by Vince Kuraitis and Neil P. Jennings of Untangle Well being
Right here’s a top level view of right now’s weblog publish:
- A Temporary Recap: What are UDHPs?
- Thesis: EHRs Can Develop to Grow to be UDHPs
- EHRs At present Personal the Buyer Relationship
- Many Prospects Have an “EHR-First” Choice for New Functions
- Epic and Oracle Well being are Making Sturdy Actions Towards Changing into UDHPs
- Antithesis: EHRs Can NOT Grow to be Efficient EHRs
- EHRs Carry a Lot of Baggage
- Prospects are Skeptical
- EHR Analytics Are NOT Optimized To Obtain Crucial Well being System Aims
- EHR Switching Prices are Diminishing
- Cloud Native Platforms Speed up Innovation and Efficiency
- It’s Not in EHR DNA to Grow to be A Broad-Primarily based Platform
- Synthesis and Conclusion
This can be a lengthy publish…over 4,000 phrases…so we’ve clearly bought rather a lot to say on the matter. Hope you introduced snacks!
A Temporary Recap: What are UDHPs? (Unified Digital Well being Platforms)
In our earlier intensive publish on UDHPs, we described them as a brand new class of enterprise software program. A December 2022 Gartner Market Information report characterised the long-term potential:
The [U]DHP shift will emerge as probably the most cost-effective and technically environment friendly solution to scale new digital capabilities inside and throughout well being ecosystems and can, over time, change the dominant period of the monolithic digital well being report (EHR).
The DHP Reference Structure is illustrated in a weblog publish by Higher. Be aware that UDHPs are visually depicted as “sitting on prime” of EHRs and different siloed sources of well being knowledge:
We famous that nearly any sort of enormous healthcare group — well being programs, well being plans, pharma firms, medical system firms, and many others. — had a necessity for UDHPs. Nevertheless, right now’s focus is extra slim — we restrict the dialogue to UDHPs in hospitals and well being programs, primarily within the U.S. We use the time period “well being system” to embody hospitals and regional well being supply programs.
On this publish, we concentrate on the 2 largest EHR distributors within the U.S. — Epic and Oracle Well being; they’ve a mixed market share of 65% of hospitals and 77% of hospital beds.
Within the remaining sections, we’ll lay out arguments on either side of the difficulty of whether or not EHRs can (or can not) develop to develop into UDHPs. The graphic beneath is our crack at a visible abstract. The balloons symbolize the thesis – that EHRs can develop to develop into UDHPs; the anchors symbolize the antithesis – that EHRs can’t develop to develop into UDHPs.
Thesis: EHRs Can Develop To Changing into UDHPs
Let’s have a look at the case for EHRs increasing to develop into efficient UDHPs.
1) EHRs At present Personal the Buyer Relationship
Fueled by federal HITECH incentives and mandates, well being programs have made vital investments of their current EHRs:
- As of 2021, 96% of non-federal acute care hospitals within the U.S. had adopted an authorized EHR.
- They made big capital commitments to buy and set up their EHR, typically a whole bunch of hundreds of thousands of {dollars}.
- Many current medical workflows are constructed on EHRs.
- A majority of a affected person’s medical knowledge in a well being system resides inside their EHR.
In response to SoftwareReviews, Epic and (Oracle) Cerner Millennium EHRs obtain good to excessive scores from well being system prospects.
Thus, any new vendor making an attempt to promote new healthcare enterprise software program (i.e., a UDHP) will face a excessive hurdle: “We have already got an EHR…why ought to we contemplate you?”
2) Many Prospects Have an “EHR-First” Choice for New Functions
Well being programs have been attempting to remain afloat in a veritable tsunami of level options. This creates a variety of challenges, together with:
- Complexity and integration challenges
- Regulatory and compliance dangers
- Fragmentation of care
- Person adoption and coaching
- Price and ROI issues
As proven within the graphic beneath, a 2024 Bain & Firm/KLAS survey of well being programs discovered that 81% more and more plan to look to current distributors earlier than contemplating choices from new distributors.
Extra particularly, the survey discovered that 79% plan to look to their EHR vendor first for brand new options earlier than seeking to others.
College Hospitals is an instance of a well being system with an EHR-First technique. In response to Robert Eardley, CIO, this guideline ensures the well being system prioritizes instruments and improvements out there inside its Epic digital well being report platform at any time when possible.
