Pro Medicus, Ltd.

Pro Medicus, Ltd.

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Q4 FY2026 · Earnings Call TranscriptAugust 18, 2026

Sam Hupert

Thank you. Thanks, everybody, for joining us this morning for the full-year results presentation.

As we are currently working in three jurisdictions: Melbourne, our corporate headquarters and where we do our RIS development; Germany, our R&D and support for the Visage product; and North America, which is over 90% of our revenues and now our largest corps of people, it's the biggest group of people we have, now overtaking both Europe and the US, and Melbourne. In terms of the highlights for the year, I think I won't go through all the financials.

We have some other slides to deal with it. We did win one contract in Europe and nine in the US, worth a total of $407 million at minimums.

We completed six out of six renewals for a total of $407 million, keeping our 100% renewal run rate intact. We have all our implementations on or ahead of schedule.

Our cardiology option is gaining traction with UC Colorado, Vancouver Clinic, and others. We did announce two new products in digital pathology and an AI-optimized reporting module.

We completed or are in the process of completing two investments, one completed with 4DMedical and another with Echo IQ in cardiac AI. We're further down the track with our breast cancer detection, pending FDA clearance, and we have a very strong pipeline going into FY 2027.

In terms of the financials, we think all of the key metrics went in the right direction: revenue up to $261.7 million, underlying EBIT 196, and our margins, which were already sort of about three times our nearest competitor, we were able to eke out another 90 basis points to get them just under 75%, and the underlying NPAT again all went up. All the figures are there, I won't go through them all, but happy to have some questions on them a little later on.

As we had heralded to the market earlier on, currency was an issue in as much as this time the fluctuations were more material than they have been in the past. On a constant currency basis, certainly our EBIT and NPAT were over the 30% mark, which is our benchmark that we try and achieve greater than, and the impact in dollars was $11.8 million for revenue and $9.9 million for EBIT, bigger than previous years.

In terms of balance sheet and return to shareholders, our cash reserves went up to over $216 million, cash and financial assets now $250 million, up nearly 20%, and as a result, our total dividend increased by 25.5% to be 69 cents per share, fully franked, for the year. In terms of revenue growth, I think this chart does show quite strong revenue growth year-on-year.

For those that have seen the chart before, the bright green is the exam license recurring revenue that has grown strongly again in this last financial year. Support is for the older contracts that we have largely around RIS in Australia and some of the German contracts.

Again, in the gray, that is recurring revenue. There is the archive data migration and the professional services on top, with professional services split across the length of the contract, recurring within the life of the contract, the bulk of the revenue we have continues to be recurring revenue, which gives certainty going forward.

In terms of revenue by geography, again, I think it bears out that the US is over 90% of our revenue and growing strongly, but in the current, or previous year, FY 2026, all jurisdictions did increase, so that was very pleasing and added to the total picture. The other thing is our forward contracts of recurring revenue over a five-year window has increased now to $1.3 billion, a substantial increase, largely fed by the renewals and also by the material new contracts we wrote in the period.

This shows year-on-year. FY 2025 was a bit of an outlier because it had our biggest contract ever in Trinity, which was arguably the biggest contract ever signed in our space just for medical informatics, enterprise imaging informatics, but pleasing to say that we had our second strongest year with strong growth across multiple markets, that just about two years ago was about half what we did in this financial year.

Again, another strong year for new contracts signed. Going forward, I'll talk about the contract wins a little bit.

We came out of the gate early with our second-biggest contract in July of 2025 with UC Health, which was $170 million at minimums for 10 years. We also had one of our other biggest contracts, which came late in the period, which was Beth Israel Lahey.

For those that don't know, it is one of the two big healthcare systems in the Boston area, and it is now going to include Dana-Farber, that was previously with another healthcare system, is going across to Beth Israel Lahey, make it even more substantial and bigger. We also wrote a contract with one of the largest private reading groups in the US called Radiology Associates of North Texas for $44 million, again, at minimums, and we added archive to BayCare, who was a previous client, and that archive sale was substantial at $25 million for the length of their contract.

Then there were five other contracts that we have talked about, including contract with Heidelberg University, with a total of $55 million. Second-biggest year, very good spread across different markets: nine in the US and one contract, but a material one, in Europe.

Talking about UC Colorado, as I mentioned, it was our second biggest. It is full-stack plus one; in other words, they took cardiology as well as our worklist, viewer, and archive.

They are a highly respected hospital system and a academic medical center, and we went live with them in May 2026, towards the end of the financial year, but we will get a full 12 months of UC revenue coming into FY 2027. The University of Heidelberg, again, a very prestigious hospital.

It's regarded as one of the 12 top hospitals in the world. It's affiliated with a cancer research institute, which is the largest and most prestigious in Europe.

It has not only increased our physical footprint in Germany, but also our presence in that high-end academic space, and that went live with a full suite of products in April '26. Radiology Associates of North Texas, as I mentioned, it's the largest fully private remote reading group in the US.

We went live with breast imaging in April of '26, and just recently, about a week ago or a week and a half ago, went live with the rest of RANT, and so it will greatly increase our presence in the private market. Another academic came relatively two-thirds of the way through the year was University of Maryland.

