Which Platform of Platforms (UDHP) is Proper to your Well being System? A Market Evaluation – The Well being Care Weblog

By NEIL JENNINGS & VINCE KURAITIS

This entry is an element 5 of 5 within the sequence Platforming Healthcare — The Long View

In previous posts on this sequence, now we have coated the definitions of Unified Digital Health platforms and whether or not “EHRs can turn into UDHPs.” On this follow-on put up, we’ll speak by means of the necessities for achievement for a UDHP and which kinds of healthcare organizations are finest suited to which kinds of UDHPs. This put up will construct on findings from the earlier posts.

The Market Wants UDHPs: Key Takeaways from Earlier Posts

Key Takeaway 1: The healthcare {industry} wants UDHPs to create a centralized, widespread structure for healthcare organizations

Key Takeaway 2: The healthcare organizations leveraging UDHPs will obtain a myriad of advantages, from aggressive benefits to scientific, monetary, and operational positive factors

Key Takeaway 3: UDHPs should not all-or-nothing or mutually unique from EHRs. As we explored in our final put up, EHRs might develop into UDHPs. These EHRs as UDHPs (or the relative platform of platforms) stands out as the optimum alternative for some market segments. EHRs can also be accommodated into cloud-first UHDPs.

Key Takeaway 4 / Guiding Criterion: This put up will concentrate on US regional and native Health techniques and outpatient teams of all sizes.

The Strategy: Market -> Segments -> Choices -> Match

• For this put up, we’ll begin from the top-down market perspective, analyzing the general market panorama.
• As soon as now we have described the panorama, we’ll name out the important thing segments (group varieties, sizes, and profiles) that we’ll be evaluating.
• At this level, we’ll approximate IT budgets and IT staff sizes by group sort to find out capabilities of constructing versus relying on companions and distributors.
• Then, we’ll assessment the constraints for implementation and possession, outlining the drivers of UDHP match.
• Subsequent, we’ll break down the alternative ways UDHPs will be developed and maintained.
  • Leveraging an EHR as UDHP
  • License from UDHP vendor
  • “House grown” cloud-first answer
• Lastly, we’ll crosswalk the segments and the optimum possibility for every section, primarily based on their particular wants and estimated IT and budgetary assets.

The Healthcare Market & Main Health System Segments

Beginning with a compelling graphic from the Kaiser Household Basis, we see a 2023 breakdown of the whole US healthcare medical expenditure, totaling ~$4.9 trillion.

Whereas the whole healthcare spend that occurred in hospitals is an astounding ~$ 1.5 trillion, accounting for 31% of whole healthcare spend, this leaves a lot of care outdoors the 4 partitions of hospitals. This quantity of care occurring outdoors of hospitals aligns with efforts to push sufferers into much less acute care settings, emphasizing preventative, proactive drugs as an alternative of acute, reactive drugs. As the necessity for UDHPs applies to greater than inpatient hospitals, we will even assessment the opposite segments highlighted within the pie chart, together with: outpatient clinics and observe teams, and “different Health” containing providers delivered at different contexts like PACs and SNFs, and Ambulatory surgical facilities.

Desk 1 under illustrates the important thing segments as we outline them, together with the tough depend of whole entities, their relative breakdown by measurement, estimates of annual income, and subsequent estimates of IT finances. We’re estimating typical IT budgets as being between 2-5%, primarily based on DefinitiveHealthcare and WittKieffer sources; we perceive that just a few organizations are greater or decrease than this vary. The target, with out spending an excessive amount of time on the science undertaking, is to tough out IT budgets by section to align organizational assets and desires with the best-fitting UDHP.

Desk 1

United States Healthcare Segments: IT Finances Evaluation

1 (Health-Techniques-Infographic-2024.pdf” goal=”_blank” rel=”noreferrer noopener”>AHA – 1957 (unaffiliated) + 227 (small techniques)), 2 (Statista), 3 (Futuremarketinsights), 4 (Businesswire), 5 (NIH), 6 (Health-system-priorities-2025-2030″ goal=”_blank” rel=”noreferrer noopener”>Chartis), 7 (Health-systems” goal=”_blank” rel=”noreferrer noopener”>DefinitiveHC), 8 (DefinitiveHC),9 (GrandviewResearch, income per MD) , 10 (AMGA), 11 (Grandviewresearch), 12 (IT-expenses-us-hospitals” goal=”_blank” rel=”noreferrer noopener”>Definitive Healthcare), 13 (IT-leadership” goal=”_blank” rel=”noreferrer noopener”>Witt Kieffer), 14 (Precedence Research), 15 (Ibisworld as of 2023), 16 – these firms doubtless skew greater as they’re distant first, relying on digital care platforms.