3) Epic and Oracle Are Making Sturdy Actions Towards Changing into UDHPs
Maybe the perfect argument that EHRs are able to changing into Unified Digital Well being Platforms is that Epic and Oracle Well being are already making daring strikes. Let’s check out them individually.
Epic’s EHR Growth Plans
Epic is greater than a primary EHR — it gives current prospects a broad base of capabilities. Interop guru Brendan Keeler has written extensively about Epic. In his article “An Epic Saga: The Origin Story” he describes how Epic grew to its present dimension. The Appendix gives an intensive checklist of “Epic Modules.”
In an insightful 2024 evaluation of Epic’s dominant market place, Seth Joseph included an inventory of Merchandise You Can Substitute with Epic. The checklist included over 150 capabilities “that will help you establish areas the place you might use your Epic software program to both change or keep away from buying area of interest purposes…”
Epic is also increasing new choices to new buyer classes. Within the article “Epic Past the Supplier Empire“, Brendan Keeler gives an in depth checklist:
Well being Grid — software program offered to
- Labs
- Medical system firms
- Payers
- Telehealth firms
- Scientific trials
Well being Grid Adjoining choices
- Cosmos — “an enormous medical dataset created by pooling data from Epic well being programs”
- Payer Gateway — a “lighter-weight service for payers that permits them to obtain medical knowledge from Epic healthcare organizations”
- Chart Gateway — “Epic’s service that streamlines how life insurance coverage firms get medical data from Epic healthcare organizations”
- EpicCare Hyperlink — “a web-based portal product that lets Epic healthcare organizations supply non-Epic suppliers a solution to work together with them.”
Different stuff
- Provide Store — providers choices
- Revcyclers — “Third events working with Epic and supply billing providers to assist enhance income cycle outcomes”
- Cornerstone Companions — deep relationships with Microsoft and InterSystems
However wait…there’s extra. At HIMSS 2025, Epic introduced extra AI capabilities within the works and that it’s growing a healthcare-specific enterprise useful resource planning (ERP) system. Whereas we view an ERP as a giant stretch, it’s additionally a possible game-changer for Epic.
Utilizing a framework created by David Yuan of Tidemark, Brendan Keeler capsulized Epic’s broader platform technique:
With additions just like the ERP, Epic is clearly evolving past a standard EHR system, however is it sufficient to satisfy the UDHP wants of contemporary well being programs?
Oracle Well being Goes Past Being a Conventional EHR
In October 2024, Oracle introduced a brand new EHR. As described by the corporate, Oracle Well being has many traits that make it look extra like a UDHP than a standard EHR. It goals to go considerably past the capabilities of a standard EHR:
- Embedded Synthetic Intelligence (AI): In contrast to EHRs the place AI is usually a bolt-on, Oracle’s new system is designed with AI as a core part, built-in throughout the complete medical workflow. This features a Scientific AI Agent, AI-driven insights on the level of care, AI-powered summaries, and customized care plans.
- Enhanced Person Expertise: Recognizing the clinician burden related to conventional EHRs, the brand new system emphasizes an intuitive and user-friendly design with options like voice-driven navigation and search, multimodal search, and a customizable interface.
- Oracle Well being Information Intelligence is an AI and analytics answer embedded inside the EHR, enabling integration of disparate knowledge sources, real-time insights, and inhabitants well being administration instruments.
- Subsequent-Era Oracle Cloud Infrastructure gives benefits of enhanced safety, scalability, and efficiency, and higher knowledge change.
- Affected person Engagement Instruments: The brand new EHR features a reimagined affected person portal centered on empowering sufferers to entry and management their medical historical past, facilitating communication with suppliers, and enabling self-service capabilities for sufferers to handle appointments, pay payments, and entry well being data.
- Deal with Worth-Primarily based Care: The system is designed to help value-based care fashions by streamlining data change between payers and suppliers, bettering care coordination, and offering insights into value and useful resource allocation.
Oracle Well being goals to maneuver past being a system of report to changing into a system of motion — an clever, built-in platform that actively assists clinicians, engages sufferers, and drives higher outcomes in a extra environment friendly and safe method. Oracle’s most up-to-date announcement of a platform partnership with Cleveland Clinic and G42 is in keeping with the migration towards changing into a UDHP.
