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-Yr Framework for Platforming Healthcare. An up to date v2.0 of a graphic depicting this 30-Yr Framework is proven above.
In the present day’s submit 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 outline:
- Mayo Clinic Platform
- Enterprise and Strategic Implications of UDHPs
- APPENDIX: Extra 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 purpose of constructing the long run Mayo Clinic enterprise mannequin that would transfer past the bricks-and-mortar strategy to conventional healthcare and open up new avenues for services and products. The adoption of a platform enterprise mannequin was thought-about important to serving sufferers past the normal Mayo Clinic geography in addition to a approach 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, significantly in respect to catalyzing innovation in medical purposes of AI. The database referred to 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 a part of the MCP ecosystem. The dataset is known as “Information 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 similar to Mercy have joined as knowledge contributors within the MCP element referred to as Mayo Clinic Platform Join. These are the first elements of the platform.
The Mayo Clinic Platform Playbook identifies six key success elements:
- A privacy-protecting, safe collaborative setting with de-identified knowledge from international sources. Longitudinal databases of affected person information are important to medical analysis and the event of recent medical decision-support instruments, therapeutics, and digital well being options. Privateness and safety should be maintained to guard the belief of Mayo Clinic’s sufferers.
- Breadth and depth of affected person knowledge have to be ample to generate insights for each uncommon and customary ailments.
- Seamless capabilities to each ingest various knowledge sources (e.g. -omic (genome, metabolome, and so on.), EHR, wearables, social determinants of well being (SDoH)) and to ship actionable insights on the level of care.
- Chopping-edge knowledge science analytic instruments, strong computing energy, and uniform knowledge requirements.
- Robust 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 via 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 programs way more possible.
AI governance is a core element of the MCP and why they have been one of many authentic sponsors of the Coalition for Well being AI (CHAI) to deliver collectively main business gamers to create the requirements for accountable AI throughout validation, explainability, and transparency. Guaranteeing that AI instruments have been rigorously validated is important for clinician adoption of AI in addition to sustaining the belief of sufferers. These requirements act as a sort of “guidelines of the street” for know-how answer suppliers on the MCP.
MCP makes use of ServiceNow’s Utility Portfolio Administration (APM) answer that allows customers to create a complete stock of all purposes utilized by an organization. Many well being programs wrestle to cope with the buildup of purposes over time and this creates safety points, redundancies, and dangers to hospitals. The APM answer facilitates integration of software portfolios with clearer traces for possession, duty for upkeep and decommissioning, and administrative roles.
For MCP such a answer gives 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 on.) and past when the MCP companions with each know-how distributors on their platform and exterior hospitals and programs.
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 may 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 will likely be complementary to EHRs. EHRs are deeply entrenched in as we speak’s healthcare supply programs.
However as famous earlier, the roots of as we speak’s EHRs are as programs of file to doc claims submissions. To be truthful, Epic, Oracle, and different EHRs are trying to maneuver past their historic slim scope.
However, the long-term prize is to turn out to be the system of motion that automates interoperability, knowledge sharing, and workflows inside and throughout healthcare organizations. The BOI Technique Playbook depicts the basic platform shift:
Well being interoperability guru Brendan Keeler has famous that it in all probability received’t be one other EHR that displaces Epic:
Disruptive software program change for B2B SaaS takes many years throughout all industries for enterprise dimension purchasers. Significant disruption shouldn’t be a pure play competitor however the finish results of a whole platform change (Home windows was disrupted by cell, 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 standard EHR. Writing in Cloud Wars, Bob Evans makes a case for Oracle’s technique:
… the bromide about how “what obtained 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 will likely be overmatched and pushed to the periphery within the fashionable world of cloud and AI. Larry Ellison has dedicated the total sources of his complete firm to making sure that Oracle Well being can deal with not solely EHRs and adjoining segments but in addition all the $16-trillion healthcare business….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 susceptible to changing into commoditized because the value-creation and value-capture alternative shifts towards UDHPs.
UDHPs Allow New Ecosystems & Strategic Partnerships
Whereas non-public well being programs are possible early clients, UDHPs may be adopted by or prolonged to many different sectors or subsectors of healthcare. Let’s contemplate some examples:
Consulting agency Zühlke described how UDHPs may be deployed by life sciences firms.
As a result of life sciences firms… aren’t tech firms, they’ll normally need to contemplate licensing a digital well being know-how platform within the type of a platform as a service (PaaS). This allows them to sidestep a few 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 firms.