We’re additionally together with two succinct charts from the Witt Kieffer piece, as a result of they inform a transparent story in regards to the enormous variance in IT spent throughout the healthcare continuum.

Supply: IT-leadership” goal=”_blank” rel=”noreferrer noopener”>WittKieffer

Supply: IT-leadership” goal=”_blank” rel=”noreferrer noopener”>WittKieffer

Defining Match: Segments (and their wants) Are Not Created Equal

Desk 1 above highlights the big selection of healthcare segments that make up the multi-trillion greenback US healthcare market. As these organizations vary from just a few physicians to tons of of hospitals spanning huge geographic areas, IT shouldn’t shock anybody that the organizational wants will range drastically.

Whereas the UDHP market continues to be in growth, listed below are a few of our issues on what’s going to outline profitable architectures and implementations. We summarize the determinants of organizational match into two buckets: Capabilities & Wants

Organizational Capabilities

As proven in Desk 1 above, IT budgets are finite, together with IT and technical groups’ time. Discovering the fitting answer for the fitting group ensures that wasted money and time are prevented. The UDHP ought to “match” your group’s capabilities.

Finances & Employees

Finances is an apparent start line, with the 2-5% of annual revenues offering clear constraints. A small observe with just a few hundred thousand {dollars} in annual IT finances shouldn’t be contemplating a multi-million greenback Epic set up, after all.

Straight correlated with finances is the scale of your IT staff. There are staffing ratio discussions, with {industry} commonplace really helpful ratios of IT employees to non-IT employees from 1:50 as much as 1:150 or so. Whereas considerably apparent for the smaller organizations (in case you have 5 clinicians and three assist employees, you doubtless have a singular IT one who can also be an workplace supervisor), it is a consideration for the medium to massive organizations. In case your whole staff measurement is proscribed, including new applied sciences to handle in-house will be daunting. Employees and staff measurement come into play not only for longitudinal upkeep, but additionally for implementation.

Budgets can be utilized to find out which UDHP choices are possible, however staffing will affect how the UDHP will probably be carried out and maintained.

Present IT Footprint

The group’s present technical footprint can also be an vital issue when figuring out the optimum UDHP implementation strategy. As that is straight associated to the IT technique, we will even body this part as some high-level guiding questions:

• What are the core techniques of workflow and of file?
• Which of the next does the IT footprint embody?
  • Software program as a Service
  • Platforms as a service
  • Infrastructure as a service
• Does the group construct and keep purposes, portals, and techniques from scratch?
• Are present IT techniques hosted regionally? Hybrid? On public clouds?
• Does the group have a growth staff? A DevOps staff?

Organizational Wants

The complement to capabilities is the group’s present wants. Overbuilding or overinvesting will not be the purpose; the purpose is discovering the fitting match. To outline organizational wants, we’ll break them down into drivers of complexity, the necessity to keep aggressive, and IT technique.

Drivers of Organizational Complexity

Whereas delivering healthcare in right this moment’s digital-first world is complicated for all suppliers and practitioners, organizations function at completely different ranges of complexity primarily based on their scale, scope, enterprise mannequin, and footprint.

Beginning with scale, bigger organizations sometimes have extra difficult wants. Because the variety of beds enters the hundreds, the variety of suppliers exceeds 2,000, and also you begin getting into tens of millions of annual visits, each the number of interactions and the quantity of interactions enhance. Along with the variety of folks (sufferers, suppliers), the variety of bodily places is one other main driver of complexity, the place a single, standalone small hospital could also be easier than a multi-state, multi-specialty doctor group.

The scope of the group’s care providers is one other main issue. Are there solely outpatient/ambulatory practices? Are they solely major drugs? Or, are there specialty teams? Is there a mixture of acuity settings? Does the group have pressing care, emergency drugs, residence Health, hospital outpatient specialties? Does the group have its personal labs, imaging facilities, and surgical procedure facilities? As you proceed so as to add extra kinds of care that may be delivered, the IT infrastructure is challenged in new and thrilling methods.