It is an academic medical center known for its R Adams Shock Trauma Center that became a leading center of trauma treatment in the US and globally. It's based out of Baltimore, Maryland, and it was a reference site for a key Visage competitor for many, many years, a good one to win from a tactical point of view as well as footprint.

As I mentioned before, Beth Israel Lahey, it is full-stack. It is a very highly respected hospital system, academic teaching center, as well as community and specialty hospitals, and it will now include the Dana-Farber Cancer Institute.

It plus our other client base in the state of Massachusetts will give us, by far, the biggest share of the hospital systems in that state. In terms of contract renewals, I won't go through all of them.

We announced them as they came, but it was six out of six, and allowed us to maintain our 100% client retention record. I think the interesting things with renewals, they were all for a five-year period, the full contract term, and they were all for higher per-transaction dollar values than the original contract done previously.

Again, keeping in the way that we've been able to do renewals with increased pricing and for a minimum of five years, and in some cases, actually longer. In terms of implementations, it was our busiest period ever.

There were 16 if we include the four cohorts, because Trinity is so large, it had to be done in bits. Having said that, some of the cohorts, particularly 1 and 2, were as big as doing an NYU as a big bang, they're huge.

Four were completed in the financial year. UC Health was completed in May, FMOL and VCU were cloud migrations.

U Heidelberg, as we mentioned, 12th best hospital in the world, went live towards the middle of the second half. To round things out, RSNA '25, which is our biggest conference of the year, many of you have heard me speak about it, that was our busiest to date and provided a very solid number of leads going forward.

In terms of implementations, we often get asked, particularly by the analysts that are on the call, when did the sites go live, and, how how completed are they? We've decided to include this slide.

You'll see that as of, 30th of June, 2026, Trinity was 75% complete. A number of the others, 100% complete.

As I mentioned, RANT, which was 10% complete at 30th of June, is now 100% complete as of two weeks ago, and the new sales that we made, subsequent to that, in terms of U Maryland, Beth Israel, Tidal, and St. Luke's, which we announced, I think, a week and a half ago, obviously, they're still in the pre-implementation, planning phase, but will be live, in on the dates that we've, put in that, go-live targets.

Now, the only thing about go-live targets is sometimes a client will push the the target out a week or two or a month, due to internal things, but by and large, we we have never we have never, to date, been the hold-up for a go-live, and as you can see, the amounts that we did in the last fiscal year was was really, 16 was most probably our record. In terms of Trinity, this was our largest contract ever, has a national footprint.

As I said, the first four cohorts were done by June 2026. We completed the fifth cohort in July 20th of 2026, just after the end of the financial year, so that cohort 6 and 7 are around 13% remaining, we have now done about 87% of Trinity by volume, and pretty much all of that will contribute 12 months' worth into FY 2027, a material step-up in terms of transaction numbers and value.

We have always said and I think it's becoming more and more prevalent, that our implementation capability is a competitive advantage. We're able to do very large-scale projects in a quarter to a fifth of time of industry norms, like UC Colorado.

Getting Trinity live within such a short window has never been done before. We think it is a huge differentiator for us, particularly as the market now is looking to move to cloud quite rapidly, being able to implement quickly and complete those implementations has turned out to be a very big strategic plus.

Just going through two or three other quick things. Most of you would have been aware we made some strategic investments.

One was a $10 million dollar investment in 4DMedical, for two years, maturing in July 2027, and the terms of the deal were basically if the share price doubled, then we would get double our money back. If it went more than that, which it clearly has, we would be able to get equity based on that.

We did book an unrealized gain of $172 million as of 30th of June, but clearly, the final result will depend on the 4D share price in July of next year. Echo IQ was another investment, similar, but slightly different.

It was $10 million convertible notes with an option to do another $10 million at the same strike price, if Echo IQ receive FDA clearance for their EchoSolv, which is the heart failure algorithm currently in with the FDA. It has a coupon rate again of 12.5%, and there are options attached, should the share price continue to improve, again, a two-year window, and the end value of that investment will largely depend on the Echo IQ share price at the time.

In terms of AI progress, a few quick things. I know there's been an enormous, lot of talk around about AI in the market, but I think a few things have, stood to be true.

Healthcare and AI are a deal- ideally matched. Matter of fact, speaking to some of the founders of the big AI companies, they say the number one, market where AI could have the most impact is in healthcare.

Imaging is at the vanguard of that. 75 to 80% of FDA-approved algorithms in healthcare are for imaging.

Like everything in healthcare, it is a highly, regulated environment. There's FDA in America, CE in Europe, and TGA here.

The important thing about healthcare is, unlike other areas, it is mission-critical. There can't be downtime, and certainly, there can't be any errors or hallucinations, because people, health and welfare are at stake.

The other thing we've seen time and time again is AI must be embedded in the complex workflows used by clinicians. It It is not well accepted if it runs in a window on the side, and it must be trusted.

People need to know that this is not just a black box. They need to understand the clinical evidence and support behind it, in order to use it.