Oracle Well being remains to be in its early levels of a roll-out, with an early adopter program launched in 2025. Due to this fact, intensive, broadly printed surveys and large-scale buyer suggestions about this new platform aren’t but out there.
Antithesis: EHRs Can NOT Grow to be Efficient UDHPs
Now let’s look at arguments suggesting that EHRs aren’t able to changing into well being programs’ “platform of platforms” — a UDHP.
1) EHRs Carry a Lot of Baggage
At this time’s EHRs are criticized on a lot of fronts: errors and questions of safety, value, lack of competitors, lack of interoperability, and lack of usability for clinicians. COVID-19 highlighted most of the weaknesses in EHRs as being “massive, sluggish monoliths that don’t rapidly adapt to new, emergent calls for on their design and workflow.”
However what in regards to the excessive satisfaction scores beforehand cited? EHRs usually tend to contemplate well being system directors as their “prospects.” As famous above, clinician “person” satisfaction is usually low.
Distributors even have allowed prospects to customise EHR implementations. Native customization results in substantial variations in how the system operates from one website to a different. The usually-used colloquial phrase is that there are “50 dialects of Epic.” Whereas a point of EHR customization is critical and might enhance clinician buy-in, over-customization can lead to issue interoperating, as knowledge definitions and workflows can differ enormously. With every EHR occasion probably distinctive, extending EHRs to develop into UDHPs carries ahead organization-specific configurations which can lead to substantial longitudinal upkeep (for both the well being system or the companions related to the EHR).
Lastly, Epic’s distinctive dimension and dominant market place might entice antitrust challenges from authorities regulators. Even right now, as Seth Joseph paperwork, Epic is already attracting lawsuits from a number of “smaller, adjoining distributors.” As Epic provides ERP and Cerner and Epic proceed including adjoining options and capabilities, they’re increasing their positions, probably garnering extra regulatory oversight.
2) Prospects are Skeptical
Even whereas many well being programs may need an “EHR-First” integration desire, many are additionally skeptical of their EHR vendor’s guarantees and their capacity to combine new apps. Sage Progress Companions report entitled The New Healthcare C-Suite Agenda: 2024-25 addressed the difficulty:
C-Suites are at a know-how crossroads: Only a few are glad with their EMR vendor, the market is flooded with level options however integrations are irritating staff extra, and regardless of the coverage relaxations round telehealth over the past three years, telehealth and in-home hospital instruments usually are not effectively built-in with EMRs.
When requested “How effectively does your present vendor stay as much as the guarantees it makes in regards to the EMR, solely 26% responded “extraordinarily effectively” or “very effectively.”
Maybe most significantly, “𝐨𝐧𝐥𝐲 𝟏𝟕% 𝐨𝐟 𝟐𝟎𝟐𝟑 𝐫𝐞𝐬𝐩𝐨𝐧𝐝𝐞𝐧𝐭𝐬 “𝐬𝐭𝐫𝐨𝐧𝐠𝐥𝐲 𝐚𝐠𝐫𝐞𝐞” 𝐭𝐡𝐚𝐭 𝐭𝐡𝐞 𝐄𝐌𝐑 𝐰𝐢𝐥𝐥 𝐦𝐞𝐞𝐭 𝐭𝐡𝐞 𝐦𝐚𝐣𝐨𝐫𝐢𝐭𝐲 𝐨𝐟 𝐭𝐡𝐞𝐢𝐫 𝐨𝐫𝐠𝐚𝐧𝐢𝐳𝐚𝐭𝐢𝐨𝐧’𝐬 𝐧𝐞𝐞𝐝𝐬 𝐦𝐨𝐯𝐢𝐧𝐠 𝐟𝐨𝐫𝐰𝐚𝐫𝐝, down from 25% in 2022.”
3) EHR Analytics Are NOT Optimized To Obtain Crucial Well being System Aims
Any particular person EHR can NOT be seen because the “supply of fact” for a affected person’s medical historical past:
A number of EHR Distributors. Each within the U.S. and overseas, bigger well being programs typically are Frankenstein’s monsters stitched collectively from numerous acquisitions. Thus, they often sport a patchwork of competing EHRs. A HIMSS Analytics examine discovered that the typical well being system has 18 completely different EHR distributors throughout inpatient and outpatient settings.
A number of Level Options and Sources of Information. Affected person knowledge in well being programs is unfold throughout a number of programs, not simply EHRs.
