By VINCE KURAITIS, GIRISH MURALIDHARAN & JODY RANCK
This entry is Part 2 of half 3 of three within the sequence Platforming Healthcare — The Lengthy View. This essay is the following within the sequence entitled “Platforming Healthcare — the Lengthy View”. The sequence presents a 30-12 months Framework for Platforming Healthcare. An up to date v2.0 of a graphic depicting this 30-12 months Framework is proven above.
Right now’s publish is part 2 and can proceed to explain and talk about a possible successor to the EHR period — Unified Digital Well being Platforms (UDHPs). Right here’s an summary:
- Mayo Clinic Platform
- Enterprise and Strategic Implications of UDHPs
- APPENDIX: Further Readings on UDHPs
Mayo Clinic Platform: Healthcare platforms and AI
The Mayo Clinic Platform (MCP)was launched a number of years in the past with the objective of constructing the longer term Mayo Clinic enterprise mannequin that might transfer past the bricks-and-mortar method to conventional healthcare and open up new avenues for services and products. The adoption of a platform enterprise mannequin was thought of important to serving sufferers past the normal Mayo Clinic geography in addition to a solution to incentivize innovation in AI and decentralized care within the residence.
A big longitudinal database with each structured and unstructured knowledge gives a basis for the MCP, notably in respect to catalyzing innovation in scientific purposes of AI. The database known as Mayo Clinic Platform Uncover has over 7.3 million de-identified affected person information that can be utilized for coaching AI fashions in addition to in analysis and discovery for early-stage startups particularly who want to be part of the MCP ecosystem. The dataset is known as “Knowledge behind glass” for the privateness and safety requirements which can be wanted to create the bedrock for a collaborative ecosystem.
Supply: Mayo Clinic Platform Playbook
MCP is a three-sided market that has answer builders, knowledge suppliers, and clinicians composing the three sides. MCP acts because the orchestrator of the ecosystem and extra companions corresponding to Mercy have joined as knowledge contributors within the MCP part known as Mayo Clinic Platform Join. These are the first parts of the platform.
The Mayo Clinic Platform Playbook identifies six key success components:
- A privacy-protecting, safe collaborative surroundings with de-identified knowledge from international sources. Longitudinal databases of affected person information are important to scientific analysis and the event of recent scientific decision-support instruments, therapeutics, and digital well being options. Privateness and safety have to be maintained to guard the belief of Mayo Clinic’s sufferers.
- Breadth and depth of affected person knowledge have to be enough to generate insights for each uncommon and customary ailments.
- Seamless capabilities to each ingest numerous knowledge sources (e.g. -omic (genome, metabolome, and so forth.), EHR, wearables, social determinants of well being (SDoH)) and to ship actionable insights on the level of care.
- Reducing-edge knowledge science analytic instruments, strong computing energy, and uniform knowledge requirements.
- Sturdy governance to imagine safety, scientific validity, interoperability and validation of applied sciences match for goal.
- Pathways for commercialization of efficient, validated options.
MCP vets startups and extra mature know-how distributors by means of a course of that may start with offering entry to the longitudinal database for creating and coaching fashions (early-stage startups) to scaling options throughout MCP and affiliated hospitals with Mayo Clinic. The strong governance construction and integration with MCP makes scaling into different methods far more possible.
AI governance is a core part of the MCP and why they had been one of many authentic sponsors of the Coalition for Well being AI (CHAI) to deliver collectively main trade gamers to create the requirements for accountable AI throughout validation, explainability, and transparency. Guaranteeing that AI instruments have been rigorously validated is critical for clinician adoption of AI in addition to sustaining the belief of sufferers. These requirements act as a form of “guidelines of the street” for know-how answer suppliers on the MCP.
MCP makes use of ServiceNow’s Software Portfolio Administration (APM) answer that permits customers to create a complete stock of all purposes utilized by an organization. Many well being methods battle to take care of the buildup of purposes over time and this creates safety points, redundancies, and dangers to hospitals. The APM answer facilitates integration of utility portfolios with clearer strains for possession, duty for upkeep and decommissioning, and administrative roles.
For MCP this sort of answer provides a myriad of benefits when orchestrating an ecosystem of know-how distributors and purposes which can be built-in with Mayo Clinic’s digital infrastructure (EHRs, pathology and radiology purposes, and so forth.) and past when the MCP companions with each know-how distributors on their platform and exterior hospitals and methods.
The problem of sustaining belief in a UDHP is appreciable. Within the MCP case, one can discover know-how options that may have a platform enterprise mannequin that engages with a number of different know-how distributors. This creates a “platform of platforms” situation with appreciable complexity and might carry with it cybersecurity dangers if collaborators of those exterior platforms have safety vulnerabilities or challenges with interoperability. Due to this fact a rigorous vetting course of with requirements for not solely validation of AI fashions however inclusive of integration into the MCP community.