We think we're ideally placed to benefit from AI. We are the gatekeeper for image-based AI, for now, at 11% of the market in the US and growing.

Anyone that wants to fully integrate the AI output that's image-based, needs to integrate to, in our instance, the Visage desktop. It is a very important place to be in the value proposition.

We have the ability to embed AI into that core Visage offering, which we think, again, will be a strategic advantage for it. Importantly, we have a capital-light strategy.

We don't need to invest billions in data centers, and we don't need to invest hundreds of millions of dollars producing foundation models, like many others do, to get the result that we're aiming for. I think we're incredibly well positioned being the gatekeeper and adopting a capital-light strategy.

Things that we've done, as I mentioned, breast cancer detection, we did that with NYU. We are pending FDA clearance.

We've done the investments with Elucid for cardiac CT, 4DMedical, and Echo IQ, for their cardiac heart failure. We've extended our research agreements with UCSF, Mayo, NYU, and others, that will help us not only do the sourcing of the algorithms, but help in the clinical validation process, which is such an important part of it all.

We are looking at a growing number of third-party AI algorithms to integrate into the platform on a curated basis. The team is the same team that leads our Visage development, because both Malte Westerhoff and Detlev Stalling, the two co-founders of the Visage platform, have PhDs in this particular area, well suited.

We have Ming, who is our PhD medical scientist based out of Yale, that also is part of the team that looks and assesses the third-party algorithms. Our products, we've made very significant progress on our concept of one platform.

Unlike others that have various products that are all different and different codebases and run on different servers, ours is the one platform, one codebase. No one has ever done this before.

We started with, obviously, diagnostic imaging, including all breast imaging and advanced visualization in the one desktop. We've extended that to cardiology, which is doing well.

We've now extended it into the areas of digital pathology, and we're replacing something not pixel-based, but something that was always part of the radiologist desktop, which was the reporting system, because radiologists dictated in the past and used voice recognition to create a clinical opinion or report, as we call it. We've now brought out two products that we think fill out the mix, which is the digital pathology and the AI-optimized reporting system.

Very significant steps taken in terms of new products, as well as ongoing updates to the Visage 7 platform, so, arguably, our biggest year in development that we've had. The things that always make us different continue to be the same in terms of legacy technology as compress and send.

Many of you have heard me say this before: files are just getting too big, and so ours is totally different. We use a streaming technology.

We don't move the file; we just stream the pixels, a bit like the Netflix of diagnostic imaging, but it's a lot more sophisticated because it's two-way streaming, and adaptive streaming depending on bandwidth, depending on network, depending on number of pixels need to be streamed, etc. Here's some new data points.

There's some new CT called photon-counting CT where you have up to 10,000 images, each image over half a meg, so that's 5 gigs right there. High-density breast tomosynthesis can be 6 gigabytes plus a study.

Digital pathology, massive, between 6 and 20 gigabytes, a set of slides. There's a new form of breast ultrasound called opto-acoustic where the files are 10 gigabytes plus.

You can see that as new equipment and new technologies come out, the files are growing exponentially, and the old compress and send technology just is not able to cope. The other thing driving the industry is not just the size of the images, but the number of images and the number of radiologists around to read them.

The shortage has continued. It's acute.

Pretty much every group worldwide is on the hunt for radiologists to just do the work volume that they currently have, yet alone additional work. The fact that we are able to increase radiologists' productivity whilst maintaining the same or better accuracy, to the degree we do, is again a very strong strategic advantage for us.

Cloud has been a big thing for us again. Many people talk about it; we believe we're the only ones that can do a full cloud, even to this day.

We celebrated our fifth anniversary of our first cloud client in MedStar in 2020, and every single implementation since in the US has been 100% cloud-based. The market is beginning to understand the delta between hybrid cloud and real cloud, and I think that's getting a big plus for us in the RFPs we deal with.

Open archive, again, I won't go into too much, but as we go more into cloud, we do more and more open archive, not only as full-stack with new clients, but also some of the clients that were originally on-premise, as they move to cloud, they will adopt archive, and we've had a number of instances of that. There's less and less on-premise work, as a result, going forward.

The workflow, another key part, it allows for a lot of workload distribution dynamically. It's a very intelligent product.

It's been well received by the market, and again, part of that full-stack strategy that has played out significantly over the last 24 months and particularly in the last year as well. Visage 7 reporting, this is the new one.

This was announced at SIIM in 2026. We've had our first implementations, which are in Europe at the moment.

It replaces third-party product, and it allows radiologists to have one single desktop that includes not only everything to do with image, but now also the reporting. We're looking to bring it into the US, early calendar year '27.

We think it has a lot of incredibly good features, including AI optimization for drafting and revision, which will make the radiologist far more productive, and, of course, it'll have complete integration between image and text, both being Visage. Measurements come straight across, areas of interest come across, things that used to plague radiologists, we've been able to solve by this integration being the same product, the same codebase.

Cardiology imaging, again, I won't talk too much about it, most of you heard about it, we did release it a few years ago. We are seeing a lot of increased traction.