Supplier organizations’ enterprise fashions additionally play a key function in organizational complexity, with the shift in direction of value-based care and risk-bearing fashions. As supplier organizations shift in direction of risk-bearing fashions, IT is commonly an incremental shift with risk-based and fee-for-service fashions operating in parallel. Along with the (comparatively) easier configuration of including one other insurance coverage plan, the information and care supply coordination of risk-based plans are an order of magnitude extra difficult than conventional fee-for-service care fashions. This shift has expanded past enterprise Health techniques and enormous hospitals and is cascading by means of massive ambulatory practices, which have distributed footprints and traditionally smaller IT budgets.

Geographic footprint is a serious driver of organizational complexity and IT (amongst different) wants. Is the group a singular location or unfold out inside a metropolis? Is IT distributed throughout a number of states, international locations (Canadian presence), or different geos (tribal nations, US territories, and so forth.)? As organizations develop to multi-state footprints, for instance, there are differing rules for licensure (the scope of NPs for instance), e-prescribing, and different localizations like regional language wants: this all have to be accommodated in EHRs and different techniques. That is all on prime of the necessity for referral networks, reference labs, pharmacies, and native Health Information exchanges. As well as, there are regional privateness, knowledge sharing, and different necessities that apply to cross-state or multi-region companies. When geographies span a number of kinds of borders, IT will get much more difficult.

Geography is extra than simply technicalities associated to knowledge sharing, licensure, and care supply: we can’t neglect the folks and their cultural and regional variations. The US is an extremely numerous nation the place there are 430 languages spoken throughout the states and territories. Addressing cultural, language, and regional variations is a complexity that many massive Health techniques and nationwide healthcare suppliers face, and there are a myriad of research exhibiting that sufferers are extra engaged, have higher outcomes, and are extra happy with care delivered of their most well-liked language. Anybody who has labored on an internationalization or localization effort for a product will perceive the complexity, however the implications of languages, regional variations and norms, are far reaching and can’t be underestimated. They develop past multi-language assist, impacting content material (care summaries, letters, affected person directions), and even workplace schedules.

Group Must Stay Aggressive / Differentiated

Past simply managing their very own complexities, healthcare organizations are sometimes run as companies (there are some not-for-profit organizations, together with a nationwide chief that we spotlight later). With the shift to decrease acuity care contexts, personal fairness rollups, regulatory modifications, and the fixed want for extra patient-centric care – the market and opponents are altering rapidly!

Organizations have quickly altering wants with a view to keep aggressive and differentiated within the digital-first healthcare ecosystem. Each organizational wants and affected person/supplier expectations are driving initiatives for lasting differentiation.

Beginning with organizational wants, some organizations are constructing aggressive data moats, leveraging differentiated knowledge entry and repositories, to stay aggressive. Whether or not accessed as a part of a digital community or trade or owned wholly internally, this strategy depends on IT infrastructure to securely retailer, course of, safe, and dealer knowledge to linked techniques.

When it comes to expectations, whereas sufferers right this moment have extra management of their very own healthcare data, IT continues to be not sufficient. Main organizations understand that sufferers don’t wish to work together with separate care contexts, specialties, and services individually. As a substitute, they’re prioritizing unified affected person experiences (a element of UDHPs) to simplify affected person interactions throughout their technical and operational ecosystem. This transition to affected person consumerism is offering one other level the place organizations compete: affected person engagement and loyalty.

IT Technique

As organizations get bigger in measurement, they’ve extra outlined IT methods, with enterprise organizations sustaining multi-year roadmaps. These roadmaps define the prescribed strategy to realize organizational priorities and outline the tasks and budgets for upcoming years.

Whereas this level is foundationally vital, IT additionally varies drastically, relying on the idiosyncratic wants of every group. Nonetheless, there are some widespread themes and choices we are able to sometimes discern when reviewing a roadmap. We’ll body them as questions under:

• Is the group attempting to develop or shrink the scope of its IT operate?
• Is there a powerful desire for constructing vs. shopping for vs. partnering?
• What key unmet wants have but to be addressed and are prioritized?
• What’s working right this moment (and notably excluded from roadmaps)?
• The place does organizational management have their sights targeted to extend effectivity, competitiveness, differentiation, and care high quality by way of IT efforts?

