By VINCE KURAITIS, GIRISH MURALIDHARAN & JODY RANCK
This entry is Part 2 of half 3 of three within the sequence Platforming Healthcare — The Long View. This essay is the subsequent 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.
At present’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: 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 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-about important to serving sufferers past the standard Mayo Clinic geography in addition to a approach to incentivize innovation in AI and decentralized care within the house.
A big longitudinal database with each structured and unstructured information supplies a basis for the MCP, significantly in respect to catalyzing innovation in scientific functions of AI. The database known as Mayo Clinic Platform Discover 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 specifically 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 might 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, information suppliers, and clinicians composing the three sides. MCP acts because the orchestrator of the ecosystem and extra companions comparable to Mercy have joined as information contributors within the MCP part known as Mayo Clinic Platform Connect. 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 information from world sources. Longitudinal databases of affected person data are very important to scientific analysis and the event of recent scientific decision-support instruments, therapeutics, and digital well being options. Privateness and safety must be maintained to guard the belief of Mayo Clinic’s sufferers.
- Breadth and depth of affected person information should be ample to generate insights for each uncommon and customary illnesses.
- Seamless capabilities to each ingest numerous information 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 information science analytic instruments, sturdy computing energy, and uniform information 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 expertise distributors by 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 way more possible.
AI governance is a core part 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 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 highway” 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 functions utilized by an organization. Many well being programs wrestle to cope with the buildup of functions 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, accountability for upkeep and decommissioning, and administrative roles.
For MCP this sort of answer 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 so forth.) 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” 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 can be complementary to EHRs. EHRs are deeply entrenched in in the present day’s healthcare supply programs.
However as famous earlier, the roots of in the present day’s EHRs are as systems of record to doc claims submissions. To be honest, Epic, Oracle, and different EHRs are trying to maneuver past their historic slim scope.
However, the long-term prize is to grow to be the system of motion that automates interoperability, information sharing, and workflows inside and throughout healthcare organizations. The BOI Strategy 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 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 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 acquired 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 can be overmatched and pushed to the periphery within the trendy world of cloud and AI. Larry Ellison has dedicated the total assets of his complete firm to making sure that Oracle Well being can deal with not solely EHRs and adjoining segments but additionally your entire $16-trillion healthcare trade….Oracle has been coping with every part from software program integration to large 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 vulnerable 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 programs are possible early prospects, UDHPs may be adopted by or prolonged to many different sectors or subsectors of healthcare. Let’s contemplate some examples:
Consulting firm Zühlke described how UDHPs may be deployed by life sciences corporations.
As a result of life sciences corporations… usually are not tech corporations, they’ll normally wish to contemplate licensing a digital well being expertise 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 deal with their core enterprise.
Salesforce described how its UDHP providing is appropriate for Med Tech corporations.
Many MedTech corporations depend on a number of expertise programs that weren’t designed with buyer engagement or the flexibility 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 may combine with present information 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.
Better’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 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 giant and/or advanced subsectors of healthcare supply. Medical imaging is one instance the place a UDHP could be deployed by an imaging middle, a big radiology group, and even inside a well being system. Based on NetApp, “medical imaging includes 90% of medical information [storage] worldwide.“ Of the over 1,000 FDA-authorized AI medical device 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 position in UDHP adoption and implementation, the specifics are unclear and up for grabs. We anticipate that over time AI can be embedded in each layer of healthcare IT and can 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 struggle 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 significant position.
- At present’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 features which might be dwell or in improvement.
- 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 health firm create a novel 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 way more durable.
UDHPs Allow Platform Enterprise Fashions
Incumbent healthcare organizations can lengthen UDHP technological infrastructure to reconceptualize themselves as having platform business models. SAP makes the case that “the longer term 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 features 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 instances paralyzed your entire system.
A platform mannequin of well being care and ecosystem is basically totally different. A platform is constructed round safe, collective assets comparable 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 system corporations, well being tech startups, sufferers, and payers, amongst others, to design built-in end-to-end options which might be supported by longitudinal scientific information and AI algorithms. A platform is purposefully collaborative and fuels innovation and entry as an alternative of limiting it.
UDHPs Advance the Motion Towards Cloud (CIO POV)
Throughout industries, the IT panorama is experiencing a big 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 scale back vendor lock-in. This development 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 development by leveraging its scalability, flexibility, and accessibility. Cloud infrastructure allows UDHPs to combine disparate programs, facilitate information sharing, and assist progressive 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 corporations), or an oligopoly (a small group of dominant corporations — sometimes three to 5):
- UDHP patrons will choose to “single house”, i.e., choose a single UDHP platform
- Switching prices can be very excessive
- Community results can be sturdy
We foresee the UDHP market as turning into a battle for functions and builders. Builders choose to work on as few platforms as potential, ideally one or two.
UDHPs thus may have sturdy oblique community results. Consumers will choose UDHPs that supply a variety of functions created by builders; builders will converge on platforms which have the best variety of patrons.
The smartphone operating system (OS) market supplies 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 present these winners every boast over 2 million apps on their OS platforms.
Implications: Because the UDHP market turns into extra concentrated, there can be just a few 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, change the dominant period of the monolithic digital well being file (EHR).”
At present, the UDHP market continues 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 significant platform shift. Within the quick time period, they have to collaborate with EHRs; in the long run, they’ll commoditize EHRs. They permit new platform enterprise fashions and facilitate the event of recent ecosystems and partnerships.
UDHPs will play a significant position within the broader “platforming” of healthcare. They’re a development value watching.
Vince Kuraitis JD/MBA is an unbiased advisor with over 35 years’ expertise throughout 150+ healthcare & tech corporations. He publishes The Healthcare Platform Blog, the place this publish first appeared.
Girish Muralidharan was an SVP at GE Healthcare till April 2024 and held a wide range of Government enterprise administration roles throughout Imaging gear, tech enabled companies, digital platforms & options during the last 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, information analytics, and SDoH with Chilmark Analysis.