Our first really big contract was with UC Colorado, but we've now signed a number of others, some with existing clients, some with new, we call it full-stack plus one, and we are seeing more and more RFPs where there is diagnostic imaging and cardiology together, definitely not all of them, but an increasing number. Digital pathology, as we've mentioned, this is a new product.

We have it working in Europe, and we're again look to bring it to the US early in calendar year 2027. It will round out our diagnostic imaging platform.

It is different to the diagnostic imaging market, which is 100% digital. Digital pathology, the market is less than 10% penetrated for various reasons.

One of the key ones being that color slides that are produced in digital pathology create very big files, and the cost benefit has not been there until recently. We are seeing increasing interest from prospective clients and new clients in digital pathology, this will be an important part of the product mix.

The RIS, again, we've been able to eke out some growth in Australia with some new bolt-on clients as well as increased volume from some of our big users. We are the undisputed market leader in RIS in Australia.

Clinical outcomes, we talk a lot about the money, but we are moving the needle in terms of what radiologists can do, and at what speed, and therefore, the clinical outcome that they achieve, and I think this is fundamentally important, because not only do we make them quicker, we make them more capable, and in many cases, more accurate. The growth strategy, we often get asked about it.

I think it's the same that we have had, that has been working: win new clients, which is our footprint, as we've grown our market share, and the market share of 11% is on a higher figure. We used to estimate the market at around $670 million.

We now estimate it with organic growth, somewhere around $690 million, the 11% is of that $690 million. The launch new products, we've just talked about that, and the enter new geographies, we think our position at U Heidelberg, which is so preeminent, prestigious, will provide us with an excellent base not only to expand within Germany and surrounding areas, but, in the future, also other parts of the EU.

Just mentioned that, $690 million and 11%, whilst it's a material figure, we still have an enormous amount of runway. Pipeline is the second-last thing I'll talk about.

It has been robust. We did have a big year of sales, but on the flip side of that, we've had an increased number of inbound RFPs across all market segments, and we have opportunities at various stages of maturity in the pipeline, and various sizes.

It is a diverse and robust pipeline, and a reasonable portion of that came out of RSNA '25, which was our biggest, so, yes, the pipeline is very robust, and we see opportunities across a lot of segments. There's the latest U.S.

News Best Hospitals. We're greater than 50%.

We do 11 of the top 20 hospitals, so, by far, the largest provider systems to that client base. We are growing in the IDN space.

We are growing in the private market space. Academics, IDNs, private market, all of them have improved for us in the last fiscal year.

RSNA '25, as I mentioned, was huge for us. It was there that we were able to do an Apple Store event.

I think it's the first time in Chicago Apple Store has been used for such an event. There were over 450 people there.

This is a photo of just some of them, and it was showing how the Vision Pro is being used by some of our clients. Incredibly well attended and interesting.

Some of the groups that attended have shown increased interest in the product, citing that store event as showing that we really are at the pointy edge when it comes to new product development and new technologies. This is the team, biggest ever, and we think that it'll be replicated, if not outdone, by RSNA later this year.

In summary, we had our record financials. Cloud was a big advantage.

We had our second-biggest year of contract wins, with six out of six renewals, new products, cardiology, increased penetration, and strong pipeline that will set us up well for FY 2027. Thank you for that, and we're open up to questions.

Operator

Thank you. If you wish to ask a question via the phones, you will need to press the star key followed by the number 1 on your telephone keypad.

If you wish to ask a question via the webcast, please type your question into the Ask a Question box and click submit. We ask that questions be limited to two per person.

Please rejoin the question queue for any follow-up questions. The first phone question today comes from Josh, Josh Kannourakis from Barrenjoey.

Please go ahead.

Josh Kannourakis

Hi Sam, Danny, and Garry. Thanks very much for taking my questions.

Can you hear me okay?

Sam Hupert

That's better now. Yeah.

Josh Kannourakis

Perfect. Just the first one, just with regard to the implementation.

Obviously, that's all going on track. If we look across to '27 now, you obviously have those uplifts coming through.

What's your expectations in terms of once the go-lives happened to be able to achieve above the minimums, as you sort of have been doing historically? When we sort of look at, I think, consensus around 26- 3 340 or so for next year, it feels like a lot of next year's growth feels like it's covered by that.

Is that fair to say at the moment, where we're sitting?

Sam Hupert

Yeah. There are a few things, as we mentioned in our corporate presentations.

A lot of the implementations that we did in FY 2026 came in the second half, and some late. That's just how they occurred.

That wasn't intentional. It's when the clients were ready.

So '27 will get a big leg-up with those now being 12 months. Trinity Cohort 5 was third week of July, so as good as 12 months, all the rest, BayCare, UC Colorado, first four cohorts.

Then, yes, you're right. Because it takes roughly six months from signing for the groups to be ready to go live, we know that some of the ones that are there like Beth Israel, like U Maryland, etc., will fill out the rest for the financial year.

Then the other thing is, our clients, the growth rate of existing client base is roughly three times that of industry average. Obviously, the bigger the base is and apply that formula, that grows as well.

It's multi-factorial, but you're correct. The sales we made will cover a fair bit of that revenue upside.

Josh Kannourakis

Got it. Just my second question, which follows on from the market volume growth, Sam.