Defining UDHP Choices for Completely different Healthcare Segments

Whereas healthcare at-large wants UDHPs, the particular wants range by group measurement and complexity. Associated, not all implementations of UDHPs will have to be the identical, and we see three major paths for organizations to implement and architect their UDHPs.

Mapping UDHP Choices to Market Segments

Choice 1: Leveraging an EHR as a UDHP

There are a number of drivers that push healthcare organizations towards their EHR because the default UDHP. These techniques already accommodate the complexity, sensitivity, and technical necessities for working in a regulated {industry}. A few of the main tailwinds, as coated in our earlier put up (“Health-systems-platform-of-platforms-udhps/”>Can EHRs be Health System’s “Platform of Platforms” (UDHPS)) are as follows:

• EHRs Presently Personal the Buyer Relationship
• Many Prospects Have an “EHR-First” Desire for New Functions
• Epic and Oracle Health are Making Sturdy Actions Towards Changing into UDHPs

Because of finances constraints, the EHR stands out as the solely sensible UDHP possibility for a lot of organizations. Smaller practices and medical teams could have a single IT particular person, liable for EHRs, {hardware}, software program, printers, fax machines, and all the things else. If IT budgets are beginning round $100,000 per 12 months, and EHRs could take as much as half of that, there isn’t budgetary or employees room for different techniques. Elation calls out that the anticipated license value of an EHR per clinician is round $1,200 per 12 months; Folio3 shares an analogous quantity. That is earlier than upkeep, assist, coaching, and different bills associated to the EHR, and earlier than different IT-related bills not associated to the EHR. When the EHR makes up a considerable portion of the finances, IT is sensible to look there first.

Along with these factors talked about within the earlier put up, when EHRs are tailor-made to smaller organizations, distributors perceive that their clients want a associate that fills in gaps. athenaHealth’s athenaOne package deal providing, for instance, contains add-ons that complement the core EHR throughout the group: from affected person engagement and communication, to pre-visit and sched/reg assist, to RCM and declare submission assist. Positioned as an “all-in-one observe answer,” they’re framing the providing as greater than an EHR and provide many UDHP advantages.

Shifting upmarket to bigger doctor teams and small hospitals or Health techniques, IT budgets get bigger as income grows and care contexts get extra difficult. As we start to see multi-state footprints, massive multi-specialty teams, and acute care settings, organizations could outgrow the ambulatory-focused EHRs like athenaHealth, ECW, and others. That is the place Epic and Cerner step in and are comfortable to satisfy these organizations’ wants.

Epic’s Connect (previously referred to as Group Join), for instance, is a selected providing that permits massive Health techniques to sublicense their Epic occasion, provisioning entry to regional hospitals or Health techniques. Whereas this feature permits smaller healthcare organizations to leverage the advantages of Epic, the fee will be an order of magnitude greater than outpatient, license-based EHRs.

In 2024, OhioHealth Van Vert Hospital invested $12MM to transition to Epic by way of CareConnect. Leveraging the identical budgetary assumptions as above, if the EHR is ~50% of finances, and finances is ~2-5% of income, this implies that the hospital has >$480MM in annual income ($12M * 2 / .05). Implementing Epic as a standalone Health system or hospital group is dear, and a 2024 put up from Information–Technology/ehrs/how-much-4-Health-systems-are-paying-for-ehrs/” goal=”_blank” rel=”noreferrer noopener”>Becker’s notes that prices could begin within the tens of tens of millions, however can attain a billion {dollars} or extra for bigger Health techniques.

Because the IT budgets get bigger, technical groups enhance in measurement and capabilities, and IT naturally follows that extra superior choices are explored or required.

Choice 2: License from UDHP Vendor

As denoted above, not all organizations have enough IT budgets and employees to architect, construct, and handle their very own system. However, for big Health techniques with greater than a billion {dollars} in annual income (estimated at ~175 or so in america), these choices begin to turn into possible if not mandatory. These massive hospitals and Health techniques could start wanting past their EHR to satisfy their UDHP and platform-of-platforms wants. Why?