Affected person and Information “Leakage.” At this time’s sufferers are extra motivated by comfort than loyalty to 1 well being system; affected person leakage throughout care suppliers is critical. A examine in Worldwide Journal of Medical Informatics discovered that “solely 4.5 % of expenditure-weighted particular person Medicare beneficiaries had their MU medical data related to a single vendor, whereas 19.8 % of expenditure-weighted beneficiaries had their MU medical data saved in 8 or extra distributors.”
Affected person Well being and Care Information is More and more Outdoors of EHRs. A McKinsey examine examined how a lifetime of affected person well being and care knowledge is more likely to be created (see the graphic beneath).
By including the numbers in the precise column, you’ll see that an individual generates an estimated complete of 1,106.4 terabytes of well being knowledge over the course of a lifetime. Nevertheless, solely 0.4 terabytes — or 0.04% — is medical knowledge, i.e., more likely to reside in right now’s EHRs.
The implication: EHRs are more likely to include solely a fraction of a affected person’s well being and care knowledge. Optimum end-to-end analytical programs for affected person knowledge — ones designed for each prevention and care – might want to pull knowledge from throughout a various vary of sources. These capabilities don’t exist in right now’s EHRs.
We’ve famous that the roots of EHRs are as programs of report to doc processes for fee-for-service billing, nevertheless it goes deeper than that.
Pushed by early incentives like Significant Use, EHR design closely prioritized billing for particular person providers and administrative duties. Consequently, their structure emphasised documenting the quantity of care delivered for reimbursement, reasonably than the worth of affected person outcomes and effectivity.
The restricted interoperability inherent in lots of early EHR programs fostered knowledge silos. This fragmentation made it troublesome to realize the great, holistic affected person view important for efficient value-based care (VBC) and value-based funds (VBP), care coordination, inhabitants well being administration, complete value of care measurement and administration, and different capabilities wanted for cutting-edge well being programs.
In flip, conventional EHRs sometimes lacked entry to longitudinal claims knowledge and the delicate analytics essential to robustly measure prices and affected person outcomes. In addition they often lacked standardized mechanisms for capturing patient-reported outcomes (PROs) and didn’t streamline medical workflows to particularly help value-focused care supply. Because of this, these programs weren’t inherently designed to optimize for the rules and numerous fee fashions of VBC.
Whereas EHR know-how has superior, these foundational limitations proceed to current vital hurdles for well being programs navigating the advanced transition in the direction of VBC and inhabitants well being. Addressing these inherent design constraints is essential for realizing the total potential of digital well being in a future-proofed, value-driven healthcare panorama.
4) EHR Switching Prices are Diminishing
Previously, switching EHRs was akin to shifting homes throughout a blizzard…with three toddlers and a herd of goats. Excessive switching prices created a defensive moat to guard EHRs from opponents, both different EHRs or a brand new class of UDHPs.
Nevertheless, authorities coverage, laws, and regulation over the previous 20 years have promoted interoperability and applicable change of affected person knowledge. The HITECH Act, the twenty first Century Cures Act, the promotion of HL7 FHIR APIs, and the creation of TEFCA exemplify this pattern.
As affected person knowledge turns into extra fluid and readily shareable throughout completely different programs, switching prices are diminished. That is much more pronounced exterior the U.S., the place requirements like openEHR – a standardized medical knowledge mannequin which separates knowledge from purposes – are gaining traction, demonstrating the potential of information standardization to ease system transitions. The EU Information Act mandates the flexibility to change knowledge suppliers seamlessly.
Moreover, the evolution in the direction of a UDHP doesn’t essentially require a whole and fast EHR substitute. As we mentioned in a earlier weblog publish, UDHPs might be architected to combine with and leverage current knowledge repositories, together with EHRs. This incremental strategy to UDHP adoption can considerably scale back the perceived and precise prices of transitioning to a extra unified digital well being ecosystem.
5) Cloud Native Platforms Speed up Innovation and Efficiency
The roots of EHRs are as programs of report to doc fee-for-service billing processes, changing on-site processes with (sometimes) on-prem software program. UDHPs, then again, are sometimes cloud native software program, permitting broad scalability, availability, and appearing as hubs for innovation. With CHIME’s 2024 survey suggesting “24% of CIOs highlighted applicational rationalization and optimization a prime precedence,” this begs the query: the place ought to this utility rationalization and optimization happen?