I know there was a few concerns earlier in the year, after a number of the sort of hospital groups and some of the reading groups and things that could talked about some hits to elective volumes, and the like, as a result of some of the removal of Medicaid funding packages. Just keen to hear your view on whether you've seen any of that, and maybe if not, why not, to [wrap?]

?

Sam Hupert

We haven't. I think there's more work out there that can be read.

That's one thing, that it's producing more. When we say 8%, obviously, and sometimes it's 9, it just depends year-on-year, some of that is acquisition, some of that's organic growth.

No, we haven't seen any slowing off, and we haven't seen any group number go down. Quite the opposite, they've all gone up.

Josh Kannourakis

Right. Just on that, do you think that's though due to the type of clients that you've got within the portfolio, if you had looked at more of the lower end or larger sort of public-related hospitals, would they have more impact to that, do you think?

Sam Hupert

It's possible, but again, that's not what we've seen. Some of them are a bit more expansive.

There's no secret about NYU. They're opening new centers, and they're sort of on the front foot.

They're not the only ones. We see more and more of that.

Maybe it is the client base, but we do spread across a whole lot, regional ones and other bits and pieces that most people hadn't heard of till we announced them, and they seem to be doing pretty well, too. By and large, no, we haven't noticed any decrease.

Quite the opposite.

Josh Kannourakis

That's great. Thanks, Sam.

Thanks, guys. Appreciate it.

Operator

Thank you. The next question is from David Stanton from Jefferies.

Please go ahead.

David Stanton

Good morning, team, and thanks very much for taking my questions. Just on the previous question, you talked in the presentation about a benchmark of around 30% growth.

Should we be thinking that on a constant currency basis for FY 2027 for revenue and profit?

Sam Hupert

That's what we aim, yes. In some years, as I've said, currency doesn't have a material impact.

What we report in constant currency are much the same. It just really depends how much it moves around from period to period.

Yes, we think that that's achievable, given we know all the stuff we put on late in FY 2026, as we mentioned, Trinity and all those others. They're actually big in their own rights.

It's not just that they came on towards the end of the financial year, but they're big. Having full 12 months of them will have an impact in '27, which we know already.

Then the other ones we're putting on. Yes, we think we can't predict currency, I don't think anyone can, but yeah, constant currency basis, and hopefully reported, if currency doesn't move too much, we're still aiming for that.

Danny English

Yes. Good morning, David.

Just on that, the reported number does carry just under $12 million of currency headwind that's got nothing to do with our underlying operating performance. That's something to bear in mind.

Also, secondly, the growth rate is being measured of a materially larger base each year. In absolute dollar figures, the increase in FY 2026 was extensive, and it will set us up really well for FY 2027.

David Stanton

Understood. Second question, please: be interested in your aspiration for your North American PACS market share, currently at 11%.

What do you think that could get to as an aspirational target on a three-year view, please?

Sam Hupert

Yeah. That's a good question.

Maybe I'll answer it this way. No one's gotten from 0 to 11% as quickly as we have.

No one's gotten the mix of the luminary institutions in that 11% like we have, and we have over 50% of them. I think when we look at it, we say, well, what's to stop us from getting from 11 to 12 to 15% to more?

We think we have the best technology, we don't have technological debt. We think we have a highly optimized implementation capability.

You can sell it, but you have to put it in, and I think we're proving that. Then we're looking at what is the market itself, because it's made up of slightly different segments.

The private market have different drivers to a Mayo Clinic. They need the same platform, but they have slightly different drivers.

Can we address the large majority of the market with our product? The answer is 100% yes, because we already are.

We have it in the private market, we have it in small groups, and then we have it in Mayo Clinic and NYU. It's the same product.

We have a figure out there that we believe from a TAM point of view, it could be up to 85% of the market is addressable, if not more. The only reason that 15 or 10% is not, it's purely around commercials.

It's when small is too small, with all the data security and contracting. Having said that, that tail is actually reducing or nearly disappearing, because those clients are so small, it's not viable for them to stand on their own two feet without being part of something bigger.

That 85% could in time go to 90%. We're at 11.

Where would I like to be? Well, 90.

Obviously, step by step, we are making good progress, and we believe going from 0 to 10, when we go from 10 to hopefully 20 will be quicker than the first 10. We're starting to see that, we're at nine 8, 9, 10, now 11.

Bear in mind, the pie is bigger, too. The number that 11% is now $690 million.

Look, I don't think there's any impediment. It's purely how many opportunities come to market, and of those, how many we win, and we're seeing more coming, and we're winning more.

David Stanton

Understood. Thank you very much.

Operator

Thank you. The next question comes from Paul Mason from E&P.

Please go ahead.

Paul Mason

Hey, team. Just a couple on the reporting tool.

The first I wanted to ask about is just what proportion of your customer base you think is on the sunsetted PowerScribe 360 tool? Second, related to that, is just if you could give some color on whether you think that element might actually be tendered out separately across your client base, or whether it sort of requires a whole-of-system tender that might come up at the end of contracts before you'd be able to chase it?

Thanks.

Sam Hupert

Oh, yeah. I'll answer the second one last.

