By VINCE KURAITIS, GIRISH MURALIDHARAN & JODY RANCK

This entry is Part 2 of half 3 of three within the collection Platforming Healthcare — The Lengthy View. This essay is the following within the collection entitled “Platforming Healthcare — the Lengthy View”. The collection 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 publish is part 2 and can proceed to explain and focus on 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: 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 might transfer past the bricks-and-mortar strategy to conventional healthcare and open up new avenues for services. The adoption of a platform enterprise mannequin was thought-about important to serving sufferers past the standard Mayo Clinic geography in addition to a strategy to incentivize innovation in AI and decentralized care within the dwelling. 

A big longitudinal database with each structured and unstructured knowledge supplies a basis for the MCP, significantly 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 data 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 reminiscent of 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 setting with de-identified knowledge from world sources. Longitudinal databases of affected person data are very important to scientific analysis and the event of latest scientific 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 should 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 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, sturdy computing energy, and uniform knowledge requirements.
• Sturdy governance to imagine safety, scientific validity, interoperability and validation of applied sciences match for objective.
• Pathways for commercialization of efficient, validated options.

MCP vets startups and extra mature expertise 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 sturdy governance construction and integration with MCP makes scaling into different programs far more possible.

AI governance is a core part of the MCP and why they have been one of many unique sponsors of the Coalition for Well being AI (CHAI) to carry collectively main business gamers to create the requirements for accountable AI throughout validation, explainability, and transparency.  Making certain 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 type of “guidelines of the street” for expertise 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 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 software portfolios with clearer strains for possession, duty for upkeep and decommissioning, and administrative roles. 

For MCP this kind of answer gives a myriad of benefits when orchestrating an ecosystem of expertise 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 expertise 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 expertise options that may have a platform enterprise mannequin that engages with a number of different expertise distributors. This creates a “platform of platforms” state of affairs 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 probably be complementary to EHRs. EHRs are deeply entrenched in right now’s healthcare supply programs.

However as famous earlier, the roots of right now’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 slender scope. 

However, the long-term prize is to develop into 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 gained’t be one other EHR that displaces Epic:

Disruptive software program change for B2B SaaS takes many years throughout all industries for enterprise measurement purchasers. Significant disruption is just not a pure play competitor however the finish results of a complete platform change (Home windows was disrupted by cell, not by one other PC OS or antitrust). What disrupts an incumbent EHR gained’t be one other EHR.

Oracle’s new, subsequent era EHR must 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 gained’t get you there” will present a stark instance of why area of interest suppliers that dominated the on-prem world will probably be overmatched and pushed to the periphery within the trendy world of cloud and AI. Larry Ellison has dedicated the total assets of his total firm to making sure that Oracle Well being can deal with not solely EHRs and adjoining segments but in addition your entire $16-trillion healthcare business….Oracle has been coping with every thing from software program integration to huge world deployments to advanced governance points for the world’s largest and most-complex organizations for greater than 30 years.

EHRs possible gained’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 non-public well being programs are possible early prospects, 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 firms.

As a result of life sciences firms… are usually not tech firms, they are going to normally wish to take into account licensing a digital well being expertise platform within the type of a platform as a service (PaaS). This permits them to sidestep a few of the complexity of constructing their very own platform and give attention to their core enterprise.

Salesforce described how its UDHP providing is appropriate for Med Tech firms. 

Many MedTech firms depend on a number of expertise 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 small business, 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 expertise 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 individuals, 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 significantly giant and/or advanced subsectors of healthcare supply. Medical imaging is one instance the place a UDHP is likely to be deployed by an imaging heart, 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 gadget 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 position in UDHP adoption and implementation, the specifics are unclear and up for grabs. We anticipate that over time AI will probably be embedded in each layer of healthcare IT and will probably be utilized to a variety of administrative and scientific workflows – each inside and throughout organizations. 

An instance – previously, there have been big battles over consumer interfaces:

• Within the Nineteen Eighties – the GUI conflict between Apple and Microsoft
• Within the Nineteen Nineties – browser wars between Netscape Navigator and Microsoft Web Explorer. 
• Within the 2000s – cellphone working system wars amongst a dozen contenders resulted in big wins for Apple iOS and Android

One other consumer interface battle is shaping up for clinician mindshare. AI will play a serious position.

• 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 dwell or in growth.
• UDHPs themselves can compete with EHRs by incorporating extra user-friendly AI interfaces. UDHPs will supply 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 way more durable.

UDHPs Allow Platform Enterprise Fashions

Incumbent healthcare organizations can lengthen 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 progressive 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 progressive platform mannequin:

Our present healthcare mannequin capabilities as a pipeline, which is linear, extremely transactional, and rigid. The failings of this mannequin have 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 your entire system. 

A platform mannequin of well being care and ecosystem is essentially completely different. A platform is constructed round safe, collective assets reminiscent of 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 gadget firms, 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 pattern is pushed by the necessity for scalability, cost-efficiency, and entry to superior companies like AI and analytics. 

UDHPs align strongly with the cloud computing pattern by leveraging its scalability, flexibility, and accessibility. Cloud infrastructure allows UDHPs to combine disparate programs, facilitate knowledge sharing, and assist progressive purposes.

Lengthy-Time period Potential for Winner(s)-Take-All?

At the moment 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 — sometimes three to 5):

• UDHP consumers will favor to “single dwelling”, i.e., choose a single UDHP platform
• Switching prices will probably be very excessive
• Community results will probably be sturdy

We foresee the UDHP market as turning into a battle for purposes and builders. Builders favor to work on as few platforms as attainable, ideally one or two.

UDHPs thus may have sturdy oblique community results. Patrons will favor 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 supplies 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 probably be a couple of winners and lots of losers. Patrons 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, change the dominant period of the monolithic digital well being file (EHR).”

In the present day, the UDHP market remains to be very early – about 5% penetrated.

UDHPs supply compelling worth propositions –  enhancing scientific 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 serious platform shift. Within the quick 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 latest ecosystems and partnerships. 

UDHPs will play a serious position 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 publish 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 tools, tech enabled companies, digital platforms & options over the past 2 many years.

Dr. Jody Ranck is a researcher with over 30 years of expertise in world and home US well being expertise and lined AI, knowledge analytics, and SDoH with Chilmark Analysis.