Many MedTech firms depend on a number of know-how programs 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 your corporation, and may combine with current knowledge and homegrown programs 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 the town of London. The “end-of-life Common Care Plan (UCP) – is supporting a inhabitants of roughly 10m folks, throughout 5 Built-in Care Techniques, over 40 NHS trusts, and 1,400 normal 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 significantly massive and/or complicated subsectors of healthcare supply. Medical imaging is one instance the place a UDHP is perhaps deployed by an imaging heart, a big radiology group, and even inside a well being system. In keeping with NetApp, “medical imaging includes 90% of medical knowledge [storage] worldwide.“ Of the over 1,000 FDA-authorized AI medical machine algorithms, roughly 75% relate to medical imaging.
AI Will Play a Main Function 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 will likely be embedded in each layer of healthcare IT and will likely be utilized to a variety of administrative and medical workflows – each inside and throughout organizations.
An instance – previously, there have been large battles over person interfaces:
- Within the Nineteen Eighties – the GUI struggle between Apple and Microsoft
- Within the Nineties – browser wars between Netscape Navigator and Microsoft Web Explorer.
- Within the 2000s – telephone working system wars amongst a dozen contenders resulted in large wins for Apple iOS and Android
One other person interface battle is shaping up for clinician mindshare. AI will play a significant function.
- In the present day’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 stay or in growth.
- 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 high of EHRs?
As famous in TechCrunch, “the interface is the place the revenue is.” We are able to anticipate the battle…however anticipating the winner(s) is way 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 long run hospital is a platform.”
Mayo Clinic has been a poster little one for modern pondering with its Mayo Clinic platform. Dr. Gianrico Farrugia, President and CEO at Mayo Clinic, described Mayo’s transition from a standard pipeline enterprise mannequin to an modern platform mannequin:
Our present healthcare mannequin features as a pipeline, which is linear, extremely transactional, and rigid. The failings of this mannequin have been clear in the course of 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 instances paralyzed all the system.
A platform mannequin of well being care and ecosystem is essentially completely different. A platform is constructed round safe, collective sources similar to a strong analytic engine and an open ecosystem of trusted collaborators and is extremely dynamic, self-learning, inherently accessible, and scalable. This strategy brings collectively suppliers, medical machine firms, well being tech startups, sufferers, and payers, amongst others, to design built-in end-to-end options which can be supported by longitudinal medical 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 direction of cloud computing. Organizations are more and more adopting multi-cloud and hybrid cloud methods to optimize operations, improve flexibility, and scale back vendor lock-in. This pattern 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 pattern by leveraging its scalability, flexibility, and accessibility. Cloud infrastructure permits UDHPs to combine disparate programs, facilitate knowledge sharing, and assist modern 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 corporations), or an oligopoly (a small group of dominant corporations — usually three to 5):
- UDHP consumers will choose to “single residence”, i.e., choose a single UDHP platform
- Switching prices will likely be very excessive
- Community results will likely be robust
We foresee the UDHP market as changing into a battle for purposes and builders. Builders choose to work on as few platforms as doable, ideally one or two.
UDHPs thus may have robust oblique community results. Consumers will choose UDHPs that provide a variety of purposes created by builders; builders will converge on platforms which have the best variety of consumers.
The smartphone working system (OS) market gives an analogy. In 2006, there have been 12 firms providing smartphone OSs; by 2015, the battle was over — Android and Apple iOS owned greater than 99% of the market. In the present day these winners every boast over 2 million apps on their OS platforms.
Implications: Because the UDHP market turns into extra concentrated, there will likely be a couple of winners and lots of losers. Consumers ought to consider distributors rigorously.
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).”
In the present day, the UDHP market continues to be very early – about 5% penetrated.
UDHPs provide compelling worth propositions – enhancing medical care, overcoming the restrictions 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 significant platform shift. Within the brief time period, they need to collaborate with EHRs; in the long run, they will commoditize EHRs. They allow new platform enterprise fashions and facilitate the event of recent ecosystems and partnerships.
UDHPs will play a significant function within the broader “platforming” of healthcare. They’re a pattern price watching.
Vince Kuraitis JD/MBA is an unbiased marketing consultant with over 35 years’ expertise throughout 150+ healthcare & tech firms. He publishes The Healthcare Platform Weblog, the place this submit first appeared.
Girish Muralidharan was an SVP at GE Healthcare till April 2024 and held quite a lot of Govt enterprise administration roles throughout Imaging gear, tech enabled providers, digital platforms & options over the past 2 many years.
Dr. Jody Ranck is a researcher with over 30 years of expertise in international and home US well being know-how and lined AI, knowledge analytics, and SDoH with Chilmark Analysis.