Yes, it comes tendered out. We've already received some RFIs and things.

Coming back to your first question, there's been this fork in the road. You're right, there was a company called Nuance that had most of the speech-to-text engines, they used to be called Dragon, and they had Dragon Medical, and they really cornered the majority of the diagnostic imaging market, particularly in the US.

There was a second group came out of Europe called M*Modal, it's now called Fluency, I think. 3M bought them years ago, and we see some of that, some of the groups in Australia use Fluency.

They're the two big ones. We think there's been this fork in the road where all of a sudden, PowerScribe in its original version is coming to end of life, and people would have to upgrade to a new version now.

Nuance has been bought by Microsoft a few years ago, and that's not their core business, as you know. We think there's a huge opportunity, and yeah, there could be mid-cycle.

Absolutely. You could easily sell that back to existing clients, and we think because it's the same platform, and image and text fully integrated because it's the one platform, there's some big advantages there.

Now, clearly, we have to sell it. There's a whole product cycle to it, but we're already off and running, because it's live in Europe at the moment.

Paul Mason

Yeah. Oh, just on that, would most of your existing customers actually probably use PowerScribe then, or M*Modal, or

Sam Hupert

Yeah.

Paul Mason

Okay. Great.

Thank you.

Operator

Thank you. The next question comes from Chris Cooper from J.P.

Morgan. Please go ahead.

Chris Cooper

Thanks, Sam. Maybe just a quick follow-up on that one.

I had a similar line of questioning, but can you contextualize what the incremental contribution might be in some way? Maybe just give us some sense of incremental pricing or maybe just an idea about the business model.

Is this going to be a pay-per-click model in a way that clearly Visage is, or is this going to be something more like a subscription model?

Sam Hupert

Yeah. It'll be pay-per-click, because it's a one-for-one correlation.

Pretty much every exam, every test needs a report. They'll pay per usage, and that is a model that is currently in the market for reporting systems.

In terms of the pricing, we haven't finalized it yet, but my gut feel would be it could be material. It could be somewhere around 30, 35% additional if they took it for everything.

Depending on the modules, could be a bit more. It's a material component.

It'll be a material component add-on if people take it. Now, having said that, we're not the only new shiny toy on the block.

There's a number of reporting tools that have either been around or are around that will try and compete with us. I think our main advantage will be the quality of the product and the fact that it's part of the desktop, you don't need to do data elements from pixels to text, which is what you need.

Whilst there's competition and there'll be price pressure, it could be quite material if clients do take it.

Chris Cooper

All right. Thank you.

Maybe just one more on AI, please. We're obviously seeing one of your peers, in particular, demonstrating very clear demand for these cardiac CT algorithms.

You've obviously got your own partnership with Elucid. What are the next steps at this point for integrating that into the Visage workflow, and how could the economics for that work, please?

Sam Hupert

Yeah. We're not wedded to one in any one AI area.

We made a small investment in Elucid to get inside the tent, and we would resell the product. Why would people buy it from us?

Because they're already dealing with us. That's a huge thing.

Also, if there's pixel-based output, in other words, image-based output, we could integrate that into the desktop. We are in the process of finalizing reseller agreements like we will be in the process with Echo IQ and others, and it'll be a reseller where we get a pass-through plus an integration fee.

That's the way we see it. If it's our own AI, then we'll just sell that ourselves.

Chris Cooper

Great. Pleased to take in the questions.

Operator

Thank you. The next question is from Sarah Mann from Moelis Australia.

Please go ahead.

Sarah Mann

Morning, Sam and Danny. Just a question on the renewals.

Clearly, you've had a good run rate this year in terms of what you've achieved. Can I just ask, have any of those discussions been, I guess, assessed against other competitors, or have they all been closed-door discussions?

Sam Hupert

I'll just have to go through them all in my head. I believe they've all been closed-door.

As we've been successful that way, and, yeah, it's all about term and price. In some cases, people, like OSU, have taken additional product at that point in time.

We were very pleased to get six out of six, maintain our record, and, obviously, deal with the ones that are still ahead of us.

Sarah Mann

Right. Okay.

Then just on the Veterans Affairs opportunity. Obviously, you've transitioned over your existing VISN customer to the cloud.

Can you talk about, I guess, how this is impacting, or how this is, I guess, changing interest from other kind of VA customers?

Sam Hupert

Sorry, I couldn't quite hear the last bit.

Sarah Mann

We've done

Sam Hupert

transition to the cloud, yes, that's correct.

Sarah Mann

Yeah. I'm just asking, I guess, how it's driving interest from other Veterans Affairs.

Sam Hupert

Oh, no. It's huge, but what's happened with the Veterans Affairs is it is now gone to a whole-of-VA RFP process, which they haven't released yet, but they said they will.

In the past, various VISNs could buy on their own, and they've taken the Veterans Affairs teleradiology project and the new PACS project and bundling it into a whole-of-Veterans Affairs RFP, which is due to come out, well, they say, within 60 days, but with the government, you never know. Certainly, the two things happened with VISN 23: first of all, they were a viewer and archive client, and then they actually acquired worklist from us in the year.