UDHPs will reshape many aggressive dynamics of healthcare.
A Platform Shift – Disrupting EHRs?
Within the short- to medium-term, UDHPs might be complementary to EHRs. EHRs are deeply entrenched in right this moment’s healthcare supply methods.
However as famous earlier, the roots of right this moment’s EHRs are as methods of file to doc claims submissions. To be truthful, Epic, Oracle, and different EHRs are trying to maneuver past their historic slender scope.
However, the long-term prize is to grow to be the system of motion that automates interoperability, knowledge sharing, and workflows inside and throughout healthcare organizations. The BOI Technique Playbook depicts the elemental platform shift:
Well being interoperability guru Brendan Keeler has famous that it most likely received’t be one other EHR that displaces Epic:
Disruptive software program change for B2B SaaS takes a long time throughout all industries for enterprise measurement purchasers. Significant disruption will not be a pure play competitor however the finish results of a complete platform change (Home windows was disrupted by cellular, not by one other PC OS or antitrust). What disrupts an incumbent EHR received’t be one other EHR.
Oracle’s new, subsequent era EHR needs to be characterised extra as a UDHP than as a conventional EHR. Writing in Cloud Wars, Bob Evans makes a case for Oracle’s technique:
… the bromide about how “what bought you right here received’t get you there” will present a stark instance of why area of interest suppliers that dominated the on-prem world might be overmatched and pushed to the periphery within the trendy world of cloud and AI. Larry Ellison has dedicated the total sources of his whole firm to making sure that Oracle Well being can deal with not solely EHRs and adjoining segments but additionally all the $16-trillion healthcare trade….Oracle has been coping with every part from software program integration to huge international deployments to complicated governance points for the world’s largest and most-complex organizations for greater than 30 years.
EHRs possible received’t go away, however they’re prone to turning into commoditized because the value-creation and value-capture alternative shifts towards UDHPs.
UDHPs Allow New Ecosystems & Strategic Partnerships
Whereas personal well being methods are possible early clients, UDHPs will be adopted by or prolonged to many different sectors or subsectors of healthcare. Let’s take into account some examples:
Consulting agency Zühlke described how UDHPs will be deployed by life sciences corporations.
As a result of life sciences corporations… will not be tech corporations, they may often wish to take into account licensing a digital well being know-how platform within the type of a platform as a service (PaaS). This permits them to sidestep a number of the complexity of constructing their very own platform and concentrate on their core enterprise.
Salesforce described how its UDHP providing is appropriate for Med Tech corporations.
Many MedTech corporations depend on a number of know-how methods that weren’t designed with buyer engagement or the power to work with one another in thoughts. It’s important to combine this right into a unified expertise. A single platform that’s simple to handle, can develop with what you are promoting, and might combine with current knowledge and homegrown methods can energy your group extra successfully.
Authorities organizations are candidates for UDHP adoption. An Australian public hospital system deployed ServiceNow’s UDHP.
Higher’s UDHP is the underlying know-how supporting the OneLondon shared care planning answer throughout town of London. The “end-of-life Common Care Plan (UCP) – is supporting a inhabitants of roughly 10m folks, throughout 5 Built-in Care Methods, over 40 NHS trusts, and 1,400 common practices.”
A report for the Norwegian Directorate of e-health illustrates how a UDHP may transcend EHRs to allow a broader digital care supply system:
Lastly, we see the potential for the creation and adoption of UDHPs that cater to notably giant and/or complicated subsectors of healthcare supply. Medical imaging is one instance the place a UDHP is perhaps deployed by an imaging middle, a big radiology group, and even inside a well being system. In accordance with NetApp, “medical imaging includes 90% of medical knowledge [storage] worldwide.“ Of the over 1,000 FDA-authorized AI medical system algorithms, roughly 75% relate to medical imaging.
AI Will Play a Main Position in UDHP Adoption
Whereas we foresee that AI will play a key function in UDHP adoption and implementation, the specifics are unclear and up for grabs. We anticipate that over time AI might be embedded in each layer of healthcare IT and might be utilized to a variety of administrative and scientific workflows – each inside and throughout organizations.
An instance – prior to now, there have been big battles over person interfaces:
- Within the Nineteen Eighties – the GUI warfare between Apple and Microsoft
- Within the Nineteen Nineties – browser wars between Netscape Navigator and Microsoft Web Explorer.
- Within the 2000s – telephone working system wars amongst a dozen contenders resulted in big wins for Apple iOS and Android
One other person interface battle is shaping up for clinician mindshare. AI will play a serious function.
- Right now’s EHRs are famend for his or her poor UI and UX. EHR incumbents are scurrying to construct extra user-friendly AI interfaces. Epic has 125 AI-enabled options which can be dwell or in improvement.
