to the Board quarterly. | Required where competition would otherwise apply. A vendor-neutral layer with no functional equivalent is the argument that gets written here. | Requesting department drafts, Purchasing accepts. |
| State bid statute | Applies to public and state-owned institutions regardless of internal policy. | NY: discretionary to $150,000, OSC approval over $50,000, and $150,000 for healthcare facilities. OH: ~$79,600 for 2026 under ORC 9.17, and county hospitals inherit it via ORC 339.05. MA: three written quotes $10,000–$50,000. CT: open market to $50,000 with three quotes. RI: small purchase $10,000. ME: informal quotes $25,000 or less. NH: over $35,000 requires published review criteria. VT: simplified bid to $250,000, and AGO certification for services $25,000 or more per year. NJ: $100,000 for state colleges. PA: no thresholds apply to software license maintenance agreements and extensions. | Under the ceiling in NY, OH, VT, NJ and PA. Over it in MA, CT, RI, ME and NH, where $30K triggers quotes or published criteria. | Institutional purchasing, under statute. |
| Software pre-approval | Category, not dollars. Some institutions gate all software regardless of price. | Temple: "Software requests require pre-approval prior to TUmarketplace submission." Pennsylvania DGS exempts software license maintenance from thresholds entirely, in the opposite direction. | Applies at any amount where it exists. | IT, before Purchasing will process the requisition. |
| Value analysis or IT governance | Characteristics, not dollars: PHI, LIS or EHR integration, clinical workflow change, net-new vendor, security review. | Only one published charter with stated triggers was found. Covenant HealthCare Policy 641 sets capital review at over $5,000 and a new technology / high financial impact trigger at $500 or more per procedure or $25,000 additional expense per year, plus any product with less than 12 months of FDA clearance. Its new technology committee meets monthly and the policy allows 21 business days. | $30,000 a year exceeds the one published financial trigger found. Non-diagnostic scope with no PHI and no EHR write-back is what avoids the characteristic triggers; the dollar trigger it does not avoid. | Committee, meeting monthly or quarterly. Three to six months, up to a year. |
| Capital committee or board | Capital classification, or a large dollar value. | NYC Health + Hospitals: board approval at $10 million or more; micro-purchase to $100,000. UVM: board at $2 million, or $1,000,001 for professional services, or any contract over ten years. Ohio State: SVP approval for contracts over $1 million. | Far below. Not a gate for this purchase. | Board or trustees. 12 to 18 months on an annual cycle. |
| Grant-funded purchase — the path when a CCSG shared resource, CURE, MLSC or CTSA award pays | ||||
| Classification under Uniform Guidance | What kind of thing is being bought. This determines every gate after it. | 2 CFR 200.1 defines intangible property to include "software, or software subscriptions or licenses." Equipment and supplies are both limited to tangible personal property, equipment being the lesser of the institution's capitalization level or $10,000. | A SaaS subscription is intangible property, not equipment. It never enters the 200.313 equipment regime. | Sponsored programs makes the call. |
| Micro-purchase threshold | Dollar value against the federal MPT, which the institution may raise. | Federal MPT rose to $15,000 on October 1, 2025 (FAR Case 2024-001). 2 CFR 200.320 lets an institution self-certify to $50,000, and higher with cognizant agency approval. Ohio State's approved threshold is $75,000, applied to federal and non-federal funds alike. | Under the MPT at Ohio State and at any institution self-certified at $50,000. No quotes, no bid, no justification. This is the lightest gate anywhere in this table. | PI and department administrator. |
| Simplified acquisition threshold | Dollar value between the MPT and the SAT. | Federal SAT rose to $350,000 on October 1, 2025. Above the MPT, 200.320 requires price or rate quotations "from an adequate number of qualified sources." | Well below the SAT. Where the institution has not raised its MPT, $30K sits in the small-purchase band and needs quotes. | Sponsored programs and central purchasing. |
| NIH prior approval | Scope change or significant rebudgeting. | Equipment over $25,000 is a scope-change indicator, but that applies to equipment and a subscription is not equipment. Rebudgeting is significant when a direct cost category moves 25 percent or more. Requests go to the grants management officer 30 days ahead and only the GMO's response is valid. Note the NIH Grants Policy Statement still quotes the superseded $250,000 SAT. | No prior approval for the purchase itself. The realistic trigger is rebudgeting if the line was not in the approved budget. | The authorized organizational representative signs, not the PI. The PI's signature is retained internally. |
| Cancer center governance | Shared resource operation and access policy. | The CCSG notice of funding opportunity requires applicants to describe shared resource "policies on operation and use" and charge-back systems, and requires "Center Director oversight of CCSG-supported Shared Resources." No NCI program officer concurrence requirement for a shared resource purchase was found, and no dollar threshold for one. | Decided inside the center. | Cancer center director and shared resource leadership. |
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%.