We've actually took them into cloud and added worklist as well. They're full-stack, cloud, and as it's the VAEC, which is that hyper-secure cloud that you have to be in and get all these ATOs to work in, and whatever else.

We cleared all the hurdles for that, and we believe we're the only ones that have been able to do that, the only company to this point in time.

Sarah Mann

Great. Thanks very much.

Operator

Thank you. The next question is from Peter Meichelboeck from Select Equities.

Please go ahead.

Peter Meichelboeck

Hi, guys. Thanks for taking my question.

Just on the operating cash flow, I think it was up 15% over the full year, but it was flat in the second half versus PCP. I gather that's got a fair bit to do with the timing of the implementations that sort of came towards the end of the year, but just wanted to check if there are any sort of one-offs or any other timing issues in that second half?

Danny English

No, we haven't. Peter, in terms of capital, we've obviously invested into 4DMedical and some share buybacks, so that had an impact on the actual growth of cash, but, by and large, our capital priorities haven't changed.

We still fund our R&D and delivery and capability whilst maintaining strong balance sheet, and return any surplus capital through fully franked dividends.

Peter Meichelboeck

Yeah. I was specifically just thinking about operating cash flow when I was looking at that.

Mhm. I guess, look, the second part of my question was going to be sort of following on from the implementations.

Historically, you've had a fairly consistent sort of second-half bias in terms of revenue, given the sort of the status of where this year's implementations or 20- FY 2026 implementations have come through. Should we be thinking a similar revenue seasonality in '27?

I know it depends on what other contracts that come along this year, but just given that sort of implementation that you had in '26, could we be looking at '27 being a bit more even in terms of revenue seasonality?

Danny English

There are two things to that. The pattern is what you would expect from us, where revenue steps up as each implementation goes live.

We had four Trinity cohorts in FY 2026 and UC Health all went live at different points throughout the year, the revenue contribution builds rather than arriving in one step, and that is very much reflected in our absolute numbers and revenue growth in the second half. This will position us really well for FY 2027.

Now, on that, secondly, FY 2027 will be bigger, as you already mentioned. A lot of these contracts that were implemented towards the latter end in the second half '26 will now come to full fruition in FY 2027, you will see a step-up from that.

Sam Hupert

Look, then the question is: do you see a step-up second half '27 from first half '27? There always is, because we put more and more on.

Given that there'll be such a big step-up in first half '27 already, then the question is how big will the delta be. There will be a delta, it just really depends how quickly we bring on the new contracts in the first half.

Peter Meichelboeck

Great. Thank you.

Operator

Thank you. The next question is from Madeleine Williams from Canaccord.

Please go ahead. Hi, team, and

Madeleine Williams

thanks for answering my questions. Just, firstly, the sort of contracts that you've been winning, and sort of the cycles that the company goes through.

I'm just wondering if you can comment on sort of if you're seeing anything in terms of the cycles in terms of the contracts that you're winning, and how that might look over the next couple of years. Then the second part to the question is: is there any consideration of sort of the staffing situation and, I guess, your capacity to sort of take on additional contracts?

Sam Hupert

Yeah. I think a few things about the contracts that we see now and what's happened recently.

The market's sort of a lot more attuned to cloud and starting to understand what's really cloud and what's not. The market's also a lot more attuned to implementation capability, because in the old days, everybody took three years to do a site.

Regardless of who you chose, you figured it was going to take you two or three years of pain, and that was standard. That's now changed, because more and more people are aware that we can do these things, because we've done it for their peers.

We are seeing a different dynamic in the industry, and that network effect we talk about in terms of our sales. Then the last dynamic is because we have more product, we tend to sell more at the get-go, not to everybody, but to the majority, and so bigger TCVs.

That's worked well. Sorry, and the second part of the question?

Garry Sherriff

Staff.

Sam Hupert

Staff. Yeah.

With staff, yeah, that's the balancing act we go through all day, every day; in other words, how to right-size things. Obviously, we bring on new staff.

You look at our cost base, it's gone up in a very measured way, and we bring on staff across the organization trying to predict where we need them, so that when we did do Trinity, we were able to do it on time. When we did do BayCare and we did do UC Colorado, sure, it was tough because they're almost a compressed timeline, but we were able to get them all done.

I don't think at this point that we see any constraints staff-wise to taking on new business. We've never ever been the hold-up for a go-live, and we don't intend to be.

We know what coming down the pipe with the ones we've got, and clearly, with the ones that we hope to get, we try and look forward and understand what sort of staffing requirements we'll have. Then the last thing is, because we do it so much quicker than others, we can recycle the teams.

They're not out on-site for three years; they're out on-site for a few weeks, then they rest up, other teams go out, and so we have a lot more flexibility by rotating the people that we have.

Madeleine Williams

Thanks for that. Just my second question is just in relation to cardiology.

There's obviously crossover in hospitals and things like that, but they are sort of quite distinct departments. I'm just wondering what your thoughts are as it relates to any additional investments and staff that you would need to really go after that market, considering that it is seeming like it is a pretty big opportunity with sort of the expanding products?

