[DataDrivenMD]

Your point is well-taken. I agree that such an upgrade is unlikely to be sold as a standalone product. What is more likely to happen is that it will be included for a nominal fee as an add-on to a new purchase or service agreement.

To understand how this would work, we need to 1) understand the lifecycle of big-ticket medical equipment (ME) and 2) recognize that ME products are at the core of multiple revenue streams. The first point has to do with the renewed/refurbished market for used/last-generation ME. The second point has to do with the service agreements/warranties/support contracts that are needed in order to keep the ME operational. These factors combine to yield a sales process with multiple negotiating dimensions.

How these negotiations actually play out depends on whether you're a deep-pocketed healthcare system or not (it sucks, but it's true). If you can afford it, you'll have lots of ways to sport the latest and greatest ME without breaking the bank on any single purchase. Some of your old stuff will end up in the renewed/refurbished ME market, thereby offsetting your total cost of ownership (either directly or indirectly). Once used ME hits secondary markets, the customer profile changes: these customers are not looking to keep up with the Cleveland Clinics and Stanford's of the world. They're looking for long-term value, so reliability and longevity is top priority - and this is where I see software "upgrades" coming into play. Some of these customers may already have one or two MRIs, while others may not. In either case, the software "upgrade" becomes a differentiator that speaks directly to the priorities of these customers.

TL;DR - Today, healthcare providers with limited financial resources (e.g. those in developing countries, rural areas) are incentivized to purchase capital equipment through "discounts" on service/support. In the future, we're likely to see software "upgrades" (such as those made possible by FB's work) bundled/leveraged as an incentive. The net effect is the same: extend the clinically useful lifespan of medical equipment (MRIs in this case) and greater access to medical technology around the world.