Cloud native software program is a powerful contender, providing most of the CIO-sought advantages and the flexibility to scale in a cost-transparent method. Neil’s current piece “Head within the Cloud: At this time’s Healthcare Government” covers the shift to cloud-first infrastructure because of extra than simply market wants, but additionally a change in management. Because the Epic-selecting CIOs of the 2010s are retiring, a brand new technologist profile is rising and leaning cloud-first.
To be clear, we’re not referring to easily lifting-and-shifting an EHR from on-prem to the cloud. Whereas altering internet hosting suppliers and places can add incremental advantages to efficiency, value of possession, and scalability, the total advantages of cloud-first platforms usually are not achieved by migrating legacy software program.
To get the total advantages of a cloud-first strategy, there’ll must be a re-architecture of programs. This can be a massive process, however we’ve got most of the items right now, with scalable databases, Grasp-Information-Administration merchandise, EMPI merchandise, and headless EHRs (ONC Licensed EHRs of report that allow prospects to reskin the affected person and provider-facing experiences). Some main organizations are already creating cloud-hosted centralized knowledge platforms that create a single supply of fact, brokering knowledge throughout their technical ecosystem. Beneath, we’ll cowl some main advantages of this extra encompassing cloud-first strategy.
The place EHR distributors have traditionally moved slowly, cloud service suppliers are quickly including shared providers and tooling. With their consumption-based pricing fashions, they’re straight incentivized to allow and encourage onboarding new customers, use instances, purposes, and databases. Not everybody will want or wish to construct from scratch within the cloud, and as highlighted within the earlier publish, cloud-hosted ERP platforms are additionally rising to the event to satisfy UDHP wants.
Past the checklist of advantages above, it’s the strategy of those new service suppliers that encourages us to query whether or not EHRs can stay UDHPs in the long run. The cloud service suppliers (or hyperscalers) and ERPs are prepared to combine with anybody, host and provision something wherever, and supply centralized, distributed accessible, – and in addition open – programs. AWS and Azure, for instance, would fortunately host your Epic occasion, connect with your athenaHealth tablespace, and your level options. Please, proceed including extra!
And, they’ve probably the most superior, scalable databases and knowledge platforms to accommodate that knowledge. This makes the subsequent technology of level options, CDS options, or AI-derived brokers even simpler to create as cloud-first, as the info are already there, centralized, and accessible.
EHR prospects are additionally flocking to cloud distributors already, seeing advantages in internet hosting prices, scalability, testing, and different areas. From KLAS’ Epic within the Public Cloud 2024 report: “The bulk [of survey respondents] make the most of a cloud supplier for Epic catastrophe restoration, and this typically serves because the preliminary step within the Epic cloud migration journey.” IDC takes it a step additional of their 2024-2025 Well being Information Platforms for Suppliers Vendor Evaluation, introducing multi-cloud implementations as a doable route, stating that “Practically half (49.2%) of U.S. healthcare suppliers will prioritize IT modernization initiatives extending into 2025. This emphasizes the necessity for platforms that scale successfully and combine seamlessly with current and rising programs within the healthcare ecosystem. Multicloud adaptability will likely be important to attaining this.“
This implies one reply to the query of the place utility rationalization and optimization ought to happen: within the cloud. The cloud distributors are prepared and in a position to accommodate any EHR and are aligning incentives to speed up cloud adoption. If these cloud platforms can handle healthcare’s knowledge complexity, what’s stopping them from being the UDHPs accelerating innovation in healthcare?
6) It’s Not in EHR DNA to Grow to be a Broad-Primarily based Platform
EHRs are set of their methods – kinda like your uncle who nonetheless makes use of a flip cellphone. In contrast to a lot of right now’s most profitable tech firms, EHRs usually are not “platform native.” We checklist some potential methods this might inhibit an EHR’s enlargement towards changing into a UDHP:
“Software program Considering” vs. “Platform Considering.” To actually perceive the transformative potential of Unified Digital Well being Platforms, it’s essential to differentiate between conventional “software program considering” and extra expansive “platform considering.” By their very definition, UDHPs aren’t merely new software program; they symbolize a basic shift in the direction of a platform enterprise mannequin, full with a new algorithm requiring a unique mindset for achievement.
Seth Joseph astutely noticed that EHRs nonetheless consider themselves as software program firms, whereas the larger alternative is emigrate from being “a software program vendor within the market to {the marketplace} itself.” This transition necessitates a basic change in how these programs are conceived, constructed, and operated.