Sam Hupert

Yeah. We do have people that are more cardiology-focused.

That's their remit, and it'll be the same with pathology. They're in the mix of our current staffing numbers.

We have people that in Berlin are more product-focused around cardiology, but not solely. Bear in mind, it's a lot easier if it's all on the same platform, because it's already implemented in radiology.

We don't have to do anything else to, for instance, get new servers, or new infrastructure, or all the stuff that would hold up a sales process. Being on one platform and using one team makes it easier.

Yes, you need people who understand how to speak to cardiologists, which are slightly different to radiologists, and obviously, we're staffing for that as well. It'll be the same for pathology.

Madeleine Williams

Great. Thank you.

Operator

Thank you. Moving to the webcast questions.

The first webcast question is: did the company lose any tenders to competitors during the last six months, and if so, why?

Sam Hupert

Trying to think. Off the top of my head, I'd have to think about it.

I don't believe we did. We do.

Obviously, we don't win every single one. Usually, the ones we don't win are around price.

Some groups don't look at the value; they just look at the price. In the last six months, I don't think we have lost any that I know of.

Operator

Thank you. The next webcast question is: what is the addressable market outside of the USA for your Visage product?

What is the limiting factor in expanding this platform worldwide?

Sam Hupert

There are two regions where we don't actively look at the moment. One is Japan, because you have to go through a Japanese regulatory cycle, and Japan is very parochial, they tend to buy from Konica and Fuji, that are Japanese-based companies.

The other one is China. That's a black box to us, and issues about IP, and IP sovereignty, and all of those things that we don't think are resolved to the point where would make sense for us to address those markets.

Anything outside those two, technically, we can do. We can implement, support anywhere.

Some places in Europe, maybe language. We already have it in German, obviously, English, Italian of all things, but could have it in multiple languages.

Those sort of standard type of things that we would need to look at, but I think the biggest one is really the size of the market. US is just so much bigger than everything else.

That's why we focus on it. Having said that, we've made strong step by getting U Heidelberg, which is so preeminent, and that could open up other opportunities within the EU in particular.

Then there's, of course, the UK and NHS, and the problem there is the NHS itself rather than anything else. It's the market.

Things are changing. I think cloud is just starting to be distributed inside the EU, which I think will be good for us.

We are looking at opportunities there, but our main focus, certainly, as we sit here today, is the US. Any other region other than the two I mentioned, we could easily do.

Operator

Thank you. The next webcast question is: as Visage incorporates more AI capabilities, do you see new competitive dynamics or partnership opportunities?

For example, DeepHealth, with its expanding AI-powered and FDA-approved clinical solutions, do you see them more as an emerging competitor or a potential partner?

Sam Hupert

All right. That's really two questions in one, I think.

We see a lot more partnership opportunities. It's not possible for one group to have every single algorithm.

There're just too many of them. We have a combination of our own, those we develop with partners, and third-party.

For groups like DeepHealth, it's possible we could partner with them on some of their algorithms. I think the thing for them is they're actually they're part of RadNet and a provider.

They wear two hats, which could preclude them from selling their algorithms more widely. Look, we could definitely look at some of their things.

We haven't to date, but that doesn't mean we wouldn't if it made sense.

Operator

Thank you. The next webcast question is: what is the outlook for EU sales?

Why is that much tougher market for PME, and is this changing?

Sam Hupert

Yeah. Question before the last one was sort of addressed to that, but the basic idea is the opportunities, each one is much smaller, and also, Europe is maybe five years behind the way the US look at informatics in our area.

Cloud's just starting to come in. The problem is it's all funded by government, and most governments don't say they don't have money for healthcare.

Europe's a tougher market, but not impossible. As you can see, we won U Heidelberg.

We are looking for opportunities there and opportunities outside Germany, but having said that, we just don't believe there is as many or as large as what we see in the US, but we'll look to do both.

Operator

Thank you. The next webcast question is: have any existing Visage customers express interest in deploying 4DMedical's CT LVAS or Echo IQ's EchoSolv products through the platform?

Sam Hupert

It's a bit early for that. We think we will find some.

As we are looking at finalizing Echo IQ. We just the other day finalized the convertible note, which was from binding MOU to contract.

I think we will see some of that, but it is a bit early for that.

Operator

Thank you. The next webcast question is: what is Dr.

Hupert's view on the bill HR 7558 passing through the US Congress, and does he view this as an opportunity?

Sam Hupert

I'm not an expert on it, but my understanding, it is about interoperability of images in the Veterans Affairs. Any standard and any interoperability can only be good.

Certainly, if the VA go to one platform, as I mentioned a little earlier when I was asked about VA, then that need is not fully, but largely mitigated because of one platform, all the images would be available, as currently it's a hotchpotch of platforms. Look, if they do pass it, I think it could only be good for the industry, and we don't see that as being a negative for us, quite the opposite.

Operator

Thank you very much. That does conclude the Q&A session.

I'll hand the conference back to Sam for any closing remarks.

Sam Hupert

Just really wanted to say thanks, everybody, for your interest. I know it's been a busy reporting season, and we appreciate you being on the demonstration and webcast.

Thank you.