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 subsequent 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.
At this time’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 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 aim of constructing the longer term Mayo Clinic enterprise mannequin that might 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 of important to serving sufferers past the normal Mayo Clinic geography in addition to a option to incentivize innovation in AI and decentralized care within the dwelling.
A big longitudinal database with each structured and unstructured information offers a basis for the MCP, notably in respect to catalyzing innovation in medical functions 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 “Knowledge behind glass” for the privateness and safety requirements which might be wanted to create the bedrock for a collaborative ecosystem.
Supply: Mayo Clinic Platform Playbook
MCP is a three-sided market that has resolution builders, information suppliers, and clinicians composing the three sides. MCP acts because the orchestrator of the ecosystem and extra companions corresponding to Mercy have joined as information contributors within the MCP element referred to as Mayo Clinic Platform Join. These are the first parts of the platform.
The Mayo Clinic Platform Playbook identifies six key success elements:
- A privacy-protecting, safe collaborative setting with de-identified information from world sources. Longitudinal databases of affected person information are important to medical analysis and the event of latest medical 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 information should be enough to generate insights for each uncommon and customary illnesses.
- Seamless capabilities to each ingest numerous information sources (e.g. -omic (genome, metabolome, and many others.), EHR, wearables, social determinants of well being (SDoH)) and to ship actionable insights on the level of care.
- Chopping-edge information science analytic instruments, strong computing energy, and uniform information 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 expertise distributors via a course of that may start with offering entry to the longitudinal database for growing 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 rather more possible.
AI governance is a core element 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. Making certain 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 highway” for expertise resolution suppliers on the MCP.
MCP makes use of ServiceNow’s Software Portfolio Administration (APM) resolution that permits customers to create a complete stock of all functions utilized by an organization. Many well being methods battle to take care of the buildup of functions over time and this creates safety points, redundancies, and dangers to hospitals. The APM resolution facilitates integration of utility portfolios with clearer strains for possession, accountability for upkeep and decommissioning, and administrative roles.
For MCP this sort of resolution provides a myriad of benefits when orchestrating an ecosystem of expertise distributors and functions which might be built-in with Mayo Clinic’s digital infrastructure (EHRs, pathology and radiology functions, and many others.) and past when the MCP companions with each expertise 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 expertise options that may have a platform enterprise mannequin that engages with a number of different expertise 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. Subsequently 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 immediately’s healthcare supply methods.
However as famous earlier, the roots of immediately’s EHRs are as methods of document to doc claims submissions. To be honest, Epic, Oracle, and different EHRs are trying to maneuver past their historic slender scope.
However, the long-term prize is to turn into the system of motion that automates interoperability, information 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 gained’t be one other EHR that displaces Epic:
Disruptive software program change for B2B SaaS takes many years throughout all industries for enterprise dimension shoppers. Significant disruption isn’t 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 gained’t be one other EHR.
Oracle’s new, subsequent technology EHR ought 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 received 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 likely 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 tackle not solely EHRs and adjoining segments but in addition the whole $16-trillion healthcare trade….Oracle has been coping with all the pieces 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 doubtless 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 methods are doubtless early clients, UDHPs may be adopted by or prolonged to many different sectors or subsectors of healthcare. Let’s think about some examples:
Consulting agency Zühlke described how UDHPs may be deployed by life sciences corporations.
As a result of life sciences corporations… should not tech corporations, they are going to often need to think about licensing a digital well being expertise 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 give attention to their core enterprise.
Salesforce described how its UDHP providing is appropriate for Med Tech corporations.
Many MedTech corporations depend on a number of expertise 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 your small business, and may combine with current information 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 expertise supporting the OneLondon shared care planning resolution 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 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 notably massive and/or advanced subsectors of healthcare supply. Medical imaging is one instance the place a UDHP may be deployed by an imaging middle, a big radiology group, and even inside a well being system. In line with NetApp, “medical imaging includes 90% of medical information [storage] worldwide.“ Of the over 1,000 FDA-authorized AI medical machine 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 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 big battles over person interfaces:
- Within the Eighties – the GUI struggle 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 person interface battle is shaping up for clinician mindshare. AI will play a serious function.
- At this time’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 might 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 will anticipate the battle…however anticipating the winner(s) is far 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 longer term 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 capabilities 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 the whole system.
A platform mannequin of well being care and ecosystem is essentially completely different. A platform is constructed round safe, collective assets corresponding to a strong analytic engine and an open ecosystem of trusted collaborators and is very dynamic, self-learning, inherently accessible, and scalable. This strategy brings collectively suppliers, medical machine corporations, well being tech startups, sufferers, and payers, amongst others, to design built-in end-to-end options which might be supported by longitudinal medical information 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 methods, facilitate information sharing, and help modern functions.
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 want to “single dwelling”, 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 turning into a battle for functions and builders. Builders want to work on as few platforms as potential, ideally one or two.
UDHPs thus could have robust oblique community results. Patrons will want UDHPs that supply a variety of functions created by builders; builders will converge on platforms which have the best variety of patrons.
The smartphone working system (OS) market offers 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. At this time 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 number of winners and lots of losers. Patrons 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, change the dominant period of the monolithic digital well being document (EHR).”
At this time, the UDHP market remains to be very early – about 5% penetrated.
UDHPs provide compelling worth propositions – enhancing medical 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 brief time period, they need to collaborate with EHRs; in the long run, they’ll commoditize EHRs. They allow new platform enterprise fashions and facilitate the event of latest ecosystems and partnerships.
UDHPs will play a serious function within the broader “platforming” of healthcare. They’re a pattern price watching.
Vince Kuraitis JD/MBA is an unbiased guide 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 quite a lot of Government enterprise administration roles throughout Imaging gear, 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 coated AI, information analytics, and SDoH with Chilmark Analysis.