As highlighted within the earlier Health-systems-platform-of-platforms-udhps/” goal=”_blank” rel=”noreferrer noopener”>put up:

• EHRs Carry a Lot of Baggage
• Prospects are Skeptical
• EHR Analytics Are NOT Optimized To Obtain Important Health System Aims
• EHR Switching Prices are Diminishing
• Cloud Native Platforms Speed up Innovation and Efficiency
• IT’s Not in EHR DNA to Grow to be A Broad-Based mostly Platform

The final put up additionally shared a HIMSS examine that confirmed that the common hospital had 16 EHRs in 2016. Whereas this quantity has doubtless consolidated down prior to now decade, multi-EHR and multi-system-of-workflow architectures are very a lot a actuality right this moment. Specializing in the complexity angle on this piece, we’ll spotlight 4 extra, complementary factors as to why an outside-the-EHR UDHP will be the best answer for bigger hospitals and enterprise Health techniques.

There are 4 major causes that we’ll spotlight the necessity for a UDHP to exist past the core EHR:

1. No singular EHR can accommodate all the things that Health techniques must do
2. Some level options are nonetheless higher than their EHR-native competitor
3. Some organizations leverage a number of core EHRs (there are organizations that use each Cerner and Epic throughout their hospitals)
   1. Whether or not as a consequence of M&As, IT or clinician desire, or different causes, some Health techniques nonetheless use a blended EHR footprint.
   2. This presents in numerous methods, however is usually one of many following:
      1. One system for inpatient, one for outpatient
      2. One system for clinicals, one for RCM
      3. Or, distinct techniques at distinct places (typically as a consequence of M&A)
4. M&As and rollups are nonetheless operating rampant
   1. Mergers and acquisitions mix greater than market footprints and scientific capabilities; additionally they deliver IT groups and infrastructure. That is the place we start to see the true glimpses of Frankstein’s monster.
   2. Some stats from Health-system-ma-review-despite-industry-stabilization” goal=”_blank” rel=”noreferrer noopener”>Kaufman Corridor:
      1. 72 whole transactions in 2024, with 27 not together with a divestiture. Whereas this quantity could not appear that top in a vacuum, the whole image of the final decade+ shines mild onto the true quantity of those transactions. From 2014 to 2024, there have been 933 whole M&A transactions. That’s lots of technical complexity to scrub up.

When it comes to licensing an outside-the-EHR platform, the primary Health-platforms/” goal=”_blank” rel=”noreferrer noopener”>put up within the UDHP sequence features a complete listing of doable distributors, constructing from Gartner’s authentic Health-platforms” goal=”_blank” rel=”noreferrer noopener”>listing. We now have additionally highlighted in earlier posts that the license strategy will not be an all-or-nothing strategy, and sometimes entails a hybrid mannequin, constructing on prime of 1 or a number of EHRs. Every group’s particular wants are completely different, they usually could use their licensed platform from a UDHP associate to various levels.

Choice 3: “House-grown” cloud-first answer

The ultimate possibility that we’ll cowl on this put up is for the main Health techniques, and certain restricted to the highest 15-20 techniques as a consequence of complexity, expense, and staffing necessities. Progressing past the cloud and platform vendor partnerships talked about above, these techniques are constructing enterprise knowledge platforms and UDHPs straight inside cloud environments, leveraging cloud providers from AWS, GCP, Azure, InterSystems, or others.

Beginning with a mini case examine. We plan to additional expound upon Ascension’s work in a future put up.

The State of affairs: Ascension checks all the bins for a big, complicated group.

Ascension’s Scale: 16 States, 94 wholly owned or consolidated hospitals, 27 extra hospitals by means of partnerships. 99,000 associates, 23,000 suppliers.

Ascension’s Scope: Inpatient, outpatient, and all the things in between.