- UDHPs themselves can compete with EHRs by incorporating extra user-friendly AI interfaces. UDHPs will provide low code/no code instruments to handle workflow and processes throughout care groups.
- May a startup digital well being firm create a singular AI interface layer on prime of EHRs?
As famous in TechCrunch, “the interface is the place the revenue is.” We will anticipate the battle…however anticipating the winner(s) is far tougher.
UDHPs Allow Platform Enterprise Fashions
Incumbent healthcare organizations can prolong UDHP technological infrastructure to reconceptualize themselves as having platform enterprise fashions. SAP makes the case that “the longer term hospital is a platform.”
Mayo Clinic has been a poster baby for revolutionary considering with its Mayo Clinic platform. Dr. Gianrico Farrugia, President and CEO at Mayo Clinic, described Mayo’s transition from a conventional pipeline enterprise mannequin to an revolutionary platform mannequin:
Our present healthcare mannequin features as a pipeline, which is linear, extremely transactional, and rigid. The failings of this mannequin had been clear throughout the pandemic, the place collaboration was restricted and stress to particular person nodes led to factors of failure. This, in flip, hampered and in some circumstances paralyzed all the system.
A platform mannequin of well being care and ecosystem is essentially totally different. A platform is constructed round safe, collective sources corresponding to a strong analytic engine and an open ecosystem of trusted collaborators and is very dynamic, self-learning, inherently accessible, and scalable. This method brings collectively suppliers, medical system corporations, well being tech startups, sufferers, and payers, amongst others, to design built-in end-to-end options which can be supported by longitudinal scientific knowledge and AI algorithms. A platform is purposefully collaborative and fuels innovation and entry as a substitute of limiting it.
UDHPs Advance the Motion Towards Cloud (CIO POV)
Throughout industries, the IT panorama is experiencing a major shift in the direction of cloud computing. Organizations are more and more adopting multi-cloud and hybrid cloud methods to optimize operations, improve flexibility, and cut back vendor lock-in. This development is pushed by the necessity for scalability, cost-efficiency, and entry to superior providers like AI and analytics.
UDHPs align strongly with the cloud computing development by leveraging its scalability, flexibility, and accessibility. Cloud infrastructure permits UDHPs to combine disparate methods, facilitate knowledge sharing, and assist revolutionary purposes.
Lengthy-Time period Potential for Winner(s)-Take-All?
Presently there are 20+ UDHPs. This market has many long-term traits of a extremely concentrated, winner(s)-take-all market. By “extremely concentrated”, we imply a monopoly (one dominant agency), a duopoly (two dominant companies), or an oligopoly (a small group of dominant companies — sometimes three to 5):
- UDHP patrons will desire to “single residence”, i.e., choose a single UDHP platform
- Switching prices might be very excessive
- Community results might be robust
We foresee the UDHP market as turning into a battle for purposes and builders. Builders desire to work on as few platforms as potential, ideally one or two.
UDHPs thus could have robust oblique community results. Consumers will desire UDHPs that provide a variety of purposes created by builders; builders will converge on platforms which have the best variety of patrons.
The smartphone working system (OS) market gives an analogy. In 2006, there have been 12 corporations providing smartphone OSs; by 2015, the battle was over — Android and Apple iOS owned greater than 99% of the market. Right now these winners every boast over 2 million apps on their OS platforms.
Implications: Because the UDHP market turns into extra concentrated, there might be a number of winners and plenty of losers. Consumers ought to consider distributors fastidiously.
Unified Digital Well being Platforms are a brand new class of enterprise software program, one which Gartner predicts “will, over time, exchange the dominant period of the monolithic digital well being file (EHR).”
Right now, the UDHP market continues to be very early – about 5% penetrated.
UDHPs provide compelling worth propositions – enhancing scientific care, overcoming the constraints of EHRs, providing modular architectures, enabling a standard infrastructure, and offering aggressive benefit.
UDHPs additionally promise to shake up the aggressive panorama of healthcare by creating a serious platform shift. Within the quick time period, they have to collaborate with EHRs; in the long run, they will commoditize EHRs. They permit new platform enterprise fashions and facilitate the event of recent ecosystems and partnerships.
UDHPs will play a serious function within the broader “platforming” of healthcare. They’re a development price watching.
Vince Kuraitis JD/MBA is an unbiased advisor with over 35 years’ expertise throughout 150+ healthcare & tech corporations. He publishes The Healthcare Platform Weblog, the place this publish first appeared.
Girish Muralidharan was an SVP at GE Healthcare till April 2024 and held a wide range of Govt enterprise administration roles throughout Imaging gear, tech enabled providers, digital platforms & options during the last 2 a long time.
Dr. Jody Ranck is a researcher with over 30 years of expertise in international and home US well being know-how and coated AI, knowledge analytics, and SDoH with Chilmark Analysis.