Growth By way of In-Home Improvement vs. Growth By way of M&A. Traditionally, Epic has largely favored enlargement by means of in-house improvement reasonably than embracing the platform technique of development by means of acquisitions and fostering an exterior ecosystem. Judy Faulkner, the influential founding father of Epic, has famously said Epic won’t ever be offered and has additionally traditionally maintained a stance towards buying different firms.
This inward focus contrasts sharply with the strategy of established platform giants who’ve made a whole bunch of acquisitions:
Alphabet (Google) — 200+
Amazon — 125+
Meta — 100+
Microsoft — 275+
To scale successfully and exponentially, it’s essential to take an ecosystem-first strategy.
Foot-Dragging On Interoperability vs. Interoperability by Default. The early historic strategy of many EHR distributors has been characterised as foot-dragging on interoperability, a stark distinction to the “interoperability by default” ethos of profitable platform companies.
Constructing One Firm vs. Constructing an Ecosystem of Companions. Lastly, till the previous decade the normal EHR mannequin was operated below the belief that exterior builders weren’t actually mandatory, a viewpoint diametrically against the platform enterprise mannequin the place builders are central.
In 2017, Epic opened its app retailer to a sluggish begin. Epic was seen as unresponsive by many app builders. We additionally bear in mind builders claiming that Epic was not respecting their mental property rights, i.e., “Your IP is now our IP.”
Epic has since developed way more vibrant developer applications. In but one other weblog publish, Brendan Keeler describes and charges builders’ choices in working with Epic. He concludes by advising devs to “mood your expectations.”
Synthesis and Conclusion:
OK, we’ll admit that the Thesis/Antithesis factor was a little dramatic. Let’s revisit the wording:
- Thesis: EHRs Can Develop To Changing into UDHPs
- Antithesis: EHRs Can’t Grow to be Efficient UDHPs
We’ll additionally concede that the wording is a bit deceptive — it implies black/white eventualities below which EHRs both will or is not going to develop into UDHPs. The fact, as all the time, is messier than a binary selection. It’s not ‘EHRs will completely develop into UDHPs’ or ‘EHRs are doomed to the dustbin of historical past.’ It’s extra like…shades of grey, with a wholesome dose of ‘we’ll see.’”
The UDHP market could be very early — the Gartner report that we cited in our earlier weblog publish on UDHPs estimated that the market is just 5% penetrated and that UDHP adoption will take 5 to 10 years.
As we’ve famous, UDHPs might be adopted incrementally and over time. UDHPs can accommodate EHRs as elements, and UDHPs and EHRs usually are not mutually unique: we don’t see EHRs as going away any time quickly.
We count on that completely different organizations will make completely different choices, relying on a lot of components similar to:
- Measurement and sources. Bigger well being programs doubtless will see higher wants for a UDHP; smaller programs extra doubtless will look to their EHR for integrations.
- Organizational complexity and geographic footprint. Multi-state footprints, a mixture of care settings throughout the acuity spectrum, and extensive ranges of specialties all add complexity, required connections, and extra alternative with a UDHP strategy.
- Present EHR vendor. Some EHR distributors would possibly succeed at growing UDHP capabilities, others may not. TBD.
- Pricing of UDHPs vs. EHRs. TBD.
- Evolution of UDHP capabilities and market acceptance. TBD.
- UDHP vendor and market evolution. In our earlier publish, we highlighted over 20 UDHP vendor “candidates”, and later advised that this quantity would shrink drastically.
In our subsequent publish on this sequence, we’ll section the healthcare supplier market to guage for whom (which hospitals and well being programs) the EHR might function the UDHP and when it is smart to decide on a cloud-first answer.
Vince Kuraitis JD/MBA is an impartial advisor with over 35 years’ expertise throughout 150+ healthcare & tech firms. Neil Jennings is Vice President, Consulting at Untangle Well being. Vince publishes The Healthcare Platform Weblog, the place this publish first appeared. The authors wish to thank a number of colleagues for his or her evaluate and commentary on an earlier draft of this publish: Michael Byczkowski, International Head of Healthcare at SAP; Brendan Keeler, Interoperability Follow Lead at HTD Well being; Sandra Raup, President at Datuit; and Chris Notaro, CEO of Untangle Well being.