Ascension’s Employees: ~3,000 working in IT (per LinkedIn)

Ascension’s IT Footprint: Heterogenous, 18 EHRs, 40+ affected person portals

Want for differentiation / competitiveness: Excessive, each regionally and throughout the 16 states

The Drawback:

• Sufferers should not conscious of “care contexts,” they count on a unified expertise.
• Ascension’s numerous set of EHRs and myriad of different techniques weren’t tightly built-in
• No singular EHR nor operational system was an entire supply of fact
• There have been knowledge variations throughout techniques that compound and exacerbate expertise inconsistencies throughout shopper digital touchpoints

The Resolution:

• Ascension created an “Enterprise Knowledge Service Layer (EDSL),” mapping knowledge from a number of EHRs right into a unified, centralized FHIR schema to facilitate frictionless shopper entry to normalized and harmonized knowledge
  • This depends on deep partnerships with EHR distributors and different companions.
  • FHIR, not totally adopted by all vendor companions, was made extra accessible utilizing REST APIs and a GraphQL orchestration layer to supply knowledge on demand to digital purposes
• A unified affected person expertise, “AscensionOne” was developed on prime of the EDSL to supply a singular place for sufferers to e book visits, get care, handle their Health data, and pay for care.

The Outcomes So Far:

After one 12 months, over 400,000 members are utilizing the unified affected person expertise, constructed on prime of the Enterprise Knowledge Service Layer. The appliance is averaging 4.8 stars within the app retailer.

Ideas from a frontrunner on EDSL efforts:

MJ Barrois, Senior Director of Product Administration:

“Our mission to raised serve our communities was a key driving issue behind our funding in constructing our inside platform. EDSL represents our dedication to assist form a future the place extremely interoperable and moveable knowledge is instantly accessible to all of our sufferers. To supply care to these most weak and in want, we try to be good stewards of their knowledge and we work intently with our EHR companions to make healthcare knowledge securely out there, simply discoverable, and comprehensible to the sufferers we serve.”

Summarizing the house grown possibility:

Whereas this feature will not be the optimum alternative for all organizations, Ascension is paving a path that will probably be simpler for others to comply with. As we revisit the maturity curve proven above, the technical capabilities and necessities will get simpler 12 months after 12 months. AI is accelerating knowledge mapping and infrastructure optimization. We count on that the “homegrown” answer will probably be extra attainable for the highest 50 or so Health techniques within the subsequent few years. If there’s ever any doubt about what the cloud techniques can do, we’d recommend testing this cloud comparison cheat sheet from ByteByteGo. You’ll be able to rapidly see that the cloud platforms can deal with just about something you’ll be able to throw at them in case you have the fitting staff and budgets in place.

Trying forward

At this time, AI and our better-than-ever {hardware} proceed lowering obstacles to entry, and the necessity for UDHPs will rise as organizations enhance their IT footprints. Selecting a platform to construct round is the vital resolution organizations ought to make right this moment. This platform resolution will probably be an integral element of organizations’ AI methods, which is a vital lever for brief time period competitors and long-term differentiation. There may be lots of noise round AI implementation finest practices right this moment, however the consensus (per AIDoc) seems to be {that a} centralized, ruled platform strategy is finest, which depends on unified digital Health platforms and knowledge.

As we glance just a few years out, a extremely doable situation is that by 2030, cloud-first implementations like Ascension’s will probably be commonplace not simply among the many prime 7 Health techniques, however the prime 50. Internet hosting EHRs (like Epic and Cerner) on public clouds, pioneered by Geisinger, has been de-risked. As soon as within the cloud, IT’s solely a matter of time earlier than the opposite cloud-first capabilities are evaluated and deemed a step ahead from legacy, healthcare-specific platforms and providers.

For the following cohort down in measurement in the identical interval, IT is very doubtless that EHR-complementing UDHPs will probably be licensed by the following prime 150 Health techniques and hospitals. These already cloud-first techniques will play properly with cloud-hosted EHR techniques and supply entry to cloud advantages not attainable as a consequence of employees and budgetary limitations of those smaller organizations.

What’s the closing frontier? Ideally, by 2030, we will even start seeing uptake in openEHR and open-syntax, cloud-first platforms in america. Epic isn’t going wherever, but.

Vince Kuraitis JD/MBA is an unbiased marketing consultant with over 35 years’ expertise throughout 150+ healthcare & tech firms. Neil Jennings is a options engineer on the Health Care staff at Akamai Applied sciences. Vince publishes The Healthcare Platform Blog, the place this put up first appeared. The authors thank a number of colleagues for his or her assessment and commentary on an earlier draft of this put up: M.J. Barrois, Senior Director of Product Administration at Ascension; Jim Sabogal, Healthcare Vertical Lead at CDW; and Taylor Gartley, Director at Fold Health.